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Home My WebLink AboutMRS. M'S SUMMER HOUSE - CLOSED FOOD i i LMRS. Is SUMMER HOUSE 540 MAIN ST, Hy ;, I #y Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health Donald A.Gaudagnoli,M.D. tt9 �rr��scE F.P.(Thomas)Lee,._ 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt. Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 1070 Issue Date: 01/01/2022 DBA: MRS. M'S SUMMER HOUSE OWNER: LYNN MITCHELL Location of Establishment: 550 MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2027 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE- ICE CREAM: G�� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: NO SERVSAFE REQUIRED, ONLY ALLERGY AWARENESS. ON 10/22/2016, THE BOH GRANTED A GREASE TRAP VARIANCE. A GREASE TRAP INTERCEPTOR SHALL BE INSTALLED AND MAINTAINED ON A REGULAR BASIS. THE MENU IS RESTRICTED TO FUDGE AND TAFFY. THIS IS NOW TRANSFERABLE AND MUST BE POSTED EASILY ACCESSIBLE FOR VIEWING BY THE HEALTH INSPECTOR. For Office Us mad oy_�"'F' .� Town of Barnstable Initials: " P MM& v BARNS�,B,E : Inspectional Paid Am�Pd onal Services 039. Public Health Division Check# /� Thomas McKean,Director d 200 Main Street,Hyannis,MA 02601 1 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE iZ= b i NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ( S }Z�,�p�� - ��, -V�k_p 7lj ADDRESS OF FOOD ESTABLISHMENT: " , MAILING ADDRESS(IF DIFFERENT FROM ABOVE): \ 6, 6 tuff 6 716® � E-MAIL ADDRESS: ;E 1'k I "+C TELEPHONE NUMBER OF FOOD ESTABLISHMENT: r TOTAL NUMBER OF BATHROOMS: ,,WELL WATER:YES NO_CZ(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTS TOTAL: SEATING: MUST OBTAIN A COMMON VICT LER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE D_INING,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 FormsTOODAPP 2020.doc t OWNER INFORMATION: � FULL NAME OF APPLICANT L ,{�'A r ti -4? L SOLE OWNER• YES NO OWNER PHONE# ADDRESS_ CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: S A List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records.You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. / / 1. L, 2. S NA URE 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/ai)plications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-2019.doc A �t Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. Paul J.Canniff,D.M.D. a , 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, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 1070 Issue Date: 01/01/2021 DBA: MRS. M'S SUMMER HOUSE OWNER: LYNN MITCHELL Location of Establishment: 540 MAIN STREET HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: NO SERVSAFE REQUIRED, ONLY ALLERGY AWARENESS. ON 10/22/2016, THE BOH GRANTED A GREASE TRAP VARIANCE. A GREASE TRAP INTERCEPTOR SHALL BE INSTALLED AND MAINTAINED ON A REGULAR BASIS. THE MENU IS RESTRICTED TO FUDGE AND TAFFY. THIS IS NOW TRANSFERABLE AND MUST BE POSTED EASILY ACCESSIBLE FOR VIEWING BY THE HEALTH INSPECTOR. r D �`1HWE Town of Barnstable F r Of Initials: 92 - Date Paid/ Amt Pd$ BARNSrABLE, : Inspectional Services n v 101ASS' Check# 1639. Public Health Division °rEc Nta+ 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 Z-O NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: (� s:R vcs au s9 � kiD owa 11I1S• 9t I"�C.�n �5 t i�T'S ADDRESS OF FOOD ESTABLISHMENT: ��y NL>�� 1 �I.�i viu�t S }'�I� 01160 I MAILING ADDRESS(IF DIFFERENT FROM ABOVE): v (D O OZ..L 1 E-MAIL ADDRESS: S r�`-� L� Q TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( 6% TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO ✓ ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: /_/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: Ile 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)? TXPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) V OOD SERVICE ETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED a BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/NO OWNER PHONE ginADDRESS `� ��'�_6p-� ,Jv�— pk�ii.IAZJ�L 94A- O L%3 CORPORATE OWNER: CORPORATE ADDRESS: �C9-�cc� �� . ►v O3�7� PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. 1" SS L . Luym kw 110 ` / ' 2. Zcc�G &/ q/2,2— -/0/ SIGNA URE 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/henithdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Apphcation FormsTOODAPP REV3-2019.doc Town of Barnstable John T.NOF o BOARD No HEALTH rman Board of Health Donald A.Gaudagnoli,M.D. Paul J.Canniff,D.M.D. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 1070 Issue Date: 12/10/2019 DBA: MRS. M'S SUMMER HOUSE OWNER: LYNN MITCHELL Location of Establishment: 540 MAIN STREET HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: CQ� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: NO SERVSAFE REQUIRED, ONLY ALLERGY AWARENESS. ON 10/22/2016, THE BOH GRANTED A GREASE TRAP VARIANCE. A GREASE TRAP INTERCEPTOR SHALL BE INSTALLED AND MAINTAINED ON A REGULAR BASIS. THE MENU IS RESTRICTED TO FUDGE AND TAFFY. THIS IS NON- TRANSFERABLE AND MUST BE POSTED EASILY ACCESSIBLE FOR VIEWING BY THE HEALTH INSPECTOR. r. For Office Use Initials: a� Town of Barnstable in Date Paid, Amt Pd$ BARNSTABLE, Inspectional Services �67b MASS. '6,� 39va�e Public Health Division cheek# ` ; MA _ Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 r APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT �_•� DATE NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: Ka- ADDRESS OF FOOD ESTABLISHMENT: �� AA CL(kf MAILING ADDRESS(IF DIFFERENT FROM ABOVE):of V E-MAIL ADDRESS: rS Q It S �-e> TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ca& TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: ' SUASONAL: DATES OF OPERATION:_/_/_ TO 7; i NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) i( fL)je_ *** E & NEW FOOD ONLY*** l SEASONAL,MOBIL ��"�, � REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 l� Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: ff FULL NAME OF APPLICANT VW'L KC�C JAP l \ SOLE OWNER: es NO OWNER PHONE # AE:Z� ADDRESS CORPORATE OWNER: CORPORATE ADDRESS: NI PERSON IN CHARGE OF DAILY OPERATIONS: J=��( 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 I f /CO. 2. nao -� / 4SIk*4AT !E\0F APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to ovenine!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.31S`each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-2019.doc s r Town of Barnstable BOARD OF Paul J n ff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. John T.Norman F.P. Thomas Lee Alternate �$ _�� • , 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 1070 Issue Date: 12/20/18 DBA: MRS. M'S SUMMER HOUSE OWNER: LYNNE MITCHELL Location of Establishment: 540 MAIN STREET HYANNIS MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: . 0 Total Seating: 0 FEES (� FOOD SERVICE ESTABLISHMENT: _ $250.00 YEAR. 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: - -- MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: NO SERVSAFE REQUIRED, ONLY ALLERGY AWARENESS. ON 10/22/2016, THE BOH GRANTED A GREASE TRAP VARIANCE. A GREASE TRAP INTERCEPTOR SHALL BE INSTALLED AND MAINTAINED ON A REGULAR BASIS. THE MENU IS RESTRICTED TO FUDGE AND TAFFY. THIS IS NOW TRANSFERABLE AND MUST BE POSTED EASILY ACCESSIBLE FOR VIEWING BY THE HEALTH INSPECTOR. r- 4 �pIME � Initials: o� Town of Barnstable Date Paid i Amt Pd$ 9WMMASM S^B $ Inspectional Services i(� n 1 `0 Check# .I v 0� '. A'F�►+�'° Public Health Division Thomas McKean,Director Z 0 200 Main Street, Hyannis, MA 02601 =� Office: 508-862-4644 Fax: 508-790-6304 ""' 'sal"i 'APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE t -'140 L 8 NEW OWNERSHIP RENEWAL L,,-' NAME OF FOOD ESTABLISHMENT: KA.� 14,� ADDRESS OF FOOD ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT FROM ABOVE): Lf7� f sA g Q-A '1C f E-MAIL ADDRESS: TELEPHONE NUMBER"OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) Q ) ANNUAL: SEASONAL: DATES OF OPERATION: TO 1 a-./-3 1/ t 17 NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE ✓ RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES — (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED QAApplication FormsT00DAPPREV2018.doc r� ______ _ '4 PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT \I VGA da� SOLE OWNER• YES/NO OWNER PHONE # � ADDRESS__tG -Fb x. j2 Q&L�--l..t-dA, k CORPORATE OWNER: if FEDERAL ID NO. : (J47-9 9--3 3 CORPORATE ADDRESS: eO g, q� L _A- PERSON IN CHARGE OF DAILY OPERATIONS: -U, .` List (2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date Woo 6 mtv�e((, d- b i'?,0-- ck-0- 12 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/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 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q Upplication FonnsTOODAPPREV2018.doc oF.HE►o TOWN OF BARNSTABLE HEATH INSPECTOR'S Establishment Name: Date: Page: of OFFICE HOURS ARN E.o PUBLIC 0 MAIN HEALTH DIVISION s 00-9:30A.M. 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified M63v: �0� HYANNIS, MA 02601 M-8 -FRI.62-4644 No Reference R .Red Item PLEASE PRINT CLEARLY 508-8 FOOD ESTABLISHMENT INSPECTION REPORT NameOne Tvoeofof T m:S'fi s ec ion Operation(s) outine Address.. Risk Fo ervice ection Level eta' Previous Inspection Telephone ntial Kitchen Dater 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 ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) N a1 Corrective Action Required: ❑ No ❑Yes Non-critical(N)violations must be corrected immediately or Overall Rating �� within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils B=One critical violation and less than 4non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste. (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #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 ��LJJJ ✓✓✓l.� V"V�IrV 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 { Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 14 590.003(B) J1 Demonstration of Knowledge* V 3-302.11(A)(1) Raw Animal Foods Separated from 3'202.12'� Additives* 3-501.15 Cooling Methods for PHFs * , _ __ I_. _ .19 -------- - - _ PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties Cooked and RTE Foods. 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 7 5 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* 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 2 . Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) q 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 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 Wazewashin Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* 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* 3-401.11 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* Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )( 3-201.17 Game Animals* F 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C ; Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 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* 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 . 3-203.18 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 1 28. 1 Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S.590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.00 . I *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF�r�Eroh TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: . of ti^ OFFICE HOURS TH BAR E. PUBLIC 2 0 MAIN LSTREEET 3:30-4:30 P.M. DIVISION : 0- :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified FRI mass. HYANNIS,MA 02601 M $-8 -62- 64 4644 t679• No Reference R-Red Item PLEASE PRINT CLEARLY �p a - 'FON1"` FOOD ESTABLISHMENT INSPECTION REPORT 508 Name X,� Date Tvoe of T Inspection Ooeration(s) outine Address Risk Food Service ection Level etail 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 u Inspector Out: lb A k4w j 0 V\3- f__ -L_� l/ Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ `� Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.-Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories U Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations I 'n Critical(C)violations marked must be corrected immediately. (blue&red items) �"�t✓ 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. y,t ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection todahe 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. (FC-4 590.005 B=One critical violation and less than 4non-critical violations 9 25.Equipment and Utensils )( ) 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 o la hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i cal violations. . f 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 anon-critical violations. If 1 critical refrigeration. ( )( violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y IN #Seats Observed Frozen Dessert Machines: Outside Dining Y N Pl '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 Violation 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.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 590.004(F) 7-102.11 Common Name-Working Containers 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* 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* P g Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* 590.003(G) Reporting by Person in Charge* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 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 terateReser ice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and water From Regulated Sources 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 Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a 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* I Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145'F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System * gg Not Otherwise Processed to Eliminate Equipment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathogens* Effective rnaoor 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 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* 10 P ing,mobile food,temporary and residential Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Hr/d Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* 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 practiceRequires should be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) 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 foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* Lu Proper Cooling of PHFs fallowing sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°17 Item Good Retail Practices rFC 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 -2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection -3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils -4 .005 * 5-205.11 Accessibility,Operation and Maintenance3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste -5 .006 590.004(J) labeling of Ingredients• Supplied with Soap and hand Drying Devices 27. Physical Facility -6 .007 7 Conformance with Approved Procedures 1 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 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. oFTrw r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: M(S, MS dyM17ff VaJS( Date: 60;5J/q Page:_�of � q OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNnAB,E. . 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified mM MON.-FRI. HYANNIS,MA 02601 No Reference R-Red Item PLEASE PRINT CLEARLY A +639•n 0 - 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT 6 Name ��- r1°5 ��mr>wr vS Date��C� Tvne of T e oInspection aCJ Operation(s) ou m Address 54o No S r Risk F d Service = ection � 1{0,h 06 CU4 9�`� Level etas Previous Inspection NN 1��"4 Telephone Res, ential Kitchen Date: ; 6b4b k 1 J Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint - Person in Charge(PIC) Time Bed&Breakfast HACCP In:Q 15o Other InspectorRYQr1 �Urtb Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE 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.Proper Adequate Handwashing CONSUMER ADVISORY ®!�fn ((� ❑ 11.Good Hygienic.Practices ❑ 22.Posting of Consumer Advisories (v/`�/ /`jL�� J �( 1 ' Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: �].No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. = ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of'105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils B=One critical violation and less than 4non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 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 anon-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print:31.Dumpster screened from public view Pyall n LL vrl s Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N YYJJ #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature M 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* L 8 Cross-contamination 1q 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 75 590.004(F) Other* 3-501.16(A) Hot PHFs Maintained At or Above 140'F*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* 2 590.003(C) Responsibility of the Person-in-Charge to ' 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage*7-202.11 Restriction-Presence and Use* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 590.003(G) Reporting by Person in Charge* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 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 Rlated 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* * 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* i Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. L 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg ame/n/aoo/ 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* f Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* 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 practiRequirements should be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the g 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 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003. 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability tl 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* -103.12 Conformance with Approved Procedures* S:590Formback6 2doc 8 *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. f Town of Barnstable pQt�T Barnstable Board of Health HAWNC11V 9 Mnsa g 200 Main Street, Hyannis MA 02601 1639. ♦Q' 2007 Office: 508-862-4644 Paul J.Canniff,D.M.D. FAX: 508-790-6304 Junichi Sawayanagi Donald A.Guadagnoh,M.D. BOARD OF HEALTH MEETING RESULTS Tuesday, November 22, 2016 at 3:00 PM Town Hall, Hearing Room 367 Main Street, 2nd Floor, Hyannis, MA I. Hearing — Rental Sheila Perry, tenant at 170 Winter Street, Hyannis, requested a hearing. No one was present. The Board voted to withdraw this item. II. Variance — Septic: A. Peter McEntee, Engineering Works, representing Nick and Robin Mahairas, owners of The Mills Restaurant— 135 and 159 (aka 149) Route 149, Marstons Mills, Map/Parcel 078-019 and 078-020, 65,158 square foot parcel, failed septic, requesting three variances. GRANTED. The Board voted to grant the three variances with the seating count of the restaurant at 50 seats. B. Thomas Roux representing Michael Dinapoli, owner— 542 Main Street, West Barnstable, Map/Parcel 133-010, 0.95 acre parcel, failed septic system, requesting one variance. Continued to Dec 20, 2016. Corrections needed to the plan included (but not limited to) putting variances on the plan, itself, no wells shown on plan, plan shows a public water line on plan (in error), .D-box under driveway is not H2O. it is missing the description of the current SAS, and the scale on the plot plan is not correct. III. I/A Monitoring Plan: Thomas Smith representing Bonnie Smith, Trustee — 1627 Phinney's Lane, Barnstable, Map/Parcel 776-018, 1.4,359 square foot parcel, I/A septic plan previously approved by the Board of Health, monitoring plan to be approved. Page 1 of 3 BOH 11/22/2016 y_ APPROVED. The Board voted to approve a standard monitoring plan identical to the previously approved monitoring plan with quarterly monitoring for the first two years with the possibility of requesting a reduction in testing from the Board of Health with the following condition: a 2-bedroom Deed Restriction must be recorded at the Barnstable County Registry of Deeds and an official copy must be supplied to the Health Division. IV. Food — New Lynn Mitchell, Mrs. M's Summer House — 550 (a.k.a. 540) Main Street, Unit# 4, Hyannis, Map/Parcel 308-074-OOD, menu of a variety of fudges, on town sewer, requesting a grease trap variance. Granted.. The Board granted the grease trap variance with the condition that the only prepared foods at the location will be fudge and taffy. The owner will sell other items (i.e. dam without preparation being doWbn location. V. Food — Temporary Event: Joseph Berlandi representing the Barnstable Village Association, sponsors of the Barnstable Village Holiday Christmas Stroll scheduled for Wednesday, December 7, 2016. The event will be held on Main Street, Barnstable Village. The food items will be grilled hot dogs and hamburgers. Granted.. The Board granted the annual temporary food event of the Barnstable Village Holiday Christmas Stroll which will serve grilled hot dogs and hamburgers. The cooking will be done in the parking lot of the Barnstable Market. VI. Craigville Motel: MOVED TO DEC 2016 Application fora motel license. VII. Hearing — Septic: Edward Pesce, P.E., Pesce Engineering, representing Wianno Knoll Condo Trust— 727 Main Street, Osterville, Map/Parcel 141-013, 83,579 square feet lot, requested, failed septic system, multiple variances requested. Continued to January 24, 2017 meeting. The Board would like to have a "general" wastewater master plan with the consideration of handling the replacement systems in determined phases. This will be discussed at the January meeting before considering a proposed plan for the failed system. VIII. Hearing — Rental RESOLVED Kevin and Alicia Voegeli owners - 19 Camp Street and 53 Camp Street, unregistered. Page 2 of 3 BOH 11/22/2016 IX. Old / New Business: A. Minutes. B. Marijuana Use in Public Places. ADDITIONAL: C. Monitoring Results - Oyster Harbors Club, 170 Grand Island, Osterville. The Board is in agreement. Winston Steadman updated the Board on the monitoring of the Oyster Harbor Club's I/A system. He is interested to add to the system to try to equalize the flow through the leaching as currently, there is 2300 gal/day going into the system.all within a six hour time period. He will make an adjustment.so the flow is spread over a 24-hour period. i Page 3 of 3 BOH 11/22/2016 of Barnsta to Barnstable • * Town ' Board of Health 1 v "M SS. 200 Main Street,Hyannis MA 02601' 2007 Office: 508-862-4644 Paul Canniff,D.M.D. FAX: 508-790-6304 Donald Guadagnoli,M.D. Junichi Sawayanagi November 29,2016 Ms, Lynne Mitchell 16 Fox Trot Run Sandwich, MA 02563 ., � _ � dE?n'�7x.'�E rs E,Sj.A¢t ,y:v-r• ' '"4�a,�+a-:�t�^i ^ .��"'s t°�.4�a"+'} , � 4, '$� .: _. RE; MrsM'sSumerHouse�5"40 Main:Street; Ult#4, HyaR rns Dear Ms. Mitchell, You are granted a variance from Section 322-3 of the Town of Barnstable Code, which requires minimum 1,000 gallon capacity grease traps at all food establishments. This variance will allow you to operate a new food establishment utilizing an under-the-sink grease interceptor at Mrs. M's Summer House, 540 Main Street, Hyannis with the following conditions: (1) The grease interceptor shall be installed and properly maintained (cleaned) on a regular basis in accordance with the MA Plumbing Code. (2) The menu is restricted to fudge and taffy. (3) This variance is not transferable to another owner or lessee of this establishment. (4) This variance decision letter shall be posted on a wall adjacent to your food service permit in an easily accessible location for viewing by a health inspector during inspections. This conditional variance is granted because there is no feasible location for an external 1,000 gallon grease trap, according to the Town Engineer. Also, the Board is of the opinion that very little grease would enter the plumbing system/sewer line at this establishment if the menu is limited to the items listed above and proper food waste disposal procedures are followed properly. erely y rs au C iff, Chairman Q:WP/Grease Trap varaince Mrs Ms Summer House 2016.docx tb�z�/G p tHE WA IT � I' ��IS V DATE: (� H 5 �44 FEE:BAIMFrABL � MASS. q n- � �^ %639. �0� REC. By 's (2 6lvim"_ Atf°M,�a Town of Barn"fie �. SCHED. DATE: Board of Health a 200 Main Street, Hyannis MA 02601 IWA Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790.6304 �J, . _•qJ Junichi Sawayanagi �� Paul J.Canniff,D.M.D. ,� VARIANCE REQUEST FORM Q LOCATION �1 a Property Address: Assessor's Map and Parcel Number: � '�� _� Size of Lot: Wetlands Within 300 Ft. Yes Business Name: No }Subdivision Name: (�/ APPLICANT'S NAME: �>n f' \I�e `L Phone ; Did the owner of the property authorize you to represent him or her? Yes _ No are— PROPERTY OWNER'S NAME CONTACT PER N Name: Name: LUPOTl�7�l/ Address:, Address: ►% !J c/1 k1-1 0 ash Phone: Phone:._ . L— _Ilei,-s I1;k VARIANCE F OM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space nee e �� L•��J ep C ,_ _-- 4�1) NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System ❑ Checklist (to be completed by office staff-person receiving variance request,application) Please submit copies in 4 separate completed sets. _ Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) _ Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian ,Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner a6thorized you to represent him/her for this request Applicant understands'that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining variance renewals[same owner/leasee only),and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) _ Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman t,ts� �''t3b1✓� NOT APPROVED Rinichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. NAas C:_\cache\Temporary Internet Files\OLKAE\VARIREQ.DOC P"AC &Z4: rg wl. r MAIL-IN REQUESTS Please mail the completed variance application form to the address below. Also include four, copies of engineering plans, house plans, authorization letter, etc. (see check-list below). In addition, please include the required fee amount (see fees at bottom of this page). Make $95.00 check payable to: Town of Barnstable. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street "r Hyannis, MA 02601 Checklist _ Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) $95.00 variance request application fee (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/lessee only], outside dining variance renewals[same owner/lessee only ,and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, you must mail the required $95.00 fee.. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. In addition, please mail four copies of engineered plans, house plans, authorization letter, etc. (see check-list below): Checklist _ Four(4)copies of engineered plan submitted(e.g.septic system plans) Completed seven(7)page checklist confirming review of engineered septic system plan by the submitting engineer or registered sanitarian _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) $95.00 variance request application fee (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/lessee only], outside dining variance renewals [same owner/lessee only],and variances to repair-failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page i � Town of Barnstable °F'THE tok� Regulatory Services Richard V. Scali, Director BARNSTABLE " MASS. ' Public Health Division BFRNSTABMl-C OEERM -WSTWWHx6 9 MASS. A anasTor,niu.s•osremvtE•wsT ecawxFe!r:. �p i63q. �� 1639-2014 rEo 39r A Thomas McKean, Director3�g 200 Main Street,Hyannis, MA 02601 Office: 508-862- Fax: 508-790-6304 APPL CATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT . DATE: I D, Z_q • [ G I NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: E-MAIL ADDRESS: Y\-'\r 5 t l L-.5 L . esw� TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (5o 8)`?-7 D - $v(o`-f l q7-2$ J NUMBER OF SEATS*: INSIDE: OUTSIDE: TOTAL: s * Note: If indoor seating provided, see Licensing regarding Common Victuallers License TOTAL NUMBER OF BATHROOMS: a ANNUAL OR SEASONAL OPERATION: R•r\A Q A L O� TYPICAL HOURS OF OPERATION MON-FRI: LO :CSZ TO O( �� ,,� I IJ g"V_ N. - 6 - C>C) o�� a PCk�sv-- DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) -7 a t4 S 4'i —�\ S �Jo'/ KC', IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY FOOD SERVICE-- � ,RETAIL FOOD <— BED & BREAKFAST CONTINENTAL BREAKFAST *IF SEATING: ALSO, MUST OBTAIN RESIDENTIAL KITCHEN A COMMON VICTUALLER'S LICENSE MOBILE FOOD FROM LICENSING DIVISION. TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER) ***REMINDER*** IF OUTSIDE DINING, YOU MUST BE APPROVED BY THE HEALTH DIVISION AND ' LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? �. IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? N �� CONTACT INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: __/ /NO ADDRESS ' 1 C ,� PHONE # o Q'i I_- IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 2. STATE OF INCORPORATION �n_s1,� ram. FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DO NOT PREPARE FOOD AND CONTINENTAL BREAKFAST): EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO CERTIFIED FOOD PROTECTION MANAGERS. AT LEAST ONE CERTIFIED FOOD PROTECTION MANAGER IS REQUIRED TO BE ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON EACH OF THE CERTIFICATES*** LIST THE NAMES OF YOUR CERTIFIED FOOD PROTECTION MANAGERS (I.E. SERVSAFE.) I. e_ EXPIRATION DATE: 2. EXPIRATION DATE: / / EFFECTIVE FEBRUARY 1, 2011 EACH FOOD ESTABLISHMENT THAT COOKS, PREPARES, OR SERVES FOOD INTENDED FOR IMMEDIATE CONSUMPTION EITHER ON OR OFF THE PREMISES SHALL HAVE AT LEAST ONE CERTIFIED FOOD ALLERGEN AWARENESS TRAINED STAFF MEMBER. *** PLEASE PUT THE NAME OF-THE ESTABLISHMENT ON THE CERTIFICATE*** LIST THE NAME OF YOUR CERTIFED FOOD ALLERGEN AWARENESS TRAINED STAFF. 1. EXPIRATION DATE: / / SIGNATURE OF APPLICANT AND DATE Q:Wpplication Forms\Foodapp2.doc ServSafe !'JT:,^.wl."ae!ti:d'YMl A�.AKIs3Ilul EXAM SESSION # I �, CHECK SCORE and PRINT CERTIFICATE Please note: you must do this directly from WWW.SERVSAFE.COM It takes up to 2 weeks for ServSafe to post the results on their website. STEP 1 : Go to www.servSafe.com Select "Check Your Exam Score" on the Students tab. If you already have a Profile for the ServSafe website, Log in with your User name and Password. IF NOT, you must create New Profile with a User name and Password. When creating your New Profile, enter the same information you are entering on your Answer Sheet forI thisexam, including the same spelling of your name. STEP 2: Go to www".ServSafe.com Select "Check Your Exam Score" on the Students tab. Enter your User ID & Password STEP 3: Have your Exam session # ready to enter for this class. You will not be able to connect to your Exam Score and/or Certificate without the Exam session# STEP 4: Select "View score" and "Print Certificate" ServSafe contact info: www.servsafe.com Call or Text ServSafe: 800-765-2122 Common mistakes • Not waiting long enough to check your score from ServSafe website (takes up to 2 weeks) • (If you put a valid email address on your answer sheet, ServSafe will notify you when results are ready to be viewed on their website.) • Misspelling of your name on your answer sheet ~ Incorrect.Exam Session # • ServSafe does not automatically mail certificates to you. You must go to their website to check your score and print out your own certificate. 1 Message /°rn Page 1 of 1 Dew Miorandi, Donna From: Boule, Andrew Sent: Monday, November 14, 2016 3:07 PM To: Miorandi, Donna Cc: Parsons, Roger Subject: RE: Mrs. Mitchell's Fudge at 550 Main St., Hyannis Hi Donna, My apologies, the propertV I was working on is located at 362 Main St. I did not realize that there were two Mrs. Mitchell's on Main St! see no issues givin them the ree .t. .Lynn will'be happy-to know that we are still planning on fixing her sewer line at 362 Main St with an anticipated date of Dec. 5. Andrew Boule Division Supervisor 2e; -5-5-0 Barnstable Department of Public Works Water Pollution Control Division 1jv`� 617 Bearses Way Hyannis MA 026d1 Office: (508) 790-6335 Fax: (508) 790-6325 �' Cell: (508) 776-0944 -----Original Message----- , 7,Y, From: Miorandi, Donna /j Sent: Monday, November 14, 2016 2:57 PM Fo o 14 T 3 4Z /,10 A, To: Boule, Andrew Subject: Mrs. Mitchell's Fudge at 550 Main St., Hyannis Hi Andrew: I was copied your memo regarding the clog in the line at 550 Main St., Hyannis. Mrs. Mitchell doesn't plan on opening until after the first of the year so hopefully the problems you speak of will be fixed by them. However, please let me know if they are not since I will be the one to give them the green light to open. Thanks so much Donna Z. Miorandi, R.S. Health Inspector 508-862-4639 (direct office line) 11/17/2016 0 . FIMEr The Town of Barnstable Department of Public Works BARNSTABI,E snxri MBLE, ` 382 Falmouth Road,Hyannis,MA 02601 =Tgu `°""-WXW MASS. g 039. Office: 508.790.6400 1639-2014 Fax: 508.790.6406 www.town.barnstable.ma.us Daniel W. Santos,P.E. Director MEMO: TO: Thomas A McKean,Director Health Division FROM: Roger D. Parsons, P.E.,Town Engineer RE: Application for Variance,External Grease Trap—550 Main Street,Hyannis (Mrs. Mitchell's) DATE:November 10, 2016 The Department of Public Works recommends the ganting of the above n is lce t imit�eow operation of the facility without an external grease trap. Thisrecommendation to the manufacture and sale of fudge as presented to the Board of Health and does not allow expansion to any other controlled use. The property dimensions and configuration of the sewer connection do not allow the placement of an external grease trap. The recommendation is conditioned upon the following: • Adequate internal grease recovery devices are in place and functioning. • Records of grease removal are submitted to the Department of Public Works on a monthly basis. Rationale No feasible construction of a 1000 gallon external grease trap is possible based upon the physical size of the property and configuration of the sewer piping. CC: Andrew Boule Crocker, Sharon From: McKean, Thomas Sent: Monday, November 14, 2016 3:57 PM To: Crocker, Sharon Subject: FW: 550 Main Street/ Fudge � � From: McKean, Thomas Sent: Monday, November 14, 2016 3:56 PM To: Parsons, Roger Cc: Miorandi, Donna; Paul Canniff(canniff.paul gmail.com) Subject: 550 Main Street/ Fudge Hi Roger, I received both of your phone messages today. I understand that you have no objection to granting a variance from the external grease trap requirement at this location. I also understand the underground piping must be "worked-on"to remove the grease clogging material and roots before any foods can be prepared there. 1 Crocker, Sharon From: McKean,Thomas Sent: Thursday, November 10, 2016 12:54 PM To: Miorandi, Donna; Crocker, Sharon Cc: Paul Canniff Subject: Fw: 550 Main Street (Mrs. Mitchell's)Hyannis Grease Trap variance.doc From: Boule, Andrew <Andrew.Boule()town.barnstable.ma.us> Sent: Thursday, November 10, 2016 11:20 AM To: McKean, Thomas Subject: FW: 550 Main Street (Mrs. Mitchell's)Hyannis Grease Trap variance.doc Good Morning Tom, Please see my comments below in response to Roger's approval recommendation. I have been working with this property owner to address some root issues caused by Town planted trees. Currently this line is obstructed, and I am treating it as a Town problem. I am hopeful that I can have this work completed within the next month. I am waiting to hear back from my contractor, who I reached out to again this morning. Once this work is complete, I am on board with Roger's recommendation. Andrew Boule Division Supervisor Barnstable Department of Public Works Water Pollution Control Division 617 Bearses Way Hyannis MA 02601 Office: (508) 790-6335 Fax: (508)790-6325 Cell: (508) 776-0944 -----Original Message----- From: Parsons, Roger Sent: Thursday, November 10, 2016 11:03 AM To: Boule, Andrew Subject: RE: 550 Main Street (Mrs. Mitchell's)Hyannis Grease Trap variance.doc Hi Andrew please forward your concerns to Tom McKean as superseding my letter the internal grease attenuation would have to meet plumbing code thanks Roger From: Boule, Andrew Sent: Thursday, November 10, 2016 10:25 AM To: Parsons, Roger Cc: Ruggiero, Amanda Subject: RE: 550 Main Street (Mrs. Mitchell's)Hyannis Grease Trap variance.doc Roger, This property has been a problem area. I have work planned for this property that should be completed by the end of this calendar year(hopefully early December). I actually reached back out to my contractor this morning for an exact 1 date. 'There is root intrusion, What appears to be a large rock or a large*l of grease stuck in this line. At this time this line is —80% obstructed. (Photo attached). I can't recommend they start making fudge here until this issue is resolved. As I mentioned, a contractor has been lined up, but I am waiting on an exact date. Did the property owner provide you with any information on the internal grease trap that they plan to use? Andrew Bou16 Division Supervisor Barnstable Department of Public Works Water Pollution Control Division 617 Bearses Way Hyannis MA 02601 Office: (508) 790-6335 Fax: (508) 790-6325 Cell: (508)776-0944 -----Original Message----- From: Parsons, Roger Sent: Thursday, November 10, 2016 10:01 AM To: McKean, Thomas Cc: Miorandi, Donna; Boule, Andrew; Ruggiero, Amanda Subject: 550 Main Street (Mrs. Mitchell's)Hyannis Grease Trap variance.doc 2 Staff meeting comments for BOH hearing on Nov. 22, 2016 Mrs. M's Summer House, 550 Main St., Hyannis requesting a variance to an in ground grease trap. She will be just making fudge. I have no problems with her plans and finish schedule. Mrs. Mitchell took her Servsafe (10/22/16) and will obtain her allergen certificate as well. The plumbing inspector will approve through the permit process the internal grease trap. Roger Parsons, town engineer, has no problems with it. However, as noted, from Andrew Boule (Supervisor of DPW) there is a clog in the line in that area caused by tree roots and a LARGE BALL OF GREASE in the line. DATE GC rA FEE + BARMASS.LE, • A-�c�i e n OG�L I 9 MASS. qj 039• REC. BY ATf°` �A Town of Barnstable SCHED. DATE: fiA- Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 ou �� 2�� JunichiSawayanagi F"0 Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION �.— / � Property Address: Jf L Cj L�nlf 7 //L� � Gtnl� Assessor's Map and Parcel Number: 0.6 Size of Lot:------" Wetlands Within 300 Ft. Yes Business Name: No 7Z Subdivision Name: APPLICANT'S NAME: Phone Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON ' Name: Name: L Z n 0 Ali / Cal Address:. Address: r6x Phone: Phone:._ Al d 6AZM L '�� IVL— __47 -s'r�l,' VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space nee e ) SZ)c c_e &Y-) KA0 i @2j�—fzFxJh=� 6t 'LIL_ .4N9 �L r G' r a NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System ❑ Checklist (to be completed by office staff-person receiving variance request,application) ' Please submit copies in 4 separate completed sets. - _ Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g.septic system plans) h0.. )L �or I Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engidr'mr registered sanitarian `1 a+Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) � Signed letter stating that the property owner authorized you to represent him/her for this request J Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expen (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED .lunichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. C:.\cache\Temporary Internet Files\OLKAE\VARIREQ.DOC YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FL, 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: 1 Fill in please: j APPLICANT'S YOUR NAME/S: L�✓`✓� �1 ��k l� MOM� jW BUSINESS YOUR HOME ADDRESS: TELEPHONE # Home Telephone Number NAME OF CORPORATION: �j,(LS 1.ei-1 ►h cz�l - r r. NAME OF NEW BUSINESS Lk15 Ktj &J- TYPE OF BUSINES IS THIS A HOME OCCUPATI ? YES N ADDRESS OF BUSINESS ` -) - MAP/PARCEL NUMBER 3CP U:M 1� (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER' FFICE This individual has been ' or f an er i irements that pertain to this type of business. Auth ri d i na re*-* a COMMENTS: 2. BOARD OF HEALTH This individual has be rmed of the rmit req ' ments that pertain to this type of business. Authorized Signature* COMMENTS: ZVU4 OUZIJ wa 3. CONSUMER AFFAIRS [LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: CALICO F<.,.. r ' Health Department Requirements n Maintaining a Sanitary and Low Risk Fudge Operation We encourage all of our customers to inquire with their county about their locality's food code requirements before they install their fudge operation. Increasingly, public health authorities measure compliance with regulations by the degree of risk involved in specific operations and by the precautions taken to minimize that risk. We recommend the followiing instructions to all our customers to help make their fudge operations successful, sanitary and low risk. Handling Supplies We provide an NSF and UL (National Sanitation Foundation and Underwriters IY_ Laboratories) approved fudge warmer/mixer (fudge kettle) to our customers.. We also provide packaged fudge ingredients, nuts, flavors, and other ingredients which are processed by reputable firms under regulated conditions. These food supplies should be stored off the floor in a cool dry place (never in a restroom) and away from toxic chemicals and cleaning compounds. The butter used in making the fudge should be stored in a refrigerator or should be used t within two hours of purchase, if not refrigerated. The fudge itself does not require refrigeration because it has a low moisture content (water activity of 0.70) which inhibits bacterial growth. As a result, fudge is not what health officials term a "potentially hazardous food." a r 1 O Calico Cottage,Inc. USA REV June 6,2016 210 New Highway•Amityville,NY 11701-1116 631 841-2100.800 645-5345(USA&Canada)a Fax:631 841-2401 o www.calicocottage.com a :4 Page 52 j t Handling Fudge ` When making fudge in their shops, our customers place the fudge ingredients, After the ingredients have been warmed for butter and water in the fudge kettle. is poured into pans which have been lined about 37 minutes, the liquid fudge with a silicone-impregnated parchment paper. The warm fudge then gradually nature and solidifies. The finished fudge is kept at room cools to room temperature temperature. When a consumer asks to buy fudge, the store clerk cuts a piece of fudge from the full slab, weighs it, and puts it into a box for the consumer to take home. The fudge is not consumed on the store operator's premises. 5 . To uphold proper sanitary procedures, we instruct our customers to never touch u the fudge with their bare hands at any time. This includes during the making, packaging of the fudge. In addition to frequent cutting, weighing and y handwashing, we recommend that our customers use plastic gloves, spatulas, paper tissues, tongs or other similar utensils to prevent direct hand contact. Hands should be washed thoroughly before handling supplies and equipment. We suggest the use of readily available antibacterial liquid hand soaps. The store clerk should also avoid handling fudge trays and paper liners without p rotection. When the fudge has cooled, hands should be washed thoroughly e trays and when trimming the paper liners. before removing the fudge from th Local health officials may require additional precautions. 6 P f USA REV June 6,2016 ©Calico Cottage,Inc. 210 New Highway•Amityville,NY 11701-1116 631 841-2100^800 645-5345(USA&Canada)•Fax:631 841-2401 •www•calicocottage.com Page 53 Cleaning Equipment making fudge for the day, they clean the After our customers have finishedy_ fudge kettle. They fill the unit with fresh water and turn on the heat and M h agitator. The bowl will heat the water to about 1600 F. After about 15 minutes, t the operator turns off the unit and pours the water out into a bucket for disposal in a sink located in their store. This sink should not be a bathroom sink. If there is any residue in the bowl or on the agitator, the agitator would be removed for further rinsing in the sink and the bowl should be wiped down with a damp health he appropriate riate .. t sponge or paper towel. After rinsing, if rt is required by pp p would be chemically sanitized according to agitator wo Y bowl and a department, the g �. the directions on a bottle of an approved sanitizer. Such items should be available from janitorial supply companies or restaurant supply dealers. to sanitize the pans and utensils used in making and serving When necessary, the fudge, we recommend a 4-step process to be repeated as necessary: . ■ Scrub thoroughly in hot (1001-120' F), soapy water; ■ Rinse well in clean., hot (1701 F) water; ' ■ Immerse for one or more minutes in an approved sanitized solution at 75' F or higher; ■ Air dry. r To rovide additional protection and to avoid accidental contamination, the p fudge is protected by a sneeze guard. We also recommend that the fudge and kettle be well covered when not on display or during the store's after-hours. if I`tRw USA REV June 6,2016 ` ©Calico Cottage,Inc. 210 New Highway•Amityville,NY 11701-1116 631 841-2100.800 645-5345(USA&Canada)•Fax:631 841-2401 •www.calicocottage.com page 54 Other Considerations We suggest to all our customers that they install a smooth floor instead of carpet around the fudge area in order to make it easier to clean in the event that fudge or ingredients should fall on the floor. Prior to a prospective customer becoming involved with our program, we , advise them that they may need both a hand sink in:their location (a bathroom sink is often adequate) as well as a small two or three-compartment sink from t which to obtain water to make fudge and to clean the utensils. The customer should check their locality's food code requirements because some regulations vary. Additional hand. washing facilities may also be required in some locations. y Note If your health inspector cites a requirement that may be difficult or impossible for you to observe, you may be able to obtain a variance y by making your case to the public health administrator. Fudge making is a low risk operation, and the chance of illness is generally regarded to be negligible where sneeze guards and the practice of "no R handling" of the fudge is in place. The Food and Drug Administration's new Food Code allows variances from j specific requirements if the retailer can demonstrate his/her adherence to low- risk procedures. ©Calico Cottage,Inc. USA REV June 6,2016 210 New Highway•Amityville,NY 11701-1116 631 841-2100.800 645-5345(USA&Canada)•Fax:631 841-2401•www.calicocottage.com Page 55 j CALICO COTTAGE, Other Supplies Enformatoon About Batter and Bakery Tissue In making fudge using Calico's forest quality ingredients, two pounds of butter are used with each carton of fudge ingredients along with approximately 6 1/2 cups of water. Salted butter is preferable. Purchasing butter in bulk from either a food distributor, butter and egg s distributor-or warehouse club can save you money. It's also a good idea to make provisions for storing some butter on your premises. A small refrigerator would , s be fine. In addition, you will need to obtain a supply of plastic tissue. After fudge is cut for sale, it is placed on a 10" x 10 3/4" plastic tissue, weighed, wrapped and j placed into a box or bag. There are two types of sheets that can be used: a waxed paper sheet or a plastic . sheet. Calico recommends using a plastic sheet because it is grease-proof, waterproof, non-absorbent and best prevents oils in the fudge from staining the box in which the fudge is placed. In addition, plastic sheets do not permanently }' S Y stick to the fudge. Waxed paper sheets often end up being permanently stuck to the fudge. Plastic sheets (packed 1,000 to the box) are available from Calico. ©Calico cottage,inc. USA REV June 6,2016 210 New Highway-Amityville,NY 11701-1116 631 841-2100.800 645-5345(USA&Canada)-Fax:631 841-2401-www.calicocottage.com Page 56 f Barnstable Property Maps Page 1 of 1 Parcel Details 'g '�' ` a J n �yCa ✓ ik � Y .. ... .._-. ........ ......_.. ._.._.- .._....� .— __ -... _.._..-_. .Y'. tied - :-/'. M ' W Select Condo Unit 130807400A - COLOMBO, DAVID L TR t l fi Locations„`z` Parcel: 308074 ` t S Address: 544 MAIN STREET (HYANNIS) �- r ` S� Village: HY + t 'V I s Acreage: 3.8335515515, Full Property Info' xi Property Photo . i4.. 6• v, .ice 7H _ r� tii ce' r t �a titi 4 v a s t Fr 3 p ` tits • � f � �J � 1 -� r 5 ;NV s, t� 4�i' _ { 00 1 ' iq Owner& Mailing Address Owner: COLOMBO, DAVID L TR CAFE REALTY TRUST vvek i Mail Address: 540 MAIN STREET _ HYANNIS v I MA 02601 Assessed Value (FY16) Building Value: $613,700 Extra Features: $37,500 V Outbuildinqs: $0 179 Basemap _..._. Home Layers Parcel Details 400ft https:Hgis.townofbarnstable.us/Html5 Viewer/Index.html?viewer=propertymaps&run=Fin... 10/27/2016 f 1 • • 1 Proper Configuration and Location of a Fudge Factory fresh FUDGE o o0 a REAR COUNTER FRONT COUNTER Since fudge is an impulse item, the fudge display is best located in a straight line with, and next to, a main cash register that is always staffed by an employee who interacts naturally with customers. ©Calico Cottage,Inc. USA REV June 6,2016 210 New Highway•Amityville,NY 11701-1116 631 841-2100.800 645-5345(USA&Canada)•Fax:631 841-2401 •www.calicocottage.com Page 13 ` ll 4 MOWN Fudge Display Cabinet Specificatens SNEEZE GUARD BRACKETS Set of 3 Brackets are available from Calico Cottage 800 645-5345 14" Brackets must be mounted flush with the front and outside edges of the counter GLASS 27" 114"Tempered Glass 33" (Safety glass may be substituted) Obtain glass locally I CABINET 6- All interiors and shelves to be faces \ with formica or equalT ' G FRONT VIEW(Customer Side) BACK VIEW(Fudge Maker Side) 14° GLASS FRONT T SLIDING DOORS Perforated for 27" air circulation GLASS FRONT 2" LLEI 6" BLACK VINYL,BASE BLACK VINYL EASE CUTAWAY VIEW(LEFT SIDE) RIGHT SIDE VIEW 10 141/2" h-- SLIDING SLIMLINE FLUORESCENT FIXTURE GLASS ON 2 SIDES,FRONT DOORS -Ballast must be mounted &TOP outside of the display cabinet TWO SHELVES Formica s/4'•thick or wire type Adjustable to slant or FORMICA horizontal position SIDES& GLASS TOPS BLJk VINYL BASE BALLAST FOR 3„ FLUORESCENT FIXTURE 21 MOUNTED OUTSIDE DISPLAY CASE O Calico Cottage,Inc. 9/ 5/06 210 New Highway-Amityville,NY 11701-1116.631 841-2100.800 645-5345(USA&Canada)-Fax:631V841?2401 www.calicocottage.com Page 24 Proper ettlDousplay If the kettle is to be located where it is accessible to the customer, it should also be protected by glass. This is done for two reasons: so that people do not touch it when it is warm and to keep the area sanitary. Calico stocks special aluminum brackets for kettle sneeze guards. 11 av Kettle ®del TDB-8): The counter top space required to accommodate the base of the 110-volt kettle is 2411wide x 24" deep and ideally should be no higher than 31" from the floor so that employees of varying heights will be able to work with the kettle easily. 2201, KP-ttLQ.QMQ d -9 s � ,�_�. —sa �� s 3 snoula Be no g e to WY!ftIgVn9ftLs will e able ow For either type kettle, a small shelf must be provided. It should be a sliding shelf and is needed to hold the tray when pouring the fudge from the kettle. It can be pushed out of the way when not in use. Note that if the kettle is placed on a back counter that is at least 3 1" deep, there will be sufficient space to hold both the kettle and tray and therefore a pull out shelf will not be necessary. o Calico Cottage,Inc. 210 New Highway•Amityville,NY 11701-1116.31 841-2100.800 645-5345(USA&Canada)•Fax:31v841?2401 www.caiicocottage.com Page 25 Other Fixturing Considerations If you need to install a two or three compartment sink, it's a good idea to allow sufficient space for the largest item, which is the fudge kettle agitator, and install a sink that has cavities measuring: Model T DB-8: At least 14" wide x 14" long and 4" deep Ii Retailers should contact restaurant equipment supply companies in their local area to source sinks. ©Calico Cottage,Inc. Rev.9125/06 210 New Highway•Amityville,NY 11701-1116.631 841-2100.800 645-6345(USA&Canada)•Fax:631.841-2401 wiww.calicocoffage.com Page 26 a. Aluminum nee a Guard Brackets For a Kettle Cabinet , (Not required for kettles located on rear counters) Calico makes available a set of four aluminum brackets to be used in constructing a three-sided sneeze guard with which to protect the kettle while on display. These are for the kettle only. The brackets are grooved for 1/4" glass (safety or tempered). They are 33 1/2" high and the bases are tapped and supplied with 2 lengths of bolt to accommodate the varying thickness of countertops, 1 3/4" and 2 1/4" both of which are 5/16 UNC (coarse pitch threading) bolts. Be sine to install brackets onto the base before measuring for glass. Calico offers the set of four brackets. For pricing, call 800 645-5345. ©Calico cottage,Inc. Rev.9/25/06 210 New Highway•Amityville,NY 11701-1116.631.841-2100.800 645-5345(USA&Canada)•Fax:631 841-2401 www.calicocottage.com Page 27 FA a e AT 1 Ov Fudge Kettle (Model T ® ) Cabinet Specifications TOP VIEW SNEEZE GUARD BRACKETS Fudge Maker Side -Brackets are needed only if the kettle can be accessed by customers " T , -1 Ala"X 1 1/4"Brackets are 33 !a I ; FUDGE ! available from Calico Cottage KETTLE ; 800 645-5345 PLACEMENT, -Brackets must be mounted flush P4 with the edge of the counter 25' --- ----- 7/s"HOLE IN COUNTER 3111 FOR FUDGE MACHINE ELECTRICAL CORD �o A 6" Customer Side SNEEZE GUARD GLASS -1/4"Tempered Glass on three sides (Safety glass may be substituted) -Obtain glass locally FRONT VIEW(Customer Side) BACK VIEW(Fudge Maker Side) 4.4 64" 31"Maximum Counter Height PLASTIC LAMINATE 00 NOTE:Ifthe fudgemaker's height is less than 5'3",counter height should be lowered to 27" BLACK VINYL BASE L 24"MINIMUM .�.� I 30"PREFERABLE I LEFT SIDE VIEW CUTAWAY VIEW(LEFT SIDE) GLASS PULL OUT SHELF -This shelf is essential to hold fudge pan when pouring from kettle -16"wide x 23"deep PLASTIC LAMINATE ADJUSTABLE SHELF BASE PLEASE NOTE: BASE -All interiors and shelves to 3" be faced with Plastic Laminate 21" 24" I � ©Calico Cottage,Inc. Rev.9/25/06 210 New Highway"Amityville,NY 11701-1116.631 841-2100.800 645-5345(USA&Canada)-Fax:631 841-2401 www.calicocottage.com Page 28 •M_ E WWI Electrical Requirements for Calico's Fudge Kettle Model TDB-8 110 Volt ONLY (See page 31 for 220-'Volt Kettle Model TDB-7 Electrical Requirements) Uses 110 volts on a dedicated 20-ampere circuit It may be easy to accommodate your kettle's electrical needs if you have both of the following: • A dedicated 15-ampere, 110-volt outlet at the kettle location. 0 • 12 gauge wiring to that existing outlet. If our electrician tells you that the y y above is already in place, then you will need to change the receptacle to one of the following, and change the circuit breaker to 20 amperes. If you do not have the • HUBBELL correct wiring, as #5361 above, you will need to (Single outlet) have your electrician ono HUBBELL install a dedicated 20- #5362 ampere circuit, with one (Duplex of the outlets listed to outlet) the right. Hu � NEMA 5-20R IMPORTANT: ® The plug furnished with the kettle is a Hubbell #5366 (NEMA 5-20P) and is affixed to a power cord 6 feet in length. Your electrician will have to provide one of the above outlets within 12" of the kettle location. Otherwise, an extension cord of proper amperage will be needed. ■ You must have the outlet installed and tested before we can provide training at your location. Be sure your electrician receives a copy of this information. ©Calico Cottage,inc. Rev.9/25/06 210 New Highway-Amityville,NY 11701-1.116.631 841-2100.800 645-5345(USA&Canada)^Fax:631 841-2401 www.calicocottage.com Page 29 ti _ What You'll Need t® Get Started Inside this section, you'll find important information on: - a The Importance of Signage ® Your Initial Order a The Utensil Kit ® Digital Scales a Boxes: Custom Printed and Main ® Health Department Requirements a Other Supplies El INJ - � rr h"� { ��x"�'Y a `•; . 1 � w ©Calico Cottage,Inc. 210 New Highway.Amityville,NY 11701-1116 USA REV June 6,2016 631 841-2100.800 645-5345(USA&Canada).Fax:631 841-2401 -www.calicocottage.com Page 35 . _ a 4 ' Barnstable Property e Maps Page 1 of 1 .05 f 1 F u Parcel Details p . 1, 0 ¢,, �, Almai Y I F. Select Condo Unit 130807400A- COLOMBO, DAVID L TR r ` 4 PIq Location �;j�, F Parcel: 308074 ' Address: 544 MAIN STREET a N4 ''' + (HYANNIS) 40� ,w 1 c y �i Village: HY `' ;,u Acreage: 3.83355155 Full Property Info ;csf` af ? i W. Property Photo 4 .:.�?q rgaE y` NWR 3 r� 1 i `F ,1�+P iy [ xtte yt v ! l of c rhnxun. .. httl j \ � r 4 -z._ Owner&Mailing Address Owner: COLOMBO, DAVID L TR CAFE REALTY TRUST ,k\ vei i,�)' Mail Address: 540 MAIN STREET HYANNIS i MA 02601 CAv C74 "W Assessed Value (FY16) Building Value: $613,700 Extra Features: $37,500 V I kk, Outbuildinqs: $0 7 w,. Basemap Home ,Fyt, Layers Parcel Details 400ft https:Hgis.townofbarnstable.us/Html5 Viewer/Index.html?viewer=propertymaps&run=Fin... 10/27/2016 a m s _,rrra *az �lI��IG R ` � EMPLOYEES W'SH HANDS ST i I EXHIBIT B ovERNANG Mir C J I HEREBY CERTIFY THAT THIS PORTION OF THE PLANS FILED WITH THE MASTER DEED OF 540 MAIN CONDOMINIUM SHOWS THE UNIT DESIGNATION OF THE UNIT BEING CONVEYED AND OF THE IMMEDIATELY ADJOINING UNITS, AND THAT IT FULLY DEPICTS THE LAYOUT OF THE UNIT. ITS LOCATION, --- DIMENSIONS, APPROXIMATE AREA, FAIN ENTRY, AS BUILT. 3 t; 46 UN F"- 3 5.F, J t ol OVcRttANG PREPARED FOR: CODE REALTY L C" THE PURPOSE OF�"THIS DIAGRAM L IS TO DEPICT EXISTING DIMENSIONS THE BSC GROUP, INC RELATIVE TO A CONDOMINIUM 349 MAIN ST., WEST YARMOUTH MA MASTER DEED. CUNT_-4 SCALE 540 MAIN DATE: 3/3/08 CONDOMINIUM CRAIG A.' FtEl.p PLS DATE BSCI 4932101 FOR THE BSC 5'Id7' 8c' 544 �} GR MAI.oUP ,.:_ N I SIRE NC. £T __,_ HYANNIS, MASSACHUSEFTS SHEET I OF I A y 4r, P-Qcc�v 14AFn 46 IN oc 4 I - ti r F 2 e)a- 5AC) ,11- f 9 _ ' r .o.�. v._.---.,..."++e•.t^fx, .rt-. ...... -yw..^��eY.f,+M••e+cr-:til:..L..... a. 'Fr+..•r - 2 �j S ' Fr.sM e�w w,_ Fe N Fri,