HomeMy WebLinkAboutBAXTER'S BOATHOUSE - FOOD BAXTER' S BOATHOUSE
l CLUB 32 t jr
} 177 Pleasant St.Hy.'
AREA "D" -SIDE DECK DININGNET AREA = 302 SFALLOWABLE NO. OF OCCUPANTS = 20SEATING PROVIDED = 20 +/-@LOOSE PICNIC TABLES20 SEATSAREA "E" -EXTERIOR DINING AT OUTDOOR PATIO -EDGE OF PARKINGNET AREA = +/-1087 SFALLOWABLE NO. OF OCCUPANTS = 72SEATING PROVIDED = 7272 SEATSWALK-UP SERVICE AREA(NO SEATING)AREA "C" -OUTDOOR DECK DINING(FISH & CHIPS DECK)NET AREA = 829.40 SFALLOWABLE NO. OF OCCUPANTS = 55SEATING PROVIDED = +/-55 @ LOOSE PICNIC TABLESAREA "B" -FISH & CHIPS DINING ROOMNET AREA = 864.30 SFALLOWABLE NO. OF OCCUPANTS = 57SEATING PROVIDED = 5757 SEATSAREA "A.1" -"BOATHOUSE DINING ROOM"NET AREA = 1073.30 SFALLOWABLE NO. OF OCCUPANTS = 71SEATING PROVIDED = 71AREA "A.2" -"BOATHOUSE DECK"NET AREA = 325.20 SFALLOWABLE NO. OF OCCUPANTS = 21SEATING PROVIDED = 2020 SEATS58 SEATS13 BAR SEATS1/8" = 1'-0"1PROPOSED SEATING LAYOUTSTAMP:TITLE:DATE ISSUED:DRAWN BY:DRAWING NO.:ARCHITECTSCLEAR PATH ADVISORS, LLC( RICHARD FENUCCIO ARCHITECT)8 WEST BAY ROADOSTERVILLE, MA 02655Rick@ClearPath-Advisors.comTEL. (508) 280-32096/7/2023 5:08:51 PMC:\Users\skhal\OneDrive\Public\Rick\Baxter\Baxter.rvtPROPOSEDSEATINGLAYOUT.A1.1AuthorPROPOSED SEATING LAYOUT177 PLEASANT STREETHYANNIS, MA 02601BAXTER'S RESTURANTREVISIONSNo. Description DateOCCUPANT LOAD ANALYSIS:THE FOLLOWING OCCUPANT LOAD ANALYSIS AND SEATING LAYOUT IS BASED UPON A FIELD MEASURE SURVEY CONDUCTED ON APRIL 7, 2023 AND A REVIEW OF APPLICABLE SECTIONS OF THE 2021 IBC(INTERNATIONAL BUILDING CODE)TOTAL NO. OF ALLOWABLE OCCUPANTS = 296 OCCUPANTSTHE FOLLOWING IS THE MAXIMUM ALLOWABLE NUMBER OF SEATS BY ROOM OR EXTERIOR DECK SPACES:AREA A.1:BOATHOUSE DINING ROOM= 71AREA A.2:BOATHOUSE DECK AREA= 20AREA B:FISH & CHIPS DINING ROOM= 57AREA C:OUTDOOR DECK (FISH & CHIPS)= 55AREA D:SIDE DECK DINING= 20AREA E:OUTDOOR PATIO -PARKING EDGE= 72TOTAL= 295MAXIMUM ALLOWABLE OCCUPANTS6/20/2023(Dining Areas- Staff Not Included)
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I _ Town of Barnstable BOARD OF HEALTH
John T.Norman
Board of Health Donald A.Gaudagnoli, M.D.
RAMM ABLL 2 F.P.(Thomas)Lee
7A 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt.
ti6J9.
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: 304 Issue Date: 01/01/2022
DBA: BAXTER'S BOATHOUSE CLUB
OWNER: WARREN T. BAXTER INC.
Location of Establishment: 177 PLEASANT STREET HYANNIS, MA 02601
Type of Business Permit: FOOD SERVICE
Annual: Seasonal: YES
IndoorSeating: 180 OutdoorSeating: 100 Total Seating: 280
FEES
FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST: -
MOBILE-FOOD:
MOBILE-ICE CREAM: Q�
FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
I
OFIHE THY For Office..:-.. sc Pnlj;—Initials;0J0 .�
Town of Barnstable 3 ul 1�
!Datc Pa►d�: P $BARNSfABLE, Inspectional Services
n p_
9�A a�• •�
lEOMp�a Public Health Division —
Thomas McKean, Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
APPLICATION FOR PERMIT TO OPERATE-A FOOD ESTABLISHMENT
DATE 3/2/2022 NEW OWNERSHIP_...... RENEWAL X
NAME OF WOOD ESTABLISHMENT: Baxter's Fish'N Chips/Baxter's Boathouse Club
ADDRESS OF FOOD ESTABLISHMENT: 177 Pleasant St: Hyannis, MA 02601
MAILING ADDRESS(IF DIFFERENT FROM ABOVE):
E-MAIL ADDRESS: smulcahy.baxterscapecodCgmail.com
TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (508 ) 77.5 _ 4490
TOTAL NUMBER OF BATHROOMS: 5
WELL WATER:YES NO X ... (ANNUAL WATER ANALYSIS REQUIRED)
ANNUAL: SEASONAL: X DATES OF OPERATION: 4
jj. 2-TO 1_0-� 1 OL222
.NUMBER OF SEATS: INSIDE: 180 OUTSIDE:_��TOTAL 270
SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSIN: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? YeS
IS AN AIR CURTAIN PROVIDED AT WAYPSTAFF SERVICE DOOR(S)?.No
TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW)
v N' OOD SERVICE
_RETAIL FOOD-ONLY required for TCS1oods(foods requiring refrigeration/freezer)
_BED& BREAKFAST
_CONTINENTAL BREAKFAST
CO1"PAGE 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,MOBILF. & NEW FOOD ONLY*=r,'
REQUIRED TO CALI:HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED
PLEASE CALL 508-862-4644
Q:1Application FprmsTOODAPP 2020.doc
ti
OWNER INFORMATION:
FULI.NAME OF APPLICANT Samuel T. Baxter
SOLE OWNF. .TYES,/'NO OWNER PHONE# 508-280-0040
ADDRESS 54 Quail Lane.Hyannis Port
CORPORATE OWNER:
CORPORATE ADDRESS:
PERSON IN CHARGE OF DAILY OPERATIONS: Samuel T. Baxter
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-Chris Blair 2 /10 /25 1. Samantha Mulcahy 3 /12 /26`
2.Ben Baxter 2 /10: j25
e?
SIGNATURE Oh APPLI ' NT°" DATE
***FOOD POLICY INFORMATION***
SF,ASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Ilealth Div.
prior to opening!! ]Tease call I lealth 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 it State.Certi;fied lab prior to opening.and monthly thereafter,
with sample results submitted to the Health Div. Failure to do so willresult in the suspension or revocation of your Frozen,Dessert
Permit until the above terms are met.
CATERING POLICY.: Anyone who caters within thcTown o.f Barnstable must:notify the Town by fax or mail prior,to catering
event. You must complete a catering noticc.found at httpi//www.townoibantistable.us/healthdivision/apglicatio.ns.asp.
OUTDOOR COOKING: Outdoor cooking,preparation,or displayof any food product bya food estahlish;rne it.is prohibited.
NOTICE: Permits run annually from January.Ist'to Dec.3.15,each calendar year. IT IS SOUR RESPONSIBII:,CI'Y'I'O RE"1'URN
THE COMPLETED APPLICATION(S),AND 1U."QUIRT D hl ES-BY DEC Ist. "
Q:!,Applicadon ForinAR E)DAPP'R.EV3-2019"doe
F1g7 Town of Barnstable BOARD OF HEALTH
John T. Norman
Board of Health Donald A.Gaudagnoli,M.D.
Bnn,INq ARX Paul J.Canniff,D.M.D.
M'� �a�9• .� 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: 304 Issue Date: 01/01/2021
DBA: BAXTER'S BOATHOUSE CLUB
OWNER: WARREN T. BAXTER INC.
Location of Establishment: 177 PLEASANT STREET HYANNIS, MA 02601
I
Type of Business Permit: FOOD SERVICE
Annual: Seasonal: YES
IndoorSeating: 180 OutdoorSeating: 100 Total Seating: 280
FEES - - ------
FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2021
RETAIL FOOD: ,
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST: - -- - - -----
MOBILE-FOOD:
MOBILE-ICE CREAM:
FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent T
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
SINE For Office • Initials:
Town of Barnstable Date Paid3 a Amt Pd� �._
131IMSTABM Inspectional Services
1639. Public Health Division
Thomas McKean,Director CIGpjft1 r: 35q 00 / SD.CDrn�s�
200 Main Street, Hyannis, MA 02601 flowp. P*Iw3
Office: 508-862-4644 Fax: 508-790-6304
APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
DATE 2- 25 i21 NEW OWNERSHIP RENEWAL
,, o4.4%-- w s e
NAME OF FOOD ESTABLISHMENT: - C-r S t T ISM N G1nt�I�k-k-� S Llv�
ADDRESS OF FOOD ESTABLISHMENT: CAr1r1 t S
MAILING ADDRESS(IF DIFFERENT FROM ABOVE):
E-MAIL ADDRESS: SbG1�C-�'C rCAT�C. CO� 01 r`�Gl rl 1 C M
TELEPHONE NUMBER OF FOOD ESTABLISHMENT5kP$ ) - 4qcl
TOTAL NUMBER OF BATHROOMS: S
WELL WATER:YES NO \/�.. (ANNUAL WATER ANALYSIS REQUIRED)
ANNUAL: SEASONAL: ✓DATES OF OPERATION:Ll/I b/2 l TO 10
NUMBER OF SEATS: INSIDE: 1 C0 OUTSIDE: '1 0 TOTAL: Z"�y
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)? N U
TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW)
FOOD SERVICE
RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer)
BED&BREAKFAST
CONTINENTAL BREAKFAST
COTTAGE FOOD INDUSTRY(formerly residential kitchen)
MOBILE FOOD
FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED)
CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2)
*** SEASONAL,MOBILE & NEW FOOD ONLY***
REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED
PLEASE CALL 508-862-4644
Q:Wpplication FormsTOODAPP REV3-2019.doc
f OWNER INFORMATION:
FULL NAME OF APPLICANT Sam-N it I T. C3 A K-+c r
SOLE OWNER:&YENO OWNER PHONE# 5015 "2 TO - O 040
ADDRESS 514 6.yat t 'Por--
CORPORATE OWNER:
CORPORATE ADDRESS:
PERSON IN CHARGE OF DAILY OPERATIONS:
List(2) Certified Food Protection Managers AND at least(1) Allergen Awareness Certified Staff
All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT.
**ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records.You
must provide new copies and POST THE CERTIFICATES at your food establishment.
Certified Food Managers Expiration Date Allergen Awareness Expiration Date
1. SGN'�C��'1'1r1c` N1u�Cli2 s 2 Z -(l.��G`��
2. Cv--\✓ s -IRS 1akr 2 iv gas
i
2 �Z1r 2U Z 1
SIGNATURE OF APPLI 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.ast).
OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited.
NOTICE: Permits run annually from January 1 st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st.
Q:\Application FortnsTOODAPP REV3-2019.doc
Town of Barnstable BOARD OF HEALTH
ay John T.Norman
�Y Board of Health Donald A.Gaudagnoli,M.D.
BARN rum' Paul J.Canniff,D.M.D.
sd39.
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: 304 Issue Date: 01/01/2020
DBA: BAXTER'S BOATHOUSE CLUB
OWNER: BAXTER'S BOAT HOUSE CLUB
Location of Establishment: 177 PLEASANT STREET HYANNIS, MA 02601
Type of Business Permit: FOOD SERVICE
Annual: Seasonal: YES
IndoorSeating: 180 OutdoorSeating: 100 Total Seating: 280
FEES
FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2020
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST:
MOBILE-FOOD:
MOBILE-ICE CREAM:
FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
For Office Use 01alylInitials:
'"E'°"�ti Town of Barnstable
Date Paid AnIt..Pd$ c> j.
IARNSTABLE, ; Inspectional Services
MASS.
'°39
MASS. �`� Public Health Division Check#
A
QED MAC
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 Z0 2UZv NEW OWNERSHIP RENEWAL
NAME OF FOOD ESTABLISHMENT: ?j06-7q-10 U S e—
i C l��
ADDRESS OF FOOD ESTABLISHMENT: `� hr�(�nk F'ly(�nl S
MAILING ADDRESS(IF DIFFERENT FROM ABOVE): sctly .2_
E-MAIL ADDRESS: (' e GUr^
TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (56T)1�5 - g SIG
TOTAL NUMBER OF BATHROOMS:
WELL WATER: YES NO X... (ANNUAL WATER ANALYSIS REQUIRED)
ANNUAL: SEASONAL: ��DATES OF OPERATION: Li /Ic) /wro 0 / i 2 / 7,
NUMBER OF SEATS: INSIDE: 1�ID OUTSIDE: el-D 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? `/ S
IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? b
TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW)
'AFOOD SERVICE
RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer)
BED&BREAKFAST
CONTINENTAL BREAKFAST
COTTAGE FOOD INDUSTRY(formerly residential kitchen)
MOBILE FOOD
FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED)
CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2)
*** SEASONAL, MOBILE & NEW FOOD ONLY***
REQUIRED TO CALL HEALTH DIV. FOR INSPECTION PRIOR TO PERMIT BEING ISSUED
PLEASE CALL 508-862-4644
Q:\Application FormsTOODAPP 2020.doc
,4*
y
OWNER INFORMATION:
FULL NAME OF APPLICANT
SOLE OWNE : YES/ OWNER PHONE # SOgd -Zoo C)04 0
ADDRESS 5Li &uc)- 1,\ 1--0.rL \ ���5 -py-t- , A- b 2-1a'41
CORPORATE OWNER: -T+ -ZlQ. 'nn
CORPORATE ADDRESS:
PERSON IN CHARGE OF DAILY OPERATIONS:
List(2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff
All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT.
**ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You
must provide new copies and POST THE CERTIFICATES at your food establishment.
Certified Food Managers Expiration Date Allergen Awareness Expiration Date
1. SGrrGC �� v�CC� / dl DOl
a / /O l2d0W t.C"
-- Z >-?1(40i Zozo
SIGNATURE OF ApPk4VANT DATE
***FOOD POLICY INFORMATION***
SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div.
prior to openine!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance.
FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter,
with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert
Permit until the above terms are met.
CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering
event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp.
OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited.
NOTICE: Permits run annually from January Ist to Dec.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st.
QAApplication FormsTOODAPP REV3-2019.doc
i
Town of Barnstable BOARD OF HEALTH
Paul J Canniff,D.M.D.
Board OI Health Donald A.Gaudagnoli,M.D.
LIARNSTABIX. John T.Norman
MAS&
via , 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: 304 Issue Date: 03/01/2019
DBA: BAXTER'S BOATHOUSE CLUB
OWNER: BAXTER'S BOAT HOUSE CLUB
Location of Establishment: 177 PLEASANT STREET HYANNIS MA 02601
Type of Business Permit: FOOD SERVICE
Annual: Seasonal: YES
IndoorSeating: 280 OutdoorSeating: 0 Total Seating: 280
FEES
FOOD SERVICE ESTABLISHMENT: $300.00 YEAR: 2019
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST: - - - - -- - - - - ------ -- ---. -
MOBILE-FOOD:
MOBILE- ICE CREAM: Q�
FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent
TOBACCO SALES:
5
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
S a
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------------
k�
�OpIME Tp�y For Office Use OI - Initials:
Town of Barnstable o* Date,Paid 3 , Amt PdPd s 3� — i
BARNSTABLE, . Inspectional Services
q MARS. $'FOMA�A`0 Public Health Division Checic# Jb
Thomas McKean,Director -
200 Main Street, Hyannis,MA 02601 _ o
Office: 508-862-4644 Fax, 508-790-6304
i
APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
DATE 3 1 It NEW OWNERSHIP RENEWAL
NAME OF FOOD ESTABLISHMENT: k-1�� 5 i S1 iJ Ch��s ><kl �c�-11ry s� G lu b
ADDRESS OF FOOD ESTABLISHMENT: �1^) I����t 5C,✓1k S� �IyG��r�IS l c�zbU I E
MAILING ADDRESS(IF DIFFERENT FROM ABOVE):
E-MAIL ADDRESS: SW 0-ecf cape [lyi�Gi `-�I •C-
y
TELEPHONE NUMBER OF FOOD ESTABLISHMENT: rsm 115
TOTAL NUMBER OF BATHROOMS: 9
WELL WATER:YES NO'; ...(ANNUAL WATER ANALYSIS REQUIRED)
ANNUAL: SEASONAL: X DATES OF OPERATION: q /12- /1'9 TO �O !H /i9_
t
NUMBER OF SEATS: INSIDE: OUTSIDE: b 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
- i
REQUIREMENTS. I :
IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? \i-es
IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? yes
E CHECK ALL THAT APPLY BELOW)
TYPE OF ESTABLISHMENT: (PLEAS HE W)
FOOD OD SERVICE
RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer)
BED&BREAKFAST
CONTINENTAL BREAKFAST
COTTAGE FOOD INDUSTRY(formerly residential kitchen)
MOBILE FOOD
i
FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED)
CATERING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE 0)
TOBACCO SALES... (ANNUAL TOBACCO SALES APPLICATION REQUIRED)
*** SEASONAL,MOBILE &NEW FOOD ONLY***
REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED
Q:1Applicatim Forms\1-'00DAPPRGV2018.doc
R
tit
1
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PLEASE CALL 508-862-4644
OWNER INFORMATION:
FULL NAME OF APPLICANT �a 1 , Sax+c L
SOLE OWNER: YES 149 > OWNER PHONE#
f— a
ADDRESS ,,C .�a• I +—I 1 .
CORPORATE OWNER: FEDERAL ID NO.:
f �
CORPORATE ADDRESS: �A�""
' I S
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
°S_� Zu Z
Z
'N�i�l.C�r'` •
2. �akc 3 11 / 2-4�'
t
k
SIGNAT APPLICANT DATE
i
***FOOD POLICY INFORMATION***
SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div.
prior to openinel l 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.
i
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/liealtlidivision/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 I st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC l st.
QA,\,,ieation Porms\F00DAPPRFV1111 oc
I
!
pptME Ion TOWN OF BARNSTABLE,, HEALTH INSPECTOR,s Establishment Name: Date: .� qe: of
OFFICE HOURS
PUBLIC HEALTH DIVISION 8:00-9:30 A.M.
BARNSrABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
a39: .0� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY
�A'EO MP+p F2,0.2 ESTABLISHMENT INSPEPCfTION REPORT 506-862-4644
Name Date ITM12e of Type of Inspection
tion 1 Routine
Address Risk nod Services Re-inspection:12Level Re il`!/ Previous Inspection
Telephone Residential Kitchen
Mobile Zre-operationOwner HACCP Y/N Temporary ness�
Caterer General Complaint
Person in,Charge(PIC) Time Bed&Breakfast HACCP
In:
Other °
Inspector Out:
C/
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 /:C6;7 7-�� /
FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures
44
❑ 5.Receiving/Condition ❑ 17.Reheating
❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling
❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding -
PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control
❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP
❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY
❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations ��
Critical(C)violations marked must be corrected immediately. (blue&red items) _ Corrective Action Required: ❑ No El 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 re ardless of the number of critical,results in an.F.
25.Equipment and Utensils (FC 4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 4 non-critical violations 9
26.Water,Plumbing and Waste if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot
g (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of
27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must
28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration.
within 10 days of receipt of this order. violation,4 to 8 non critical violations=C.
w
29.Special Requirements (590.009) y p
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-� rease Rendered Y N
#Seats Observed Frozen Dessert Machines: 111' Outside Dining Y N '. Si to Print:
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N
Dumpster Screen? Y N IV
:_ . .Y ,�,:�-�-. �.--.�.-�,....».e -�. -. � .-.. � -- n,..:-. .�.�.`.^-_..-�+- . .ram_- .... - � ... _-�.-...-��--^---^""4�.,,..r•�.--..-.P.._,.,..�, .f .--.-- . . _. •�•�-'•- ... - .. _ _ •._ ..r-..... ..--..•..°�-•.-� _ .- r-� ^- -` .. _- -�.. . . -
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 L114 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 Unappro4ed'Additives
Contamination from Raw Ingredients 75 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F
590.004(F) *- --
EMPLOYEE HEALTH - 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* *
Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F
2 590.003(C) Responsibility of the Person-in-Charge to. _ 7-102.11 Common Name-Working Containers* *
Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F
7-201.11 Separation-Storage*Applicants* 3-302.11(A) Food Protection* � P g 20 Time as a Public Health Control
590.003(F) Responsibility of A Food Employee or An 3-302,15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*Applicant To Report To The Person In Cfiarge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements
3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions*
590.003(G) Reporting by Person in Charge* Contamination from the Consumer.
3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR
3-306.14(A)(B)Resumed Food and AdulteReserrated
or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) �Removal of Exclusions and Restrictions Disposition ofAduIterated or Contaminated ( )
Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
4 Food and Water From Regulated Sources F9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and
( ) P _ * _ _ _ 4-501.11-1 - Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations Raw Seed Sprouts Not Served*_
3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served
3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of
3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or
5-101.11 Drinking Water from anA roved S stem* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec*
g PP Y Not Otherwise Processed to Eliminate
Equipment*
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) Ratites,Injected Meats-155°F 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*
Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or
3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary
and - ide in cater-
* Ratites-165°F IS sec* in mobile food,[em or and residential
Sources g• P �
10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under
Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms*
Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to
3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors.
* 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* practices Other 590.009 violations relating to good retail
590.004(C) Wild Mushrooms ( )( )( )
3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements.ld 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 Commercially Processed RTE Food-140°F* (Blue Items non-critical
23-30)
3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne
3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F
3-202.18 Shellstock Identification* ( ) 590.000
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
Tags/Records:Fish Products
5-203.11 Numbers an P
d Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003
5-20411 Location and Placement* Temperature
Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004
.
3-402.11 Parasite Destruction* Temperature Ingredients to 41'F/45°F 25. Equipment and Utensils FC-4 .005
5-205.11 Accessibility,Operation and Maintenance
3-402.12 Records,Creation and Retention* Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008
009
HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements
3-502.11 Specialized Processing Methods* 30. Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 Conformance with Approved Procedures* S:590Forrnback6-2doc
*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.
oFIKE roh TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: age: of
OFFICE HOURS
PUBLIC HEALTH DIVISION 8:00-9:30 A.M.
BARNsrABLE. 200 MAIN STREET 3:30-4:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
7 '639• 00a HYANNIS,MA 02601 MON.-464FRI No Reference R-Red Item PLEASE PRINT CLEARLY
508-862-4644
prFD M16 FOOD ESTABLISHMENT INSPECTION_REPORT
Name Dat Type of T section
O ion outine
Address ( Risk ood Service spection
` Level Previous Inspection r
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 G
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 CHEMICALSell
❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives �sL
❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals
FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous F ods) 4 AA
❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures
❑5.Receiving/Condition ❑ 17.Reheating
❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling i
❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding
PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control
❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS
❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP
❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY
❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations
Critical(C)violations marked must be corrected immediately. (blue&red items) . Corrective Action Required: ❑ No ❑ Yes
Non-critical(N)violations must be corrected immediately or Overall Rating
within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension
C N Official Order for Correction: Based on an inspection today,the items ® Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other:
checked indicate violations of 105 CMR 590.000/Federal Food Code.
23,Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations,
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F.
25.Equipment and Utensils FC-4 590.005 6=One critical violation and less than 4non-critical violations g
( )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot
26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If
C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of
27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to a non-critical
28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address tical violations. If 1 critical refrigeration.
within 10 days of receipt of this order. violation,4 to anon-critical violations=C.
w
29.Special Requirements (590.009) y p
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 PIC's Signature Print:
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N
Dumpster Screen? Y N
„ �.. - .. ... _ - ..orF:r�'"'`'''i�-, - .- �•L-�.-•..+.-.,--Cam.:..,-,,_�,..�.-.-.�--:•-*-"v'-�-"�°d. ^-•--.�.-,a+''v�.r�^'Z-.►T,'M"•?`'�r�e-�.. � i
Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*
590.003(B) Demonstration of Knowledge* 3-302.1 l(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs
2-103.11 Person-in-Char a Duties Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding
g 3-302.14 Protection from Unapproved Additives
Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41
EMPLOYEE HEALTH 590.004(F)
3-302.1 I(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*
Requiie Reporting by 7-102.1 l Common Name-Working Containers Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above l30°F*
Applicants* 3-302.11(A) Food Protection*
7-201.11 Separation-Storage* 20 Time as a Public Health Control
Pred Use*
590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.1 I Restriction- sence an3-501.19 Time as a Public Health Control*
Applicant To Report To The Person In Charge* 7-202.12 Conditions of Use*
3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements
590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions*
Contamination from the Consumer
3 590.003(D) Exclusions and Restrictions* 6- 7-204.11 Sanitizers,Criteria-Chemicals* ! REQUIREMENTS FOR
3-306.14(A)(B)Returned Food and Reservice of Food*
590.003(E) Removal of Exclusions and Restrictions Disposition ofAdultereted or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
'
Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
4 Food and Water From Regulated Sources g • • Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and
3-201.12 Food in a HermeticallySealed Container* * Raw Seed Sprouts Not Served*
Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and
3-201.13 Fluid Milk and Milk Products* ` 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served*
3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 1 g Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or
Equipment* Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking'Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef#-li-111200J
590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec*
Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell
Shellfish and Fish From an Approved Source 3-401.1 l(B)(1)(2) Pork and Beef Roast-130'F 121 min-* Eggs*
3-201.14 Fish and Recreationally Caught Molluscan
4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec*
Contact Surfrf aces of Equipment*
Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590-009(A)-(D)in cater-
, Sources* 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 _ ( )O p
*d A d H di C 11 Cl 301- . ean Condition-Hands anrms
Regulatory Authority 2 3-401.12 Raw Anima]Foods Cooked in a Microwave the appropriate sections above if related to
3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors.
590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special
Requirements.
5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec*
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23.30)
ti Critical and non-critical violations,which do not relate to the foodburne
12 Prevention of Contamination from Hands ( ) g illness interventions and risk factors listed above,can be found in the
3-]01.11 Food Safe and Unadulterated* 3-403.1 I E Remaining Unsliced Portions of Beef Roasts*
8 1 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
3-202.18 Shellstock Identification* 13 lHandwashing 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* 5-205.1 I Accessibility,Operation and Maintenance
_ Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008
HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009
3-502.11 Specialized Processing Methods* 30. 1 Other
3-502.12 ' Reduced'Oxygen Packaging Criteria*
8-103.12 Conformance with Approved Procedures* '
S:590Formback62doc
*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.
pt*K�E roy TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of
Py OFFICE HOURS
PUBLIC HEALTH DIVISION a:oo-ssoA.nn.
BARNSTABLE. = 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
M679• .0� HYANNIS,MA 02601 nnoN.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY
�ptFC MPr p 508$624644 -
FOOD ESTABLISHMENT INSP CTION REPORT
Name DateLy Type of Type of Inspection ;41
Qpffatgmw Routine '4
Address Risk pod Serv• Re-inspection
Level Previous Inspection 44
Telephone Residential Kitchen D
Mobile
Owner HACCP YIN Temporary Suspect Illness
Caterer General Complaint 12
Person in Charge(PIC) Time Bed&Breakfast HACCP
Other
In:
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
f)-,K.
FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures
❑ 5.Receiving/Condition ❑ 17.Reheating
❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling
❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding
PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control
❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP
❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY
❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations
Critical(C)violations marked must be corrected immediately. (blue&red items) ,A4 [E�] Corrective Action Required: ❑ No ❑ Yes
Non-critical(N)violations must be corrected immediately or Overall Rating
within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension
C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other:
checked indicate violations of 105 CMR 590.000/Federal Food Code.
23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations,
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F.
25.Equipment and Utensils FC-4 590.005 B=One critical violation and.less than 4�on-critical violations g
( )( ) cited in this report may result in suspension or revocation,of the food if no critical violations observed,4 to 6 non-critical violations=B.
26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically 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 non-critical. . 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.
within 10 days of receipt of this order. violation,4 to 8 non critical violations=C.
29.Special Requirements (590.009 Y P
30.Other DATE OF RE-INSPECTION: In pectoris Signature Print:
31.Dumpster screened from public view vjmlj)w�z" MT/�� A
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
#Seats Observed Frozen Dessert Machines: Outside Dining _Y_N s Ignature Print:
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N
Dumpster Screen? Y N -
Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*
590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs
Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding
2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives
Contamination from Raw Ingredients 15 590.004(F)
590.003(C) Responsibility of the Person-in-Charge to 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*
Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F*
P g
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* 20 Time as a Public Health Control
590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*Applicant To Report To The Person In Charge* 3-304.11 Food Contact with Equipment and Utensils*
7.202.12 Conditions of Use* 590.00411 Variance Requirements
590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions*
( ) ance q
Contamination from the Consumer
3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR
3-306.14(A)(B)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions Disposition 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* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of
3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or
5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec*
Equipment* Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff cti"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 Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater-
3-201.15 Molluscan Shellfish from NSSP Listed Chemical*
* Ratites-165°F 15 sec* in mobile food,temporary and residential
Sources g, P aTY
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 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* 3A03.1I(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30)
Critical and non-critical violations,which do not relate to the foodborne
3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the
6 TagsiRecords:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
* 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F
3-203.12 Shellstock Identification ( ) Item Good Retail Practices FC 590.000
3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F
Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003
* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004
3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005
3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008
HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009
3-502.11 Specialized Processing Methods* 30. 1 Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
i
F IHE r TOWN OF BARNSTABLE. HEALTH INSPECTOR'S Establishment Name: _Date: A`� - age: of
P� "ya OFFICE HOURS
PUBLIC HEALTH DIVISION 8:00-9:30 A.M.
BARNSTABLE, = 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
� t'6 q �•� - HYANNIS,MA 02601 MON.-FRI.-862-0644 No Reference R-.Red Item - - PLEASE PRINT CLEARLY-.
`reD MPS°
FOOD ESTABLISHMENT INSPECTION REPORT 508
Name Date ' T e of T sec ion
O e s o
Address % Risk ervic ction
/ 72 Rloz, Level Previous Inspection
Telephone Residential Kitchen Date:
e-o erati•
Mobile P
Iness
Temporary ec l
Owner HACCP Y/N p ry
Caterer General Complaint
Person in Charge(PIC) Time Bed&Breakfast HACCP
Other
In:
Inspector YA 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) ❑
VA
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 HS �
❑.10.Proper Adequate Handwashing CONSUMER ADVISORY
❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations
Critical(C)violations marked must be corrected immediately. (blue&red items Corrective Action Required: ❑ No ❑ Yes
Non-critical(N)violations must be corrected immediately or Overall Rating
within 90 days as determined by the Board of Health. ❑ Voluntary Compliance. ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension
C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other:
checked indicate violations of 105 CMR 590.000/Federal Food Code.
23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9-or more non-critical violations,
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F.
(FC-4)(590.005 6=One critical violation and less than 4 non-critical violations g
25.Equipment and Utensils ) cited in this report may result in suspension or revocation of the food
if no critical violations observed,4 to 6rion-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot
26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of
27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8 non-critical violations: If 1 critical refrigeration.
28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8 non-critical violations=C.
29.Special Requirements (590.009) within 10 days of receipt of this order.
30.Other DATE OF RE-INSPECTION: Inspector's Signature Print:
31.Dumpster_screened from public view . l J
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
#Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print:
Self Service Wait Service Provided Grease Trap Size a Variance Letter Posted. Y N
Dumpster Screen? Y N
Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
i
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*
590.003 * * 3-501.15 Cooling Methods for PHFs
(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives
- Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding
2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives
Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F
590.004(F)
EMPLOYEE HEALTH_, 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*
2 590.003(C) Responsibilityof the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F*
7-202.11 Common Name-Working Containers* 3-501.16(A) Roasts Held At or Above 130°F*
Require Reporting by Food Employees and Contamination from the Environment
7-201.11 Separation-Storage*
Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control
3-302.15 Washing Fruits and Vegetables
7-202.11 Restriction-Presence and Use*
590.003(F) Responsibility of A Food Employee or An 3-501.19 Time as a Public Health Control*Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements
590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q
Contamination from the Consumer
3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR
3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g � )
Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
4 Food and Water From Regulated Sources y 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 Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served*
y Pe 7-206.13 Tracking Powders,Pest Control and *
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served
3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or
5-101.11 Drinking Water from an Approved System* gg Not Otherwise Processed to Eliminate
Equipment*
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective riuzoor
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 3-302.13 Pasteurized Eggs Substitute for Raw Shell
Shellfish and Fish From an Approved Source Equipment* 3-401.11(B)(1)(2) Pork and Beef Roast-10'F 121 min* Eggs*
4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*
Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater-
3-201.15 Molluscan Shellfish from NSSP Listed Chemical*
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 Authority
Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms*
Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to
3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors.
590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special
Requirements.
5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec*
3-202.t1 PHF's Received at Piopef Temperatures* I 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)
g �ty Critical and non-critical violations,which do not relate to the fuodborne
3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F
3-202.18 Shellstock Identification g Item Good Retail Practices FC 590.000
3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F
Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003
5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004
3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005
3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008
HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009
3-502.11 Specialized Processing Methods* 30. Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 Conformance with Approved Procedures* S:590Fomrback6-2doc
*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.
Op 114E A TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of
W OFFICE HOURS
PUBLIC HEALTH DIVISION 8:00-9:30 A.M.
BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
:';9. HYANNIS,MA 02601 M-8 -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY
'�ao MA+p
FOOD ESTABLISHMENT INSP CTI N REPORT 508
Name Date Re of Ty6e o ectio
to s outine
Address { Risk Food ce action 1
9AXLevel etas Previous Inspection l
Telephone Residential Kitchen Date: G
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:
G
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) l
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(HS )
❑ 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 t
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.
(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 if: no hot
C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of
27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must
violations observed,c to anon-critical violations. If 1 critical refrigeration.
28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address
within 10 days of receipt of this order. violation,4 to 8non- ritical 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
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N A .
#Seats Observed Frozen Dessert Machines: Outside Dining Y N PI 's Prin ��
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N
Dumpster Screen? Y N
Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*
590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs
Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding
2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives
Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F
EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying7-102.11 Common Name-Working Containers Information-Original Containers* 590.004(F)
*
2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F
Require Reporting by Food Employees and Contamination from the Environment 7-201.11 *
Separation-Storage 3-501.16(A) Roasts Held At or Above 130°F*
Applicants* 3-302.11(A) Food Protection* LIP— 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 Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( )
Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and
* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations
3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served*
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served
3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 183-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
5-101.11 Drinking Water from an Approved System*
4-601.11(A) Clean Utensils an Eggs d Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or
Equipment* Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff ti-urrzoor
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*
3 401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
Shellfish* 4-703.11 Methods of Sanitization-Hot Water and
3-201.15 Molluscan Shellfish from NSSP Listed * Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater-
Chemical Ratites-165°F 15 sec*
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 3A01.12 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 practiceRequirements.
should be debited under#29-Special
5 Receiving/Condition 2-0Ol.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* 3403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
* 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30)
3-202.15 Package Integrity g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome
3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the
8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and listed
CMR an be
0
* 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140*F to 70°F
3-203.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000
3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F
Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003
3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004
* 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005
3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 1 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 17008.
HACCP Plans 6-301.12 1 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.
1qppI-rqY TOWN OF BARNSTABLE H LTH INSPECTOR'S Establishment Name: _ (-� _ " J 0 1rX- ate: Page: of
�o FFICE HOURS
PUBLIC HEALTH DIVISION �, :00-9:30A.M.
BAR- NnABLE. 200 MAIN STREET :30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION. Date Verified
MASS. g. MON.-FRI.
9g, +bas•p.• HYANNIS,MA 02601 08-862-4saa No Reference R-Red Item PLEASE PRINT CLEARLY
'FDN1A` FOOD ESTABLISHMENT INS C I REPORT
Name Date Tvue of Type of Inspection
g Routine '
Address Risk + ood Se ce Re-inspection
Level i Previous Insp
Telephone Residential Kitchen Qa
Mobile re-operation
Owner HACCP YIN Temporary ss
f t"!
Caterer General Complaint
Person in Charge(PIC) Time Bed&Breakfast HACCP �SO kip" � \
Other 7
Inspecto p
Each violation checked requir s an explanation On the narrati a 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) 1
❑ 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 J\�
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations
Critical(C)violations marked must be corrected immediately. (blue&red items) I ��I I Corrective Action Required: ❑ No El
Non-critical(N)violations must be corrected,immediately or Overall Rating I
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 6=One critical violation and less than 4non-critical violations g
(FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot
26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of
27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must
28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical iolations. If 1 critical refrigeration.
' ation,4 to 8non-Critical vi"iovx C.
29.Special Requirements (590.009) within 10 days of receipt of this order.
Si
30.Other DATE OF RE-INSPECTION: s, ctor 9n ure ® � Prin.
31.Dumpster screened from public view -M-7
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N ,
#Seats Observed Frozen Dessert Machines: Outside Dining Y N Prrs-Signa re 1 Prin
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N -��/t/A
Dumpster Screen? Y N lJ�
Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*
590.003 * * 3-501.15 Cooling Methods for PHFs
(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives
Cooked and RTE Foods.* * 19 PHF Hot and-Cold Holding
2-103.11 Person-in--Charge Duties - 3-302.14 Protection from Unapproved Additives
Contamination from Raw Ingredients 1 g Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F
590.004(F)
EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*
2 590.003(C) Responsibility of the Person-in-Charge to Other* g g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F*
7-102.11 Common Name-Working Containers 3-501.16 A
Require Reporting by Food Employees and Contamination from the Environment ( ) 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 3-501.19 Time as a Public Health Control*
- 3-302.15 Washing Fruits and Vegetables *
Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use
3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements
590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions*
Contamination from the Consumer
3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* „ . - REQUIREMENTS FOR
3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for 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
4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served* .
3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served
3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155'F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or
Equipment
5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective inrzooi
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.l l(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 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater-
Ratites-165°F 15 sec*
Sources* ing,mobile food,temporary and residential
1=010 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 Requirements.
Reheating for Hot Holding practices should be debited under 929-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 O 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 Unshced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
* 13 Handwashing Facilities 3-501.14 A
3-202.18 Shellstock Identification ( ) Cooling Cooked and nd From 70°F to 41°F/45°F Fr from 140°F to Item Good Retail Practices FC 590.000
3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours /45
5-203.11 Numbers and Capacities*
Within 4 Hours* 23. Management and Personnel FC-2 .003
TagsiRecords:Fish Products p
3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004
5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005
3-402.12 Records,Creation and Retention* Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 1.008
HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009
3-502.11 Specialized Processing Methods* 130. 1 Other
3-502.12 1 Reduced-Oxygen Packaging Criteria*
8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
`oF�ME ror TOWN OF BARNSTABLE. HEALTH INSPECTOR'S Establishment Name: AX 7�_r( Date: 2! f Page: of
1a OFFICE HOURS
PUBLIC
2 0 MAN STREET 3
DIVISION- : 0-9:30A.M.
BARNSTABLE. :30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
�p MASS.q. `e$ HYANNIS, MA 02601 soe 86Z-Fasaa No Reference R-Red Item. PLEASE PRINT CLEARLY
p FOOD ESTABLISHMENT INSPECTION REPORT /<
- o 4. o4er
Name r-f Date �e of of Inspection
r
r s Routine h M
Address 177 P/QAfA _4- Risk ood SREnspection r t
Level Retail Previous Inspection do
Telephone Residential Kitchen Date: p
Mobile Pre-operation
Owner HACCP Y/N Temporary Suspect Illness
Caterer General Complaint
Person in Charge(PIC) Time Bed&Breakfast HACCP
In: Other Hi, ecLed Inspector - Out: �(�2.
✓/ W Gtf'l -
Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. to
Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) eGt
Anti-Choking 590.009(E) I CA et44�
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 SUSCEPTI7BE POPULATIO S(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) l ® Corrective Action Required: o ❑ Yes
Non-critical(N)violations must be corrected immediately or Overall Rating
within 90 days as determined b the Board of Health. I Voluntary Compliance Employee Restriction/Exclusion Re-inspection Scheduled Emergency Suspension
Y Y � ❑ rY P ❑ ❑ P ❑ 9
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=YF 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 9rion-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of
27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8rion-critical violations. If 1 critical refrigeration.
28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address viol 4 t non-critical violations=C.
29.Special Requirements (590.009) within 10 days of receipt of this order.
30.Other DATE OF RE-INSPECTION: Inspe or's Si re PDA
31.Dumpster screened from public view (2
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
#Seats Observed Frozen Dessert Machines: Outside Dining Y N PI ' ignat a Print:
Self Service Wait Service Provided Grease Trap Size: Variance Letter Posted Y N
Dumpster Screen? Y N
Violations related to Foodborne Illness - Vo/ations 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 Assi ent of Responsibility* 8 Cross-contamination Law Cooled to 41°F/45°F Within 4 Hours*
( ) gnm14 Food or Color Additives
590.003 * * 3-501.15 Cooling Methods for PHFs
(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives
Cooked and RTE Foods.* .- , PHF Hot and Cold Holding
2-103.11 Person-in-Charge Duties - 3-302.14 Protection from-Unapproved Additives*
Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F
590.004(F)
EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*
2 590.003(C) Responsibility of the Person-in-Charge to Other* g g 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F*
Require Reporting by Food Employees and Contamination from the Environment * Ti
3-501.16(A) Roasts Held At or Above 130°F*
3-302.11(A) Food Protection 7-201.11 Separation-Storage*g 20 me as a Public Health Control
�590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements
590. 3(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q
00 - - - Contamination from the Consumer
3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR
3-306.14(A)(B)Resumed Food and Rlated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions g � )
Disposition of Adulterated or Contaminated
Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and
* 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations
3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served*
3-201.13 1 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served
3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 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 Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or
5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathogens* e//cn-ritizoor
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 r f ces of Equipment*
of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*
Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater-
* Ratites-165°F 15 sec* in mobile food,temporary and residential
Sources g, P
10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under
Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms*
Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to
3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* 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 Requirements.
ochrsshould 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)
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* F18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F.
3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000
Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003
3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004
* 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005
3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008
HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009
3-502.11 Specialized Processing Methods* 130. 1 Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 1 Conformance with Approved Procedures* S:590Fon"back6-2doc
'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.
`gyp IHE r TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: t rc/ '{r( Date: Page: _of/
OFFICE HOURS --;�
B AR E.O•` PUBLIC
2 0 MAN STREET 3:30-
DIVISION - : 0 4:30 P.M.:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
�p e;v: `0$ HYANNIS, MA 02601 508-s2-4W No Reference R-Red Item PLEASE PRINT CLEARLY
'FDN1P�' FOOD ESTABLISHMENT INSPECTION REPORT
Name Date Tyne of Type of Inspection '
Qj2eration(s) Routine r
Address7 7 Risk Food ervl Re-inspection 1
e �h Level Previous I sp ction t
Telephone Residential Kitchen D t 7
Mobile Pre-oper '
Owner HACCP Y/N Temporary c Illness
Caterer General Complaint
Person in Charge(PIC) Time Bed&Breakfast HACCP
In: Other
Inspector V S' A 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) ❑ Q ,/Yvr r
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
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations
Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: No ❑ Yes
Non-critical(N)violations must be corrected immediately or
within 90 days as determined b the Board of Health. Overall Rating
Y Y ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled El Emergency Suspension
C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other:
checked indicate violations of 105 CMR 590.000/Federal Food Code.
23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations,
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F.
25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than non-critical violations
26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot
27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of
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.
viol
29.Special Requirements (590.009) within 10 days of receipt of this order.
' n,4 non- riVcal violations=C.
30.Other DATE OF RE-INSPECTION: Insp is Signature Pr'
31.Dumpster screened from public view
iv'S�w►
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N -�
#Seats Observed Frozen Dessert Machines: Outside Dining Y N P t e Pr'
����
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 far PHFs
Cooked and RTE Foods.* 19 PHF Hot and Cold Holding
2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives*
Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F
EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F)
590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* *
Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F
2 *
Applicants* 3-302.11(A) Food Protection*
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 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*
Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004(11) Variance Requirements
590.003(G) Reporting by Person in Charge
* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions*
Contamination from the Consumer
3 1590.003(D) I Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR
3-306.14(A)(B)Returned Food and Reservice of Food 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
590.003(E) Removal of Exclusions and Restrictions g
Disposition ofAdulterated or Contaminated
Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and
g
3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control
Seed Sprouts Not Served*
ol 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
Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of
3-202.16 Ice Made From Potable Drinking Water* 3 401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or
5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec*
pp Y Not Otherwise Processed to Eliminate
Equipment* ( )( ) Pathogens*590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game g * E ecr;ve 1/I1200I
4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec*
590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell
Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs*
4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*
Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or
3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary
and - ide 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* the appropriate sections above if related to
Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave
3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors.
Other
ating
o good retail
590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* practices 0should.009 rbe debited olations lunder t#29-Special
11 Good Hygienic Practices 17. Reheating for Hot Holding 3-201.17 Game Animals* g Requirements.
5 Receiving/Condition 2401.11 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* 3A03.11(C) Commercially Processed RTE Food-140°F* (Blue Items non-critical
23-30)
3-202.15 Package Integrity Y Critical and non-critical violations,which do not relate to the foodborne
* 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts*
' 3-101.11 Food Safe and Unadulterated O g illness interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
* 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F
3-202.18 Shellstock Identification ( )
3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000
Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003
* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient° 24. Food and Food Protection FC-3 .004
3-402.11 Parasite Destruction Temperature Ingredients to 41 F/45 F 25. Equipment and Utensils FC-4 .005
3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008
HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009
3-502.11 Specialized Processing Methods* 130. 1 Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
Town of f arns tar]e
Foard of .Fealth
Town Hall- �.
Eyanniso. MA
To whom it may concEm:
This past Saturday, July 20th, early in the evening I took
my kids to Baxters fish and Chips at the end of Pleasant Street,
Hyannis. I was shocked to see what 'looked_and smelt--like sewer
water .coming up fr.on a steel cover in the ground and running into
the harbor. There was a young man sweeping the water and when I
asked him why the owner does not fix the problem he told ire "the
owner is a Hyannis cop enough said".
I hope someone will check this out to make sure that no more
of this dischargegoes into the harbor and add to the polution
problem.
Sincerely,
,,i RECEIVED
n Hc
arding
Scudder Bay Drive jUL 2 y ZN3
Sa 3
Cenrerville, MA.
TOWN OF 13ARNS-VPIBLE
NTH DEPT.
� (� L
COMMONWEALTH OF MASSACHUSETT
G.L. C. 131 s. 40
EXTENSION PERMIT
FILE NO. 3-16 DATE: June 22, 1976
To: Warren T. Baxter et ux PROJECT LOCATION:Hyannis Inner Harbor
77 Pleasant St. Hyannis, P�;a.
Hyannis, Ma.02601
This Document extends the Order of Conditions issued to Novgn ber:-:13, 1973
for a period of one (1) year from the date of
termination of the last Order of Conditions issued in regards to this project or exten-
sion of same which ever is the. later date. +~
THE EXTENSION MUST COMPLY WITH THE FOLLOWING:
1) Orders of Condition issued November 13, 1973
_ 2) A new plan shall be drawn to reflect the actual conditions now existing at the site
and the original conditions set forth on the project by the Barnstable Conservation
C rmssion . Copies of the new plan are to be filed with the Barnstable
Conservation Cor.¢nission, Department of Public Works TVaterF7ays Division, and
Department of Environmental Quality Engineering Wetlands Division prior to work
in started.
3) A .copy of the Orders of Condition as recorded at the Barnstable Registry of Deeds
shall be filed with.the Barnstable Conservation Com Assion.
4) Iniediately following oompletion of the project, it shall be certified to be as per
orders and plans herein sited by a professional engineer registered in the
Signatures of Issuing Authority: Commonwealth of Massachusetts in writing to the
Barnstable Conservation Commission
on this Z� day of ( 19 76 before me personally appeared
to me known to be the4
person described in and who executed the foregoing instrument and acknowledged that he
did same as his free act and deed.
Notary Public My Commission Expires
CHARLES D. SPOHR, PE
CONSULTING ENGINEER
TEL. 548-0623 REG. PROFESSIONAL ENGINEER
45 FELLS ROAD MASS. No. 7468
FALMOUTH, MASS. 02540 R. I. No. 2146
ASHRAE
22 March 1974
Mr, John M. Kelly
Director of Public Health
Board of Health
397 Main St.
Hyannis, Mass. 02601
Rea Sewage Disposal System
Alterations
Baxter Fish N-Chips
Hyannis, Mass.
Dear Mr. Kellys
I have supervised the sewage disposal system alterations at
Baxter's FishN-Chips and certify the alterations have been
completed in accordance with drawing #12113 approved by the
M.D.P.H. on 2/20/74.
Very truly yours,
C 40• 1+A-00V
Charles D. Spohr, P.E.
CDSsms
ccs Mr. Roland Dusseault, P.E.
Southeastern Health Region
Middleboro, Mass. 02346
Mr, Warren Baxter
Baxter's Fish-N-Chips
177 Pleasant Street
Hyannis, Mass. 02601
Cannons Engineering Corp.
350 Main Street
West Yarmouth, Mass,
MAR 27 1974
TOWS! OF BARNS i A�3LE
BOARD- of1HEALTH
F
.Washington fit. ,
Boston, Mass. 02111
Vebru4ry 19, 1974
Charles B. Spobr, P1140 M B fN 'AM.—subeurf4co Sevage Si sal
45 Pella R0 d Alterationo to ' sting System at Baxter f s
a3mbuth, I+ assach tts 42540 _ pish'n Ch .ps 1'leaaant Str t,, 14rWu� a,
,fob No. 73
Gentlemen.
The Department of Public Health, in response to your request, has had one
of it- engineers ex6mine the soil at the above-noted site and hae revi d a Ptah
titled
s f
T3Ao3C` �N N'N
177 MAN'; ` MMMS XWSP
, .
lamb,: C.D. SPoo AM: 12 UN 71 ,
Nwa: JOB. SHUT .l 0V 1 SLAM: AS SHOWN
MCA; C.D.$-. VOW NO. 1.2113
Coil examinationA conducted at the subject site on Novembet 5ii 1973 in the
area proposed for subsurface sevage disposal indicate that the natural soil, beneath
uph4 t, fill, loam and subsoil, consists .of coarse sand which has a percolation rate
of less than two mutes " inch�. {drdund water *Aa +�nc4unt+ertd at an elevation
of o.24 Feet
lne plan y r osea 'to dispose of 1#9 011011a pear day of sewage from the
Subject Project by means of an existing 40000 gallon concrete septic tt a new
distribution box, and leaching field with a total available leaching area of 3,C
square feet. A new, IOW gallon grease trap will be installer'! prior* to the septic
tank to intercept all: kitchen wasted,
The Divlai6n of Environment4l He4ith hereby approves the plan with the
following provUiona f
1. The out�tt tee ah the grows tftp. shall O%tend 53 inches below the
liqut d .-leve! li. :
2. The new distribution, box ghalj hove a oaet, iron fr-OkO .and cover .to grade.
3. A4 water services to the re taur"ant dh4a be a minims of .10 feet 4way
f°rot6 any part cif the !ayst = .
Oon:struction ehaal be, in strict accordance with. the. approved plan and
Arta.c]a XI, of the $tgte $an ihxy Code d no further chang�!:� will be
made,fn tDepartmeiihe appr vpd glen without they priorvr3tten ap ova1 of�this3
5. A ?3 app04— 'forks dOnatVuetion ,Pe—*it m 4t.be o�ned a the far', able
d of Heaxth,prior to the ;start of any eonotru`ction .
6. Written OerttficO on that tie- di* .I °fac .it e>a have been crin tructed in
a flrdance w h the approved plank and ie .e Xl of the State dnatary
Oode mutt be .etbmitted: o.the ateb :e.Boar'd cif".Is IS with �e copy to tk�is
oftjeeL*by Your engine. . . 0&0-4 y` prior to the;ay0; b6im backki-Add.
Nothing in, this prov"Ibn 3e.:$nten4e4 to int rfere with the`right !of the.
Bo o#' Health to inepct the d3poaa cilStea at
l d t .me dur3 ;
cc>n�trtetiom -
TM .SyStem ,shall;not bcryvered ;until: ► .Oe>ntif cate of rvcbliercce ie iadued
by the Bairn$tabl,e, Board.o I ealth.
Hnclosed herewith are -Atiatupod a n d coploo, of the pl-sn a, copy: of which.
mat die kept.`on the Site, wed,be Used tOr.eonstruetian purpoeea;k
VOY truly your#
for tha � ectaa
Aeiaxa . itez`Y time `"
utheaatern 11e410.legion
kev lle,Hoopftat
wp�, Maosuhusetta 02346
p/tdw/RPP.
cc; Beirnst ble $cad of Ae4M
397 Min Street
Ayann3:'O$''maseachusetta. 02W1
Vwm#tablel county leiatb Pepartment
County, Count.`Hou#e
Barnstable, Ma+ eaehuaett ,
&%1C
P.O. Box 999 • W. Yarmouth, MA 02673 • (508)775-2800 (800)698-3993
Septic Pumping & Installation •Plumbing •Heating •Fire Sprinklers
May 14, 1991
Town of Barnstable
Health Department
367 Main Street
Hyannis MA 02601
Attn: Director of Public Health
Thomas A. McKean
Re: Baxters Boathouse
Dear Sir:
We have a prearranged maintainance schedule of monthly grease trap pumping during
the season of May to October and we also pump the septic tank in October. This has
be done since the system was installed.
The Baxters are ready to connect to the sewer system when it is extended down
Pleasant Street.
Sincerely,
. Robert non
jrc:smd
TOWN OF BARNSTABLE
DEPARTMENT OF PUBLIC WORKS
WATER POLLUTION CONTROL DIVISION
617 BEARSE'S WAY HYANNIS, MA 02601
(508) 790-6335
Date: March 6, 1996
To:Baxter's Fish and Chips
177 Pleasant Street
Hyannis,MA
Subject: Grease trap
The Town of Barnstable requires all restaurants to have a grease trap installed so that grease does not
enter the sewer system. The purpose of a grease trap is to prevent the grease from blocking the piping.
Blockages cause flooding of buildings and roadways with sewage. The grease trap needs to be pumped
out on a regular basis.
To ensure the effectiveness of the grease trap,the Town of Barnstable Board of Health and the
Department of Public Works, Water Pollution Control Division(WPCD)monitor and enforce the attached
regulation. Regulation, #310 CMR(Commonwealth of Massachusetts Regulation)Paragraph 15.351.2,
sets the minimum standard for cleaning grease traps.
WPCD monitors grease trap pumping and semiannually forwards a copy of this letter to the Board of
Health. Our records indicate that your facility has not pumped its grease trap in the past year. When you
apply for your seasonal restaurant license this year at the Health Department they will have our list
indicating that your grease trap hasn't been pumped. They will require you to pump your grease trap
before issuing the seasonal license.
If you have questions call the above phone number.Your participation is essential and your cooperation
appreciated.
Sincerely,
Peter oyle,
Supervisor,WPCD
enc.
PD/eje
I
Cffi�cllpm����
350 Main St. • W. Yarmouth, MA 02673 • 775-6264
Div,sion of Canco Energy Corporation Septic Services a Pumping • Installation
September 29 , 1988
Mr . Thomas Mullen
Superintendent
Department of Public Works re : }Baxter ' s Fish N Chips]
South Street Pleasant St . , Hyannis]
Hyannis MA 02601
Dear Sir :
We have been servicing this establishment for a number of
years and we find that the septic system is not working
properly , requiring continuous pumping - particularly on
weekends . We therefore recommend and request permission
for the installation of a pump station connecting to sewer
system on Pleasant Street .
It would be impossible to install a new Ti-tle V system in
this area because of the fill land condition and high water
water table .
Very truly yours ,
A & B CANCO
J. Robert Cannon
JRC :mm
cc : Town of Barnstable Board of Health
cc : Barney Baxter
TOWN OF BARNSTABLE
�F7NET0
OFFICE OF
139TABL s BOARD OF HEALTH
rAea. 367 MAIN STREET
9�C i639
th" HYANNIS, MASS. 02601
�0 MA'f
September 27, 1988
TO: Thomas Mullen
Superintendent, Dept. of Public Works
FROM: Thomas McKean
SUBJECT: Baxter's Fish N'Chips Food Service Establishment
The onsite sewage disposal system servicing Baxter's Fish N'Chips, located
at 177 Pleasant Street, Hyannis, requires continuous pumping and is inadequate.
The owner of the building is required to keep the system pumped daily, if
necessary. Failure to keep the system pumped and failure to upgrade the system
to meet Title 5 and Town Health Regulations which does not appear feasible,
or failure to connect the building to Town Sewer, may result in suspension
or revocation of the food service permit and cessation of food establishment
operations.
It is strongly recommended, if at all feasible, Baxter's Fish'N Chips Food Service
Establishment be permitted to connect into the Town sewer system.
Copy to: Robert Cannon
jc
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✓ g� (SE"i �` p � � r
P t�
TowSph
SERIES
KOLDFLO
SERVICE CASES
LOW PROFILE
DELI
DOUBLE DUTY
}
�m HOW i CC R A it FA X 2'1 5 6 9 4 8 9 0` PAUL
Mg.
Ud CO;'ray Koiciff oervice ses
DELI DOUBLE DUTY LOW-PhOFILE
GENERAL SPECI"IFICATIONS AND FEATURES
CONSTRUCTION: Body Internally reinforced Urfl-Structure.Mounted or,ht gauge
DOOR$: Top doors are slide type-Rear display section doors are constructed of ex-
galvanized external bottom frame with stool channel runners.Built to m,,,t,,, trudel aluminum,reinform with internal corner gussets.The doors are removable from
with heavy duty usage. the track frame around the entire opening,
INTERIOR: Anodized a!um.inurn full.040 thickness,Display area finlsho4 y1h a halt Euh door Is air sealed with an air see!wiper between doors which provides 1,01 protec-
neat treated while enamel long wearing surface,The floor Is stamped Out of o sheet of tion from air Inks.The upper doors are equipped with No thicknesses of sealed Oiss-
anodized full hard aluminum,and embossed drain off rain trap:]cutters to the built-in d The lower door is hinged type with.aluminum interior and exterior.
outlet,Sectional,removable floor racks provided to protect Inside floor. I . .
FRONT DISPLAY CLASS: Three pane clear view glasses,sealed into insulating spaces.
UTERIOR;Mirror finish oalniess steel t,,�ps and loweffront glass sill bumpe1rail Ior 4R- Guaranteed for 5 years against oisPiay distortion from defect to the seal between the
case lengths are stamped-out of one piece sheet,no seams or lolning pfeGosks permit- glasses,
tad.rormed stainless steal end trirn protects the case ends from damage.Front and
ends finished with a Nat treated while enamel long wearingsuNm.Optional oolarends REFRIGERATION: $oil Contained.
and from panel wilablt.Rear of can is of hard wearing aluminum,rsslstar to grease, All model&are equipped with extra heavy duty cooliq,coils.Efficient oravily KOLDFLO
and cleans easily. colls.The top coil has 10 tubes,and extra storage coil Is made with 4 tvNs,top co!l is
length of case.Expansion valve supplied,$tendard,
INSULATION: High density energy saving frothed-in-placo Urethane equal toitwicif the
inswating value of other insulating material.CFC free,environmentally safe. I Self Contained models are fully Interconnected with the compressor unit built into the
lower compartment at one end,ready for operation when supplies with suitable voilage,
ILLUMINATJON: Two rows of full length fivotosotnt shielded lighting rtoujijed antler .;See compressor unit data for sins and Electrical information,Copeland compressors
Inside 100 of case to provide flood lighting through entire interior display arO;. standard.
AFFLIANCE RECEPTACIE:Supplied at(ea.,of case In 115V-15 AMP. i REMOTE:available.
MEZZANINE SHELF 7 Ono full length adjustable shelf 12'wide mad-of slai!I ess stool, ENERGY SAVER CONDENSATE EVAPORATOR; 07,self-contained models condensate is
will not sain from food acids. i dissipated automatically by meaRs of condensing unit hot gas.
FLOOR RACKS:Coated white epoxy heavy welded wire rods, DEFROST TIME CLOCK: Adjvslable time clock furnished standard,Defrosts coils auto-
matipally as customer requires.(self-contained models only)
QUALITY CONTROL, All Woray models are fully tested to strict speeificatijid s by our
Q:C,Test Department. . NOTE:All specifications are subject to change without notice.Maximum recommended
MAIN DECK SHELVING:Heavy wire rodwelded electro-plated and while ql l epoxy ambient conditions 75°K,55%R.H.
finish The shelves are adivstalals,sectional and removable.
EN(�NEERING SPECIFICATIONS
.I . I
Door•Size Dls6tay Electrical Case
Model No. Upper Lower C;I fis 8 Voltage Amps Wt. Comp. 01mensions
L11 X W L"x H" ; D"x HN x
SC-ODS35.4L 19'/Ie X 19'ho i T
22 X 11 1/2 26" 45" 6.0 400 1/4 50 X 35 1/2 x 44
i 11 5V_WC1'
SC-COS35-6L 29 s/9 x 19 3h 22 X 11 1/2 26* 166' 1 Phase 8.7 575 113 72 x 35 44
SC-CDS35-8L 19";,-.s X 19 she 22 X 11 1/7 26' i90, 1 9.1 750 1/3 96 X 35 1h x 44
li
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CAII Rights Reserved,McCray Refrigerator,Uoldflo, registei d.
Q -Dimensional Tolerance 1/4"
SPEC lf ICA'rIONS b, &ECIT TO CHANGE WITHOUT NOTICE,
x"
DE IN
CFC FREE CFC InAtt
1 INSULATION HFIFRIOERANT W14ar_MMUDI�_l
-FLk;ORF,jrENT
SMCCED LAMPS
20'
S 494
11 3 PLit FRONT"LASS ct
7,'�%l.17 A 8 L
11E22AN[NE SMP F
44'
d",Srf OUT -CONDENSING
DRAIN
MOUSING
21' ks
t jilt F LOOP F;.0(D rl
2
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0'1-4
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29-
DISTRIS1.)7E0 BY
HOWARDf MdRAY WRIGER00111t M INC
Grant Avenue and Sluograss Road
Philadelphia. FA 19114 (21$)464.680-11
F&C Countertops
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-OFFICE OF THE BOARD. OF HEALTH
OF THE
o BA3389TABLF., a TOWN OF BARNSTABLE, MAS
9p MASS. r
pA 1639. -- ----- -'-- 19
a m�Y�"� SEWAGE DISPOSAL PERMIT
Permission: is granted to ___ '_ __-- -------- -
--- to construes —#-- ----h 6
\ Sketch
U on ye Premises of
h
---- -----: - - --------- - ----- --- - -
In the viljpge of
-- -- -- X
----- -------------------------------- -- -=------- ----------
""orfeet from any source of water supply ` _
20 feet from building
10 feet from property line
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Health C`
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Commonwealth of Massachusetts
Executive Office of Environmental Affairs MEPA Office
i Y
ENVIRONMENTAL
NOTIFICATION FORM
Project: C::B_axter's=Boat--House-
177 Pleasant Street
Hyannis, Mass.
Proponent: Samuel T. Baxter, Trustee
177 Pleasant Street
Hyannis, Mass.
prepared by:
Sullivan Enginee ring,Inc.
7 Parker Road, P O Box 659
Osterville, MA 02655
508-428-3344
4
I
Commonwealth of Massachusetts For Office lice Only
For
Office of Environments[Affairs
Executive Office of Environmental Affairs o MEPA Office
EOEA No.:
Environmental MEPA Analyst:
ENF Notification Form I
Phone: 617-626-
The information requested on this
form must be completed to begin MEPA Review in accordance with the provisions of the
Massachusetts Environmental Policy Act, 301 CMR 11.00.
Project Name:
Baxter's Boat House
Street: 177 Pleasant Street
Municipality: Barnstable (Hyannis) Watershed: Hyannis Inner Harbor
Universal Tranverse Mercator Coordinates: Latitude: 41 39'00"
UTM: 461150ON 393480E Lon itude: 70 16' 43"
Estimated commencement date: April 2006 Estimated completion date: May 1, 2006
Approximate cost: $30,000.00 1 Status of project design: 100%complete
Proponent: Samuel T. Baxter, Trustee
Street: 177 Pleasant Street
Municipality: Barnstable (Hyannis) State: MA Zip Code: 02601
Name of Contact Person From Whom Copies of this ENF May Be Obtained:
Peter Sullivan, P. E.
Firm/Agency: Sullivan Engineering Inc. Street: 7 Parker Road, P. O. Box 659
Municipality: Osterville State: MA Zip Code: 02655
Phone: 508-428-3344 Fax: 508-428-3115 E-mail: osulloeOaol.com
Does this project meet or exceed a mandatory EIR threshold (see 301 CMR 11.03)?
❑Yes X No
Has this project been filed with MEPA before?
[]Yes (EOEA No. ) No
Has any project on this site been filed with MEPA before?
[]Yes (EOEA No. ) No
Is this an Expanded ENF (see 301 CMR 11.05(7)) requesting:
a Single EIR?(see 301 CMR 11.06(8)) ❑Yes No
a Special Review Procedure? (see 301CMR 11.09) ❑Yes No
a Waiver of mandatory EIR? (see 301 CMR 11.11) ❑Yes No
a Phase I Waiver? (see 301 CMR 11.11) ❑Yes No
Identify any financial assistance or land transfer from an agency of the Commonwealth, including
the agency name and the amount of funding or land area (in acres): none
f
Are you requesting coordinated review with any other federal,.state, regional, or local agency?4.-
❑Yes(Specify ) 19 No
List Local or Federal Permits and Approvals: Town of Barnstable Conservation Commission file(fiumbe-'r
SE3-4328. The project has been filed with Chapter 91 Waterways and also with the US'Army CorQs`
of Engineers. -'
L_
"" I1
__n Zln cnc 'Ann
Which ENF or EIR review threshold(s) does the project meet or exceed (see 301 CMR 11.03):
❑ Land ❑ Rare Species Bl Wetlands, Waterways, & Tidelands
❑ Water ❑ Wastewater ❑ Transportation
❑ Energy ❑ Air ❑ Solid & Hazardous Waste
❑ ACEC ❑ Regulations ❑ Historical &Archaeological
Resources
Summary of Project Size Existing Change Total State Permits &
& Environmental Impacts Approvals
® Order of Conditions
❑ Superseding Order of
Total site acreage °� Conditionss4-: A 3.43, '
New acres of land altered 0 Chapter 91 License is
pending
Acres of impervious area 0.45 0.45 ❑ 401 Water Quality
Square feet of new bordering 0 Certification
vegetated wetlands alteration ❑ MHD or MDC Access
Permit
Square feet of new other 17SF ❑ Water Management
wetland alteration Act Permit
Acres of new non-water ❑ New Source Approval
dependent use of tidelands or ❑ DEP or MWRA
waterways Sewer Connection/
Extension Permit
till IS Other Permits
Gross square footage 3975 0 3975 (including Legislative
Approvals) — Specify:
Number of housing units 0 0 0
US Army Permit pending
Maximum height(in feet) Less than 30'
TR�NSPORTATION
Vehicle trips per day 125 0 125
Parking spaces 74 0 74
WATER/WASTEWATER
Gallons/day (GPD) of water 1990 0 19W
use
GPD water withdrawal NA
GPD wastewater generation/ NA
treatment
Length of water/sewer mains NA
IL (in miles)
CONSERVATION LAND: Will the project involve the conversion of public parkland or other Article 97 public
natural resources to any purpose not in accordance with Article 97?
❑Yes (Specify ) 5qNo
Will it involve the release of any conservation restriction, preservation restriction, agricultural preservation
restriction, or watershed preservation restriction?
❑Yes (Specify ) PkNo
RARE SPECIES: Does the project site include Estimated Habitat of Rare Species, Vernal Pools, Priority Sites
of Rare Species, or Exemplary Natural Communities?
❑Yes (Specify ) jQ No
HISTORICAL /ARCHAEOLOGICAL RESOURCES: Does the project site include any structure, site or district
listed in the State Register of Historic Place or the inventory of Historic and Archaeological Assets of the
Commonwealth?
[]Yes (Specify ) M(No
If yes, does the project involve any demolition or destruction of any listed or inventoried historic or
archaeological resources?
❑Yes (Specify ) CqNo
AREAS OF CRITICAL ENVIRONMENTAL CONCERN: Is the project in or adjacent to an Area of Critical
Environmental Concern?
❑Yes (Specify ) CkNo
PROJECT DESCRIPTION: The project description should include (a) a description of the project site,
(b) a description of both on-site and off-site alternatives and the impacts associated with each
alternative, and (c) potential on-site and off-site mitigation measures for each alternative (You may attach
one additional page, if necessary.)
Theproject
o'ect site is an approximately half acre parcel on the waterfront in Hyannis Inner
P J PP Y P Y
Harbor. e Baxter family has been at this site since 1919 when it was purchased by Benjamin D.
Baxter and Elizabeth Baxter and was used primarily for offloading and packing fish from local
and transient fishing vessels as well as for restocking boats with ice and supplies and packaging
and delivering fish to the Boston fish markets and other retailers. In the 1930's Benjamin D.
Baxter Jr. started a trucking company at the Pleasant Street property and shipped goods from
here. The fish and chips storefront restaurant was opened at this location in 1957 and on July 4,
1967 they opened Baxter's Boathouse Club and it has operated continuously at that location since
• that time. As of today, the operation is still built entirely over the water and customers can still
tie up in their boats and have lunch or dinner. There is also a commercial dock where tourists
and sightseers can watch the charter boats and commercial fishing boats unload their daily catch.
The project proposes to permanently remove the berthed vessel the Govenor Brann from
its resent slip location at Baxter's Boat House. The Govenor Brann is resent! used for outdoor
P P presently
dining by Baxter's and will be replaced by a pile supported timber deck. The existing floats
associated with the Boat House operation will be rearranged and supplemented with some
additional floats. A 3 foot wide pile supported timber walkway will be added along the seaward
face of the existing building for maintenance of the structure and for public access.
The net footprint reduction is approximately 1160 sf and the net bottom area reclaimed by
elimination of the slip is approximately 1740 sf.
As an alternative, the project could be accomplished by substituting another barge for the
Govenor Brann in the same boat slip. However, the Harbormaster and Waterways Committee of
the Town of Barnstable, boat line operators and fishing boat operators who make use of this busy
harbor, all prefer the proposed solution.
The project as proposed is not a detriment to any interests of the_public in the waterway
Y
since it reduces the use of the waterway and opens up the harbor which is favored by the
Harbormaster and Waterways Committee of the town. By removing the barge and placing the
proposed pier further inland, the harbor watersheet is increased.
Again, the Baxter family has been at this site since 1919 and the shorefront restaurant was
opened in 1957 and has operated continuously ever since. All other structures now existing have
CH-91 licenses, as was a proposed pier which was licensed but never built in the location. Since
the properties were licensed and operated, they qualified for grandfathering but the petitioners
were not aware of the requirements that further action was needed nor of the time frames
required for such filings. This application seeks to secure a license for the continued operation of
• Baxter's Boathouse at this site.
The proposed solution as described in the project scope reduces the use of the water sheet
by over 1000 square feet.
LAND SECTION —all proponents must fill out this section
• I. Thresholds / Permits
A. Does the project meet or exceed any review thresholds related to land (see 301 CMR
11.03(1) _ Yes _X_ No; if yes, specify each threshold:
II. Impacts and Permits
A. Describe, in acres, the current and proposed character of the project site, as follows:
Existing Change
Total
Footprint of buildings _0.09acres none
Roadways, parking, and other paved areas 0.43 acres none
Other altered areas (describe) _0_`
Undeveloped areas �0
B. Has any part of the project site been in active agricultural use in the last three years?
_ Yes _X No; if yes, how many acres of land in agricultural use (with agricultural soils) will
be converted to nonagricultural use?
C. Is any part of the project site currently or proposed to be in active forestry use?
_ Yes _X_ No; if yes, please describe current and proposed forestry activities and indicate
whether any part of the site is the subject of a DEM-approved forest management plan:
D. Does any part of the project involve conversion of land held for natural resources purposes in
accordance with Article 97 of the Amendments to the Constitution of the Commonwealth to any
purpose not in accordance with Article 97? _ Yes _X_ No; if yes, describe:
• E. Is any part of the project site currently subject to a conservation restriction, preservation
restriction, agricultural preservation restriction or watershed preservation restriction? _Yes
_X_ No; if yes, does the project involve the release or modification of such restriction?
Yes _ No; if yes, describe:
F. Does the project require approval of a new urban redevelopment project or a fundamental
change in an existing urban redevelopment project under M.G.L.c.121A? _ Yes _X_ No; if
yes, describe:
G. Does the project require approval of a new urban renewal plan or a major modification of an
existing urban renewal plan under M.G.L.c.121B? Yes _ No _X_ ; if yes, describe:
H. Describe the ;project's stormwater impacts and, if applicable, measures that the project will
take to comply with the standards found in DEP's Stormwater Management Policy: Exempt as a
CH-91 license is required
I. Is the project site currently being regulated under M.G.L.c.21 E or the Massachusetts
Contingency Plan? Yes _ No X_ ; if yes, what is the Release Tracking Number (RTN)?
J. If the project is site is within the Chicopee or Nashua watershed, is it within the
Quabbin, Ware, or
Wachusett subwatershed? _ Yes X_ No; if yes, is the project site subject to regulation
under the Watershed Protection Act? Yes X No
K. Describe the project's other impacts on land:
•
III.. Consistency
A. Identify the current municipal comprehensive land use plan and the open space plan and
describe the consistency of the project and its impacts with that plan(s): Town of
Barnstable Local Comprehensive Plan adopted Barnstable Town Council,October 30, 1997 and approved
Cape Cod Commission, February 12, 1998
Policy 7.2.5 Hyannis: the small New England seacoast town image and character is to be reinforced
Strategy 7.2.5.2 Zoning Hyannis& Harbor: Zoning for Hyannis should ensure that existing height
limitations and water views are protected. It is our opinion that Baxter's Boathouse captures the harbor
character and ensures views, vistas and activities of a harbor setting and its existing height is one story, with
the exception of a part of the building in the middle which is 2 stories(with a maximum height of less than
25 feet),and the water view will remain much the same as it has been for over 85 years. A local artist has
made this site a topic of one of her paintings.
B. Identify the current Regional Policy Plan of the applicable Regional Planning Agency and
describe the consistency of the project and its impacts with that plan: Cape Cod Commission
Regional Policy Plan
Coastal Resources: 2.2.1.1 Development and redevelopment along the coastline shall not
interfere with existing public access.
2.2.1.2 Public access shall be provided. The project as proposed will enhance public access by the
addition of a wallkway and boat slips. We wish to stress that this proposal is merely a reconfiguration of
existing use of the watersheet and is our opinion a good project as there is a net decrease of 1000 sf
and there are positive aspects with regard to navigation and public use of the watersheet.
C. Will the project require any approvals under the local zoning by-law or ordinance (i.e. text or
• map amendment, special permit, or variance)? Yes _ No _X_ ; if yes, describe:
D. Will the project require local site plan or project impact review?
Yes _X_ No; if yes, describe:
RARE SPECIES SECTION
I. Thresholds [Permits
A. Will the project meet or exceed any review thresholds related to rare species or habitat (see
301 CMR 11.03(2))? _Yes _X_ No; if yes, specify, in quantitative terms:
B. Does the project require any state permits related to rare species or habitat? _Yes
X No
C. If you answered "No" to both questions A and B, proceed to the Wetlands, Waterways, and
Tidelands Section. If you answered "Yes" to either question A or question B, fill out the
remainder of the Rare Species section below.
II. Impacts and Permits
A. Does the project site fall within Priority or Estimated Habitat in the current Massachusetts
Natural Heritage Atlas (attach relevant page)? _ Yes _ No. If yes,
1. Which rare species are known to occur within the Priority or Estimated Habitat
(contact: Environmental Review, Natural Heritage and Endangered Species Program,
Route 135, Westborough, MA 01581, allowing 30 days for receipt of information):
2. Have you surveyed the site for rare species? _Yes _ No; if yes, please include
the results of your survey.
3. If your project is within Estimated Habitat, have you filed a Notice of Intent or received
• an Order of Conditions for this project? _ Yes _ No; if yes, did you send a copy of
the Notice of Intent to the Natural Heritage and Endangered Species Program, in
accordance with the Wetlands Protection Act regulations? _ Yes _ No
-5-
• B. Will the project "take" an endangered, threatened, and/or species of special concern in
accordance with M.G.L. c.131A (see also 321 CMR 10.04)? _ Yes _ No; if yes, describe:
C. Will the project alter "significant habitat" as designated by the Massachusetts Division of
Fisheries and Wildlife in accordance with M.G.L. c.131A (see also 321 CMR 10.30)? _ Yes
No; if yes, describe:
D. Describe the project's other impacts on rare species including indirect impacts (for example,
stormwater runoff into a wetland known to contain rare species or lighting impacts on rare moth
habitat):
WETLANDS,WATERWAYS,AND TIDELANDS SECTION
I. Thresholds / Permits
A. Will the project meet or exceed any review thresholds related to wetlands, waterways, and
tidelands (see 301 CMR 11.03(3))? _x_Yes _ No; if yes, specify, in quantitative terms:
B. Does the project require any state permits (or a local Order of Conditions) related to
wetlands, waterways, or tidelands? _x_Yes _ No; if yes, specify which permit:
C. If you answered "No" to both questions A and B, proceed to the Water Supply Section. If
• you answered "Yes" to either question A or question B, fill out the remainder of the Wetlands,
Waterways, and Tidelands Section below.
II. Wetlands Impacts and Permits
A. Describe any wetland resource areas currently existing on the project site and indicate them
on the site plan: Land Under the Ocean and Coastal Bank
B. Estimate the extent and type of impact that the project will have on wetland resources, and
indicate whether the impacts are temporary or permanent:
Coastal Wetlands Area (in square feet) or Length (in linear feet)
Land Under the Ocean 1471 SF footprint floats, walkway, and deck with only 17
SF of bottom displacement.
Designated Port Areas
Coastal Beaches
Coastal Dunes
Barrier Beaches
Coastal Banks _no new impacts
Rocky Intertidal Shores
Salt Marshes
Land Under Salt Ponds
Land Containing Shellfish
Fish Runs
Land Subject to Coastal Storm Flowage
Inland Wetlands
Bank
Bordering Vegetated Wetlands
• Land under Water
Isolated Land Subject to Flooding
Bordering Land Subject to Flooding
-6-
Riverfront Area
C. Is any part of the project
1. a limited project? _ Yes _x_ No
2. the construction or alteration of a dam? _ Yes x_ No; if yes, describe:
3. fill or structure in a velocity zone or regulatory flood_way? _ Yes _x_ No
4. dredging or disposal of dredged material? _ Yes x No; if yes, describe the
volume of dredged material and the proposed disposal site:
5. a discharge to Outstanding Resource Waters? _ Yes _x_ No
6. subject to a wetlands restriction order? _ Yes _x_ No; if yes, identify the area (in
square feet):
D. Does the project require a new or amended Order of Conditions under the Wetlands
Protection Act (M.G.L. c.131A)? _x_ Yes _ No; if yes, has a Notice of Intent been filed or a
local Order of Conditions issued? _x_ Yes _ No; if yes, list the date and DEP file
number:_SE3-4328 . Was the Order of Conditions appealed? _ Yes _x_ No. Will
the project require a variance from the Wetlands regulations? _Yes _x_ No.
E. Will the project:
1. be subject to a local wetlands ordinance or bylaw? _x_ Yes _ No
2. alter any federally-protected wetlands not regulated under state or local law?
Yes _x_ No; if yes, what is the area (in s.f.)?
F. Describe the project's other impacts on wetlands (including new shading of wetland areas or
removal of tree canopy from forested wetlands): Removal of the Govenor Brann reclaims approx
1740 sf of bottom area which was shaded by the boat.
III. Waterways and Tidelands Impacts and Permits
A. Is any part of the project site waterways or tidelands (including filled former tidelands) that are
subject to the Waterways Act, M.G.L.c.91? _x_Yes _ No; if yes, is there a current Chapter
91 license or permit affecting the project site? _x_Yes — No; if yes, list the date and
number: 863, 2926, 5157, 183, 910 & 3217
B. Does the project require a new or modified license under M.G.L.c.91? _x_Yes
_ No; if yes, how many acres of the project site subject to M.G.L.c.91 will be for non-water
dependent use?
Current _0.11_ Change _0.02_ Total _0.13_
C. Is any part of the project
1. a roadway, bridge, or utility line to or on a barrier beach? _ Yes _x No; if
yes, describe:
2. dredging or disposal of dredged material? _ Yes _x_ No; if yes, volume of
dredged material
3. a solid fill, pile-supported, or bottom-anchored structure in flowed tidelands or other
waterways? _x_ Yes _ No; if yes, what is the base area? 3770 sf existing with only
2600 sf proposed for a reduction of 1170 sf
4. within a Designated Port Area? _ Yes _x_ No
D. Describe the project's other impacts on waterways and tidelands:
IV. Consistency:
A. Is the project located within the Coastal Zone? x_ Yes _ No; if yes, describe the
project's consistency with policies of the Office of Coastal Zone Management: Public access
management principles #1. Project improves the public access by the addition of the walkway
and boat slips.
• B. Is the project located within an area subject to a Municipal Harbor Plan? _ Yes _x_ No;
if yes, identify the Municipal Harbor Plan and describe the project's consistency with that plan:
-7-
WATER SUPPLY SECTION
I. Thresholds / Permits
A. Will the project meet or exceed any review thresholds related to water supply (see 301 CMR
11.03(4))? _Yes _x_ No; if yes, specify, in quantitative terms:
B. Does the project require any state permits related to water supply? _ Yes _x_ No; if
yes, specify which permit:
C. If you answered "No" to both questions A and B, proceed to the Wastewater Section. If
you answered "Yes" to either question A or question B, fill out the remainder of the Water
Supply Section below.
II. Impacts and Permits
A. Describe, in gallons/day, the volume and source of water use for existing and proposed
activities at the project site:
Existing Change
Total
Withdrawal from groundwater
Withdrawal from surface water
Interbasin transfer
Municipal or regional water supply
B. If the source is a municipal or regional supply, has the municipality or region indicated that
there is adequate capacity in the system to accommodate the project? _ Yes _ No
C. If the project involves a new or expanded withdrawal from a groundwater or surface water
source, —
1. have you submitted a permit application? Yes No; if yes, attach the
application —
2. have you conducted a pump test? _ Yes _ No; if yes, attach the pump test
report
D. What is the currently permitted withdrawal at the proposed water supply source (in
gallons/day)? Will the project require an increase in that withdrawal?_
Yes _ No
E. Does the project site currently contain a water supply well, a drinking water treatment facility,
water main, or other water supply facility, or will the project involve construction of a new facility?
_ Yes _ No. If yes, describe existing and proposed water supply facilities at the project
site:
Existing Change
Total
Water supply well(s) (capacity, in gpd)
Drinking water treatment plant (capacity, in gpd)
Water mains (length, in miles)
F. If the project involves any interbasin transfer of water, which basins are involved, what is the
direction of the transfer, and is the interbasin transfer existing or proposed?
G. Does the project involve
1. new water service by a state agency to a municipality or water district? _ Yes
No
2. a Watershed Protection Act variance? _ Yes _ No; if yes, how many acres of
alteration?
3. a non-bridged stream crossing 1,000 or less feet upstream of a public surface drinking
-8-
water supply for purpose of forest harvesting activities? Yes No
• FP Y P P 9 — —
H. Describe the project's other impacts (including indirect impacts) on water resources, quality,
facilities and services:
111. Consistency -- Describe the project's consistency with water conservation plans or other plans
to
enhance water resources, quality, facilities,and services:
WASTEWATER SECTION
I. Thresholds / Permits
A. Will the project meet or exceed any review thresholds related to wastewater (see 301 CMR
11.03(5))? _ Yes _x_ No; if yes, specify, in quantitative terms:
B. Does the project require any state permits related to wastewater? _ Yes _x_ No; if yes,
specify which permit:
C. If you answered "No" to both questions A and B, proceed to the Transportation -- Traffic
Generation Section. If you answered "Yes" to either question A or question B, fill out the
remainder of the Wastewater Section below.
11. Impacts and Permits
A. Describe, in gallons/day, the volume and disposal of wastewater generation for existing and
proposed activities at the project site (calculate according to 310 CMR 15.00):
Existing Change
• Total
Discharge to groundwater (Title 5) _
Discharge to groundwater (non-Title 5)
Discharge to outstanding resource water
Discharge to surface water
Municipal or regional wastewater facility
TOTAL
B. Is there sufficient capacity in the existing collection system to accommodate the
project?
_ Yes _ No; if no, describe where capacity will be found:
C. Is there sufficient existing capacity at the proposed wastewater disposal facility?_ Yes
No; if no, describe how capacity will be increased:
D. Does the project site currently contain a wastewater treatment facility, sewer main, or other
wastewater disposal facility, or will.the project involve construction of a new facility? _ Yes
No. If yes, describe as follows:
Existing Change
Total
Wastewater treatment plant (capacity, in gpd)
Sewer mains (length, in miles)
Title 5 systems (capacity, in gpd)
E. If the project involves any interbasin transfer of wastewater, which basins are involved, what
is the direction of the transfer, and is the interbasin transfer existing or proposed?
F. Does the project involve new sewer service by an Agency of the Commonwealth to a
-9-
f
municipality or sewer district? _ Yes _ No
• G. Is there any current or proposed facility at the project site for the storage, treatment,
processing, combustion or disposal of sewage sludge, sludge ash, grit, screenings, or other
sewage residual materials? Yes _ No; if yes, what is the capacity (in tons per day):
Existing Change
Total
Storage
Treatment, processing
Combustion
Disposal
H. Describe the project's other impacts (including indirect impacts) on wastewater generation
and treatment facilities:
III. Consistency -- Describe measures that the proponent will take to comply with federal, state,
regional, and local plans and policies related to wastewater management:
A. If the project requires a sewer extension permit, is that extension included in a
comprehensive wastewater management plan? _ Yes _ No; if yes, indicate the EOEA
number for the plan and describe the relationship of the project to the plan
TRANSPORTATION -TRAFFIC GENERATION SECTION
• I. Thresholds / Permits
A. Will the project meet or exceed any review thresholds related to traffic generation (see
301 CMR 11.03(6))? _Yes _x_ No; if yes, specify, in quantitative terms:
B. Does the project require an state permits related to state-controlled roadways?
P J 4 Y p _
Yes _x_ No; if yes, specify which permit:
C. If you answered "No" to both questions A and B, proceed to the Roadways and Other
Transportation Facilities Section. If you answered "Yes" to either question A or question B, fill
out the remainder of the Traffic Generation Section below.
II. Traffic Impacts and Permits
A. Describe existing and proposed vehicular traffic generated by activities at the project site:
Existing Change
Total
Number of parking spaces
Number of vehicle trips per day
ITE Land Use Code(s):
B. What is the estimated average daily traffic on roadways serving the site?
Roadway Existinq Change
Total
1.
2.
3.
• C. Describe how the project will affect transit, pedestrian and bicycle transportation facilities
- 10-
and services:
III. Consistency -- Describe measures that the proponent will take to comply with municipal,
regional, state, and federal plans and policies related to traffic, transit, pedestrian and bicycle
transportation facilities and services:
ROADWAYS AND OTHER TRANSPORTATION FACILITIES SECTION
I. Thresholds
A. Will the project meet or exceed any review thresholds related to roadways or other
transportation facilities (see 301 CMR 11.03(6))? _Yes _x_ No; if yes, specify, in
quantitative terms:
B. Does the project require any state permits related to roadways or other transportation
facilities? _ Yes _x_ No; if yes, specify which permit:
C. If you answered "No" to both questions A and B, proceed to the Energy Section. If you
answered "Yes" to either question A or question B, fill out the remainder of the Roadways
Section below.
11. Transportation Facility Impacts
A. Describe existing and proposed transportation facilities at the project site:
Existing Change
Total
Length (in linear feet) of new or widened roadway
Width (in feet) of new or widened roadway
Other transportation facilities:
• B. Will the project involve any
1. Alteration of bank or terrain (in linear feet)?
2. Cutting of living public shade trees (number)?
3. Elimination of stone wall (in linear feet)?
III. Consistency -- Describe the project's consistency with other federal, state, regional, and local
plans and policies related to traffic, transit, pedestrian and bicycle transportation facilities and services,
including consistency with the applicable regional transportation plan and the Transportation
Improvements Plan (TIP), the State Bicycle Plan, and the State Pedestrian Plan:
ENERGY SEC11ON
I. Thresholds / Permits
A. Will the project meet or exceed any review thresholds related to energy (see 301 CMR
11.03(7))? _ Yes _x_ No; if yes, specify, in quantitative terms:
B. Does the project require any state permits related to energy? _Yes _x_ No; if yes,
specify which permit:
C. If you answered "No" to both questions A and B, proceed to the Air Quality Section. If you
answered "Yes" to either question A or question B, fill out the remainder of the Energy Section
below. .
11. Impacts and Permits
A. Describe existing and proposed energy generation and transmission facilities at the project
• site:
Existing Change
Total
- 11 -
i
• Capacity of electric generating facility (megawatts)
Length of fuel line (in miles)
Length of transmission lines (in miles)
Capacity of transmission lines (in kilovolts)
B. If the project involves construction or expansion of an electric generating facility, what are
1. the facility's current and proposed fuel source(s)?
2. the facility's current and proposed cooling source(s)?
C. If the project involves construction of an electrical transmission line, will it be located on a
new, unused, or abandoned right of way?_ Yes _ No; if yes, please describe:
D. Describe the project's other impacts on energy facilities and services:
III. Consistency -- Describe the project's consistency with state, municipal, regional, and federal
plans and policies for enhancing energy facilities and services:
AIR QUALITY SECTION
I. Thresholds
A. Will the project meet or exceed any review thresholds related to air quality (see 301 CMR
11.03(8))? _ Yes _x_ No; if yes, specify, in quantitative terms:
B. Does the project require any state permits related to air quality? _Yes _x_ No;
if yes, specify which permit:
C. If you answered "No" to both questions A and B, proceed to the Solid and Hazardous
Waste Section. If you answered "Yes" to either question A or question B, fill out the remainder
of the Air Quality Section below.
II. Impacts and Permits
A. Does the project involve construction or modification of a major stationary source (see 310
CMR 7.00, Appendix A)?_ Yes _ No; if yes, describe existing and proposed emissions (in
tons per day) of:
Existing Change
Total
Particulate matter
Carbon monoxide
Sulfur dioxide
Volatile organic compounds
Oxides of nitrogen
Lead _
Any hazardous air pollutant _
Carbon dioxide
B. Describe the project's other impacts on air resources and air quality, including noise impacts:
III. Consistency
A. Describe the project's consistency with the State Implementation Plan:
B. Describe measures that the proponent will take to comply with other federal, state, regional,
and local plans and policies related to air resources and air quality:
SOLID AND HAZARDOUS WASTE SECTION
- 12-
I. Thresholds / Permits
• A. Will the project meet or exceed any review thresholds related to solid or hazardous waste
(see 301 CMR 11.03(g))? Yes ')( No; if yes, specify, in quantitative terms:
B. Does the project require any state permits related to solid and hazardous waste? _Yes
X No; if yes, specify which permit:
C. If you answered "No" to both questions A and B, proceed to the Historical and
Archaeological Resources Section. If you answered "Yes" to either question A or question B,
fill out the remainder of the Solid and Hazardous Waste Section below.
II. Impacts and Permits
A. Is there any current or proposed facility at the project site for the storage, treatment,
processing, combustion or disposal of solid waste? _ Yes _ No; if yes, what is the volume
(in tons per day) of the capacity:
Existing Change Total
Storage
Treatment, processing
Combustion
Disposal
B. Is there any current or proposed facility at the project site for the storage, recycling, treatment
or disposal of hazardous waste? _ Yes _ No; if yes, what is the volume (in tons or gallons
per day) of the capacity:
Existing Change Total
• Storage
Recycling
Treatment
Disposal
C. If the project will generate solid waste (for example, during demolition or construction),
describe alternatives considered for re-use, recycling, and disposal:
D. If the project involves demolition, do any buildings to be demolished contain asbestos?
_ Yes _ No
E. Describe the project's other solid and hazardous waste impacts (including indirect impacts):
111. Consistency--Describe measures that the proponent will take to comply with the State Solid
Waste Master Plan:
HISTORICAL AND ARCHAEOLOGICAL RESOURCES SECTION
I. Thresholds / Impacts
A. Is any part of the project site a historic structure, or a structure within a historic district, in
either case listed in the State Register of Historic Places or the Inventory of Historic and
Archaeological Assets of the Commonwealth? _x_ Yes _ No; if yes, does the project
involve the demolition of all or any exterior part of such historic structure? _ Yes _x_ No; if
yes, please describe:
•
- 13 -
r
B. Is any part of the project site an archaeological site listed in the State Register of Historic
Places or the Inventory of Historic and Archaeological Assets of the Commonwealth? Yes
No; if yes„ does the project involve the destruction of all or any part of such archaeological
site? Yes No; if yes, please describe:
C. If you answered "No" to all parts of both'questions A and B, proceed to the Attachments
and Certifications Sections. If you answered "Yes" to any part of either question A or question
B, fill out the remainder of the Historical and Archaeological Resources Section below.
D. Have you consulted with the Massachusetts Historical Commission? X Yes _ No; if yes,
attach correspondence
E. Describe and assess the project's other impacts, direct and indirect, on listed or inventoried
historical and archaeological resources: NONE
II. Consistency — Describe measures that the proponent will take to comply with federal, state,
regional, and local plans and policies related to preserving historical and archaeological resources:
No Part of the structure is being demolished.
ATTACHMENTS:
1. Plan, at an appropriate scale, of existing conditions of the project site and its immediate
context, showing all known structures, roadways and parking lots, rail rights-of-way,
wetlands and water bodies, wooded areas, farmland, steep slopes, public open spaces,
and major utilities.
2. Plan of proposed conditions upon completion of project (if construction of the project is
proposed to be phased, there should be a site plan showing conditions upon the
completion of each phase).
3. Original U.S.G.—S. map or good quality color copy (8-_ x 11 inches or larger) indicating
daries
• 4 List of all agencies and persons to whom the proponent circulated the ENF. in
accordance wan .16(2).
5. Other:
CERTIFICATIONS:
1. The Public Notice of Environmental Review has been/will be publishes in t`le fDliowin^
newspapers in accordance with 301 CMR 11.15(1):
(Name) (Date) 6
Barnstable Patriot
2. This form has been circulated to Agencies and Persons in accordance with 301 CMR 11.16(2).
Date ature of Responsible Officer Date c=
preparing
Name (print or type) Peter Sullivan, P. E.
Firm/Aoencv Sullivan Engineering Inc.
Street i Parker Road, P O Box 659
Municipality/State/Zip Osterville, MA 02655
Phone 508-428-3344
Commonwealth of Massaehusetts
Executive Office of Environmental Affairs - MEPA
Off ice
?>1 Causeway Street. Suite 900
Boston. \lA 02114
Telephone 617-626-1020
FORMS OF NOTICE
The following should be completed and submitted to a local newspaper:
PUBLIC NOTICE OF ENVIRONMENTAL REVIEW
PROJECT: ]-ITt4s17
LOCATION: / �J>/CcLS:t� —'
PROPONENT: Wit.C u r
The undersigned is submitting an Environmental Notification Form ("ENF") to the
Secretary of Environmental Affairs on or before
9`— 30—o�(date)
This will initiate review of the above project pursuant to the Massachusetts
Environmental Policy Act ("MEPA", M.G.L. c. 30, s.s. 61, 62 62H). Copies of the
ENF may be obtained from:
(Name, address, phone number of proponent or proponent's agent)
Copies of the ENF are also being sent to the Conservation Commission and
Planning Board of roi.-,7 G��- "��Sy� ��': (i�lunicipaliry) where they
may be inspected.
The Secretary of Environmental Affairs will publish notice of the ENF in the
Environmental Monitor,will receive public comments on the project for 20 days,
and will then decide,within ten days, if an environmental Impact Report is needed.
A site visit and consultation session on the project may also be scheduled. All
persons wishing to comment on the project, or to be notified of a site visit or
consultation session, should write to the Secretary of Environmental Affairs, 2S1
Causewav Street, Suite 900, Boston, Massachusetts 0211.4, Attention: NIEPA Office.
referencing The above project.
By .SCm(ib e} j xter, Tr". (Proponent)
•
ATTACHMENT 1 (PLANS):
Site Plan Existing Conditions at Baxters Boat House sheet 1/3
Site Plan Proposed Improvements sheets 2/3 & 3/3
i
PLEASANT STREET
"� nEH PGfj
EX 1$T A.S
L1`1GU.5T ?'iC 14
ynr�Y c(1R og7PERTY LINE INFORMATION SEE BOOK 2135 PAGE 154 AT THE
BARNSTARLE COUNTY REGISTRY OF DEEDS.
cnR PROPOSED IMPROVEMENTS SEE SE3-4329. Cc
°^R EXISTING STRuCruREs >EE DPW LICENSE PLAN N'IMBERS )
:23,853,910,2926,321795157.
S,?UNOINGS BASED ON M LW. DATUM. = m
SITE IS LOCATED INFLOODZONE A9(EL.10)
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EXISTING PLAN SITE PLAN
SCALE : I"=30' EXISTING CONDITIONS
+' AT
BAXTERS BOAT HOUSE
0 30 60fr. 177 PLEASANT STREET
HYANNIS,MASS.
SCALE: AS SHOWN DATE SEPT. .5,2005
SULLIVAN ENGINEERING IN'.
OSTERVILLE , MASS.
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OVERALL SITE PLAN P���S F�° OF
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SHEET 2 of 3
SITE PLAN
PROPOSED IMPROVEMENTS
AT
BANTERS BOAT HOUSE
177 PLEASANT STREET
HYANNIS,MASS.
SCALE: AS SHOWN DATE: SEPT 15,2�05
SULLIVAN ENGINEERING INC.
OSTERVILLE , MASS.
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EXISTING STONEREVE'MENT. 2a aF�i
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EXIST.
PRCPOSEO MAINT, 3UILOING
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. I SCALE: I aC'
y
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-3.0■ • m.y
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A a4 I A
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REPLACEEXIV. SHEET 3 of 3
20 -�J I TIMBER PILES
<_ r_1.1 SITE PLAN
m
-RAIMP 4t20 PROPOSED IMPROVEMENTS
C'.IZ nM2ER PILES. \�HEIGHT OF E40 PILES TO AT
3E.4, SPnC:NG 7C MACTH 9E 9'ABOVE OECX. BAXTERS BOAT HOUSE
EXIST 0ECX(6'-3"=) F` T0A 177 PLEASANT STREET
PARTIAL PLAN HYANNIS,MASS.
SALE AS SHOWN DATE SEPT. 15,2 05
SCALE I"=30' SULLIVAN ENGINEERING INC.
OSTERVILLE , ,MASS.
•
ATTACHMENT 2:
Copy of USGS Map Identifying Project Locus
HYANNIS QUADRANGLE
MASSACHUSETTS-BARNSTABLE CO.
7.5 MINUTE SERIES.(TOPOGRAPHIC)
b _ •f'�9 Odi' • r�l �t� �l
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-aF,y,�^t � `.� i ' `r � '( -'-" '�K '� � �L�1�Y`�`�� ,,��`�i" �'+•`�, `wk •A �3r � ��,,,q�`,rq
! '+a ' ,.,,,� al�r6 ? " ' 7x'ia r r PCs\'t��5i •� +�`�' ':� �'S;�} 'c.. ,
�` 3p•;� 4°Y �cY,ayx J .t+':O,�y��af.�4 'tt? n i,.
k 11 ' ' • Y7 '.`tsar' 'L 6�.�;�Pd :, r�, i.. ty.•..
i-" Ak
5 P, 8 r H1C
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4 ss auIleikn ,..
ry sti u
Ls a1s?d a^' �s §^", }y `.r/k` .r '.V ft�i a ,�}& re �y l ,�•• ,
'7mt
Fmod t10m1+OPo1 OM Wlftmr Fmft aww.
LOCUS PLAN
Scale: 1:12,000
Directions: From Hyannis Town Hall go Assessors Map 326
right on Main Street;Take a left onto Parcel 050
Pleasant Street; Continue on Pleasant Latitude: 41°39'00"
Street after you cross over South Main Longitude: 70°16'43"
Street, and follow to the end;Baxters is at LTTM: 461150ON
the end on the right,4177. 393480E
HYANNIS,MASS
N4136.SW7015l8X7.5
1974
PHOTOREVISED 1979
AMS 6967111$WSERIES V 814
I
ATTACHMENT 3:
ENF Distribution List
1
Attachment 3
ENF Distribution List
Secretary Stephen R. Pritchard
Executive Office of Environmental Affairs
Attn: MEPA Office
100 Cambridge Street, Suite 900
Boston, MA 02114
Executive Office of Environmental Affairs-Policy Director
Mr. James Stergios
Undersecretary for Policy
c/o Nancy Gabriel-Sackie
100 Cambridge Street, Suite 900
Boston, MA 02114
Department of Environmental Protection
Boston Office
Commissioner's Office
One Winter Street
Boston, MA 02108
Department of Environmental Protection
Southeast Regional Office
Attn: MEPA Coordinator
20 Riverside Drive
Lakeville, MA 02347
Executive Office of Transportation
Attn: Environmental Reviewer
10 Park Plaza, Room 3510
Boston, MA 02116-3969
Massachusetts Highway Department
Public/Private Development Unit
10 Park Plaza
Boston, MA 02116
Massachusetts Highway Department
District Office #5
Attn: MEPA Coordinator
Box 111
1000 County Street
Taunton, MA 02780
Massachusetts Aeronautics Commission
Attn: MEPA Coordinator
10 Park Plaza, Suite 3510
Boston, MA 02116
Massachusetts Historical Commission
The MA Archives Building
220 Morrissey Boulevard
Boston, MA 02125
Cape Cod Commission
3225 Main Street
P O Box 226
Barnstable, MA 02630
Town Council
Town of Barnstable
367 Main Street
Hyannis, MA 02601
Town of Barnstable
Planning Board
200 Main Street
Hyannis, MA 02601
Town of Barnstable
Conservation Commission
200 Main Street
Hyannis, MA 02601
Town of Barnstable
• Board of Health
200 Main Street
Hyannis, MA 02601
Coastal Zone Management
Attn: Project Review Coordinator
251 Causeway Street, Suite 500
Boston, MA 02114
Division of Marine Fisheries
Attn: Environmental Reviewer
50 A Portside Drive
Pocasset, MA 02559
Samuel T. Baxter
177 Pleasant Street
Hyannis, MA 02601
•
•
ATTACHMENT 4:
Supplemental Information
Copy of the Order of Conditions for DEP file SE3-4328
Copy of the Baxters History on Pleasant Street by Sam Baxter
Photographs of the Boat House and Governor Brann (2)
Copies of Correspondence from Mass Historic Commission
c .9 20US (M0 ,,,.r'N R FL07—n 5t034[C3:52 FAQ=. /.t
Massachusetts Department of Environmentai Protectlon DEP Fite Nun:bar:
Y. 94� Bureau of Resource Protecbon -Wetlands SE3-4328
MM"Fxe.' '' WPA Form 5 - Order of Conditions ProvidaC cy llEP
6507Massachusetts Wetlands Protection Act 141.G,1.. c. 131, §40
• and Town of Barnstable Qr'dinances Art;cle XXVII
A. G Bneral information
Important: _rom: 13k 193'77 P!w328 0 43757
When filling 1:2-23—•2004 a 12: CI130
out forms on Barnstable
the computer, Conservation vornMINIon
use only the This is6r-rance if for(check one):
tab key to
move your
cursor-do ® Ordsr of Conditions
not use the
return key. ❑ Amended Order of Conditions
o: Applicant: Samuel T. Suter&James C.Vogt, Property Owner (if different from applicant):
Trustees
Pleasant Street Realty Trust
Nome Name
177 P!eessnt Street —_
Malli+g Address Melling Addre9a
Hyannis NIA _02601 State zip code
City/Town State Zip Code city/Town
1. Project Location:
177 Pleasant Street _ _ Hyannis
love stA:idre City 'own
326 050
Asosseore taiap/Piat Number Parcel/Lot Number
• 2. Property recorded at the Registry of Deeds for:
Barnstable 2135 & 16230
Courty Book Page
Pages 154 87_
certifi:eta(if registered land)
3. Dates:
T3ecembaz 22, 0
September 9,20C4 November 23,2004 2C�4
Date Notice of Intent Filed Date Pubile Hearing Closed Date of Issuan�.e '
4, Final Approved Plans and Other Documents(attach additional plan references as needed):
Site Plan _ August 18,2004
Title Date
Title
Data
Data
Title
5. Final Plans and Documents Signed and Stamped by:
Peter Sullivan, PE
6. Total Fee:
$412.00 _
(from Appendix 8:watlar.d Fee Trarsmiral Forml
i rn„got•
WONo^n6.doc rev.129,04
•
Massachusetts Department of Environmental Protection DEP File Number:
Bureau of Resource Protection - Wetlands
WPA Form 5 - Order of Conditions SE3-4328
i'�awans-rnal.e. • Provided by DEP
•�1\9��05
p Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
ED tAAy
and Town of Barnstable Ordinances Article XXVII
B. Findings
Findings pursuant to the Massachusetts Wetlands Protection Act:
Following the review of the above-referenced Notice of Intent and based on the information provided in
this application and presented at the public hearing, this Commission finds that the areas in which work is
proposed is significant to the following interests of the Wetlands Protection Act. Check all that apply:
❑ Public Water Supply ❑ Land Containing Shellfish ® Prevention of Pollution
❑ Private Water Supply ® Fisheries ® Protection of Wildlife Habitat
❑ Groundwater Supply ® Storm Damage Prevention ® Flood Control
Furthermore,this Commission hereby finds the project, as proposed, is: (check one of the following boxes)
Approved subject to:
® the following conditions which are necessary, in accordance with the performance standards set forth
in the wetlands regulations, to protect those interests checked above.This Commission orders that all
work shall be performed in accordance with the Notice of Intent referenced above, the following
General Conditions, and any other special conditions attached to this Order.To the extent that the
following conditions modify or differ from the plans, specifications, or other proposals submitted with
• the Notice of Intent, these conditions shall control.
Denied because:
❑ the proposed work cannot be conditioned to meet the performance standards set forth in the wetland
regulations to protect those interests checked above. Therefore, work on this project may not go
forward unless and until a new Notice of Intent is submitted which provides measures which are
adequate to protect these interests, and a final Order of Conditions is issued.
❑ the information submitted by the applicant is not sufficient to describe the site, the work, or the effect
of the work on the interests identified in the Wetlands Protection Act.Therefore, work on this project
may not go forward unless and until a revised Notice of Intent is submitted which provides sufficient
information and includes measures which are adequate to protect the Act's interests, and a final
Order of Conditions is issued. A description of the specific information which is lacking and why it is
necessary is attached to this Order as per 310 CMR 10.05(6)(c).
General Conditions (only applicable to approved projects)
1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory
measures, shall be deemed cause to revoke or modify this Order.
2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any
injury to private property or invasion of private rights.
3. This Order does not relieve the permittee or any other person of the necessity of complying with all
other applicable federal, state, or local statutes, ordinances, bylaws, or regulations.
•
Page 2 of 7
Wpaform5.doc•rev.12/2/04
THE Massachusetts Department of Environmental Protection DEP File Number:
o\ Bureau of Resource Protection - Wetlands
j WPA Form 5 - Order of Conditions SE3-432s
swansrns�e.
1� • Provided by DEP
• a�0� Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
and Town of Barnstable Ordinances Article XXVII
B. Findings (cont.)
4. The work authorized hereunder shall be completed within three years from the date of this Order
unless either of the following apply:
a. the work is a maintenance dredging project as provided for in the Act; or
b. the time for completion has been extended to a specified date more than three years, but less
than five years, from the date of issuance. If this Order is intended to be valid for more than three
years, the extension date and the special circumstances warranting the extended time period are
set forth as a special condition in this Order.
5. This Order may be extended by the issuing authority for one or more periods of up to three years each
upon application to the issuing authority at least 30 days prior to the expiration date of the Order..
6. Any fill used in connection with this project shall be clean fill. Any fill shall contain no trash, refuse,
rubbish, or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard,
pipe, tires, ashes, refrigerators, motor vehicles, or parts of any of the foregoing.
7. This Order is not final until all administrative appeal periods from this Order have elapsed, or if such
an appeal has been taken, until all proceedings before the Department have been completed.
8. No work shall be undertaken until the Order has become final and then has been recorded in the
Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title
of the affected properly. In the case of recorded land, the Final Order shall also be noted in the
Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to
• be done. In the case of the registered land, the Final Order shall also be noted on the Land Court
Certificate of Title of the owner of the land upon which the proposed work is done. The recording
information shall be submitted to this Conservation Commission on the form at the end of this Order,
which form must be stamped by the Registry of Deeds, prior to the commencement of work.
9. A sign shall be displayed at the site not less then two square feet or more than three square feet in
size bearing the words,
"Massachusetts Department of Environmental Protection" [or, "MA DEP"]
"File Number SE3-4328 "
10. Where the Department of Environmental Protection is requested to issue a Superseding Order, the
Conservation Commission shall be a party to all agency proceedings and hearings before DEP.
11. Upon completion of the work described herein, the applicant shall submit a Request for Certificate of
Compliance (WPA Form 8A) to the Conservation Commission.
12. The work shall conform to the plans and special conditions referenced in this order.
13. Any change to the plans identified in Condition #12 above shall require the applicant to inquire of the
Conservation Commission in writing whether the change is significant enough to require the filing of a
new Notice of Intent.
14. The Agent or members of the Conservation Commission and the Department of Environmental
Protection shall have the right to enter and inspect the area subject to this Order at reasonable hours
to evaluate compliance with the conditions stated in this Order, and may require the submittal of any
• data deemed necessary by the Conservation Commission or Department for that evaluation.
Page 3 of 7
Wpaform5.doc•rev.12/2104
�oE»rqr Massachusetts Department of Environmental Protection DEP File Number:
o Bureau of Resource Protection - Wetlands SE3-4328
Form 5 - Order of Conditions
( :;BsAw ie W PA Provided by DEP
\��Areo3u Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
and Town of Barnstable Ordinances Article XXVII
B. Findings (cont.)
15. This Order of Conditions shall apply to any successor in interest or successor in control of the
property subject to this Order and to any,contractor or other person performing work conditioned by
this Order.
16. Prior to the start of work, and if the project involves work adjacent to a Bordering Vegetated Wetland,
the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden
stakes or flagging. Once in place, the wetland boundary markers shall be maintained until a
Certificate of Compliance has been issued by the Conservation Commission.
17. All sedimentation barriers shall be maintained in good repair until all disturbed areas have been fully
stabilized with vegetation or other means. At no time shall sediments be deposited in a wetland or
water body. During construction, the applicant or his/her designee shall inspect the erosion controls
on a daily basis and shall remove accumulated sediments as needed.The applicant shall immediately
control any erosion problems that occur at the site and shall also immediately notify the Conservation
Commission, which reserves the right to require additional erosion and/or damage prevention controls
it may deem necessary. Sedimentation barriers shall serve as the limit of work unless another limit of
work line has been approved by this Order.
see attached
•
Findings as to municipal bylaw or ordinance
Furthermore, the Barnstable hereby finds (check one that applies):
Conservation Commission
❑ that the proposed work cannot be conditioned to meet the standards set forth in a municipal
ordinance or bylaw specifically:
Municipal Ordinance or Bylaw Citation
Therefore, work on this project may not go forward unless and until a revised Notice of Intent is
submitted which provides measures which are adequate to meet these standards, and a final Order of
Conditions is issued.
® that the following additional conditions are necessary to comply with a municipal ordinance or bylaw,
specifically:
Article 27 of Town Ordinances
Municipal Ordinance or Bylaw Citation
r
The Commission orders that all work shall be performed in accordance with the said additional
conditions and with the Notice of Intent referenced above. To the extent that the following conditions
• modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent,
the conditions shall control.
Page 4 of 7
Wpaform5.doc•rev.12/2/04
SE3_4328 Baxter
Approved Plan= August 18, 2004 Site Plan by Peter Sullivan,PE
Special Conditions of Approval
I
I. Preface
Caution: Failure to comply with all Conditions of this Order of Conditions can have serious consequences.
The consequence may include issuance of a stop work order,fines,requirement to remove unpermitted
structures,requirement to re-landscape to original condition,inability to obtain a certificate of compliance,
and more.
The General Conditions of this Order begin on page 2 and continue on pages 3 and 4. The Special
Conditions are contained on pages 4.1,4.2 and 4.3 if necessary.All conditions require your compliance.
II. Prior to the start of work,the following conditions shall be sat
isfied:
1. Within one month of receipt of this Order of Conditions and prior to the commencement of any work
approved herein,General Condition number 8(recording requirement)on page 3 shall be complied with.
• 2. It is the responsibility of the applicant,the owner and/or successor(s) and the project contractors to ensure
that all conditions of this Order are complied with. The applicant shall provide copies of the Order of
Conditions and approved plans(and any approved revisions thereof)to project contractors prior to the start
of work. Barnstable Conservation Commission Forms A and B shall be completed and returned to the
Commission prior to the start of work.
3. General Condition 9 on page 3 (sign requirement)shall be complied with.
4. The Conservation Commission shall receive written notice 1 week in advance of the start of work.
III. The following additional conditions shall govern the project once work begins.
5. General conditions No. 12 and No. 13 (changes in plan)on page 3 shall be complied with.
6. The Conservation Commission,its employees,and its agents shall have a right of entry to inspect for
compliance with the provisions of this Order of Conditions.
7. This permit is valid for 3 years from the date of issuance, unless extended by the Commission at the request
of the applicant.Caution: a future Amended Order does not change the expiration date.
• 8. CCA-treated piling and structural timber(greater than 3 inches thick)are allowed. Otherwise,no CCA-
treated or creosote-treated materials shall be used.
Page 4.1
f
9. Work shall occur during the off-season only: October 15 through May I.
10. No dredging(including but not limited to effects of propeller wash) is permitted herein. Deepening the
•
berth by propeller scouring is strictly prohibited under this Order.
It. The seasonal storage of floats shall be at a suitable upland site. Floats shall not be stored on banks, marshes
or dunes.
12. Permanent piling shall be driven into place. Some initial pilot hole jetting is allowed.
The following special conditions in italics shall govern boat use at the approved pier. These
conditions shall continue over time. Note: For purposes of this Order of Conditions,the term"pier"
shall refer not only to the linear pile-supported structure,but also to any of its components or
appendages such as the float(s),ell,tee,ramp,outhaul piling,etc.
13. Any desired pier lighting shall receive prior approval of the Conservation Commission or Department.
14. Lead piling caps shall not be used.
15. Work on the pier shall ensue mid-tide rising to mid-tide falling or as otherwise necessary to provide a
I
minimum 12"clearance for work barge above the substrate.
• IV. After all work is completed,the following condition shall be promptly met:
16. At the completion of work,or by the expiration of this Order,the applicant shall request in writing a
Certificate of Compliance for the work herein permitted. Barnstable Conservation Commission Form C
shall be completed and returned with the request for a Certificate of Compliance. Where a project has been
completed in accordance with plans stamped by a registered professional engineer,architect,landscape
architect or land surveyor,a written statement by such a professional person certifying substantial
compliance with the plans and setting forth what deviation, if any,exists with the record plans approved in
the Order shall accompany the request for a Certificate of Compliance. At the time of the request for a
Certificate of Compliance an updated sequence of color photographs of the undisturbed buffer zone shall
be also submitted.
•
Page 4.2
Massachusetts Department of Environmental Protection DEP File Number:
Bureau of Resource Protection - Wetlands
SE3-4328
WPA Form 5 - Order of. Conditions
.ws Provided by DEP
\`�ATF639�s0�� Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
� y
and Town of Barnstable Ordinances Article XXVII
B. Findings (cont.)
Additional conditions relating to municipal ordinance or bylaw: 4
see attached
This Order is valid for three years, unless otherwise specified as a special condition pursuant to General
Conditions 44, from the date of issuance.
Date
This Order must be signed by a majority of the Conservation Commission. The Order must be mailed by
certified mail (return receipt requested) or hand delivered to the applicant. A copy also must be mailed or
hand delivered at the same time to the appropriate Department of Environmental Protection Regional
Office (see Appendix A) and the property owner (if different from applicant).
Signatures:
r
�, Of ec
On y ` �Day Month and Year
before me personally appeared
- fwq S I ,
to me known to be the person described in and who executed the foregoing instrument and
ackn dged tha .he/she xecute me a is/her free act and deed.
r
Notary Public My commission Expires
This Order is issued to the applicant as follows:
❑ by hand delivery on by certified mail return receipt requested,on
Date Date
ti
Page 5 of 7
Wpaform5.doc•rev.12/7/04
BARTER'S HISTORY ON PLEASANT STREET
The land located at the foot of Pleasant Street was purchased by my Great grandfather
Benjamin D. Baxter and his wife Elizabeth around 1919. They purchased the property as
their primary residence and for his business ventures. The primary business was the
offloading and packing of fish from local and transient fishing vessels.
They had two sons Benjamin D. Baxter Jr. and my grandfather Warren T. Baxter.
The two sons grew up on the property and as young men were involved in all the
operations of the fish packing business such as unloading the boats cargo, restocking the
boats with ice and supplies, and packaging and delivering the fish to the Boston fish
markets and other retail markets. During the 1930's Benjamin D. Baxter Jr. had started a
trucking company from the Pleasant Street property and shipped goods from
Provincetown to New York and Boston. My Grandfather Warren T. Baxter had started a
family, and his own business called Baxter's Fish Market in the building which in now
currently the Boathouse Club. After World War II my Great grandfather and his wife
passed away and the two sons split the Property at the end of Pleasant Street into two
halves.
• My grandfather Warren continued to operate the fish market and his brother
Benjamin continued to offload the fishing vessels and began selling them fuel.
In the 1950's my grandmother, the wife of Warren T. Baxter, installed a fiyolater deep
frying machine in the shed on the dock that was located next to the fish market. There
she made her own coleslaw, and peeled and cut potatoes to fry along with the fish she
purchased from her husband next door. In 1957 she opened what is now known as
Baxter's Fish& Chips a seafood restaurant featuring some of the freshest local seafood
around.
Next door to the Fish& Chips my Grandfather and my Father Warren T. Baxter
Jr. were busy keeping the Fish Market going but my Grandfather was getting older and
not as enthusiastic about cutting and packing fish since he had been doing it his whole
life, so he and my father came up with an idea to turn the Fish Market into a Bar and
Restaurant, and on July 4, 1967 they opened what is now known as Baxter's Boathouse
Club. They integrated the two buildings that are built entirely on pilings into one building
and used the same kitchen to operate Baxter's Boathouse Club and Baxter's Fish&
Chips.
As of today the operation is still built entirely over the water and customers can
still tie up in their boats and have lunch or dinner. There is also a commercial dock
where tourists and sightseers can watch the charter boats and commercial fishing boats
unload their daily catch.
Sam Baxter
y TW _� '�_ f � +Sra�:�� A II� .Y. h.�h 1 _.. s'c "ti• '\. /
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(7 4 45 C*-N ALUER d 4 2 .52
The Commonwealth of Massachusetts
williara Fr.ancis Galvin,Secretary of the Commonwealth
Nlassachusr�tts Historical'OrTI'MiSSIOn
February 24.2004
John R. Alger,P.C.
Attorney at Law
PO Box -449
Osterville.MA 0205-0449
RE: Baxter Bout Hawse. 177 Pleasant Street,Barnstable,,V.Lk NIHC#11C3.6563.
Dazr Mr. Alger:
Thank ycu for Sllhr.ittillg,project, gtioli and have the following plans regarding the proposed project referenced above. Staff of the
i
Massachusetts Historical Commission(MKC)have re the infor7t
comments.
Review of MHC's Inventcry of Historic and Archaeological.Assets of the Commonwealth indicates that
project area is within &,e Hyannis Main Streets WaterfrontLocal Historic District(MHC 4 BRN-AU),
which is listed in the State,Register of Historic Places(950 CNiR 7i).
After review of MHC files and the materials submitted,x.4,,iC stag)-as determ:ned that the project as
proposed will have"no Zriverse effecCon the historic,architectural,and cultural resources of theHyannis
Nla:n SErect/Wateilroni Local Historic District(950 CNIR 71.07(2)(b)(2)).
These comments are.offered to assist in corrViance with Section 106 of the National Historic Pn--serVation
Act of P.)66 is amended(36 CFR 800)and Massachusetts General Laws,Chapter 9.Sections 26-27C as
A Prep to
amended by Chapter 254of the.Acts of 1988,95t)CN14R 71,,1, if you have any questions,please reel
contact Margo Muhl Davis,Archaeologist?reservation Planner at this office.
Sincerely.
13rona Simon
State Archaeologist
Deputy State Historic Preservation Officer
Massachusetts Historical C,)rnrni.-;sion
XC: -Hyannis Waterfront Historic.District Commission
220 Morrissey Boulevard,Boston,Massachusetts 02125
(617)727-8470-Fax: (6 17)727-5 128
www.state.ma.us/sec"Mhe
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