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HomeMy WebLinkAboutMARYLOUS COFFEE - FOOD 1� NiarvLou's Coffee 1481 Iyannough a53_ �l} H.,,aanlS L,ZA.--� li Town of Barnstable BOARD OF HEALTH 8 John T.Norman Board of Health Donald A.Gaudagnoli,M.D. RARNSTAOM F.P.(Thomas)Lee,. x 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt. � Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems 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: 867 Issue Date: 01/01/2022 DBA: MARYLOU'S COFFEE - OWNER: MARYLOU E. SANDRY Location of Establishment: 1481 IYANNOUGH ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 4 OutdoorSeating: 0 Total Seating: 4 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: I N o For Office U$e • Initial . "° .� Town of Barnstable Public Health Division Date Paid Amt Pd$ BAM"ABM Inspectional Services pNAM `� i n Check# ©� s 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 ( NEW OWNERSHIP RENEWAL X NAME OF FOOD ESTABLISHMENT: Crnr /(a V5 CnQae— ADDRESS OF FOOD ESTABLISHMENT: I y;r( L �,— U- hoc MAILING ADDRESS(IF DIFFERENT FROM ABOVE): Cc 15-�- W 98 oioL13 E-MAIL ADDRESS: teary Irus TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (ng 3 - .o� V TOTAL NUMBER OF BATHROOMS:_ WELL WATER:YES No X ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: _ SEASONAL: DATES OF OPERATION:_/_/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING.MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 QAApplication FonnsTOODAPP 2020.doc I OWNER INFORMATION: FULL NAME OF APPLICANT IOU' SOLE OWNER: YES NO OWNER PHONE# (— g—c3; � ADDREssP(; I 0(,r � MA Ga01 rb CORPORATE OWNER: CORPORATE ADDRESS: ► 3 [.,h; 11C� 6� sia hr 1r�c� �a.O�l3 PERSON IN CHARGE OF DAILY OPERATIONS: (�✓t Tra 1 I__— 5 L l zO(11( List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records.You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date / 1 2. l� �GNATURE; 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.townoibarnstable.usihealthdivision/applications.ast). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 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. QPP\A lication FormsTOODAPP REV3-2019.doc h :1 Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BA&-STAB E, 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, 30513, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a'permit is hereby granted to: Permit No: 867 Issue Date: 01/01/2021 DBA: MARYLOU'S COFFEE OWNER: MARYLOU E. SANDRY Location of Establishment: 1481 IYANNOUGH ROAD HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 4 OutdoorSeating: 0 Total Seating: 4 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: For Offic �1NE Tp� Initials: ti� Town of Barnstable Date Paid k11 AmtI'd$� BARNMBLE, t Inspectional Services r_ "ASS' Check o `` ram.Public Health Division .o 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 `U-ya ,R0 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: / V cw jzw % oz-A ADDRESS OF FOOD ESTABLISHMENT: ll :w-1 1� / CU/��� MAILING ADDRESS(IF DIFFERENT FROM ABOVE): ! /7/ �l ( T �&IW Ae E-MAIL ADDRESS: L1 'S' - �A TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO_)(_ ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:_/_/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: --' TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE AOM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) REQUIRED BEFORE EVENT SEE PAGE#2 CATERING ...(CATERING NOTICE ( ) *** SEASONAL, MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsWOODAPP 2020.doc P 4 OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: ES NO /O�WNER/�P/�HONE # ADDRESS & &r M. 0&//f CORPORATE OWNER: snn CORPORATE ADDRESS: /D�J LU�l //U ( 1-hol �(/,/ PERSON IN CHARGE OF DAILY OPERATIONS: Iqlal?r /al majqojov 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 C (�� 2. -C-fW u t'Gu �lti41' io SIGN URE OF APPLICANT 67 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 htti)://www.townofbarnstable.us/healthdivision/ai)plications.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 Ist. Q:Application FormsTOODAPP REV3-2019.doc L R Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Guadagnoli,M.D. � A� F.P.(Thomas)Lee MA ,� 200 Main Street, Hyannis, MA 02601 Daniel Luczkow Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Sell Tobacco In accordance with regulations promulgated under authority granted by Sections 5,31 and 127A of the General Laws of the Commonwealth of Massachusetts and Chapter 371 of the Town of Barnstable Code, a permit is hereby granted to: Permit No: 867 Issue Date: 1/1/2021 DBA: MARYLOU'S COFFEE OWNER: MARYLOU E. SANDRY Location of Establishment: 1481 IYANNOUGH ROAD HYANNIS, MA 02601 Type of Business Permit: Non-Flavored Annual Seasonal FEES YEAR: 2021 TOBACCO SALES. $85.00 Permit Expires: 12/31/2021 Thomas A. McKean, RS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY w a Town of Barnstable For Office Use Only; Initials: 1 Date Paid I �� Amt Pd$ BAaTAB Inspectional Services Public Health Division Cheek# ��t,g P Thomas McKean, Director x 200 Main Street,Hyannis,N A 02601 Office: 508-862-4644 Fax: 508-790-6304 TOBACCO ESTABLISHMENT .PERMIT APPLICATION'Non-Flavored . /J DATE�U_� (� NEW BUSINESS OWNERSHIP RENEWAL I 4 NAME OF TOBACCO ESTABLISHMENT: ADDRESS OF TOBACCO ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT FROM ABOVE): � � �(��/� l�C JIB/l / /oU�`�q3 E-MAIL ADDRESS: - -.... Q TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: OWNER'S NAME:. &/aj YrL/fi' OWNER'S PH#�L�-I-� OWNER'S ADDRESS: l//�Y I%7 /97Z CORPORATE NAME: maw-d l Nail T,2 &imp L �, CORPORATE ADDRESS:d �,� /1/t LY7L 1- fi,1- CORPORATE ANNUAL: SEASONAL: DATES OF OPERATION:_/_/ TO DAYS CLOSED EXCLUDING HOLIDAYS(EX.MONDAYS) f TOWN OF BARNSTABLE.CODE/MA GENERAL LAW INTERNET LINKS: TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-9: a htt]2s://www.ecode360.com/33996392 MA GENERAL LAW CHAPTER 270/SECTION 6: httlis://malegislature gov/Laws/CieneralLaws/PartIV/TitleI/Chapter270/Section6. ***NEW BUSINESSES AND NEW OWNERS ONLY REQUIRED TO CALL HEALTH DIVISION AGENT FOR AN INSPECTION PRIOR TO PERMIT BEING ISSUED. PLEASE CALL 508-375-6621 ALL APPLICANTS ARE REQUIRED TO SUBMIT,THE FOLLOWING REQUIRED DOCUMENTS: 1) MA State License to Sell Cigarettes 3) IRS Federal Tax ID#Document 2) MA State License to Sell Cigars and Smoking Tobacco 4) Payment of Fee(s) -see page 4 SIGNATUR . PRINTED NAME: L DATE:16/ Q:_1Appfication Forms\TOBACCO APP-NonFavor 12-18-19.docx 4 c _ o0 Commonwealth of Massachusetts Letter ID:L1854803520 010 a Department of Revenue Notice Date:September 2,2020 �. Geoffrey E.Snyder,Commissioner Account ID:CGL-11258778-065 , mmass.gov/dor RETAILER LICENSE FOR SALE OF CIGARETTES MARYLOUS NEWS INC MARYLOUS NEWS 183 WHITING ST HINGHAM MA 02043-3845 Attached below is your Retailer License for Sale of Cigarettes(Form CT-3). Cut along the dotted line and display at your business location.At any time,you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this license. If you have any questions about your license, call us at(617) 887-6367 or toll-free in Massachusetts at (800)392-6089,Monday through Friday, 8:30 a.m.to 4:30 p.m. DETACH HERE ------------------ cl MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3 Retailer License for Sale of Cigarettes z r4 This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. MARYLOUS NEWS INC Account ID: CGL-11258778-065 MARYLOUS COFFEE Location ID: 11258778-0040 1481 IYANNOUGH RD License Number:423045120 WEST BARNSTABLE MA 02668 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above. This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date: October 1,2020 Expiration Date: September 30,2022 r 4: ESTABL t MEN'CIS DAME TOBACCO SALES Employee Signature Form This form.is for official use to indicate that the employee(s)of this establishment received and understood Chapter 371 of. the Town of.Barnstable Cade and Chapter 270 Section 6 of the Massachusetts General Laws which describes the. penalties for selling and/or giving tobacco products to any person under the:age of twenty-one (21). Below is Section: 37t-9. of.the Town of Barnstable Board of Health.Regulation: Sales to Minors—fi.371-9.Sale.and I)is..tribution of Tobacco Products. 1; No person shall sell.or:provide,a tobacco.product,as defined herein,to a person under The.minimum legal sales age. The minimum legal sales age in;the Town of Barnstable is 21 years of age, 2. Identification: Each person selling or distributing.tobaceo products,as.defined herein,. shall verify the age of the purchaser by means of valid government=issued photographic identification containing the bearer's date.of birth that the purcligser is 21 years old or older. Verification is required for any person under the age of.27. The employee(s)below received and understood.Section 371=9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270`Section 6 of the Massachusetts General Lars: 7,2 Si tore Printed Name Date v� SignaturO Printcb Name Date z r). Sign a '" Printed Name Date: Signat Printed Name Date ('Sign to Printed Name , - Da e Sgn1tur. -' Pr' ted Name Date �I '� •� r� �f�:2%1. 11 Signature PrintedName: D to . ��jb Q:40ficxtion For nATOBACCO AM NonFavor 12=18-19:'ocx r f October 30, 2020 Hi Alannah- Can you have your employee's sign this, and return to me ASAP Q Thank you Lisa lwo LLLins I NAi�n Ir- :ICI 41M'J i( _ �` 171AI Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. DAMSrABue, ; Paul J.Canniff,D.M.D. a3 MA 02601 F.P. Thomas Lee Alternate H� 200 Main Street, 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: 867 Issue Date: 12/10/2019 DBA: MARYLOU'S COFFEE OWNER: MARYLOU E. SANDRY Location of Establishment: 1481 IYANNOUGH ROAD HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 4 OutdoorSeating: 0 Total Seating: 4 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: �� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: 1� Town of Barnstable For Office Use Onlv: Initials: (y Date Paid tti ®mtPd$ BARNMBLE. Inspectional Services Check# o �L. 6 9 , l� i '�EOMo.e Public Health Division Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE i A 1- 7 NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: M /oil ( �a , n ADDRESS OF FOOD ESTABLISHMENT: l b 0 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): /93 1 ��� ��/�� l�/�/�') I /// V ,3 E-MAIL ADDRESS: C� TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 'gi - L TOTAL NUMBER OF BATHROOMS: 19 WELL WATER: YES_NO A ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: /\ SEASONAL: DATES OF OPERATION:_/ /_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: 0" TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) /1 FOOD SERVICE _RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) _BED& BREAKFAST _CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 QAApplication FormsTOODAPP 2020.doc s , OWNER INFORMATION:FULL NAME OF APPLICANT Z avow. SOLE OWNER: YES NO OWNER PHONE ADDRESS �® !/X 19 7 �C��fCO ///// D�Utf CORPORATE OWNER: /J ,�Ae CORPORATE ADDRESS: ��11/ c 22 I z� (2 PERSON IN CHARGE OF DAILY OPERATIONS: List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div.will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2. El 02D SIGNA RE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.31`each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:Vlpplication FormsTOODAPP REV3-2019.doc A Al al) v a ��p1ME For Office Us Initials:. Town of Barnstable Date Paid &UWSPABU Inspectional Services Public Health Division ° �� Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 . '✓ Office: 508-862-4644 Fax: 508-790-6304 TOBACCO ESTABLISHMENT PERMIT APPLICATION (Non-Flavored) DATE 11-, , __� l q NEW BUSINESS OWNERSHIP RENEWAL,- NAME OF TOBACCO ESTABLISHMENT: 0alw S (_. 0 ADDRESS OF TOBACCO ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 1,?3 1,1 /h2/22 /n- 6UV 3 E-MAIL ADDRESS: TELEPHONE NUMBER OF TOBACCO ESTABLISHMENT: CjajlT- OWNER'S NAME: mofillal ; '4QIIIU OWNER'S PH# ff- OWNER'S ADDRESS: &,Z JQ-Z &//92/ //1 a?K1,fl CORPORATE ADDRESS: I� 7/ �/>,,5� ,��(( CORPORATE FID# & ✓ ANNUAL: SEASONAL: DATES OFOPERATION:_/_/_ TO DAYS CLOSED EXCLUDING HOLIDAYS(EX.MONDAYS) TOWN OF BARNSTABLE CODE/MA GENERAL LAW INTERNET LINKS: TOWN OF BARNSTABLE TOBACCO CODE LINK FOR CHAPTER 371-9: https://www.ecode360.com/33996392 MA GENERAL LAW CHAPTER 270/SECTION 6: ° htt sp :Hmalegislature.gov/Laws/GeneralLaws/PartIV/Titlel/Chuter270/Section6 ***NEW BUSINESSES AND NEW OWNERS ONLY *** REQUIRED TO CALL HEALTH DIVISION AGENT FOR AN INSPECTION PRIOR TO PERMIT BEING ISSUED. PLEASE CALL 508-375-6621 ALL APPLICANTS ARE REQUIRED TO SUBMIT THE FOLLOWING REQUIRED DOCUMENTS: 1) MA State License to Sell Cigarettes 3) IRS Federal Tax ID#Document 2) MA State License to Sell Cigars and Smoking Tobacco 4) Payment of Fee(s) -see page 4 SIGNATURE: PRINTED NAME: O DATE: Q:\Application Forms\TOBACCO APP-NonFavor 11-21-19.doc 1f ! Commonwealth of Massachusetts Letter ID:L0355623552 N Department of Revenue Notice Date:September 4,2018 b1 Christopher C.Harding,Commissioner _ Account ID:CGL-11258778-065 04 mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARETTES 3 MARYLOUS NEWS INC MARYLOUS NEWS 183 WHITING ST HINGHAM MA 02043-3845 Attached below is your Retailer License for Sale of Cigarettes(Form CT-3T). Cut along the dotted line and display at your business location.At any time,you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this license. If you have any questions about your license,call us at(617) 887-6367 or toll-free in Massachusetts at (800) 392-6089,Monday through Friday, 8:30 a.m.to 4:30 p.m. DETACH HERE -------------------------------------------------------------------------------------------------------------------------------------------------- ,cxcts� MASSACHUSETTS.DEPARTMENT OF REVENUE Form CT-3T Retailer License for Sale of Cigarettes A 741 oF� This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. MARYLOUS NEWS INC Account ID: CGL-11258778-065 MARYLOUS COFFEE Location ID: 11258778-0040 1481 IYANNOUGH RD License Number: 282568704 WEST BARNSTABLE MA 02668 This certifies that the taxpayer.named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above.This license is non-transferable and may be suspended or revoked for ' failure to comply with state laws and regulations. Effective Date: October 1,2018 Expiration Date: September 30, 2020 Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Guadagnoli,M.D. '* BARnMc48Le 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 Sell Tobacco In accordance with regulations promulgated under authority granted by Sections 5,31 and 127A of the General Laws of the Commonwealth of Massachusetts and Chapter 371 of the Town of Barnstable Code, a permit is hereby granted to: Permit No: 867 Issue Date: 1/1/2020 DBA: MARYLOU'S COFFEE OWNER: MARYLOU E. SANDRY Location of Establishment: 1481 IYANNOUGH ROAD HYANNIS, MA 02601 Type of Business Permit: Non-Flavored Annual Seasonal FEES YEAR o 2020 TOBACCO SALES: $85.00 Permit Expires: 12/31/2020 Thomas A. McKean, RS, CHO, Health Agent Restrictions: PLEASE POST CONSPICUOUSLY �� Bellaire, Dianna From: Desmarais, Donald Sent: Thursday,January 23, 2020 4:05 PM To: Bellaire, Dianna Subject: RE: Marylou's Coffee- 2020 Permit Send er out From: Bellaire, Dianna Sent: Tuesday, December 03, 2019 12:13 PM To: Desmarais, Donald Cc: Bellaire, Dianna Subject: Marylou's Coffee- 2020 Permit Hi Donny; I just want to verify if you are okay with release of 2020 permit? The last inspection in August was an "F". I have everything else from them. I couldn't remember if you have any reason to hold them. Thank you. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us i j I Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. bARNI M John T.Norman �t 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems 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: 867 Issue Date: 12/20/18 DBA: MARYLOU'S COFFEE OWNER: MARYLOU E. SANDRY Location of Establishment: 1481 IYANNOUGH ROAD HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 4 OutdoorSeating: 0 Total Seating: 4 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - - - MOBILE-FOOD: MOBILE-ICE CREAM: G'� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: $85.00 FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: FIKE rp� For Office Use Only: Initials: Town of Barnstable _ i � Date Paid Amt Pd$_3 MAN. Inspectional Services r �. v�p s639 ,0� 'fo►,,�° Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,NLA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A/FOOD ESTABLISHMENT DATE /� ay �� NEW OWNERSHIP RENEWAL /1i NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: f w fwa dad MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 3 4 / E-MAIL ADDRESS: 610 a-mo fil)LU T d aam TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 7w 3�37 TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: Jl 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) A_FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL, MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q:\Application FormsTOODAPPREV2018.doc PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: ES NO OWNER PHONE#_ 7 �'� 3J J/ ADDRESS_ S -lam L2, A CORPORATE OWNER: FEDERAL ID NO. : CORPORATE ADDRESS: lk3 1-vh1k?19 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• C:�iZGL. �?�� J� o l A1C� 1 (✓c2.:�9 '�/r �Z �� l/ 1 r F // n L1,1- . '0 f 0/ SIGNATIA OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments, including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1 st to Dec.3 V each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q\Application FormsT00DAPPREV2018.doc yoF114E .� Town of Barnstable • Initials: J Inspectional Services D'{a,tPePa}�id J�Njjj;` Amt Pd$ ,3 , BARNSTAISM 9 MASS. $ Public Health Division sb3q. ♦0 200 Main Street, Hyannis MA 02601 Office: 508-790-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Fee: $85.00 MAIL TO: TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION 200 Main Street HYANNIS,MA 02601 FAX 508 790-6304 PLEASE INCLUDE TIIE REQUIRED FEE OF$85.00 APPLICATION FOR A TOBACCO SALES PERMIT ESTABLISHMENT NAME (D/B/A) ADDRESS OF BUS SS lhl� ham MAILING ADDRESS (IF DIFFERENT F OM ABOVE) l� OWNER'S NAME: LAST FII2S MIDDLE LAV"JWT, &n -61, 7% 3H7 Do you currently possess a state license to sell tobacco products? Yes No Each employee who sells tobacco products must receive and understand Chapter 371 of the Town of Barnstable Code (copy provided herein) and the Massachusetts General Law Chapter 270,,Section 6.00 (a copy is provided on the next page). Each employee who sells tobacco products must sign the Employee Signature Form ;(provided herein). Signature Date Q:\Application Forms\TOBACCO APP2019 dob.docx Commonwealth of Massachusetts Letter ID:L0355623552 MUNI b --� Department of Revenue Notice Date:September 4,2018 0. Christopher C.Harding,Commissioner Account ID:CGL-11258778-065 emu:d pF4 mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARETTES �""II'��II�III'III'�II11�"�'ICI'�'ll'I�III'll�ll'lll�ll�l�llll MARYLOUS NEWS INC MARYLOUS NEWS 183 WHITING ST HINGHAM MA 02043-3845 Attached below is your Retailer License for Sale of Cigarettes(Form CT-3T). Cut along the dotted line and display at your business location.At any time,you can log into your MassTaxConnect account at mass.gov/masstaxconnect to view and re-print a copy of this license. If you have any questions about your license,call us at(617) 887-6367 or toll-free in Massachusetts at (800)392-6089,Monday through Friday, 8:30 a.m.to 4:30 p.m. DETACH HERE -------------------------------------------------------------------------------------------------------------------------------------------------- �` cNr'SF� MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T Retailer License for Sale of Cigarettes J ov This license must be posted and visible at all times.The sale of tobacco products to anyone under 18 years of age is prohibited. MARYLOUS NEWS INC Account ID: CGL-11258778-065 MARYLOUS COFFEE Location ID: 11258778-0040 1481 IYANNOUGH RD License Number: 282568704 WEST BARNSTABLE MA 02668 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to ;, sell at retail at the address shown above.This license is non-transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date: October 1,2018 Expiration Date: September 30,2020 pF IKE r TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: i J 7/ Page: of. OFFICE HOURS BARaNSTA� E. PUBLIC2 0 N MA STREEETDIVISION � 3: -s:30 A.M. �� :300-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified -. � ,639. � HYANNIS,MA 02601 508-862-1R644 No Reference R-Red Item PLEASE PRINT CLEARLY i°rED MP�p FOOD ESTABLISHMENT INSPECTION REPORT Name Date 7 0'b Tyne of Inspection ReinAddress � Risk Food Sery e-inspection G Level 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: 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 A13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS (Jhl[ s- ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.ProperAdequate Handwashing CONSUMER ADVISORY 1 ,��j(� ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories ILo Violations Related to Good Retail Practices(Blue Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations �J Critical(C)violations marked must be corrected immediately. (blue&red items) I!� Corrective Action Required: ❑ No s Non-critical(N)violations must be corrected immediately or Overall Rating `I / within 90 days as determined by the Board of Health. EZI ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 6=One critical violation and less than non-critical violations 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. 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: Insp c r ign urIfl P 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 Cs Sig ure Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N /+� Dumpster Screen? Y N vt V Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) [De-. signment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) onstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12- Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(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*2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-201.11 Separation-Storage* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An ' 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and , 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff"rme mrzoa 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)(I)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 70 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* - 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands * Critical and nbn-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* 1g 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. 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. oFTr TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: / Page: of q OFFICE HOURS PUBLIC HEALTH DIVISIONS VVV 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified•. mA qs HYANNIS,MA 02601 MON.-FRI. t639• `0$ � 508-862-4644 No Reference R-Red:Item - PLEASE PRINT CLEARLY °IFOM�" FOOD ESTABLISHMENT INSPECTION REPORT Name Datej - �'/ T e o T e Inspect ion C. '/ O s Routine> e:;r .1 - Address Risk Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in C e(PIC) Time Bed&Breakfast. HACCP In: Other 00 Inspector Out: C Y-\ 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) n FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS d� 1 ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As'a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP it Proper Adequate Handwashing CONSUMER ADVISORY �:�� ^ �►,/� Pl.Good Hygienic Practices ❑22.Posting of Consumer Advisories , _t ' VViolations Related to Good Retail Practices(Blue Items] Total Number of Critical Violations I Critical(C)violations marked must be corrected immediately. (blue&red items) ® Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ® ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure. ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations,and no more than 3 non-critical violations. F=3 or more critical.violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 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 (FC4)(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 6.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,.infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590;008) 9 4 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspe tor' S na re Print: . 31.Dumpster screened from public view 1 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N 1 #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's ignature Print: g�1 Self Service Wait Service Provided Grease Trap Size Variance Letter Posted. Y N Dumpster Screen? Y N i i 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 75 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-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* 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 590.003(G) Re rting by Person in Charge* Contamination from the Consumer 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q po 3 590.003(D) 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 Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) Disposition ofAdulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 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 Wazewashing-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 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils an Eggs d Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eb ctwe 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 rf ces of Equipment* 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 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 4-703.11 Methods off 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* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial) Processed RTE Food-140°F* (Blue Items non-critical 23-30) 3-202.15 Package Integrity ( ) y Critical and non-aitical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140*F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70'F to 41°F/45°F Item I Good Retail Practices FC 1590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .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 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. fmm' °FIKE►o TOWN OF BARNSTABLE .. HEALTH INSPECTOR'S Establishment Name: Date: & Page: of 4 OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. � 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified a o `0 HYANNIS, MA 02601 MON.-FRI. No Reference. R-Red Item PLEASE PRINT CLEARLY 508-862-4644 FOOD ESTABLISHMENT INSP C ION REPORT Name Date Tvue of of Ins ection p // e s Rou I (/ Address Risk oo -Se e_insp, ion Level Retail--% Previ In o� Telephone Residential Kitchen Date: Mobile Pre- n Owner HACCP Y/N Temporary Suspect Illness Q v Caterer General Complaint Person in.Charge(PIC) Time Bed&Breakfast HACCP . Other . Inspectpi Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. 17C Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 596.009(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) ❑ n, . FOOD PROTECTION MANAGEMENT 12.Prevention of Contamination from Hands ATOi 1 �` n ❑ 1.PIC Assigned/Knowledgeable/Duties 13.Handwash Facilities V r EMPLOYEE HEALTH PROTECTION FROM CHEMICALS r n I ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives I ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals r b , 1 FOOD FROM APPROVED SOURCE TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods) 4 f ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures I - 1 ❑ 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 L9/ I PROTECTION FROM CONTAMINATION M 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 L 11.Good.Hygienic Practices ❑ 22.Posting of Consumer Advisories �a Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) �( I / ❑ (/VV �" tive Action Required: ❑ No Correc 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)(5910.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005 B=One critical violation and less than 4non-critical violations 9 ) cited in this report may result in suspension or revocation er 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 9rion-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- -itical violations. If 1 critical refrigeration.. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 viol tion,4 to 8rion-critical vio atio C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Ins p is i in re 42 rin 31.Dumpster screened from public view A,� JI/I Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI 's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter_Posted Y N � Dumpster Screen? Y N ` Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) '+ FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination L14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and.Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous•or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 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* g7-102:11 1 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* 1 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 Requirements 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* ( ) q 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* ,, _REQUIREMENTS FOR- 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions� Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3=202.13_ Shell.Eggs* Sanitization Temperatures* TIME/TEMPERATURECONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,PH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 ) Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Eggs Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 1/12001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency 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 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Chemical* 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 W/Id 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 practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. $ Receiving/Condition g, g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* _ 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301. revenng Contamination n g* 3-403.11 Commercially Blue Items 23-30) 3-202.15 Package Integrity 12 Preventing Cotaiatio When Tasting* C( ) Co ercial]Y Processed RTE Food-140°F* non-critical Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facllltles 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 Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 * 5-205.11 Accessibility,Operation and Maintenance * 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Foanbackfi-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical iterri in the federal 1999 Food Code or 105 CMR 590.000. .TIME 1pk, TOWN OF BARNSTABLE, HEALTH INSPECTORS I&stablishment Name: " lam' L.J Date: Page:__ q OFFICE HOURS f/ 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. o ,6}q.p 0$ HYANNIS,MA 02601 No Reference R,-Red Item PLEASE PRI CL RLY 508-862 4644 /> 'EDMP� FOOD ESTABLISHMENT INSPE T4ON REPORT ` Name Date De of lynkg Inspection t/ r 1 al) Is caw:�6 1 F I k-d -LI-)2 Routine Address Risk l ` Foor)Service =n pection z Level Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspectallness Caterer General Complaint - Person in Charge(PIC) Time Bed&Breakfast HACCP t a In: Other Inspector Out: Each violation checked require 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 Y ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) a_ ❑ 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 8,red items) Corrective Action Required: a 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 F] Embargo ❑ Emergency Closure Voluntary Disposal Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when.signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005 B=One critical violation and less than 4von-critical violations 9 ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a_right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 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 8non-critical violations: If 1 critical refrigeration. within 10 days of receipt of this order. violatio to 8 n -critical violations=C. 29.Special Requirements (590.009) y p y 30.Other DATE OF RE-INSPECTION: Inspector Sig fU Prin 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N �` e #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI 's n ure Print:f 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) h FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* $ Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 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 PStorage* 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation- Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q "Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 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 F 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* * 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 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 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of 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 cnvc uuzoot 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 (ontart 3nrfaces of Frinipmenr* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS ' Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 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 non-critical 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which.do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* Ln Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. OF 11HE ro TOWN OF BARNSTABLE ,HEALTH wSPECTOR's Establishment Name: Date* Page: of -ry OFFICE HOURS _ AR''Eo� PUBLIC 0 MAIN STREET 3:30-4:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. �b 639. HYANNIS,MA 02601 508-862-4R644 No Reference R-Red Item PLEASE PRINT CLEARLY M FOOD ESTABLISHMENT INSPEJUTION REPORT Name Date Tyne of Type of Inspection Operations) Routine Address Risk Food Service Re-inspection, Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Mao Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed 8 Breakfast HACCP In: Other Inspector C2 Out: , l I Each violation checked requires an ex anation,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) , 176/ ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures �► ❑ 5:Receiving/Condition ❑ 17.Reheating i ❑ 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 ! � v ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ( ff,<o X" , ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP _ r ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting.of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue$red items) Corrective Action.Required: ❑ No ❑Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,_the items Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an.F. B=One critical violation and less than 4 non-critical violations 9 25.Equipment and Utensils (FC4)(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 be in writing and submitted to the Board of Health at the above address violations observed,7 to 8non-critical violations: If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC77)(590.008 9 viol lion 4 to 8 on-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30:Other Insres �a#.Irf Print: DATE OF RE-INSPECTION: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N JJ #Seats Observed Frozen-Dessert Machines: Outside Dining Y N IG's Si t Print: ' //y�► /A' Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) , FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 0 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding - ' - 2-103.11 Person-in-Charge Duties - - - 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEAL in TH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Contaers* 590.004(F) 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 7-201.11 Se 3-501.16(A) Roasts Held At or Above 130°F* 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) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ -REQUIREMENTS FOR. 3-306.14(A)(B).Disprned Food and Reated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) Disposition of Adulterated or Contaminated - - - Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 - Food-and Water From Regulated Sources' 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* _ 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* .3-202.13 Shell Eggs* - Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 "Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean g8 Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or _ _ Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef vifv 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.Ftsh 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 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009 A( )-(D) Violations of Section 590.009(A)-(D)in cater- * - Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g� P �' 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and AutWildhority Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* ' Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 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 77 Reheating for Hot Holding Requirements. noirsshould 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 Commercial) Processed RTE Food-140°F* (Blue Items 23.30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) g Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-20411 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. ' n / A ��_ � ' {y's 4,,L J:1. a *. � �� . _ Y `�„ �a� i " � . • � �n� f g ,i t1l spy 11 11. ;fib i Y{ '>I .. ,� � ; �, �: t� �"' _ „F.. �. .� i/ . �r'e _� ^JJ�.. ��, •�, - ` `_ � �,.: -� , • `�'�;�: ,��.. iE� ,. _ -� _. - _ - —'T' Jt i, _��=. Illllllllllllll� _ \)av�jl "a lou Oreoi yp.. • .__.. _ .'+ram. Var�!!A Saad, Dale From: t Wadlington, Ellen Sent. Wednesday, November 15, 2006 12:12 PM To: Saad, Dale Cc: McKean,Thomas Subject: FW: Mary Lou's Coffee Shop I called Jody Murphy of Mary Lou's and gave him the information in this e-mail from Tom. He stated"P3" is the backroom and it has 3 sinks ---3 bay sink, service sink and lavatory sink. All sinks in restrooms and hand wash sinks are equipped with touchless faucets. Great trap was inspected and pumped last week, he will fax it to us. Dumpster will be screened from view of public, it will be out back. Please call Mr. Murphy at 1-617-212-8812, this establishment would like to open next week. Could you inspect on Friday or Monday of next week. Ellen Wadlington -----Original Message----- From: McKean, Thomas Sent: Wednesday, November 15, 2006 10:38 AM To: Saad, Dale; O'Connell, Timothy; Stanton, David; Desmarais, Donald; Miorandi, Donna Cc: Wadlington, Ellen Subject: Mary Lou's Coffee Shop FYI Dale and I reviewed the proposed kitchen plans this morning. We came up with a short list of comments and questions including: - No handwash sink provided in the back"work" room area -Will the handwash sinks and restroom sinks be provided with touchless faucets as required? -When was the last time the 1,000 gallon grease trap was pumped? - Is the dumpster screened from public view? Dale will contact the applicant and schedule an preliminary inspection. 1 DY - ROOTER IN Work Order Number ReadwR®®ter P.O.Box37� Sandwich,N A 02563 Phone: 508-888-6055 Date of Service Fax: 508-888-0242 CUSTOMER No. SAVE THIS INVOICE FOR YOUR GUARANTEE cusTOMER CLASS RESIDENTIAL COMMERCIAL CUSTOMER NA �,. CUSTOMER PHONE TENANT PHONE Ai Lck)` z BILLING ADDRESS , t -7 FEDERAL I.D.NUMBER PURCHASE ORDER NO. 04-3441584 CITY STATE ZIP CHARGE AUTHORIZATION MAP CODE ADDRESS(JOB ADDRESS IF DIFFERENT THAN BILLING ADDRESS) STATE ZIP APARTMENT NO. TENANT NAME DESCRIPTION OF.SERVICES d ` PRfzk 4 ,b �_� 5 c�'j 2(5 TERMS:DUE UPON COMPLETION GUARANTEE- OTHER CHARGES INVOICE AMOUNTS — I HAVE THE AUTHORITY TO ORDER THE ABOVE WORK AND DO SO ORDER AS OUTLINED ABOVE.IT IS TOTAL AGREED THAT THE SELLER WILL RETAIN TITLE TO ANY EQUIPMENT OR MATERIAL FURNISHED UNTIL $ PARTS FINAL AND COMPLETE PAYMENT IS MADE AND IF SETTLEMENT IS NOT MADE AS AGREED,THE SELLER SHALL HAVE THE RIGHT TO REMOVE SAME AND THE SELLER WILL BE HELD HARMLESS FOR ANY LABOR DAMAGES RESULTING FROM THE REMOVAL THEREOF AUTHORIZED SIQNATURE DISCOUNTS OTHER TYPE OF SERVICE ,, TERMS OF PAYMENT In the event check l9returned, TAX EXEMPT PLUMBING ❑ HEATING ❑ CASH ❑ CHECK ❑ the company will charge the p Tax SEPTIC SEWER AND DRAIN ❑ ACCT.REC. ❑ CREDIT CARD customer a$225.000 processing fee. TOTAL EXPIRATION DATE CREDIT CARD N0. � � -1 This Is to acknowledge completion of the above described work which has been done to my complete satisfacti0 ED DATE USTOMERSIGNATURE SERVICE TECHNICIAN'S NAME <_, t13 —j INVOICES_ : r° 212 PART A DESCRIPTION,VENDOR&P.O.p PRICETO COST: OTV USED • • PART a DESCRIPTION OF PART P ICETO COST. Tv USTn • TOTALS TOTALS owner: # Seats and Standing Capacity: Indoors: . 5� p tNCo • *Outdoors: A RESTAURANTS FOR STAFF USE Approved Denied Floor Plans- Received, Staff Meeting Review Date: Application form In-ground Grease Trap or GRD with a variance. ` 2a-(, fi Sewage Upgraded or Town Sewer Water Supply - Approved Source, if well, annual testing& licensed Operator Handwash Sinks-location, number, design and signs SEA f L*" Touchless fixtures Three Compartment Sink and Dishwasher (high or low temp?) Visual or audible device. Test strips, Log Book - Low sanitizer - Type of Sanitizer: Quats, Iodine, or Bleach? (Show storage Location on Plan) St E PLPI-N Mop Sink-Mops to'be hung properly and dried SEF_ pL 4 Se.r c,e. S1nk ? Frozen Dessert Machine (Dairy) Yes No K , Drain Boards-air dry utensils and equipment 5E a Pt.AW4 Ventilation Systems for Hoods (Cleaning contract) Ko 400p Number of Bathrooms Proposed: :�k- aXt S'rLNCp. �--�1. Touchless Fixtures 2. Ventilation Systems 3. Self-closing door(if located off the kitchen) 4. Soap Dispensers—Mounted 5. Paper Towels—Mounted 5. Handwashing Sign 7. Women's Room— • Covered trash bin or sanitary napkin dispenser Floors, Walls, Ceilings (Smooth easily cleanable surfaces) SEZ Pent Lighting- Sufficient/lighting shielded F Y4, fn m r, -Co rAe.M.A1N Refuse containers Covered (sufficient number and size, durable easily cleaned, insect & rodent resistant) Dumpster impervious ground and blocked from public view. Touchless sensor-operated faucets at restroom sinks. Touchless sensor-operated faucets in handwash sinks in food preparation areas. Dry storage room location shown on floor plan fF_r-- PICA Lockers for employees in designated area. go►-SE r"-j Vl " Poisonous or Toxic Materials (storage located marked on plan, labeled containers) Cut Sheets (for all food equipment) Screens for Windows and Doors, SEC P 1 • Plan approval shall be granted or denied within 30 days. • Thia lint io not inolvoiYo of all Tcdtrall State and Local requirements Q:wpfiles/Reskitl0.doc �' �: ^tprM�"- r„ /^ •"M�� � «srtnr «'� � "« a �4 m.€, `; �M;. s x��.��y''�may., r+ � �1 ' �°.,. ''ik9.r" r.� ��ry2�t� -� < � w�.� tr 3z�1 P"7sd#�� i�,v r`�. 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Bulletin theme copyright 9 2006 Seasons of the S Used b Spirit.P� YPermission. �., r '.._..�`�srxi� 'v '�u. «.o-�.:` x,.,wr: ,rr�w.µwa'..•� �'." +-� - .'�.r-,tr..:flr.,r�wa. :a' �a�w:..aeauci�...�3w;„. .w,�,�;�+:«`�e'«a�m,.:,�:�.d.Sr 1 t 4' PASTRIES EFF. 10/20/06 SUPPLIER 55 PLU $1.19 + TAX = $1.25 English Muffin Croissant Butter 57 PLU $1.25 NO TAX AMD Nemo's Banana Cake AMD Nemo's Carrot Cake AMD Nemo's Cheesecake AMD Nemo's Old Fashion Cinnamon Roll AMD Nemo's Coffee Cake MONTIONNE'S Biscotti NEW Biscotti 58 PLU $1.50 NO TAX ALMOND TREE Brownies ALMOND TREE Brownies with nuts ALMOND TREE Cookies ALMOND TREE Joey's Corn Bread AMD/D'LECTIBLE Whoopie Pies My Grandma's Slice PERKINS Cinnamon Stick PERKINS Raspberry Stick 59 PLU $1.55 + TAX = $1.63 AMD Sara Lee Cheese Butterfly Pastry AMD Sara Lee Danish Variety AMD Sara Lee Raspberry Danish PERKINS Yogurt Loaf PERKINS Yogurt Muffins PERKINS Cinnamon Roll PERKINS Figure 8 Ra9p/Lemon GARELICK Dimetria Cinnamon Roll GARELICK Cream Cheese Big Cinnamon Roll MY GRANDMA'S Jonathan Lord Crumb Cake MY GRANDMA'S My Grandma's Cake D'Lectibe Asst. Danish DMTRA Danish Mini Jonathan Lord Moon Cookies Cream Cheese Big Cinnamon Roll �r 60 PLU SANDWICHES $2.39+TAX = $2.61 Bagel/Egg/Cheese Bagel/Egg/Sauage or Bacon w/Cheese Croissant/Egg/Cheese Croissant Works OTHER BAKERY EXPRESS ARNOLD COUNTRY WHITE BREAD $2.49 count as cost CLUB WHEAT BREAD $1.89 CLUB WHITE BREAD $1.89 100% WHEAT BREAD $2.49 SANDWICH WHEAT BREAD $1.50 SANDWICH WHITE BREAD $1.50 HONEY BUNS BIG MAMA'S $1.19+ $1.25 TURNOVER APPLE OR RASPBERRY $1.19+ $1.25 BAGELS W/CREAM CHEESE $1.39+ $1.42 EXTRA CREAM CHEESE $0.45 NO TAX MY GRANDMAS WHOLE CAKE LARGE $19.50 NO TAX SMALL $ 7.50 NO TAX F • PLU LIST . REVISTED 10/20/06 (1)SM.REG (59)CRUMB CAKES,YOGURT MUFFINS, (2)MED.REG YOGURT LOAF CAKES,GRANDMAS (3)LG REG COFFEE CAKE, ALL DANISH (4)JUMB REG (FIGURE 8,CHEESE DANISH,BEAR (5)BIG LOUIE REG CLAWS,CHERRY CHEESE DANISH (6)BOT'ME-SODA CINNAMON ROLLS)YOGUR-f (8)2 LT SODA BUNDT CAKES (11)SM GOUR (60)SANDWICH (12)MED GOUR (64)SUPERLOU REG (13)LG GOUR (65)SUPERLOU GOUR (14)JMB GOUR (66)SUPERLOU SPEC (15)BEG LOUIE URMET �-67)SUPERLOU X-SPEC (16)LG CANDY BAR - (68)SUPERLOU FRAPPE (18)16 OZ FROSTYLOU (69)WOODEN NICKEL (19)16 OZ KIDZ KREAMZ (76)REG LATTE (70)32 OZ KIDZ KREAMZ (77)TALL LATTE (22)24 OZ FROSTYLOU (78)TRIPLE LATTE (68)37 OZ FROSTYLOU (79)1 REG CAP/MOCHA 320Z (20) 16 OZ SM MIXED ICED (80)TALL CAP/MOCHA (21)24 OZ MED MIXED ICED (81)TRIP CAP/MOCHA (66)32 OZ S.L.MIXED ICED (82)REG ESPRESSO (23) 16 OZ SM REG ICED (83)TALL ESPRESSO (24)24 OZ MED REG ICED (84)TRIP ESPRESSO ,64-):32:OZ S.l-.RE :-lJCEI? (8 VOLCANO SHOT (25)16 OZ SM GOUR ICED (86)REG CAFE AU-LAIT (26)24 OZ MED GOUR ICED (87)TALL CAFE AU-LAIT (65)32 OZ S.L.GOUR ICED (88)TRIPLE CAFE AU-LAIT (27)16 OZ SM X-SPEC (92)FLAVOR SHOT OR (28)24 OZ MED X-SPEC EXTRA WHIPPED CREAM (67).32 0Z S.I.X-SPEC. �9)PACK C3GS (35)16 OZ SM MOCHA/CAPP ICED (10)CARTONS CIGS (36)240Z MED MOCHA/CAPP ICED (93)PARLIAMENT PACK (67)32 OZ S.L.MOCHA/CAPP ICED (94)PARLIAMENT CARTON (37)16 OZ ICED LATTE (95)VIRGINIA SLIM PACK (38)24 OZ ICED LATTE (96)VIRGINIA SLIM CARTON (63)32 OZ.ICED.LATTE (97) BASIC.PACK (180)BOX OF BEST(REG) (98)BASIC CARTON (181)BOX OF BEST(GOUR) (99)MARLBORO PACK (50)BAGEL (100)MARLBORO CARTON (51)XTRA CRM CHEESE (109)NEWPORT PACK (55)ENGLISH MUFFINS (110)NEWPORT CARTON CROISSANTS (120)GIFT CERTIFICATE (123)PERFECT PAIR($.50OFF) (57) ALL MEMO'S PRODUCTS ALL BISCOTTI (58)ALMOND TREE COOKIES ALMOND TREE BROWNIES CINNAMON TWISTS WHOOPIE PIES JOEY'S CORN BREAD 7 � _ oi t A No. '� ' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Migoe;al *pztem Cow5truction Permit Application for a Permit to Construct( epair( ` )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 7/ -/2r/3.;L �� O rw�ner''s Name,Address and Tel.No. Assessor's Map/Parcel '�j 3— �� 7 Gi,„ YW Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures c Design Flow 4,/ 0/� gallons per day. Calculated daily flow :3!E;�o gallons. Plan Date —r_l L Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) =0,5 V AA \ 1000 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the E ironmental Cod and not t lace the system in operation until a Certifi- cate of Compliance has been ' Bo of ealth. Signed Date /c, Application Approved by Date Application Disapproved for the followin , easons Permit No. a Date Issued No. �(O.," L �/ , $ E Fee 6 computer: �,�� a,•,� THE COMMONWEALTH OF MASSACHUSETTS Entered in com p PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 5 , - ZIpprication for �Migogar *p5tern Congtruction'permit Application for a Permit to Construct( epair( ' )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Y 7z�, � Owner's Name,r Address and Tel.No. Assessor's Map/Parcel j Installer's Name,Address,'and Tel.No. Designer's Name,Address and Tel.No. e of Building: g: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building L£_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ` da 5' / gallons per day. Calculated daily flow 35- gallons. Plan Date - -�! Number of sheets Revision Date Title Size of Septic Tank A Type of S.A.S. Description of Soil i t ulk Nature of Reppai so Alterations(Answe when ap licable) =O-S'C`A \ 1000 b ir rc C-t. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the En-ironmental Cod and not t place the system in operation until a Certifi- cate of Compliance has been sued-b Bo of ealth. Signed Date /o -1-v ; Application Approved by Date Application Disapproved for the followin easons`a t Permit No.,- - _ Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded(V ) Abandoned( )by t f)— C A IPc- G-P. (?l l C-- ,.at ELT' � tt ' �r yt-ww.t � tw.. '�•-has been.constructed in accordance with the provisions of Title 5 and the for . isposal System Construction Permit No. dated Installer ` r Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date / 1 - Inspector No. 7b ��Y Il ---------------------------Fee c 0 � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 1=i5po.5a1 *p.qtem Construction permit Permission is hereby granted to Construct( )Repair( ✓'Upgrade( Abandon( ) System located at rw I Q`G �. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. - Provided: Construction must be completed within three years of the date of this permit. Date: 9. , Approved by. a� i r�r id o �-dog 000 Cam+ i 11 � „ A D_ Qf r TOWN OF B TABLE LOCATION ��" ?� f" ,,3;Z _1 U SEW E # VILLAGE_ ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.Q'1_1� SEPTIC TANK CAPACITY -:Z?C0 Q b--,q ( it o d LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by No�S�—....� FEs.��..��..._.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ALTH ..................OF...SA9445'I.�r 60.. Appliratiou for Uigpu,ial Workii Tome udiuu rantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: � - p �. .1.tL...C��. 1: (-.....�`� vr9�v1 .. ...---•-••---....---•--....-6-------------••----•-•-------•--------••-•-----........---•--...... u. Location-Address or Lot No. :._. ►�. ._..(! . �c.� 14..............................• .....S n� ------................ ... :................__...._......... Owner Address .... Installer Address qq Type of Building Size Lot..... IP........Sq. feet V Dwelling—No. of Bedrooms........___________________________....Expansion Attic ( ) Garbage Grinder ( ) p`4 Other—Type of Building RESL,_.f,4f 1L-No. of persons....+0..FWT!5... Showers ( ) — Cafeteria ( ) Other fixtures '1.O 8 4 & ......----.. �lExrl. ---------.'f�"-f'--= ............................................... Desl Flow. . .. ............... .5. allonelper erson er da . Total dail flow....... ....._....... .._ lons. 'gn ��. . s � g P P Y Y -��•�--•f- ••----•- 1� WSeptic Tank—Liquid' capacit 30®�.gallons Length...ff........ Width:............. Diameter................ Depth...�`� Disposal Trench—No._.. y_....._ Width.._.. Total Length.................... Total leaching area....................sq. ft. x 1.9610....slft.6_11D � Seepage Pit No.... �..=_-_. Diameter...I_��r.'E�F Depth below inlet.__..�::......... Total leaching area___ Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by..R.t..MC. -Q.C2.6.R......��,_ r. :... Date..'A�3Q...... .- .......... a Test Pit No. 1:.'.-.-...minutes per inch Depth of Test Pit.... 4. .._...__ Depth to ground water../ VNE....... Test Pit No. 2..............:.minutes per inch Depth of Test Pit.................... Depth to ground water....................`_.-. O Description of Soil.. A 9:b mPAC>A:._._SA1?!/�3_._ ....--6G.6l31.�.�._...�._16_-_I'� ._. ddl ... ...��1................... x ......................................... -•-••......................•..-----•--.-....-...-.•....-....----.-.-.-.....--..---.-----...----..-.-...--....-------..:-....-•---------------.......----................•-----.................. V Nature of Repairs or Alteratidns—Answer when applicable................................................................................................ ...............•------•----......-•-------•--•-•--••---•------•---•=------•--•-•---•--..............---------•-------------•--------------------------•-----•-------•------•--.........-•••--••........ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of:ITLL 5 of the State Sanitary Code—The undersigned rther agrees not to place the system in operation until a Certificate of Compliance has been is ed by e board of 7a .Signed. {lL_ l Application Approved By... .._.....��':."-i�'..:................ �``.:.... Date 'Application Disapproved for the following reasons:.............:..................f................................................................................ .....----•....................•--•--•--..........---•----•--..........--•---......---•---•-•--•----......---•------.................----•-------•----•----------••----------•---••--------.............. .. ................. � Date %Permit No.... .. ------------ ------ Issued.--•-------- �-••-•--•----•--•--.............. Date No :.�1 FEs.. .... .._. THE,COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -OWvry OF....SAQA.ISTA..B.l .............................................. 4 Appliption. for Biiiposal Works Tonstrur#ion f rrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:; . T----1.3Z Wr-v-M.5.. ..--•-•-...-°T.----16 A : . �J A y� ��( 1 r�/��-;�yL�ocaa+tlion-Address ` or Lot No j .!�l.Y..i.�e.�.:: J.L.�.eL-S.!�l.[.V..61A ................ .^-_.. �..lM� ........ '4 Owner Address W . -. -- y'' a (.............. -- ............... ......... ..................... ......... ......... ... `^•... ....... \ Installer Addressqq� Type of Building Size Lot.......l :5?.Ll Sq. feet U, Dwelling—No. of Bedrooms......_�' .................Expansion Attic 3) Garbage Grinder ( ) 04 Other:—Type of Building R�� f dT�LINo. of persons ... ..._. Showers { ) Cafeteria ( ) � Other fixtures ;IfO 4?... ,t .t. ��---•--... roc �.ilv .................................................... Design Flow.35.�2/sMT4 -f... 55 gallons per person Fier�day Total daily i ow...... 9 Q _ . .........gallons. Septic Tank-Liquid tca�pactt 30OQ.gallbns ` Length _I f........ Width .tom Diameter.................. ............... Depth S..EFP x Disposal Trench—No ....�. ......... Width�-.. Total Length ` r. t Total leaching area.. ..................sq. ft. .... Seepage -------- Diameter Depth below inlet..........._.. Total leaching area...l.964.....s1ft.C-i1C Z Other Distribution box{ ) Dosing tank 1-4 Percolation Test Results Performed by..M_ MGDWQ.UG-14.......D,CG-.E:-.. D te.-.1.73D 81.......... ,aa Test Pit No. 1....`. .minutes per inch Depth of Test Pit....MA.....__. Depth to ground water:JSlQN�..._ . Test Pit No 2...............minutes per inch Depth of Test Pit.................... Depth to ground water........................ ................ Description of Soil _�: ..,_.Q_:. (2�!_:.EAQ...�m.PA�tL._..S rvo— . .l z•.__. C:.�. P f COA 0- 0 �A STDives._.f..36 -�:(a....M�a 5A!�st2.... -GQ.GBL-E5---1.3k.-J-�4 �'/1..:. !�!�Q ..... ------------------------ -- -- ••-•--............... UNature of Repairs or Alterations—Answer when applicable........................................:_....._ ............................... Agreement: - , j The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'ITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation utitil„,a Certificate of Compliance has been issued by the board of he h. .......................... ��ate Application Approved By............................... -�.:. * ^::.. iT r ... - Date Application Disapproved for-the following reasons:. --.----• •........ ••-----------------------------------------------•-------•-••----................. • ..----•.......................... .... -• ---'-.......-'-'----- .... ................................................. Date — Permit No.... 3�..`r c__..-. Issued.. �..i ....... .._.._ s '1 THE COMMONWEALTH OF MASSACHUSETTS BOARb OF HEALTH ............... ......... 5r.�.nJ t/,at2°... ....:......... tOF "• �«" (grr#ifiratr of Tontplittnrr . THIS IS TO CERTIFY t�d v ltial Sewage Disposal System constructed ( ) or Repaired ( ) by.....................� =. •'-'-'•.. r staller f ' at.........- ( <.�t:r� �,,a..__rr ak 1 .. 1 -------------------------------- has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the d application for Disposal Wot1�s Construction Permit �,° . r' �1__1............. dated .....__._._ zo:s ^_::......._.._... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUAR NTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATEE........................ .._f1..t 1 .............................. Inspector•--............ THE COMMONWE LTH OF MASSACHU! FJ TS �_�. A.R D OF H EALT-H i F... r4gk .......OF...........6- dxi,?*tkt1!......................................... -v FEE.. ? , Disposal Works Tops inn rrmi# Permission is hereby granted---- - --c-, --:-. . r� .. ................................ / to Construct,a{( ) or Repair ( ) an Individual Sewage Disponl System f� 1�!11:w1 X',E, -•D��_v.. � ................................................ atNo...-----•...... ........ .Street - as shown on the application for�pisposal Work Construct on permit IVo'` Jl._, Dated. $ /� ' - a � . � ) . Sr t Board of Health _DATE ........................................-----......-•----. . 1 7/29/2020 ShowAsbuilt(1700x2800) t TOWN OF BAPNSTABLE LOCATION %/OZf,/ SEWAGE M 96 Vn t A ASSESSOR'S MAP&LOT ZS 3-/4-;il m su v A•�Po9prilz9 r¢voyr aggerlY S NAME&PHONE N0. �sN E 6-098- 49- SEPTIC TANK CAPACITY-7�4k 02)44Vrr 2RAv(aa.J/oQoe LEACHINO FACILrlY:(type). -Q/J eWO6`tA`4' (Aw)4044r,/054,m NO OF BEDROOMSi /O a��"er�s e,it�9fT an2cU GPO �fpL�I/LPO'�7B((k7K✓/ BUII.DER OR 0 R /�Jce9a✓✓LH 6oR.V[21 PERMrrDATE: /O-ZB•96 COMPLIANCE DATE: Iv ne 6�a1-1.7 /7f.JZcn4- eparaoon Distance etwceo tbe: nw,'� 1/JeEev f(gs�ra0gp��N9 t-96-V tiu' Maximum Adjusted Groundwater•Cabie to the tsouom�{otsa'i�ing Feed-ity" 10�peel] Private Water Supply Well and Leaching Facility(If any we0s exist -/ on site or within 200 feet of leaching facility) NO �✓11 Fat Edge of Wetland and Leaching Facility(If any wetlands exist within 300 Eat of leaching facility) .� 25�s Feet Furnished by I J71jyt-11/4'lfA, ulvI /1 �11�« efLZD.ff�kiK tyf .f�i -014_ /OGYJG6ic y•p.e. ce34{fµ�4.` 2-/ ,r7.a- $-/ 3z•Z" p ,3Z-2 dS.t` .B-Z 6Qo' �3 bo.3� B-3 ",V, S�AytYI� S.E.fo R>JEQ � 9 i- fi,)wofJq https://itsqldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=253014XO3&sq=1 1/1 Gourmet Decaf ICE® Coffee ■��������� Small Medium Superlou tAhvidus With 06hid 16 oz. 24 oz. 32 oz. 'rice dlSt 1.55 2.26 2.66 Small Medium Sworz1ou Whole; l3ean or Ground to Order Chocolate Raspberry•French Vanilla•Hazelnut•Vanilla Hazelnut 2.95 3.95 43..95 "Our Famous" 1 lb. 1/2 lb. 1/4 lb. •White Chocolate Chip•Milky Way The "Frostylou" Regular $6.99 $4.00 $2.50 Specialty ICED Coffee Marylou's personal favorite-Mocha, Vanilla, Coffee Regular Decaf $8.50 $4.75 $2.90 Small Medium Superlou g f 16 oz. 24 oz. oz. " �� For a delightful change of pace... 1.65 2.40 2.80 Screamer Gourmet $7.99 $4.50 $2.75 Almond Joy•Copa Banana•Mudslide•Nutty Irishmanu Made with chaff-spied, Vanilla Decaf Gourmet $9.50 $5.25 $3.10 Peanut Butter Cup•Roasted Toasted•Twix•Twix Decaf �ma,•]uu s -faryBl.- "Oreo Cookie Monster" Extra Specialty ICE® Coffee "Frozen Minty Lou" 6 oz. 24 oz. °Z. Ab Coffee/Hot Chai/Hot ChocolateRea 1 Medium su erlou 16 Z. cle"ecd Small Medium Large Jumbo Big Louie 2.15 2.95 3.85 "Fu g y our famous Regular Coffee 1.04 1.35 1.65 1.90 2.21 Cinnamon Hazelnut Fluff•A.O.K.Cookie•Banana Split Decaf Regular 1.04 1.35 1.65 1.90 2.21 Black'n Blueberry Cooler•Butter Ball•Funny Bone•Girl Scout Cookie Gone Bananas•Iced Cappuccino•Iced Chai•Iced Mochaccino•Mexican Mudslinger Gourmet Flavors 1.25 1.55 1.81 2.05 2.40 Minty Lou•Mochanilla Nut•Raspberry Mocha Blast•Strawberry Shortcake Famous Decaf Gourmet 1.25 1.55 1.81 2.05 2.40 Caramel Lou Decaf•A.O.K.Cookie Decaf•Girl Scout Cookie Decaf Hot Chaff 1.25 1.55 1.81 2.05 friendly service Hot Chocolate i*,.d.) 1.25 1.55 1.81 2.05 ANC plus_a, WHOLE lot more!! 1 bag 2 bags 3 bags i Tea(any size cup) 1.04 1.35 1.65 PON Our Most Regular ICE® Coffee Famous • Small Medium large 16 oz. 24 oz. 32,oz. "Funky our famous Regular Coffee 1.41 2.15 2.46 Decaf Regular 1.41 2.15 2.46 Fanabla" (__` Flavored Gourmet ICE® coffee ---� Small Medium Superlou / 16 oz. 24 oz. 32 oz. 1 1.55 2.26 2.66 Milk Juice Water Pepsi Products Gatorade Muffins•Bagels Assorted Pastries•Lottery•Cigarettes•Candy Banana Nut Cream•Blueberry Cinnamon Crumble•Cinnamon Hazelnut (not available in all stores) Creamy Irish Delight•French Vanilla•Hawaiian Chocolate Nut•Hazelnut ■ •Kahlua Cream•Milk Chocolate Almond•Milky Way•Mocha Mint �■ ��������� ' • ` •Raspberry Strudel•Snick-A-Doodledoo•Strawberry Nut Cream Did you know that Marylou's has the Toasted Almond•Tiramisu•Vanilla Hazelnut•White Chocolate Chip rjU`e $ All Prices Include 5%Mass Sales Tax. luckiest lottery in town. r Locations 05iAbington(Drive Thru) -1501 Bedford St. (Route 18) T UGS P a Abington 5 for people-on-the goy ®� —562 Wasliinkton St. (Route 723) " 0 0 Largel'Hot,.Jumbo%Hot, ._. a Braintree xou 6 �..�,.. .. . .,. .,:.. ,�-:� SuperLou/Gold:�+2.99w-- -25 Cleveland Avenue GIANT/H0- T­,3 oz=for $3.49 o Bridgewater - Also Cera}m c-M gs for,the —169 Spring St (inside Tedeschi's) i apt home,uavaitAble in Sizes. ,EiE.Bridgewater(Drive Thru) —117 North Bedford St. (Route 18) L ' gal Cohasset(Drive Thru) --132 Chief Justice Cushing Highway(Route 3A) �Oil "- o Hanover `' 1.7 ` • —211 Washington St. 1 o Bingham [Best (Coffeei 4® ing 88ST OFrZ IN TOWN —34 Whiting St. (inside Tedeschi's) tb Marylou's Famous Regular Coffee, otherwise known. Holbrook(Drive Thru) as the "Best Coffee in Town" is a special combina- tion of coffees from Colombia, Brazil and Central o Hull America. It was carefully selected by Marylou when —248 Atlantic Avenue she opened her first store in 1986. t5 Pembroke (Drive Thru) Being a true coffee lover herself and wanting to " cx —759 Washington St. (Route 14 & 53) serve the perfect cup to all her customers, she searched out many different importers until she came .i Manomet(Drive Thru) w —755 State Rd. (Route ) up with a blend that would please even the most demanding coffee drinker. o Plymouth (Drive Thru) Marylou's ground coffee beans make an excellent —63 Obery St. �Mvtii°u'S Q r THANK YOU gift...or reason to visit!Bring some C0PP88.mi.:``. o Rockland with you to a friend or relative and share the secret —200 Webster St. of The Best Coffee in Town! 0Sandwieh (Drive Thru) NOTE: To,brew best tasting coffee at home, use —69 Tupper Rd. (near Marina) Spring or carbon filtered water. o Scituate —772 Country Way a Whitman MA\RY]L®U � at our MONEY Y M yl —564 Washington St. A Oft forereteExp,nvImi' 35 69 1 f+ Ay tiw.w.titivtitiw.tiY.Y.ti r o Weymouth , —1212 Washington St. (Route 53) Purchase a book for $5.00. 511.00 Marylou Bills o Weymouth are inside. A GREAT GIFT IDEA! —768 Main St. (Route 18) Coffee brewed, whole bean, or ground to order *" A d for TAKE HOME.Visit the s website to Mar lou r order coffee gift baskets and clothing online! I he BEST coffee in town! g g *V www.marylous.com r : x TOWN OF BARNSTABLE LOCATION ������l3Z ��YB�y1 � OZdo/ SEWAGE # 9 S¢3 .LLAGE_ yY6l���S `-T ASSESSOR'S MAP & LOT 3-I4-3 A 5 -rrz 5 459SS04 ,,,�/bBaXi>Z9 r4.d�wr�y DzTGj S NAME&PHONE NO.45Y-- POfi' 17:105- -5200-O 7.5l SEPTIC TANK CAPACITY 'S LEACHING FACILITY: (type)eFOF/EZ9 [7�FJ •�J� 6 (size)Z¢X¢Q /DSO /0. NO. OF BEDROOMS /O a cetUo4✓cr(92 soa f'`9ST�o/l:ZDU 6PrJ TOTS BUILDER OR OWNER /roc®o.✓vv�y �9t�9C� PERMITDATE: COMPLIANCE DATE: lVS1`bZr!v 6Z;4T2- !Z�/7e/✓>zoo4- Separation Distance Between the: ��y�T jy �� py y_z_96 0 Maximum Adjusted Groundwater Tab'e to tth✓e Bot omVo Cea ping F�ac�' 1 ± Feet oW/ZE S Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Ala Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) 2 = Feet Fwnished by /G2� nlc�3y/I�-YJc . S Sy2t/�71,1/� H9cco./ Z�G�dpZ /DUUGyc /r/� c�.i/cs Z4 I Z 4 /.jam 14=16LI-0 4-' i 41 9 ,• 5.c'. co 2J�Q F $Jlc.ol�ly� P co C � 12'D' 176" FFE EXTNGUISH� 3 COMP.SINK HAND SINK . S ° T_ REMOVE WALL LNOER STARS MCP 5�1C Z' 5 o r►�A�LJ a: F' WALL TO BE BULT _ ( 0 11 D U/C ICE COLUMN MACHINE' SINK 0 14'D" R'V J J�T 3'6` 16�0° cp d t IEID CASE I FIRE EX7MU&ER MLK UP TO CASE i OFFICES .. 10'D, as•x sr N FLOOR PLAN 1 f 4" = 1,- 0" arx5' HONEY_ DEW. D � UTSr 0 RTE . ,132 , H A �I �f1S f� A . - __ ­ I I II I �, I I � I I � I I I . 11I I I . � 1 � 11,I � I� I I I I I I � 7� / ,: , I I I II I I I .I I � — ____ �I , ­ I r I I I I I I I I -, I I I I I � � , I I I �, I I I � ,� � I I I I I I � I I .1� I I I � � , I I I I I I I I�� I I 1, I I o , � I I I . I , I I I I I I I I I I I I � I I I I I� . I I I , I I I iI I I 1. I I I I , I � I I 11, I I I 1� I . I I I I I I I I � 1, , I I I I I I I I � ,� I I � I ',-,,�,-­­4 1 ­ I I I I I . I I � I I I I -I -I"I I� � I 1, I I I I I I I � I I I I I I I � I I I 11�,� , , I I � I I, I � I �I I I I . I 11,., I � � I I I I . , I I � I � I I I I� � I I I � I I� I I I I , I 11 � � I I I 1 1, I I I I I I I I I I I I I � I . I � I 11 � N �', I I I � I I i � . I I I I I I :q I � I I I I ,� I � I �, I I . �,I � I � ''I' ll , � I I I I I I " ,� I I I , I ,I I I I i I � � I 0 I I � iI , I I I I I � 11 I 1- I I � � 1: I I I � I � � I I I I I I I I I I i I I , 11 � I � I I 11 I � � I I � � / " . , 1� � ' , I I I � I � I � � , , � I � � I I ' ll " I 1: � � I I I I � � I 11 � � 11 I I I I I I I ' ll I I I I I I I � I . II I I I � . I I I I I I I � I � I I I I I I 11 �11 ' 'I I 1 .1; 11 I I I I I " I : I I ,, I I I ''I 1�1: I, � I I I I I I I I I � I I � I I I �, ! I I 11 I I I I I I : i � I �_ I � I I I I j ''I � I - _ I� -_ I I � I I I I I , . I . 11 I I . 11 � I I I � � � \ . � � � I I I I � . I ­ I I � I I 11 I � GENERAL NOTES : � I I 11 I i I I : ; I I I i I I : I I I I I � I I I . . � ZONING TABLE , I I � I ! � I 1.) LOCUS AREA IS COMPRISED OF. 11 I . I I � � : . I I I ; I I I . I I I I . I i I I I NESS) , I I I I I i ZONING DISTRICT: B (BUSINESS) / HB (HIGHWAY BUSI I I I i . I I I ­ -FAMILY: REF. TO PRD SECTION 240-18.A.10 I I I LOT 1A 0 PLAN BOOK 539 PAGE 24 1 1 - i MIN. ZONING REQUIRED FOR MUL11 � I , I I I I � I ASSESSOR'S MAP 253 PARCELS O14-XO3 & 014-XO4 11 I I I 11 � I i � I I . I i OVERLAY DISTRICTS: WP (WELL HEAD PROTECTION OVERLAY DISTRICT), ZONE 11 & RPOD I � � I : I � I I I DEED BOOK 20,399 PAGE 050 1 1 1 1 1 1 1 1 � I I I I I � I Nl_� I I I -�c 7.N g � I � OWNERS ' CENT"LLE LLC 7R. APPLICANTS CENTERVILLE LLC TR i EXIST USE: COMMERCIAL & RESIDENTIAL PROPOSED USE ADDING 2-1 BEDROOM APARTMENTS I a W .*z- V . I ' I ; I I I I I I . , I -1 � HYANNIS MAIN STREET TRUST I � C/O TOM CAPIZZI I I I I - I I I - S CV I t I I N11-1 . ? &U , af I ; I I I I I I I . I . z V . 91 I I I 1 1645 NEWTOWN ROAD 1645 NEWTOWN ROAD I . i I I � . I 0 1 1 0 Z.17? I I I I � I �, I i I I I I � � I I I I I I I � I N�_, . I I" z ki jz I I I I I COTUR, MA., 02635 11 I I I I I I I I I I tv -41 # -_ 0 a . I . I I COTUIT, I M&-1 026,35 ' 1 - (508)7428-9518 � � � . . I I 11 I . I . I a Z�_� I I I -4 Z 49 I . I I � 11 11, I � PHONE , I I I I - I ,*�10 >;z fvNqq � le I I I ­ I I I �, � I i I I I I I I I 11 "_� C4b �� I I I S I � 2.) PRIMARY BENCHMARK : TOWN OF BARNSTA13LE ENGINEERING DEPT. STATION 119 1 , I � ' 'I-, a I I . I I I . I I I REQUIRED/ALLOWED I PROVIDED/PROPOSED a _I* � I I ,, � 11 , I � I I I I I I I I I '11�9 I 1�'� I I I z I I I I I ' ' I I. 4 1� � DRILL HOLE IN CONCRETE CURB ISLA I ND I AT INTERSECTION OF I , . I I i OWN `1�0 I '1� �� I - 11 � � -411 1 1 �.� I I� � � I I ROUTE 132 & BEARSES WAY. I I I I � � I PARKING TABLE * SOLIARE FOOTAGE AND PARKING I Q I I I � I . I I'll � �, I I 11, ` (DATUM: NW29) I � I I I � I N�_, I ,�� . I 11 N9 I � I I I I I I 1, � I ,ELEVATION, = 70.45 � I 11 � I I - I # I I I 11 I � I I . 11 I I � I � BUILDING COMMSSIONER, DATED APRIL 4. 2007 , WHERE APPLICABLE I I a .1 11 I '��Q I I ,4b I I I I I I I � I I I I � I *1� I �� I � I � I I , � '' I �3.) A TM.E SEARCH HAS NOT BEEN PERFORMED FOR THIS SITE ' IF DETERMINED . � I I I I I . - I . I I � 11 EXISTING , I I I I I I ,, I I I � a '1� I 11 �9 I I . I I 1, I 11 : CH SHALL BE PERFORMED 13Y OTHERS. I I , � I I I t , I I TO BE NECESSARY A,TTTLE SEAR � I, � I I � I I I I I I no _11�� 1, . � � I �� I I I I I I I I I I � I ' 'I I I I 11 L I I I I I I I I 11 'N , - � I ,I 11 I I I 11 I I � �, ; , '' I I I � I ' ' I I - � I I I I I � I I I I'__� I "i 'Q1__1 I I I I I a I I I RESIDENTIAL-, 2-1 BEDROOM APARTMENTS I , I %1i 1*1 I I I I I : I I - , I I _ a' x?, I I I I I I - I I _- 3 � �I I I . I . I I a I I I ,� I 11 I I 11 I . I I I I I : ­: ---� , 4.) THE PROPERTY LINE INFORMATION SHOWN IS BASED ON CURRENT AVAILABLE RECORD . I I I I : .� I ? 1 1.5 SPACES PER BEDROOM - 2 x 1.5 '' I I I I I 11 I I I '11� �,_� -Z� � I I I I I , I 11 : I I I INFORMATION CONSISTING OF AVAILABLE PLANS DEEDS AND LAYOUTS. , I I I � � - I I I I I I I : I _� I . I i - I � I I I I �� a a I I I I I I ; I I � I � I � I 1 I I I . I I I I i � � I � I RESTAURANT (MARYLOU'S): 4 SEATS I � � I 1 I I I � I I I : I ***,., ---, "_� lz� 8 It I I I . I . ­ � . I I I I � 11 i I 11 11 I THE EXISTING FEATURES SHOWN HEREON WERE OBTAINED FROM AN ON THE GROUND FIELD I I I I I .- , a I I I I I � ,� I i I I SEATS + I I I , I I I I . � I I I 11 I I '*,,* --, I a �� I I � I I " � � . I I I I I I 11 lj I I � SURVM PERFORMED BY,BAXTER NYE ENGINEERING AND SURVEYING UNLESS OTHERWISE NOTED. I , 1 4 SEATS/1 PARKING SPACE PER 3 1 1 1 1 4, a -4 0;, � I 11 I I Ili I I I. , I ,�� I ­ I I I I I I I '' I I ­ : I I I I . I I � I i I � I I � I .1 . I I EWP./I P.S. PER 2 EMP. + 5 TAKE OUT = &33 � I I I I I '*,_� lz� , . I 11 I � I I I I I I I PLAN REFERENCES. I I I � I . I i 4 1 . I I I I I 11 I I I � I 11 I � �_� 0 1�� e I I I I I ­ � I I I I I I I I � I I I I I ,� 11 I I I I I � I'%. a -,,�� Z", ' ' I I I I I I i 11 � I I PLAN BOOK 539 PAGE 24, 1 . I I I ­1 - � ­ I I �� 11 ._ I I I i I OFFICE FIRST FLOOR AREA - = * 682 SF 11, I I � I I I - I I I I I I � � I I I %%,* I �_� '_� N��F I 11 11 I I �� . 111, I PLAN BOOK 230 PAGE 59 �, I I � 11 11 I I 11 I I a iI a � I I I I I I I I I I I I � , i 11300 SF + I PER SU17E - 682/300 + I = 3.27 � I I I I I I �_A �� I 11 _� I I PLAN BOOK 535 PAGE ,5 1 1 � � I I , I I . I I I I I I I i � . I %,** -,, ' I � � I I I I OFFICE. LOWER LEVEL AREA = 820 SF , �I 11 I I I I I I 11 i � I � **_111 a a .�� z;C;:0-- �-,-- I ' 'I 'll I I � I I PLAN BOOK, 366 PAGE 63 1 "I I I I � I I� . ,� ''I . 1 I I I +­11 1. I I I - I � � i I I I I I I 11 '_� '111� - 11 . I 11 I I I I I ; 1/m SF + 1 PER SUITE =1 644M + I = 3. 1 1 � I . I . I I I I I I a a I I le I I I ROUTE' 132 1952 LAYOUT (SHEETS 5 & 6 OF 11) � I I . -1 - I , I I I I I I I .I I I I I I I I � I I I �, , I , , � I � I I I I � I : , I I I I I I � I . I I I I I I I � I I I I TOTAL'= 1&33 �I I 1 19 SPACES . , 18 ON SITE + 6 IN - 11 I I I I � I I I I I ' ll ,I I I I '_�* I ��Q I I I I .I I I , THE PROJ�ECT LIMITS, AS FIELD SURVEYED BY I BAXTER NYE ENGINEERING MD SURVEYING I I I I ,� I I I I I 11 ,� I � 11 I I I �1� �_� 1 � I I I � I I I � I 11 a i PROPOSED ADDMONAL ENTS I I , � ' EASEMENT ON LOT 1B , I I I 11 . i I -1 0. 2005, DMD EASTERLY . I I � I � . . I I I I �I ON NOVEMBER 9 APPROXIMATELY TO LOT 1A & 18 LOT LINES AND TO THE I ( I I I 11� "I I , � I I I I I I I I I I '_� *­� I : RESIDENTIAL 2-1 BEDROOM APARTMENTS I I � I I I I I I I I " I I 1. I � 11 � � I - 11 I I I I I I I I , 11 I I 1 49 0 1 1 1 11 SIDELINE OF OLD STRAWBERRY HILL ROAD. OTHER INFORMATION SHOWN IS FOR REFERENCE I II I 11 .1 ­ I . I I I I I ' ll I I . I *�� �_� I I ENT I � 1.5 SPACES PER BEDROOM - 2 x 1.5 = 3 3 SPACES, I I I 11 I I I I � I I I I I I I a I � I ONLY AND IS GIS INFORMA71ON OBTAINED FROM THE TOWN OF BARNSTABLE GIS DEPARTM - . I � a I , I : I I I �, I 11 I � I I I -1 I � I I I I 11 I I , I I I �� i -, I I ,�� I I I'll,..... ,... . � I I � ' I I I I I I 11 I ­ I I I I � I I - - ­ I 11, 5 - 250001 0005 C . I I I I � I I ­� I I � �� "�� I -) COMMUNITY PANEL NUMBER. ' I : I � I � . \\ i I � 22 SPACES 11 t , , 24 SPACES : I I I I I I I � a '1� ,;�\\ -,,�k I � I I � i TOTAL PARKING i 41? 0 . . AS ZONE C ! THE FLOOD INSURANCE RATE MAP DEFINES THIS AREA I I I I I � I 11 . I I I . 0 11 I a eo� I I I I I I I I I I I 1. I I I I -1 - I p � I � I '_� Ns I I , I I I 11 - � I I I I � I 11 '11� I : I I I - I I i I � - . � 11 , 11 I ­ � I a 11 I I L I � 1 6.) N& INFORMATION ,, . I I � I I I I I � I I i . 1, I ; I I I . I I � I I I eFe I , �_� I 11 I ; I I : . I . I I I I I 11 I I I 11 I A �� I I I I � I � I I I � I I I . I I'd * SITE IS NOT WITHIN AN A.C.E.C. (AREA OF CRITICAL ENVIRONMENTAL CONCERN). , � I I I � 1, I : I I I I . . I I I 11 I � I! � I ' 'I � I I I I I I I I ­ I � � I 1 . 11 I � I I I I I I i I � I I I I I '*��� 0 a ) . 1 1: � � '__1 �� 1_� . � I � � I I 1 I I I I I I I I I I I I I I I I � 11 I I - I I I ft a 0 , � I � 9 SITE IS NOT WTTHIN AN AREA OF ESTIMATED HABITAT OFRARE WILDLIFE PER I ,� I I I I � � I I I I . I I I I I I I I I � I I I I ��% � I I I I , ; I I : � I I I I I I I I I � � � ill I� I I I I � I - I 11 I � I I I 11 I 11 '_�0 11-10 I I I -, : � � I I I I I I I � � I NHESP MAP OCTOBER 1, 2008 'ESTIMATED HABITATS OF RARE WILPLIFE" : I i I 11 I I , I � I � I I I I I I � I I I 11 I I I I I I : I I I I 11 I �11 I I DS PROTECTION ACT REGULATIONS - I I I I � : � � I � � . I 11 I I I I 11 I I I I I I I I I I I � 1. 1, I 11 I I T I ; I FOR USE WITH THE MA WETLAN ­ 1 (31 0 CUR 10). , I : 1 I � I I I � � I I I ­ I I I I __� '_�a Qs� 1 11 I I ; I I . I I I , I I - �, I I I I I I I I . I I I I . ­ ; I I I I I I I 11 I I I I � I I � I I � I 11 I � I I I I 11 � I I � I 1, I 0 � I � I � I I 11 I � I I I . I I I � I I 'r / I %%,* ,--_0 Z�__, I f I I - I I SITE DOES NOT CONTAIN A CERTIFIED VERNAL POOL PER NHESP MAP OCTOBER 1, 2006 1 1 1 1 1 1 1 � I I �, I I I Nz�z : - 11 I I I I I I � . . I I I 11 I 11 I , I I I I I I I I I I I � I I I I - I � � � I I I � I I I I I I I I � I I I I � I I I I 1:1 i I "I", , I 11, I I I ICERTIFIED VERNAL POOLS-0 , : ,I � I I I I I 11 I I I I 11 I 11 '' 1. I � I I I � I � I __� �� - 1 � � 11 I � I I I I I I ;l �, I � I � I I I I I , , , I i I I I I I 11 I I I I I I I I I I ; I I I I I to I I ** 0 -No ��0 � � , I 11 " � � I I //.r ,6 " \ I I I I I I � I I I I � I I I � I I � I I I I I I I . I I � I , I I I . : , li i I � I I I I I ­ I " I I I "I 'll" I 11 1� � � � 1, �. Ep, 11;� � , d 0;1- I I '_� I I I I .: , i ,� , I I I I - SITE WES APPEAR TO BE WITHIN A PRIORITY HABITAT (PH 1600) PER NHESP MAP I I - I 11 � I ,� I I I I I 1 � � . I �, 06 .111, I 0 9� ___1 *�Z� I 11 I I I I I I I � I I' ll I -PRIORITY HABITATS OF RARE SPECIES FOR SPECIES UNDER I I 11 I . I I I I , - I I I � :1 I I , 4p 1+ 'I""%* '1� �� I � I I I� � - I I I '' I I � I OCTOBER 1, 2008 1 � I I I I I I � � I I I .11 � I N?5�r , I 1 7, 1, 0 : I I I I I I I I I � , I I � � I - ; � I I I. I I I I I I I ,� I, I ­ 11 li I � I I 1 � I I I � I I I 0 '1� I i I I I THE MASSACHUSETTS ENDANGERED SPECIES ACT, REGULATIONS (321 CMR 10). I I I I I '' I I I I I I , . I I I � I I I I � I I I I I I I I I : � I I � I I 1. 1� 11 I , I " I I � a, 1. a `Z,_�_. � , , , , . I I I - � � I - I I I I � ., I . 1 I I I I I I I I . I ' ' I I I ! � 11 I I * SITE IS WITHIN A STATE APPROVED ZONE 11 GROUND WATER RECHARGE I I I � I ! � � ' ' I i I I"I I I ''I I ' 'I I I � I I I � I I� � I %\O , ?111 I 11 `1� Ili. I I : , I I � , I I : . I LOCUS NOTES 0- I I - I — I i I _ I I I SO I I , �I ! I � I I 1, I I I I I i - I I I ­ I , -0- 11 I tv I I 1, ,11 " I 10 ! , I 11 I ' I - I 11 I . I � : I I . I � I 11 I I I I I - I I � I I I � , PROTECTION AREA. I � 11 � I I I I ; I � I I I I I I ­ I I I I : . I I . Niiii � I 0 I I I � --, :`� , � , I 1, � I , 11 I -) I A , I I � I I I . - I I ; I I V \9 I : 0 � ; I I I . I I I �, � ! 1.) LOCUS IS SU&ECT M AN EA%I"T TO EIRISLANE LIMITED VEhl7URE REALTY TRUST RECORDED, � , I I � I 11 I 0 � I �; I I - I � I . I I I � I ZONING INFORMATION. I I I I I . I i I I I � I I I I I I � 1%_11 � i I _., I I I � I I I I I I %�� � A 11 I I� � I I I I I � I I I I I � � I I I I I I I - 8 & HB � I I I � I � I I I I I 1� I I I ZONING DISTRICTS. I I I I I I I , I I I I I *_�01 '! I i I I -A UA1171D PARKING E I e "i � -T I , I I '_� i , a lz�� � I IN DEED BOOK 10,831 PAGE 71 AND ASE3011' AS OEM AT DEED I 10 a � , I ' I I I I I � I I I 1 44 �� I T I \ I � I I I �. I . I I I � ,I ' ll I I I � � I I 1''.1 I .1 I I I I � . I I ­ I I i I I I BOOK 20,211 PAGES 10 & 11 VATH ASSOCIA70 SKETCH PLAN EMOT I , I I I I � � I I I I I 11 P I I)b I 11 I '11� � I 1�� I I I , WP Well Head Protec6on Overicy DisWct I I I : 11 a I . I I i I I I , I I I I �' I I I I I I 11 11 I I I .1 I I I I � I I I I I I I I * vor I I 120 a>. .iii I I I a I I .1 I I I 11 I 1�_, 11 I I � I I 11 I I I I I , I � � 11 I I � - LOCUS IS SUBJECT M A TAKING BY�THE COMMONKALTH OF MASSACHUSETTS­OF ROUTE 132 , I I �I I I I I .1100, I I�E \1 , - '1�0 ; I I I % I 19 1, �� 7.) CURRENT MINIMUM ZONING REQUIREMENTS B � I I � I I � 40 1 ;0;i 0 C,� I � ,� I 1 2.) . � � I I � ' ' I � I I � I 1 .41 1 LOT I A AREA 11 � I 1 I I I: I I --,., , � .-i . I ' I', I � I I I I . I I RECORDED IN DEED BOOK 807 PAGE 432 1 1 1 1 1 � I I � I I I - - I I I � '*� : I I? , .;Zzz:z� I I I * I 1 >1 .491;0 e0o; MIN. LOT AREA = NIA � I I I � I I I I'll, 13,735 SQ. FT. I I I , � , I . � 1� � I I I I I I � I I * I , : 1*� I MIN. LOT FRONTAGE = 120', MIN. LOT WIDTH = I 00 (ALONG RT. 132) � I I I i I I I . 1 I I I I I I I I � 11 I I 1 1,44- Nii )b I 1#1ib, 1 0.32 ACRES : I I I '_� ! � I I I I I I � I I I ! , I '. � I I I I � I I I I � , ,iiii I I WY I I k Qs� � I I , i I I �� I i , 11%* i i ip , I I I i � I I I I I I I I , - R Y I I I . : ,3.) LOCUS IS SUBJECT TO AN EASEVENT TO COMMONWEATH ELECTRIC COMPANY IN DEED BOOK I I � 4�, 40 � I � 1\ 1 I 11 � I 0 1 1 ' 'I -zzi FRONT YARD =% 20' SIDE YARD = N/A REA ARD =, NIA I - I I ; I . I I I I I I I I I I I I I - 'L : I '_�: I I I `1� 11 I ; I � I I I i I I , I � � ,� I I I 'll � I 1 4�� 1 ,Oo�dl ** I I I 1 � I I 0 ; , 11 I I 11 Q � � . 1 I I I I I ­ � I I � I � a I 11 I � � I I ' 5,266 PAGE 3W. , 1 1 1 11 I "I I I I I I 11 � I I I "I I I I I I ", 11 I 11 I I � � 11 I I ; I I I � I 1-1 I MAXIMUM BUILDING HEIGHT = .302 I � I � I I � � **** � I 6W 1. I I I I I : I'_� I I I I I I � I I - I 1� � I I I I I I,--, ,&,- ,z ,�,, 1 C4�� . BRICK I I . j I I f . I � � I I I I I � I . I . I � 70 %0 , I I ­ I I I I ,:, I 0 � k , 11 I I I I I I '00 I I I I I I I I I I ,� I I I I I I � Nk. - PLAWER � � � , r, I I I ­1 9�' . I I I I i I I I CURRENT MINIMUM ZONING REQUIREMENTS H � � I I I I � �I 11 I 11 I I I I � I I I I I I ., I 1 LOT 1 A , � � -1 /11 I I --.ii, & SIGN # 11 I I I � � I I I ­��, ,-� , I I I I �!, I � I, I 11 I I I � I I � qXr � 4�. 11�. I I I � I I � � � I 0 , I I I I MIN. LOT AREA = 40,000 S.F. . � I I I I I I , I �� I I . bi, \I � I i I I I I � I I I I i PLAN BOOK 539 PAGE 24 .Ozloe �. � I FLAG POLE � I ! 1� I 11 I I I . 1 1 1 1 1 . e 11 1, 1, I : I - 1 11 ' 'I I 1, ,� I �, 11 I � I I 11�1 I., I I I \ `-�� Is , I I i "I I I I I , � '*_1 " MIN. LOT WIDTH = 160 ­­­ I I I :i I I I � I I I I I I - I I I � I MAP 253 PARCEL 014-XO4 / * I I I I I 0 1 1, I v MIN. LOT FRONTAGE = 20' 1 1 .I I � . I I I I ''I" I I I I I � I I ***1 1 N/F HYANNIS LLC TR. -re -0- 11 I I 1-1 I '11� 0 1 1 - '971 1 1 1 1 \9� . � 11: I �, I I I I -­< 'I - , 4T YARD -�,'I 00- (ALONG RT. 132) SIDE YARD ,= -SEE * BELOW REAR YARD = 20' ' I I ' - � I I � I ! � I I I 11 � I I I , -iiiii,iiiiiiiiiiiii�,..--' , 1* I I I I I , � I � 1, � I I . I I CONCRET I , FROt ! I �, 1 ' - ' I I I � I I / -'Un - I I . � 11 LFACMG' AREA REQUIREMEN I : I I I I " *-. 1__*1 PAD I I I MAXIMUM BUILDING HEIGHT = .30' 1 � I — 78 ' I I I � I I I , % & � , -- , - ___._ ,-7, - , I � � I I �- I :1 � � I I I I I , �b z N�_, � , , '' _L��:��_ �­­, I -, ­­ '' z - ­ I­,-z­­ ­­- �., I'. .-1, ­ _ - i � I I I � I i I I 11 � I I I I I I � ' I ', I I I I I I I ,_ -, ­ I / , : - _. , I I ­­ � I I 1: ' MAXIMUk"LOrGOVERAGE-AS' -OF-Lat� ,k��4--,��,����-�-�.".,-----,;---''�---�_.,;L, - I I I . I I . " . '. - � ­­­ !_,"', '44ii/z- _­�,�,_____ I I 1, I 11 I I � �, I 1-1- ­_ -­1 � ��_,,�_�e I * I ­� � iI I � . I I I I I I , - � , _­ I I iI � I �: I I I I I I I I I I I I I I I I I I ,,k � ..;;"�iiiiiiiiiiiiiiiii� , '1__1 ARD SET 13ACK SHALL BE 30', PROVIDED THAT NO ALLOCATION OF SUCH TOTAL . I :� I � , "ii , I ­ � 1 I I I I Y/Vo 40,,_ � I � D I 1� I! *TOTAL SIDE Y I, I � EXSITNG SYSTEM CAPACITY = 781 GPDPER SEFMC PERMIT 196-543 I I I I .1 I I I I'll % I I Nii I 11zD / - I ,I 0 1 41 I I 11 I I �I I I I I C I I I 11 I I I I 11 I - 4 1 ''I I I I I -I I I � I I 11% , I I � _k I I I I I ; I I I I L �: � . � ' I 1 . '' I I I I I I I I I I I I , I � I / , � � I N11 I . I � ,� I . 11, � I RESULTS IN A SETBACK OF LESS THAN 10'. WHERE ABUTTING A RESIDOMAL DISTRICT I I : 1 I I I 11 I I � I : 11 I I I I I I 11 I I I 1 4 * I I . I I I �� EXISTING USAG I I I � 11 I I I I I I I I 0 11 I I � I , �, *1 , I ; - I I I - 11 I I I I iI � I I I � 'S�� . � L I I I - I I i I ­ I I I I I A I . I 11 I I � I I 1, I I i I I I CL_ I I � , I I I I I I I L : I I I I I MINIMUM SETBACK OF 20' IS REQUIRED. IL I I I � - I I / a I I I � i �, I I I I � . . 11 I � I I - 1 I I 0 * If Ni I �/ , 1 P / N-1 i 11, I I I I ' I ,40 it 0 1 a � I � I I I I � I :i I RES10,04TIAL- 12-1 BEDROOM APARTMENTS = 2 BEDROOMS , I � -0- I I r , \ I I I 10 . I I I I i I I I � I � � 46 ' I :, I I I * � I I I I I � I I I I I I � I I I I � & I I I I : I I I : � I ,: I I I � I I I , I I I I � i � I _ i 11 I __� RMATION SHOWN HEREIN I I � I I i I � �, ., I I i I . I . : � 1 I , i I ___� I I AT I I 1*1.i I , I / , I , : *,"'i " , I I I I I I I � I I � GPD , I Niiiii / N-11 � RESTAURANT (MARYLOU'S): 4 SEATS X 35 GPD/SE ,' 1= 140 GPD I � I I � � 1 11,4*0 1 1 1 � I�,: , I I i �� I I 1p � I . L IL i . I I .9 THE CONTRACTOR SHALL CONTACT DIG SAFE (AT 1-888-DIG-SAFE) AND UTILITY COMPANIES TO LOCATE I I I I I I 1, I � I ,, I I i I I I I I I " I I I I 11 I I I i I I I I I I �. I �� I � I � I ` N." I I i " I I � � I I I I I I I � � I I � I I I I I I I I � 11 ­ I I I , I ! I o � :1 I I I �, I � ""11111-iiiiiiiiiiiiiiii� , !� I � I I 1, I �, � . I I I L I* .,,ii � :! , I I I I OFFICE- FIRST FLOOR AREA = 682 SF� I - I - - I I� I I I � I I I *�, I I I I : I I OFFICE- LOWER LEVEL AREA = '820,,SF � 11 � I - I ,� I I I I I I � I I � - I I I a , , I I I I I � z I I 11 ALL EXISTING UTILITIES, AT LEAST 72 HOURS PRIOR TO THE START OF CONSTRUCTION. THE LOCATION OF I 11 _, � . I 1�'11 I : I' ' I I 11 I I . I � .6 A . * I s ; I ­� �. I llli � I ­ I " � I I ,�, I I -1 I.I I I I :, . I I EXISTING UNDERGROUND INFRASTRUCTURE, UTILITIES, CONDUITS AND LINES ARE SHOWN IN AN APPROXIMATE iI I I � ! , / , , I' 1 75 GPD/1000 SF = (j4M211000) X 75 GPi = 113 GPD I I - I 11 1� 11 I I � I 11 0 � I , , I L i *1;� , , , 1! ; ,I 11 11 . I I ON THE � �� I ­ I I - I �, 1 �111 I I : I I I I � Ar I 1 7 1 . I \ 11 I ,��� : I I I I 11 WAY ONLY, MAY NOT BE LIMITED TO DIOSE %IOWN HEREIN AND HAVE BMY RESEAIMED a4SED I I I I I I . � I I I I I I I - I I I I I I I � I� � I I I N1_1 a I I � I I I I I I I A P& � � 11 � v56,V , I I I 11 I- I ''L 11 I , � dv . �,� I I I I I I I 1 . I I 1! / 11, , I AVAL AE UTILITY RECORDS N070 HEREON. THE CONTRACTOR AGREES TO BE FULLY RES 68ff FOR i1, I I � I ­L ,�, - . L I ' ' I I 11 � - 0 1 1 . 11 � I 11 I - i: I 11 I :i , I ADDWNAL USAGE: ,:, � ­ I I I I � I I I 1 49 , � I I � I I I I I I � .j , ' RESIDENTIAL- 2-1 BEDROOM I I '= 2 BEDROOMS I 11 I I I I'll L I . I I jg4p I � I I I ro I I 1-11 � I :1 I I ANY AND ALL a44AGES WHICH MIGHT BE OCCASIONED BY THE CONTRACTOR'S FAILURE TO LOCATE SAID � I I I � -0- I � 1�y, INFRASTRUCTURE AND UTILITIES DWXY IF FIELD CONDITIONS DIFFERS FROM PLM INFORMATION, THE . I . 1, � I I APAMENTS , I I I I 1.t 4 ­ I � � It I I I ),�, � I � V 0 � : I , 11 � � I I*I � � I I I � I I I � I I I I I 1� I X I 10 mQj_8EDBm I I I I N. 4s; I � � � 11 I , � I __J _�_ � I I I CONTRACTOR .%IALL NOTIFY THE ENGINEER IMMEDIATELY FOR POSSIBLE ,REDESIGN. , I 11 I � I ! . . � I 11 I I �, I I I I I � � i I , , , I 11 I I � I I � I I ­ I I I � � I I I I - I I � I � I I I I I I I I � I I., t I I 11 I I I I I � i I 11 I I I � � I 11 � I , * ,* I I I "`�,� , - " I I I I ; �: � I 1,�, I �I I I = 693 GPO I 1 4t 1 1 1 0I I I // __ : I I I �l V 11 I _ � I I � I I I I I I I I I I I I /// _,��1�11 11 � I 1: I I 1 0 1 1 1 ta- I i 11 � I APPROXIMATE SEPTIC SYSTEM LOCATION PEI? 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I / " I //1-1 I _*,_� / � �_�� / / I I I 1�\ � ,* I I I I 11 I I I � I I I I I ,­r , I I i� IL' �', . 1­, I \`ii\' i BAXTER NYE ENGINEERING & SURVEYING ,��' , I _,L � I I I I I , ­ r ,�, / / � , I 'd5 I I I I I I I I I I I I 11 1\�v I �, I 11 LOT 113 //11 // N I 1 ­ //� / - 1 I "�� - /Z9 * I � I I - , , I ax - � / N"� : 11 :1: 11 I : I � I I I I � � I I �, PLAN BOOK 539 PAGE 24 11 I , , _ � I ­ I I � I I , , I I , I - r, � , I I � I � I I I I I _ "t / /1� MAP 253 PARCEL 014-XO1 I I '_'/!�� , / , , � 1�1, ,� It, I ,. ,�, I 11 I I I � I I � I ' ll I . 11 � � T� / / / , I ,/ I I \,�\ - � , I ;,- ­ 11 I , I I I , I I �, � I I -,� , //' LLC �,, / I_1< I �-� ,;�, 0 - / � I I 1 f � I I � I � � I .T� ­ - I I � ­= I I I � I � I I � I I I I I I I I I I I I I I .11 I , , I � 1��___,A_ __�_�_ 4 � I I � ,� ,,,�, . 1 ­ I � �, � I . I I I � I I , - ,-I I ,_, 1"_11 , z 1 , I r 17. I I I / �, // I / , I / Registered Professional Engineers and Land Surve , I 1� �, , I : I �. I , I I . , , ." ,� , \ - X i 178 North Street-3rd Floor, Hyannis, Massachusetts 0260 I , , N/F/SHALLOW POND M)FESSIONAL �� _- , lk__,_�,I � ,�/It� - ­, , , L I I I ­ 11 - I I I I . . I , - / ,.,� : %A- I \* yors , : i .: I I I I I / / j : � I I I I I I I , . I I 11 � �, I � �I I I I I I I............P_ ! A � I I /I - I / , / I I I / , '1�1", , < / , ", " , � -11 , ,e r I 11 I I "OF 04 � 1 :­� I , , I I I � I � L /I . ;� / I I i / I- 11 I / - 0 � � Iz I � I . � I I I I I I / I /*1 : I .: I I 1 _7� 1 1 1 1 "I ; , I 1, I I I I 11 � I I 11 I I I I . � , I I / ,k��' -, , � / � I , � j : I I � ­1 I I I , 11 � I I I I I * I I� / - I I / 1-1 I , \ Z \ i I � � .��', I � I I �1� I I I 11 I I � I L I I - I /I 1\ * \ � lyd � I I I r I 11 I // I / / I 11 I I I Phone (508) 771-7502 Fax - (508) 771-7622 1 CI ., I I I I I I I I I I I L I. / � . I * I I I I � ­ I I I 11 I I I I I I a,. . q_, ­ 11 I ­ I �, , I , I 7- I I I .- I I cr, , I - 1, , i - I I I I 1� I . � I I . I I � . I I . �1;11 11 I 11 I � I / / / I. /I llk-��,,,,� � / / " /11 4 0 1 1 1 1 1 1 � I I I 11 I � I I Ep i ­ Ir I 1 -1 � � t ., . I � / / / C'�') I I " I ­1 I" I I I ! I I I ­� I I L I I I I I � 1 , I I � / / I / I I I I - I L �, 11 . I � I � I I I I . - i I &I, I I � I I I C:X�_ _ _�Y_�<D = STONE WALL " : ' I L I I I I I 11 . .. ­ - ..-, �. . .700. * � - .,/ /�/��) / //, I ­ / /I / / I /. I -_�- =-, .- �j 1�1 I I .. I I 1 20 , 0 ' , 20 � 40 1 1 1 � 1C. CO) = WATER GKVSHUT-OFF I I I I r� .. ..", I �� ., - , . . I - I // qik��, " / / --,;-- ,_� � � I I � I I � I I . - i C � 11 I I I I -Z= =====_ = DRAIN PIPE / - I I . I �.!�,'.�� // I I / - I * I I I I L.---.NlllllL- - mmmmd � I C\ I I'll, =__=_�_ I � I I I I � I � I I I I . ..::.,. , �, ", '�_ / / I / 4�4�,." " ­ 0 - I , , / b � I � I I � No. 18 i C � I I � � � I . I . I .. I I`� ,�, 1, I I� I I � � I I � I : I �� I I � I 11 --- �_� / " 11 I // / I/ 1_,l/ / ,- -1�; -��,- , I _ _ I . m � = CATCH BASIN I I I �. � )p � :1 � !, / I � . I I I . I I I I - � . .11 SCALE IN FEET �1: I -___ — 4 1 . I , ! 10 I I I I i i , , , :, . - , I . I I LOT 1B . I N , / I 1, // , , /,;�;: 1�.11 , ,�, 1p%p . I I I I �'01 , 1 , I - -- = WATER LINE . � I I I ,, .4t / I/ \ . * : = DRAIN MANHOLE � I I I I , � I - , 0 1 . I I �� / , '.` PLAN BOOK 539 PAGE 24 - I ��-, " 'i - r I: I I I ! � ,�� � I 11 . . ` Z4, I �, I / /I I I / I � * � � I I I I � - _\ I : I I /' IC4, 1 11 �� t> N / 11, I . SCALf. I m- 20# 1 Is � �E , , ------- __ I I I 11%F , �:`�___- // Irz� // I : I I !1- � � � � I I I'_�� . , " I I I / � RAV , it� : , � 11 I ' - I 0 1 , 1, I �� = SEWER LINE I I I r' � MAP 253 PARCEL 014-XO2 0*>7 Z! %, � / I , ­ �� ­ I , , � I I I I �, ,%�. � / / �, � . I 11 I = ,SEWER MANHOLE I I 1, � : I . � ' ' � //�, /11 4 ,I / �,�� ­� / I I I I 0 1 1 1 1 . I I NAL i I I , 11 � //, �Im;, 44�, ��_ I" . z , � i 6 11 (5) , . I I I I , ' AL LLC //l 4" 2`_ I � " � I I 1 3: 1 ____ -_--- = GAS - I I I� -_� N/F SHALLOW POND PROFESSION .� I / - �, 1, I I / I / I I I I ,� I I I I I I I ELECTRIC MANHOLE I I L,r, . 4 _ I I I I _1�z��,�,�,;_�,�,� � I I . r 11,\ `�� I ., k, 1� �, I I I I I i 7 � I LINE , �11'11 I/ I , Q, : � I I � � I I -,, '-,,� I � / � I 11 I I I � I - I I - 1 ,4'71 , / // - 1,1\1, I � I � I I I � " L�, // 11 I I ,L,� - I I I I I I ­ I I i 1 11 I . --,7j­-­­-- :�= SM GUARDRAIL `____1 r I lli�(;­ 1, ��, I I I I I I I I i I I I I - 1 , C � I ,� 0 = � I I . . . � , / // ,,,�, 'V,11*1_�, �4,,Z/' L� �� I , 1� I � I : I I / �, " // .1), � �� / I, I I � I � /111'�,�; .. i I : 1 L Cc I I I I I I 11 � I: _�,, � , I , , \ \ \, I I DATE. I . I �1_ " I I " 'O , L �- . I � . C / / , I : � I L I 1 _-<>----­-6----->-- , = STOC " __1. , / , , I/, I , C\ I , , � (D = TELEPHONE MANHOLE KADE FDiCE I 1 �:7_ , 1 1 1 . I / �l 1. i I I ____1 ! 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"."i .ev 11 . , . , 'L, /,/� /I �� �� ,V+., /" " I � I I '1� I ,I � I I I � I � __ � I I I '. 1, y I I, '1� ,r I I I I I I I I I i I I I I � I � . . I �--,:��,�,> � \\ \ .,,/ , \\"" I 11 I I I I I I I I I I : I r, I - � I ", r I I I I I I I I I � 'I I I I � � I I I ,� . I 11 �1- I ')­�- ­1, ,-I , � I -) / 11 � I I I I � I . I I I I I I . I I � V, � I - I'll � I I . n M6�7 --�- - � '­ I . . ,�,,> I I 11 I'� % I I I I I I 11 I : I I I I I � a I � & SHRUBS � I . - - , , p � W\ , I \� I I I � , 'S "A", I I I . I L . I I I --­ �0 /, . , , �, I I = AIR CONDITIONER ., 1 04, - TREES '_1' - 5d OFFS, - - 9, 1 , /�,\\\�\ : I ,��:� I � o- I . I " , " I , � � / I I I I I I C I ii � :y , ­ r I I � I FLAG 04 / - / I ,� , , , 'N / � � I � I I I , ;, ,� �,\\ \ ,;,-7- \1% I - X 2a = GAS MM , I ', I_T__1 , ,\,\\ I r : I I i �, I I , , f� � ,�,�\ /', � I , � I I I . . I i I I . I ", 1 � ,� � I I I'll � 12, :, I 'll I I I I 11 1 � � � I I I I I NO. By DATE REMARKS I C , = LMUTY POWGUY Win I I 11 . 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