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WEST BEACH CLUB, INC. - FOOD
WEST BEACH CLUB,INC. 9 DALE AVE,HYANNISPORTJ R k.._ �... . ........... � r Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. awn�srx6 F.P.(Thomas)Lee 1639,Maw 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D. Alt. Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 174 Issue Date: 01/01/2022 DBA: WEST BEACH CLUB, INC. OWNER: DEAN WALTON Location of Establishment: 9 DALE AVENUE HYANNISPORT MA 02647 Type of Business Permit: FOOD SERVICE Annual: Seasonal: YES IndoorSeating: 48 OutdoorSeating: 0 Total Seating: 48 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: ---- — - MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: l_ lime For Office Use Only: Initials: .� Town of Barnstable Date Paid ild22 Amt.Pd$ 0QS— 11AR AOM ; Inspectional Services � MAM ' s639. Public Health Division Thomas McKean,Director Z g b_p3 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE �A'FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL" } NAME OF FOOD ESTABLISHMENT: w le,I iwtew/! ADDRESS OF FOOD ESTABLISHMENT: Z A MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: �y`2J - Ill TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL:�C DATES OF OPERATION: 6/If/ 40 NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING.AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential ldtchen) 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 508-8624644 Q:\Applicarion ForinsTOODAPP 2020.doc ` e i r Y OWNER INFORMATION: FULL NAME OF APPLICANT JWJ SOLE OWNER: GINO ����' ��!/ OWNER/PHONE# ADDRESS ?9 J,Fy le CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: P1G'J!/ List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have I Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. . Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. ` 1�1D� l 1� � l IS-1 2 1. l l C rwj SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/api)lications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3I't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FonnsTOODAPP REV3-2019.doc w e 11H%1 1BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Gaudagnoli,M.D. aAMNSTnnt�, Paul J.Canniff,D.M.D. MAS39& 16 200 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: 174 Issue Date: 01/01/2021 DBA: WEST BEACH CLUB, INC. OWNER: DEAN WALTON Location of Establishment: 9 DALE AVENUE HYANNISPORT, MA 02647 Type of Business Permit: FOOD SERVICE Annual: Seasonal: YES IndoorSeating: 48 OutdoorSeating: 0 Total Seating: 48 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: -------- ---.--- - - -- MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: -'" ' Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: oF1NE tq� • Initials: Town of Barnstable For Office Use Date Paid3 a Amt I'd � ,ABNSTABLE. : Inspectional Services 1�-233�-►�Zo) v� ,' `0$ Public Health Division Check# Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE Z VI NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: 1'4f 5-T ADDRESS OF FOOD ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT FROM ABOVE): /gl� J e ��✓�r 4X E-MAIL ADDRESS: '/ TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER:YES No ' ...(ANNUAL WATER ANALYSIS REQUIRED) j ANNUAL: SEASONAL: DATES OF OPERATION: �/41'41/1/TO / / 6 NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING.AND MEET OUTSIDE DINING REOUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ...(MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REOUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNE�NO OWNER PHONE# y, ADDRESS J R Zr V S CORPORATE OWNER: m6fw'a0C:1 eA N(.A( (N 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. &Ix e� � l SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div, prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3 V each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FonnsTOODAPP REV3 2019.doc d� Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. L►R�s'xBue Paul J.Canniff,D.M.D. a � 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 30513, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 174 Issue Date: 01/01/2020 DBA: WEST BEACH CLUB, INC. OWNER: DEAN WALTON Location of Establishment: 9 DALE AVENUE HYANNISPORT, MA 02647 Type of Business Permit: FOOD SERVICE Annual: Seasonal: YES IndoorSeating: 48 OutdoorSeating: 0 Total Seating: 48 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q.n FROZEN DESSERT: Thomas A.McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: f .r �J c. 'THEE rp� Initials: � � Town of Barnstable Date Paid Amt Pd$ ,AMSTAB,yr. t Inspectional Services MAS& 1639. 'OrEDna+°� Public Health Division (ash 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 5_� (/" !.M NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: �✓�9G� 6AA ADDRESS OF FOOD ESTABLISHMENT: 3we AKe: MAILING ADDRESS(IF DIFFERENT FROM ABOVE): Zo$ 117;02 ) .9y. E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: - TOTAL NUMBER OF BATHROOMS: WELL WATER: YES_NO ... (ANNUAL WATER ANALYSIS REQUIRED) o ANNUAL: SEASONAL: DATES OF OPERATION:O/0/1,FTO ( /7/ NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL, MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q1Application FormsTOODAPP 2020.doc w OWNER INFORMATION: 1 FULL NAME OF APPLICANT SOLE OWNE YES NO OWNER PHONE # ADDRESS CORPORATE OWNER: CORPORATE ADDRESS: 'J PERSON IN CHARGE OF DAILY OPERATIONS: � r 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 J� 4 l , SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: A:I 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 why caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering:notice found at http://www.townofbarnstable.us/healthdivision/apt)lications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. t Q:\Application Forms\FOODAPP REV3-20I9.00c i MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include copies of your employees food protection manager training certificates (at least two) and food allergen awareness training certificate (at least one.) In addition, please include the required fee amount (see fees at bottom of this page). Make check payable to: Town of Barnstable. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax copies of your employees' food protection manager training certificates (at least two) and food allergen awareness training certificate (at least one.) In addition, you must mail the required fee amount(see box below). Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. FEES: Bed & Breakfast Permit=$55; Food Service Permit 0-49 seats = $250; 50 or more seats $300; Continental Breakfast= $30; Retail Food (only TCS Foods) =$20;Retail Food Store—Less than 8,000 S.F. _ $100, more than 8,000 S.F. =$285; less than 1,000 S.F.; Retail Food Combo/Limited Prep. - $200.00; Cottage Food Industry= $75; Mobile Truck=$50; Mobile Ice Cream Truck= $35; Frozen Dessert License=$30; Additional non-refundable Fee for New Establishment or New Ownership= $100-$500(see staff), Late Fee= $10 A Q:Wpplication FormsTOODAPP REV3-2019.doc J'A , r Town of Barnstable BOARD OF HEALTH • Q Paul J Canniff,D.M.D. A.Ga Board of Health Donald A.Gaudagnoli,M.D. 0AWNSTTABLE John T.Norman .1639 F.P. Thomas Lee Alternate x�+39• �� 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 174 Issue Date: 03/01/2019 DBA: WEST BEACH CLUB, INC. OWNER: DEAN WALTON Location of Establishment: 9 DALE AVENUE HYANNISPORT MA 02647 Type of Business Permit: FOOD SERVICE Annual: Seasonal: YES IndoorSeating: 48 OutdoorSeating: 0 Total Seating: 48 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: CONDITIONAL UPON SCHEDULING WATER TESTS FOR BATHING BEACH. EMAIL:thelittlesandwichshop@comcast.net FNNE Tp� For Office Use Only: Initials: Sc — Town of Barnstable �;x Date Paid �o b Amt Pd$ 0 BAMSMBLE. " Inspectional Services 9 MASS.039. g Ma+° Public Health Division Check# O Thomas McKean,Director i `,� M I 200 Main Street, Hyannis, A 02601 Lo (ij�lY Office: 508-862-4644 Fax: 508-790-6304 A PLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE J NEW OWNERSHIP � RENEWA NAME OF FOOD ESTABLISHMENT: �/P Ar/ Jy,,y c Ki AX✓ ADDRESS OF FOOD ESTABLISHMENT:_g ,y//Q(� Ile ��� MAILING ADDRESS(IF DIFFERENT FROM ABOVE): y; A,1,d I0 �fS AAA E-MAIL ADDRESS: C'Li7L���p N�/,��Gli►S- afp&,! V , eAj • TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 71 J% - 01a/ TOTAL NUMBER OF BATHROOMS: y WELL WATER: YES NO ... (ANNUAL WATER ANALYSIS REQ/UIRED)g ANNUAL: SEASONAL: DATES OF OPERATION: b/I Sl I/TO NUMBER OF SEATS: INSIDE: 'N OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) ,FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q\Application FormsTOODAPPREV2018.doc i PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT � W1q SOLE OWNER:�;'7NO OWNER PHONE # ADDRESS 9 idrmll tuo pU AV` CORPORATE OWNER: G JV 'L FEDERAL ID NO. : QhL CORPORATE ADDRESS: /`%�� S D s��/j/// ``'/�7• �G 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 rLyen Awareness Expiration Date W kW SIGNATURE OF APPLICANT DATE i ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments, including mobile trucks must be inspected by the Health Dv. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation, or display of any food product by a food establidiment 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 Ist to Dec. 3I't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:Mpplication FormsTOODAPPREV2018.doc pp IKE ro TOWN OF BARNSTABLE. _ HEALTH INSPECTOR's Establishment Name: - Date 15.�age:.. of � � OFFICE HOURS - '- BAR E.O PUBLIC 2 0 MAN STREET 3�30-4:30 P.M. DIVISION' _ - 13: 0- :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified I. 'qp Me;. �e� HYANNIS, MA 02601 soa-862-4Rsaa No Reference R.-Red Item PLEASE PRINT CLEARLY 'FON1P'' FOOD ESTABLISHMENT INSPECTION REPORT Name Dat Tyne of Type of Inspection g Routine Address Risk od Service_ Re-inspection ' Level Previous Inspection 1 Telephone Residential.Kitchen Date: Mobile e-operation Owner HACCP Y/N Temporary Suspe ss �- Caterer General Complaint Person in Charge(PIC) WA Time Bed&Breakfast HACCP -� In: Other Inspector Out: C k. 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) ❑ C 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 r 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 TIMEfTEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating s ❑ 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 -e G' ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) wo- osw* ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP .0 I ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY tt,' ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories (�UPN i Vto at ons Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) (r, 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. ❑ ry Compliance Voluntary Com ❑ Employee,Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other:. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation. (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4non-critical violations regardless of the number of critical, results in an F. ' 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot aggrieved b this order,you g g. q 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 agg y y have a right to a hearing. Your request must violations observed,7 to 8non-critical violations. If 1 critical refrigeration. ' 28.Poisonous or Toxic Materials (FCJ)(590.008) be in writing and submitted to the Board of Health at the above address 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Ov (LAI�� Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N Signature Print: Si #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC 9 Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) I FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 6 Cross-contamination 1 q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 __ PHF Hot and Cold.Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 7 5 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) * . • - EMPLOYEE HEALTH � - 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to - 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance 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 oe 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* q 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(1--)) 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 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° Not Otherwise Processed to Eliminate F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 ( Drinking Water from an Approved System* * gg Equipment*590.006(A) Bottled Drinking Water* q --- 3-401.11(A)(2) Cnm_mimired Fish,Meats&Game Pathogens* elf c"ve uuzoor 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR.22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(I)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed _ Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* A 1 All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail __ 3-0Ol.l1( )( )ro) 3-201.17 Game Animals* 11 Good Hygienic Practices 77 Reheating for Hot Holding practices should be debited under 929-Special 2-401.11- Eating,Drinking or Using Tobacco* * Requirements. $ Receiving/Condition g• g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * ( )13 Handwashing Facilities 3-202.18 Shellstock Identification 3-501.14 A CoolingCooked 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 1590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 _ .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41'F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 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* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �Op THE T TOWN OF BARNSTABLE. .,, - ... .HEALTH INSPECTOR,s Establishment Name: Date: age: of h OFFICE HOURS ��_• PUBLIC HEALTH DIVISION 8:00'-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:3o-a 3o P.M. Item Code C-Critical Item DESCRIPTION," VIOLATION/PLAN OF CORRECTION Date Verified MASS. g MON.-FRI. �p ,e39. �0 HYANNIS, MA 02601 ", 508-862 asaa No Reference R-.Red Item. PLEASE PRINT CLEARLY. 'F "'' FOOD ESTABLISHMENT INSP CTION REPORT Name Da Type of T section ASe-ice outineAddres Risk ion evel Previous Inspection Telephone s., Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness 14 Caterer General Complaint Person in Charge-(PIC) Time Bed&Breakfast HACCP In: Other a / el Inspect Len I Out: (� Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. r Uy 1 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 q EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 0 - V 'Au r ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives \ L ❑ 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 Asa Public Health Control c ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.,ProperAdequate Handwashing CONSUMER ADVISORY �] ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories 10 o Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations 1 ) f' `' Critical(C)violations marked must be corrected immediately. (blue&red items) pC,J Corrective Action Required: ElNo 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 checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (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 i ' 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 8rion-critical violations. If 1 critical refrigeration. violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Sill 2§ure, tint: Self Service Wait Service Provided Grease Trap-Size Variance Letter Posted Y N ^, t �P q Dumpster Screen? Y N (� Violations related to Foodboine Illness- Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 4-22) 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* 0 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202:12- Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * - _19 _ _ PHF Hot and Cold Holding _ 2-]03.-11 Person-in-Charge Duties 3-302.14• Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45°F - - 590.004(F) - * - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* � Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to - - - 7-102.11 Common Name-Working Containers* - Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* - - - - 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control ' 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3.302.15_ .Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) q 590.003(G) Reporting by Person in Charge* _ 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-30614(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washin Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 596.003(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 - "" 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* -. - 4-501.11-1 Manual Warewashing-Hot Water 7.206.12 ARodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products*' 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS * 4-501.114 Chemical Sanitization-Temp., H. CONSUMER ADVISORY 3-202.14 Eggs and Milk Products,Pasteurized P••P 16 Proper Cooking Temperatures for PHFs t 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* _ _ Equipment* _ I _ gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg°"ve 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-1 1 min Eggs* 4-702.11 155 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 3-201.15 Molluscan Shellfish from NSSP Listed _ Chemical* ( ) ( ( )-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to l * 2-301.12 _ Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 3-202.18 Shellstock-ldentification Present 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5' Receiving/Condition - - g, g g 3-403.11(A)&(D) PHFs 165°F 15 sec - 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne 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 3-101.11 Food Safe and Unadulterated* ( ) g 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* Lis Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices VFC- 590.000 3-203.12 She 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 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection .004 3 402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices27. Physical Facility .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 _x, 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging_Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.00,0. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF, TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of " p OFFICE HOURS eAansrne�e.o PU6200 MAN STREEELIC HEALTH TSION - - 3:30=9:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified :30-4:30 P.M. MASS. $ MON.-FRI. ,e3 HYANNIS,MA 02601 508-8624644 No Reference R- Red Item PLEASE PRINT CLEARLY 'F°^^"`' FOOP ESTABLISHMENT INSPECTION REPORT _ cc Name to e o T A s ec'o r Address Risk F ervice ion _ Level lion 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 J In: Other Inspector W- . 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) ❑ CY 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 Itemsl Total Number of Critical Violationg Critical(C)violations marked must be corrected immediately. (blue&red items) tQ ® Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)( )590.008 be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N Nil a!!�y 4 #Seats Observed Frozen Dessert Machines: Outside Dining Y N P C's Sign t re Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N i Dumpster Screen? Y N V 6" 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.) -T T. 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* ; 1 3-501.15 Cooling Methods for PHFs *_. _ 19 PHF Hot and Cold Holding _ 2-103-11 - Person-in-Charge and RTE Foods.*ge Duties- -- - - - - 3-30214-"' , Protection'from-Unapproved A3ditives Contamination from Raw Ingredients Sa Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F -- -r - - 590.004(F} EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 3-501.16(A) Hot PHFs Maintained At or Above 140°F 590.003(C) Responsibility in-Charge ge to ___ _-_ - __ _ __ _ 7-102.11 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Se aration-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) I 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* _ * 11 7.202.12 Conditions of Use 590.004 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils ( ) q 590.003(G) Reporting by Person in Charge* -- - - -- - - - 'Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* 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 � - � g ( ) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4' Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* _ _. 4-501.111 -- Manual 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* 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. 6 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 -601. Clean Utensils and Food Contact Surfaces of Animal Foods That are Raw,Undercooked or _ 5-101.11 Drinking Water from an Approved System* 4 11A( ) 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* Eg,�Ii-IO2001 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 3-401.1 l(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* f Shellfish* P 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.1 I Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009 A (D) Violations of Section 590.009 A 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* __ ( )- ( )-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild ld 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 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco*. 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165'F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial) Processed RTE Food-140°F* Blue Items non-critical 23-30) 3,202,15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* ' 3-lOt.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* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70'F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 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 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 1.007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.00M. _ _ *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. pp 1HE ro., TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: Ige: of OFFICE HOURS AR"N k of PUBLIC 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item ESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4.30 P.M. ntnss. �r. ., MON.-FRI. '�b, .c9q. �• HYANNIS, MA 02601 soa-as2 asaa No Reference R-:Re :It PLEASE PRINT CLEARLY "'�`' FOOD ESTABLISHMENT INSP CTION REPORT Name cJ Dat ' Type of Type of Inspection Operation(s) Routine /l�� �• Address Risk Food Service Re-inspection ,Level Retail Previous Inspection Telephone �- Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) V �Ty�eVb` Bed&Breakfast HACCP Other- 10 aa Ir Inspector 6-� Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. fkj A- LA Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items, An 590)((G Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590Action as determined by the Board of Health. Allergen Awareness 590FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands❑ 1.PIC Assigned/Knowledgeable/Duties13.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 WC-1 V FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Fo/o©dss))//{gw ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures❑ 5 � A-, 5.Receiving/Condition ❑ 17.Reheating C ck ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling _ a ❑ 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 POPU SP) �c ❑ 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 Advisorie �/V 1 LG l - t Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Viol ions / t (C C Critical C violations marked must be corrected immediately. ( ) y (blue r3<red items) Corrective Action Required: �- 6!-Z- Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Re triction/E lusion ❑ Re nspection Scheduled ❑ Emergency SunfiW6i/ C N Official Order for Correction:Based on an inspection today,the items Embar o checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC73)(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 )( ) aggrieved b 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.Physical Facility (FC-6 590.007 99 Y Y 9 g q 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 th above ddr ss �� j �� I violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 1`Ef�7 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: VV ) 31.Dumps r screened from public view IA,/�/�1/n�/ Permit Posted? Y N \�► " - y L Grease Trap Previous Pumping Date Grease Rendered Y N PIC's Signature Print: #Seats Observed Frozen Dessert Machines: Outside Dining Y N 9 Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y . N Dumpster Screen? Y N r.:-�-v.-�-I-,.k.� ..r,�.._. `y�1�J-•`••,-'a•-,r..,s. s-T:.5^iC"�.�+�..'J--:�.�'+�.--•r/S-r.+ ,��:i+V.v..v �J.r.- ..�_-_-.�r- ..,_� ._ _..-. 5.+� -., -k..i-`-f--rw wv�/`�-�`' .�. .. r, .- sTrLL L'i.v, -° vdr`f'-'� - Imo.+:� ���I^'-�-_•r� .�-rt-y...y,r.,L�I.°...�"'.Y"......- s'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* F 8 Cross-contamination A 4 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* ` -- - * 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives Cooked and RTE Foods..*-- I _ _ *_ 19_ . _ PHF Hot and Cgld_Holding . 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 5 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH v - 3-302.11 A 2 Raw Animal Foods Separated from Each * 590.004(F} -- ( )O P 7-101.11 Identifying Information-Original Containers * 2_590.003(C)- Responsibility of the Person-in-Char e.to _ - Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F P Y g 7-102.11 Common Name-WorkingContainers Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* -- Applicants*- - - - - 3-302.11(A) Food Protection* . - ; - .- 7-201 11 Separation-Storage 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* 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) q 590.003(G) Reporting by Person in Charge* _ 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7_204.12 Chemicals for Washin 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 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004A-B Com with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) liance w L *P _ _ -- _- _ --�- - - 4-501.1-11- - Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* . P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* ._ _ .. __ _- Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. L16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness*- 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Equipment* Utensils and Food Contact Surfaces of i Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 ._ Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg cave iivaoot 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 F 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 Sanitiza[ion 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 Equi ment* -- - Shellfish* - - P 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* I g m 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * - - - - Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g� P arY 10 Proper,Adequate Handwashing 3-401:11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By - - 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.48- Shellstock Identification-Present*`- - -- - - - - 2301..12 - _ .Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 2-301.14 When to Wash* * Other 590.009 violations relating to good retail 590.004(CZ_ Wild Mushrooms* _ _ _ _ _ _ _ _ _ 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec r 3-201.17 Game Animals* 11 (`food 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 RRceivedl at_Proper Temperatures* r'r '- 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 23-30) 3-20,2:15 Package Integrity ;. 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* illness interventions and risk factors listed above,can be found in the 3-101.11 Food Safe and Unadulterated* ( ) g 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible _ Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 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 I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ _ _ _ _ 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF.KE roi TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of L OFFICE HOURS P ° PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE, • 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �`rFo MPS° 508 862 4644 FOOD ESTABLISHMENT INSPECTION REPORT Name Dat /-7/ Typ e of Type of Inspection ORe Routine Address Risk/ od Service Re-inspection G _ Level Previous Inspection Telephone Residential Kitchen Date: Mobile re-operation Owner HACCP Y/N Temporary s Caterer General Complaint Person in Charge(PIC)' Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checke 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 4 Inv A"," lArit FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Haza dous 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 r PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control 718.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS( P) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP r ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations ( _ Critical(C)violations marked must be corrected immediately. (blue&red items) l� Corrective Action Required: ❑ No Yes Non-critical(N)violations must be corrected immediately or Overall Rating ❑ within 90 days as determined by the Board of Health. ® Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health., Failure to correct violations regardless of the number of critical,results in an F. B=One critical violation and less than Orion-critical violations re g 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation ttion of rodents or insects,or lack of 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 non-critical. . If critical water,sewage back-up,infestation 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. 1 critical refrigeration. violation,4 to 8rion-critical violations C. 29.Special Requirements (590.009) within 10 days of receipt of this order. = 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' Signature Print: Self Service Wait Service Provided Grease Trap Size" Variance Letter Posted Y N Dumpster Screen? Y N 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) lAssignment of Responsibility* 8 Cross-contamination L14.. - 1° 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 F15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH_ 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*7-102.11 Common Name-Working Containers* 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Se 3-501.16(A) Roasts Held At or Above 130°F* Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 590.00411 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) Variance Requirements 590.003(G) Reporting by Person in Charge Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* 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 E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* g8 Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-40 1.11(A)(2) Comminuted Fish,Meats&Game Pathogens* EU&e utaoor 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* 8 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 1 p 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 practiRequices rhos 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* 3AD3.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23.30) 3-202.11 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3 403.11 Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 3-101.11 Food Safe and Unadulterated* �) g 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 3-501.1 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. 1 Physical Facility FC-6 .007 T Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6.2doc 'Denotes critical item-in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oFTHE.o,," TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page:. [ of I '4 OFFICE HOURS PUBLIC HEALTH DIVISION, 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. $ HYANNIS,MA 02601 - 8-8 -FRI. No Reference R-Red Item- - PLEASE PRINT CLEARLY. - �p .e3v a 0 508-862-4644 'FON1�' FOOD ESTABLISHMENT INSPECTION REPORT Name Date Type of Type of Inspection 4R. s Routine Address Risk d Sere" Re-inspection Level Previous Inspection Telephone. Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast C In: Othe Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives �✓ ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMErTEMPERATURE 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 Asa 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 tl (A �I�❑( Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations J Critical(C)violations marked must be corrected immediately. (blue&red items) 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) cited in this report may result in suspension or revocation of the food B-One critical violation and less than n-critical violations 9 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 boon-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, ewage 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 refrig tion. 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: Inspector's Signature /��A Pri 31.Dumpster screened from public view h-k " �Ka Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: #Seats Observed . 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 4 Law Cooled to 41'F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45'F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* PP 3-302.11(A) Food Protection 7-201.11 Separation-Storage* Applicants* * P g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* (11) Variance Requirements 590.003(G) Reporting by Person in Charge Contamination from the Consumer 3 590.003 D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* ( 3-306.14(A)(B)Returned Food and Reservice of Food* REQUIREMENTS FOR 590.003(E) I Removal of Exclusions and Restrictions Disposition of Adulterated 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 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. 18 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-001.11A(1)(2) Eggs-155'F IS sec dness* 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw,Undercooked or * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* 5-101.11 Drinking Water from an Approved System * Not Otherwise Processed to Eliminate gg Equipment 590.006(A) Bottled Drinking Water* -- 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* effe ce-iiuzooz 4-602.11 Cleaning Frequency of Utensils and Food Animals-155"F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3 401.11(B)(1)(2) Pork and Beef Roast-130`F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By Ratites-165'F 15 sec* 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145`F*' kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165'F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercially Processed RTE Food-140°F* Blue Items 23-30) 3-101.11 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3�03.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found.in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70'F 3-203.12. Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005- - 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 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. `oF.Ne rok TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: . of q OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARN57'ARLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASK. 0g HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �A ,679•a• 508-862-4644 'FDMP' FOOD ESTABLISHMENT INSPECTION REPORT Name Date T e o Tof-inspection / p g _RpTtine Address Risk ood Se raspesAon Level eta'I Previous Inspection Telephone C Residential Kitchen Date: G ` Mobile Pre-operation Owner �. G� H G Y/ Temporary Suspect Illness V24 Caterer General Complaint Person in Charge(PIC) IF Ime Bed&Breakfast HACCP In: Other Inspector Out: `r ` 2. Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. 1 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 i EMPLOYEE HEALTH PROTECTION FROM CHEMICALS �fL ®� ❑2.Reporting of Diseases by Food Employees and PIC ❑ v 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) r ❑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 Lin PROTECTION FROM CONTAMINATION ❑ 20.Time Asa 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 11-71 11.Good Hygienic Practices ❑ s 22.Posting of Consumer Advisories !`If 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 Mdays 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) 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• (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6von-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.yDumper Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board'of Health at the above address violations observed,7 to 8non-critical violations. If 1 critical refrigeration. 29. irements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30. PATE OF RE-INSPECTION: Inspector's Signature Print: 31. eened from public viewPermit Posted? N Grease Trap Previous Pumping Date Grease Rendered Y N natureC's Si Print: #Seats Observed •Frozen Dessert Machines: Outside Dining Y N PI 9 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 1 q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45'F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge[0 Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 7-102.11 Common Name-Working Containers* 2 Require Reporting by Food Employees and Contamination from the Environment 3 7-201.11 Separation-Storage* -501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 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 Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111- Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashin -Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* g g 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- Animal Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* - 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ery ai9 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* _ 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* Shellfish* 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 Game and Wild Mushrooms Approved By 2301.11 Clean Condition-Hands and Arms* (C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under - Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Wild Mushrooms practices should be debited under#29-Special * 11 Good Hygienic Practices 17 Reheating for Hot Holding p P 3-201.17 Game Animals g g Requirements. 5 Receiving/Condition 2 401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30)- 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* F 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-202.18 Shellstock Identification 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 s 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 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Physical Facility FC-6 .008 PP 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. 1 Other 4 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. °p THE►per TOWN OF BARNSTABLE .. HEALTH INSPECTOR's Establishment Name: ��� Date: // Page: of ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified A j,e m� HYANNIS, MA 02601 MON.-FRI. e No Reference R-Red,ltem PLEASE PRINT CLEARLY 508-8sz 4 A4 ,FOMP, FOOD ESTABLISHMENT INSPECTION REPORT Name Date 6 ) e of Type of Inspection J on Routine Address Risk Re-inspection v Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile r e io Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint a Person in$haWe(PIC) Time Bed&Breakfast HACCP _ v In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12:Prevention of Contamination from Hands ❑ 1,PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives 1713.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 L) D ❑ 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[J I I Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or _ within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the itemsroEmbargo checked indicate violations of 105 CMR 590.000/Federal Food Code. 9 ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FCC 590.005 B=One critical violation and less than 4 non-critical violations 9 )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements •. (590.009) within 10 days of receipt of this order. violation,4 to 8 non-cr'' I violations=C. 30.Other DATE OF RE-INSPECTION: Insp ctor ign 4 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed 'Frozen Dessert Machines: Outside Dining Y N PIC' i ature /'1 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) JD�e_. ssignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) onstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003 C) Responsibility of the Person-in-Charge to Other* g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* ( P �' g 7-10211 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 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 590.00411 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use * 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 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 Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y Pe 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 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 Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 1r1/2001 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) 1 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 Chemical Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed * 8 g �' S90.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* fodborne 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 * I 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * (Blue Items 23-30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the Foodborne * 12 Prevention of Contamination from Hands 3-403.11 Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated �) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 ■ 5-204.11 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 Supplied with Soap and hand Drying Devices Within 4 Hours* 26. Water,Plumbing and Waste FC-5 - .006 590.004(J) Labeling of Ingredients' 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* 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. BAXTER & NYE, INC. Registered Land Surveyors and Civil Engineers 7 Parker Road/Osterville,Massachusetts 02655/Tel.(617)428-9131 WILLIAM C.NYE,R.L.S.-President RICHARD A.BAXTER,R.L.S.-Vice President PETER SULLIVAN,P.E.-Vice President-Engineering May 29 , 1986 Town of Barnstable Board of Health P .O. Box 534 Hyannis, MA 02601 Re : The West Beach Bathing Co. Dale and Hawthorne Avenues . Hyannisport Dear Board: Please find attached a revised site plan for the Beach Club. The plan was revised at the request of the Conservation Commission . The revision consists of moving the septic system away from a dune . All flows , components and elevations remain unchanged from the original plan. ' The Club would like the Board to consider their Variance Request for upgrading the facility on the basis of no food service . It is my understanding that once the facility plan has been finalized the Club will apply for the appropriate food service permit( s ) . I trust that this meets your present needs . Very truly yours , Peter Sullivan, P . E. Baxter & Nye, Inc. PS/fmj Enclosure CC : Patrick M. Butler , Esq. MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS/AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSEITS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS ti HERRICK & SMITH VILLAGE MARKET PLACE II 297 NORTH STREET WASHINGTON OFFICE BOSTON OFFICE 1800 MASSACHUSETTS AVENUE,N.W. HYANNIS, MASSACHUSETTS 02601 100 FEDERAL STREET WASHINGTON,D.C.20036 BOSTON,MASSACHUSETTS 02110 ` 202/659-2700 TELEPHONE 617/771-4100 617/357-9000 TELECOPIER 617/771-8079 September 25, 1985 Robert L. Childs, Chairman Board of Health Town of Barnstable 367 Main Street Hyannis, Massachusetts 02601 Re: West Beach Club, Inc. Dear Chairman Childs: I am in receipt of your Notice of Violations dated September 5, 1985, and addressed to Mr. Louis P. DeRose. Please be advised that Mr. DeRose is the President of the West Beach Club, Inc. , a Massachusetts corporation. The West Beach Club is the lessee from the Hyannis Port Civic Association of premises located at Dale Avenue, Hyannisport, which were the subject of inspections by your Department which occurred on August 28, 1985. The West Beach Club was open only for the summer season and is not presently in operation. The premises closed for the season on September 21P 1985, and will not open again until mid-June, 1986. It is the purpose of this correspondence to inform you that a meeting of the Board of Directors of the West Beach Club, Inc. , of which I am a member, is presently scheduled for early November, 1985, and it is our intention to discuss at that time the food service facility at the Club and to take immediate steps to meet the requirements necessary for the issuance of a permit. 1` _ -v ,r HERRICK & SMITH Robert L. Childs, Chairman Board of Health September 25, 1985 Page 2 In the interim, I would be most appreciative if you would direct any further any correspondence or questions regarding this matter to me at the above address. Thanking you in advance for your courtesy in this regard, I am, Ver ruly yours, Pa rick M. Butler PMB: jld cc : P. Louis DeRose, President West Beach Club, Inc. Fred Filoon, President Hyannis Port Civic Association Selectmen' s Office Town of Barnstable a tuv R Complete items 1,2,3 and 4. 0 y I a dress in the"RETURN TO"spec®on the 3r srd .Failure to do this will prevent this card from being returned to you.—.he return receipt fee will provide -+ ame of the phrson delivered to and the date o? .d liv Y :br aiiditigal fees the following services are of iavpi1at4e.Consult postmaster for fees and check boxes, f on sery iceiQ)-,q'pquestecl 0 ,P! X�A;nUo%W),,t' venom,Date ana aaoress of deirvery.Ced Delivery l` 3 Article Addressed to Mr. Louis P. DeRose Irving Avenue Hyannisport, MA. 02647 4 Type of Service: Article Number ❑ Registered ❑ Insured P 522 4'44 157 XMertified ❑ COD ❑ Express Mail ays obtain signatur eof addresseeg ent and D DELIVERED. 5. Si Siy ture - Ag6nt X C9 7. Dat f Del* or C z s Addressee's Address(ONLY i sequesfe a ee pa .71 n m ti UNITED STATES POSTAL SERCCE 'OFFICIAL BUSINESS SENDER INSTRUCTIONS i4 ONTH Print your name,address,and ZIP Coded to he 35 u.�MAIL ._a space below. --�® • Complete items 1,2,3,and 4 on the reverse. • Attach to front of article if space permits, PENALTY FOR PRIVATE otherwise aft to back of article. USE,S" • Endorse article"Return Receipt Requested" ad acent to number. RETURN TO BOARD OF HEALTH - TOWN OF BARNSTABLE (Name of Sender) R o.end Street,Apt,Suite,P.O.Box or R.D.-Jo.) I ,a d ZIP Code) P"522 444 157. l' RECEIPT FOR CERTIFIED MAIL NO INSUF?ANCt COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) SentAr. Louis P. DeRose La Ch T Street and No. 00 o, P.O.,State and ZIP Code.. O d c7 Postage $ t/1 * Certified Fee Speciai'Delivery Fee Restricted Delivery Fee Return Receipt Showing to whom and Date Delivered ao Return receipt showing to whom, a) Date,and Address of Delivery T m TOTAL Postage and Fees $ 1.67 L o Postmark or Date 29 E Mailed 9/9/85 0 U. 0 a STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, r CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES.(see front) .1. It you want this receipt postmarked,stick the gummed stub on the left portion of the address side of the article aving the receipt attached and present the article at a post office service window or hand it to your rural carrier. (no extra chile) 2. If you do not want this receipt postmarked,stick the gummed stub on the left portion of the address side of the article,date;detach and retain the receipt,and mail the article. 3. It you want a return receipt,write the certified mail number and your name and address on a return receipt card, Form 3811,and attach it to the front of the article by means of the gummed ends it space permits.Otherwise,affix to back of article. Endorse front of artile RETURN RECEIPT REQUESTED adjacent to the number. 4. It you want delivery restricted to the addressee, or to an authorized agent of the addressee, endorse -RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If return receipt is re- quested,check the applicable blocks in item 1 of Form 3811. 6.Save this receipt and present it if you make inquiry. '� '�_�� •^ � "e 1. "# ;-"'+. ! . J ti l,,f;• f "R3r,,� ..� }. c.+'.s� c 7 s rt .9 js- •)_ �di f � •', � f " ;� F� f • jn rt f• } ., � + _€%, � " f.y �`,•z'�`:t 7 �' •. .,5 �M ,ry � �,'`:t� 1�ve _�`�S 5 ,. '4� 3 4 { , '{ V ,? L }{ �'` � � * < 'i ti Y 1 1 t d. P \ r S-} aV y!Y K t !eM�r Yp• • a:£ �,�t. � r�� new. 4 �:• t i..�f Z ,r�sr�'.�CJ4R ,5 {,..r, �'" "4r�:;,eP �sa m��s�•°y.srt��- 3tc�•, +j1 .wz t `.r, r "a�' 'S. n. ,, 7. ,t•' r K. d ', s 4.✓r° ; ¢,�7 .:.w � � y f 4" rd ;�7�i s 5 r ir•: r6• aro'7.+ 4" >« i �� ' �,`"-e,S. �" " � ? "sr xv ,�#" a o j: -.t f.� S ;z'9 J °•J , .1.� r �.,A w _{ J' ii';. ., a, ,:,��t i �± w ,,, 3 •rx. - e'�. � '�'• ,eE t° 1 �. ?� ,yk.,VyS. v+�•„ '^ ss +:f r�.`E�. 4 ,,, y' ,,. ! `r •-,i J "? ,n s.A,y + `'r i 4 s y! a ti ti 3 y. p 2V k r• �. a d."� ° �rG n ` ; �+ x �;•ti- S t •. J �. J = F. * r .4 A,`iz` ,i'� ` T F' }�. i'`` ♦ ti V �f .R. i, J r,: 4 1 }` �. _�e t L �. C 1.� K ♦rF'' ,�e� ., s . r y t...,: i• ,�.. r. �•..x -fit �.5 �'� '-. #�� " P >• .,iy ;'� �y1 •',r�-T- f Y�'"7'F^..r ,j +• k to '' I k .,� 4 4e'L `.t k P ai. fi �. �'� a. Y� ,�"., ,k t`�a "' � 5 rs. ;,,3"" •r r' "{�• \�•^ ,:�"f x ° � s� � �4'' S."' � 't +u �'�.. i � �' kx 4 r .t F � .. t ;.; ', ry ..+� � -.w 3 (, ♦ `"& r ea » � 47 S'. I :S + '� r i . .rY' 1 ..• 'i rl r •' + +'" c. �` 1 hi" t,s _ r e , � } ti �r�' ,e. .{`. r ;i, P 'fN ; `«.t 3 ','� ��_7 " `"t � . X * n R �.'. ii�.�it'yr7.s' '� �,,°•r. PrF 4 r v'4�.i..s�-�•a rt y x w _ t: s r .�j i. - ' .�, ., .'•�� t ��; " � .vi,'r; "�}y+ T� _,;Y q�" .�" i't <�' ,✓ s::�. �� f'tt.� �Y .a•� :-,r: 4 s September 5, 1985 r .4, 'K'.t '''�r�c.' '} Y r '..< T", d frt� " •" 7 ♦ 1f t r f,F xy ' d� ri - , ' '.. s �y �3S ` -- K.4 ♦,� I 7 �" .* -, .+u , Yp ,� ti,a` ?•`� t -a 1 rJ,• 7f �. + .s t „ ,� '!R r. ,,.•, .. • - J r :t_'Y r�� �" ."�.r ar j� r�.hh r^ t 'f 7 a 1� x '" k5 � ° ��, 'L i Sr r •'f'44 .." «r,r T+' w� ed' '4Sx 1, H . rz t itra `' rs�'-�'� r••r Y - - r 4. °5 ,.*7'4; •'� H r ,r ,5`' `71'w•�ii"'r 5r .� u,a ',; 'S ` '�7` ' a az {;l,1 �> � a .♦P'' rr .. `�y�R,� ,., ��[yv�o :rt_y K y_ c A'.'� r £"�ti ..� c�' �r4`,+.':• r,x, S_�'. � '�`�'. .. ' }.ii3s-• ,F ? N P 3;;7.j r{' �'' h. �.., ..,r R fic...y ." 3 ?.e�, r : �. .. r" F l` Xt3. ,;'y•�',F 4 5 Fr t:t t k:'t: - rT�, Louis P DeRose ,; u t�� �er , ,� r. . *:., % ? ,�.•• #. Irving Avenue. Hyaport MA.: r , [•` "tr r n,,. v .-t � yh'a� s ,+. �.r+•'y +.. 1,f'aF Vu;l -r'ti k'... ! � i 5 �.,. .. t ar, ; n niss, 026447 ° tr ,� t 7►i' r Ct' : ! .. y r..}+'S 3 r ...!♦'`' "` �- + tis'x, r _"4<�'+` 4 rtu!' .Gs+.a.. •-' .ir p'� ,w •y : .NOTICE `OF_. IOLATIONS: iOF,.""105 ..CMR' 595 000, 'STATE" SANITARY,:CODE, 5 � 'sue ARTICLE=S;:X, MINIMUM'.,. SANITARY•,`STANDARDS, .;FOR,-'FOOD",,: SERVICE =�� t` ' ESTABLISHMENTS''AND,CEASE;OPERATION.-ORDER`" � - ,.F..i � hr r i,r v` t.• fi:.af. fy' ,`.- } -F i Yi - hSr y• Y:...i F q en. ,f"w3 Sij tr"2`'� ' S, • ,, ' Mrr "T - . F a- '` Y ♦. �' � ,•��q•a s.•. homas,,McKean',And Mr. r Terrance Knowles, Health;Inspectors; for ,-,Town,- Abe" of 7:13arnstable; in'spected t'yourfood ,service" facility 'at The} es, Beach r�Club, " , I yannisport, on August 28, 1:985., x�� „�•�, " : , ,. , * ;; ' �+ ��" ♦ 3. y, j t. iY�W A ,K, � a i♦ ?. N ?i .F` !. a ,�fr,- ,f't, •r ''s'r '� r , v ,•,t it f ` ...•'fir P *' .. ay 1 # i,�`s,.:u •r ,. ,` ySF a _.5ra• ,.,..#. •„ S ; - , You`,were'sPound to begin violation `of Regulation`595 032, the operating,of a-°food �'. +S' �•', 't - `' •` "fir' t t ser'vice,establishment ;withouta permit: In°addition, you did not'complywith the° ,` c T'• requirementszthatpare mandatory prior to obtning.a permit. l, 'y. h�r''t, �� , rr Ss: ` hs.•F-:1.yet. -.{•,. y`Sa ^ '� ::r,Y "'.�r'"r� t-., yV�t y.. S r „r: •.x., M4-� r,y S .� �* �� .`� T '�� ,t i. t ' .' d t'Y' 5. °+�'� s, 1.. fi' t - "' .. �5 �" p a '" 3 •� �` t` . i't t i....� ;Ong August, 29,, 29$5; r you• were�y9Wen an order to cease; your: food aervice , �,� establish'ment: 4j"• an ,J �, '.: a �3.y, Y* ''` " <;,3 i, S,�) r- t .. FK rf µ t •�, x f • e • K• r _ �-•. t.'r--.- „ '.t .3T } � �; ,♦ •. ♦ t.rt`F - -.`+7 3s . 3'F'. x .t:.,t � ��` <<„ t R i.a I k 3 4 *J� Youraattorney Mr ;Patrick'YButle;';visited our office concerning requirement for -:obtaining.'aa tempor'ary,�per"taut for,,LaboT Da`y;{wee kend' -'However "apparently you decided�n' dt tolopen as`no,further*,rCgU(36ts WEfe'rredeived �� ' a � .,Sai �� ,�. i rr Y k °#, �+ ,tY x.y.' y '".,' ♦ s. � ri C>.; '' t'::=t �' ;'S ,t iy J"a :r j ♦3 '.. ,_ k+ ..yt 5". + �_ .5. y e� - '�- t .Y ,• l . You'are hereby-. notified'`that ,you cannot.x operate a food.-,service establishment without a,'per'mit YwYou`�aie`also not ified;that, only a,person- who,,.complies :3 '! Article 7.X; •of?<the .State'Sanitai•ys 'Code,-vand the `T6*n!, of. Barnstable,Health' "! F ,. a � °�.k`:' � �-� a 3 �' b,'{ `' + Y,+•r 7 t'f"'n< -6 ,. i y '� +'. Regulation's is'entitled to receive a#permit s r, } 4,,,F •*i., S 5r 3 '¢ 4 -.r b t�.,i� b#•". 4Y` n i ; r.,S SJ. '_ �- .-L '"rr 41.. ""'.� s � $..r 5 9 � �L v+�,v� 7 r �• s �, ` t r, ,.x f ;t r ..Please be"advised that,any fnrther`ope'ration wilh'result.in:a gropriate,legal'action_. f �}� J f s w� ,• k ''4d � r n p ,s k , y ♦,i �[� �a 4 't �5"•'rp t o.' r t [ .- 'S 's. +t • i .�.-P '«1 ,,7 t .a ;'' ,}r,. •!. ; r �=A� fine of Prot' more th+an�$100 for the first' offence�and r$500 00' for'subsequent f ' - .. y e ' r ' R X 7 offences;-.ma •be 1 vied utide ifi' 'authoritip 4 a ulat on,1 595.039 , of ,ArtidW4 �, r♦ t ;{ "State`TSanitary :Code.t Each day'sYfailure Ito comply shall `eonstitute�'a ,separate '{�:_;5, ':1�.:`. offence " r ";{4'L ,F�'� � �.+' a; -• , ., # j'''� ar� �K ' � `y�'f' .:r t' �:�r#e i •�� * , n 3 - ` 1.I�t � _,�, -i• � i♦ 3'-� 4 '-7�`- r 4��r >� "t` ?� N��z � � .)` t�rr� �: � 3•r _ #' iy ` .. -d r." ' t• , • Y , iy,r�, Y - r� PE ORDER OF;THE BOARD,OF HEALTH r,[ �._y j ♦ ; Y9t*5wL Jy .'r � _ ' "/ � :i -p '' t�'*r.r;r ! r r '� �FtTM syS gryN _• �. j"Y;• � - }k�. i• 'ti .�;� "r A" R i.e'1a a r,,�' `.�' ,. ,�� rt c"rs , .ev�,• �J'.-�` 1'" �' ,yS4 , �,�. x}y,_$ -3 ; �F��7 yT^r.jya ,�,7�•'�? ���'�1r.«, �,��""'k'•k ti w�''t9Y s'�.- � . ,a„*'t ' ,� '` �.2 � � r4 „tt ��s% 7 re a } �3f� r y Robe°rt :Childs. r �� ry` Chairman ' d ".. 11. +}, .•}F7r5 k, .. • r rF' "1 WARD OF HEALTH ` „- r :��� � z` � trti. :, � a ; ';, ,� ,it , ',".,•, , , �;; , `: TOWN OF BARNSTABLEf t ti �,/ _ .yes �,�'y •iti . 4 ae,.' >F '7 �4 t �- +'- . ; �.� is♦`-5 5"'.�s � �t r . *- v .. t s + r •,, ' n + ;s s I., t #� Y , '�34 # sl t { �`t y sr r• s r ; x3 r Y 4 ttF �, (;s t �, Y� •y„'a, " Fs `` �# �"`a' °l• s .�. r—� ^'�•':t `.:}i 7s:'7' �' # �`r'."� r,� !t � <.3 v A:'! �' ,i•, Y s r -°' J r48><.w `$, a !t• .� a' .-Iv# } r t:" 5y J. t.°s x,�5 ,d v v '► ,y ti• :1' },•.r r.. . " e :i .; ice` ANY ,> rt s " x ,! - Yr � �. .+` 7 r, tl -'r, to•L �. , r�.•.+� . '.•:i r .'�' �t ,�.�� +' ` ;`F`.. �� ,*a Y" ` t� D ..*yf * 4 i 'i� �t�* " a �1 THE COMMONWEALTH OF MASSACH SETTS BOARD OF HEALTH I r� NOTICE TO ABATE A NUISANCE / T19 { . X'.lyc % '" Cam. X,; I As owner I 1 ant of f_' +' ' (1• i you are hereby notified to remedy the conditions named below within . 24 hours of the service of this notice, according to Massachusetts General Laws,Chapter III, Section 123: 3701 i If at the expiration of time allowed these conditions have not been U remedied, such further action will be taken as the law requires and a fine of$20.00-per day may be charged. �N d ° By Order of the Board of Health -Inspector �l FO S600 A.M.SULKIN,INC.542-5858 REVISED 1979 �d V� -, v '4 BOARD OF HEALTH - TOWN OF BARNSTABLE • 367 Main Street - Hyannis, MA. 02601 PURPOSE Food Service Establishment Regular Follow-up inspection Report Follow-up,,,,,,, 2 Complaint....... 3 Investigation ..... 4 Based on an Inspection this day,the items circled below identify the violations in operations or facilities which must be corrected by Other .......... 5 the next routine inspection or such shorter period of time as may be specified in writing by the regulatory authority. Failure to com- ply with any time limits for corrections specified in this notice may result in cessation of your Food Service operations. OWNER NAME O� ES BLiSHMENT NAME �r 1J ADDRESS ZIP CODE I t Lam— (1 1 ',Cr _✓'/✓ o EST. ESTAB.NO. SANIT.CODE yw YR. MO. DAY ` TRAVEL TIME i INSPEC.TIME ` STATE COD ° INSP.PROCESS I.D. , zE r fS>??23-24 ?E 5-27 (1-7) -19 K22J WT. CO L. O :., WT. COL. .;::. FOOD SEWAGE Source;sound condition,no spoilage 30 ;.; Sewage and waste water disposal RANOriginal container;properly labeled 31 PLUMBING FOOD PROTECTION < .i> Installed,maintained 58 Potentially hazardous food meets temperature requirements """ ?: Cross-connection,back siphonage,backflow 59 ^ during storage,preparation,display,service,transportation 32 ;h acilltlestomaintain product temperature ,tF ,- < ; 33 TOILET& HANDWASHING FACILITIES _ hermomete provided and conspicuous ''f�: 34 ..�;;: Number,convenient,accessible,designed,installed IE>iG• Potentially hazardous food properly thawed 35 E Toilet rooms enclosed,self-closing doors;fixtures,good repair,clean: hand cleanser,sanitary towels/hand-drying Unwrapped and potentially hazardous food not re-served, 36 _.�•`rs devices provided,proper waste receptacles r > Food protection during storage,preparation,display, service trans o ation •...... 37 GARBAGE & REFUSE DISPOSAL Q � ' 38 Containers or receptacles,covered: adequate number In use,food(ice)dispensing utensils properly stored t 39 ?' insect/rodent proof,frequency,clean 62 PERSONNEL Outside storage area enclosures properly constructed, clean;controlled incineration 63 [Hands ersonnel with infections restricted ''•Ejs [ 40 washed and clean,good hygienic practices :,• '_: 41 INSECT, RODENT,ANIMAL CONTROL lean clothes,hair restraints : %'•' 42 resence of insects/rodents—outer openings protected, 64 FOOD EQUIPMENT& UTENSILS o birds,tunics,other animals } Food(ice)contact surfaces: designed,constructed,main- < FLOORS,WALLS & CEILINGS >4)43 tained,installed,located ?fi'> ' Floors,constructed,drained,clean,good repair,covering 65 xu? Non-food contact surfaces: designed,constructed,main- installation,dustless cleaning methods44 tained,installed,located " '' Walls,ceiling,attached equipment: constructed,good "' 66 Dishwashing facilities: designed,constructed,maintained, repair,clean,surfaces,dustless cleaning methods installed,located,operated S h: 46 = =« Accurate thermometers,chemical test kits provided,gauge 46 LIGHTING n cock(1/4" 1PSvalve) »s: — '` 3 Lighting provided as require ,fixtures shielde ' 67 Pre-flushed,scraped,soaked. ?' 47 Wash,rinse water:clean,proper temperature 48 "VENTILATION Sanitization rinse:clean,temperature,concentration,ex- ';?: Rooms and equipment—vented as required68 posure time;equipment,utensils sanitized Wiping cloths:clean,use restricted •,'< 50 SSING ROOMS '> Food-Contact surfaces of equipment and utensils clean, "'''' :. <: free of abrasives,detergents :.° 51 ;? Rooms,area,lockers provided,located,used Non-food contact surfaces of l equipment and utensils clean ' a =•• q �`�� 52 OTHER OPERATIONS Storage,handling of clean equipmentlutensils ?? 53 Toxic items properly stored,labeled,used 70 Single-service articles,storage,dispensing ti!' 54 Premises maintained free of litter,unnecessary articles, No re-use of single service articles 55 ` cleaning maintenance equipment properly stored. Author-? :; 71 !zed personnel WATER ;:} `Complete separation from living/sleeping quarters.Laundry.''j? 72 73 Water source,safe: hot&cold under pressure ti' # :?: Clean,soiled linen properly stored - ( ?t?`:' < ' 56 Received by: name FOLLOW-UP RATING SCORE 75-77 ACTION title Yes .......74-1 100 less weight of Change..... 78-C (/ No........... 2 items violated-* Delete.........D 11 Inspected by: name `s"s __ *Critical-Items Requiring Immediate Attention. Remarks on back(80-1) FORM FDA 2420(8/80) ' PREVIOUS EDITION MAY BE USED USE REVERSE FOR REMARKS r ITEM NO. REMARKS CORRECTED BY't r 77 �- U r t�- r i AV ' �' (mot � ��/� l ` '� �G(,rC (' � ��✓lJ �7 f J !'1 � � ( !�r- � � �v �� �-� f l 7-z- = V } Gooseber '% �° s •S i J�� d.� ° ;o , plsland � (rij _ •�;n u�k � •t' _ �,� o �" �,r C. E ruci A w e viler 1 �.•:. A. If (50 IIJ • 1, , Gc(� II . bb ©© o© � ,� •�4• � •• •n y ,'il_� a D't I sa 'fF f� ,.� cs ,�:•�• l X Pt �n 0 111, II 4 - moo . 't�. 0•�� •. table. / M h Schj%` /:._ _ �.gRls� (.5 W ke O°�`\ .-.�O t� •./� sT y� j l ' s1 j:fl •."' � �. v_ Q g F�e � Ill Ho rta , Q J\ a ••+Ilaaeo �� 1 , • • •0 a t,e 20 0 tN iN i ra © _ l • S I o �' .• o,:• ®- oil ° ••�. eat !�G':-'�i, •tl •i? �Q �In; �'• --�)'•: m' °Grours p x o r. Ha rbo \� _ 7 •' m 'C�"' eg _ � Bluff •k•"•�'.!" •.!, 8 •O 'C ST SON ST { •' '•u.••. .g $ 37" ,•ROAD / .� ° Sy 2 Park 1 1 Co R0 o — Ve 1 u.rant• u I _ ° •,�h' `- ;I Kalmus /c_ 1 I - " °II it I:II - •C bC -4 I ol 11 I i . o ft gz/ }� �7 ,. Di z° HYANNISZ ft)µ M. 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NAME OF APPLICANT Whitney Wright Trustee TEL. NO. 4 ADDRESS OF APPLICANT P .O...Box '301 Hyannisport, MA 02647 NAME OF OWNER OF PROPERTY The West Beach- Bathing Co. SUBDIVISION .NAME ' ----- DATE APPROVED LOCATION:OF REQUEST-- .Assessor I s map 286 - Parcel 31 -Dale & Hawthrone Aves . VARIANCE FROM REGULATION:(Li•st 'regulation) See Attachment VARIANCE._REQUESTED' (Specific••request) � See Attachment REASON- FOR VARIANCE.(May attach :letter if more space needed). See Attachment : PLANS - Two copies of plan must be submitted clearly outlining variance requested. i VARIANCE APPROVED NOT APPROVED REASON FOR DISAPPROVAL 'Robert L. Childs, Chairman Ann Jane Eshbaugh adJ y '` Grover C.M.. I'a rrish, H. BOARD OF t, i9x D. - ,` . SEATING_ ASSESSORS i NO: ANNUAL PARCEL NO.: . J SEASONAL r THE T TOWN OF BARNSTABLE Prof o�F TEMPORARY X 0^ OFFICE OF i DAH.A & : BOARD OF HEALTH � rum t659. � 367 MAIN STREET HYANNIS, MASS. 02601 DATE APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT FULL NAME OF APPLICANT West Beach Club Inc. NAME OF FOOD ESTABLISHMENT West Beach Retreat ., ADDRESS OF FOOD ESTABLISHMENT 9 Dale Avenue, Hyannis Port, MA c/o Nutter, McClennen & Fish.. 297 North street, Hyannis, .MA 02601 TEL. NO. TYPE OF ESTABLISHMENT: X FOOD SERVICE ESTABLISHMENT: RETAIL FOOD STORE MOBILE FOOD UNIT SOLE OWNER: X Yes No IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: i IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION Massachusetts FULL NAME AND HOME ADDRESS OF: PRESIDENT P• Louis DeRose, Scudder and Irving Avenue, Hyannis Port, MA 02647 TREASURER Betty Gargan, Lafeyette Avenue, Hyannis Port, MA 02647 CLERK Patrick M. Butler, P.O. Box 3, Hyannis Port, MA 02647 SIGNATURE OF APPLICANT HOME ADDRESS Scudder and Irving Avenue hyannTS Port, Massachusetts HOME TELEPHONE NO. please c ontar f patrirk M Butler, .Esq. 771-4100 RESTRICTIONS: r!,p L }__l4. J e ' irrt�i_v+t ,- k ;s r`�,4'�, '"'i S'�^ '' '." .�°S L at,,'*y .re,•�y,ai r{ �y, r r , [ 1�t t f ,.a *„ f + .,, i s +r. { ,J. .y ,ll. �e.y., ` P.., 1 + '. 'S r:` ' t r, 1 - v s`+ z r sty t x�•*•k fl k iiy', ?!.k A �, 3. +a� a P .� ,t.s L,.,i r r 'r'v.:.E r v r .�. r - -' 'f Y `f� i :. I. L ' *s r F>:C iat h y „' , }t.`i � ✓IIP n,w t.,�, e"#« ! ,tk:< ah r t ii.Ah),w � rr.�"•r yh -;n r' •at b * '+ v .s rtrr. r`k* c ..a y r. '..i . d q; r r ff' Y x 1'* g w ,s t &: tk. i.; t r «e, ; -, i r;N•rl.. r A. t o f 1 .. i% t `+ r '�^* ,..' .+L,#„3..w y r ^_r� ± t ,( a ,. . i ( y x' .n' tr [.•, r $ i, 3V' r�'. . r a x u,-,X+ .. (. yy Tt 1 4.-. i-`+ " +' (1 ° 4 *14) t- �f"•'pn` 3'r" +: `° aY tk'�,1�..,f'i , e�"- ' . 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'r.: ',at A X „ ,r .,y�r�" +4174,,!6 « 3. .IF ,i•�(F'.} 'r, i aLr,`"'t�E r" f ,. rt a -r a S., t July,2,,°1986~ ,. ,' �';; r is r �f _ �" ` t' S' � { Si r tr'f I. f.. . a l+r, i "fir i tr7. -J tart,t'`� " t I er l v• Y� ,d4:(' A. �;'. c s r m,r+ � ' - A �f. yr. t 2 `{"4 y-m a 3k �C r 1 r k� -.s• I.,. _r ,. {. , J! y rt ti •2,r' J r, ;,i•+` a �. ; } t�, <, x '.T r x s „ e i v r; )' _ iY rt,r t[.i r*, y ,wrX jr r: ,444.1 ;h'°F;'t "W'x,.'^4 4 . , 4r<"` �14e„?! 'Mar #4+(#'r%1 .tea t w ,y + r. firii N r t^T * y ,'. # Y.€,,M..I f vM{ ". W i -s•�#M*f M 4 P ,y..f" i '� # 1 ?r syt+" r . 4 a;5�,, f�. r 3t.} t.: J '3 - .x r x : ,'i� . `'Q. j_ t d..Q £..4 s r:; t t !`-"d A �, ! '''!`• 4 t r � + _ f' *- .tr# .� r..',• (. s L ,va�..g u. sr }�{ � ; ,,;s, v` �ir�"! ts'ti Jr 'V R Y^$ A' i t '/'' , t .E s[ :Sy'`t* ;{ r ,s..` ".. 1.':s .ll yr+ .' t .t �r ... - -*"'�Py '"': ``t y " 's t !.� s a,,.+ 1 f `xrF J �' s v y.- s f; I.° 8 fi. + aw t' N'4 S, 4 �Vt ij .x,r.yy r 7f .t 't Y �` .v [ i ,� ; a '" , �. ' +r`~ Mt..Patrick M. Butler, *� ,,, *{. € ll� ,� ` „a xt �e x y. tr r.'* asp i �, 3. ,.. 'h a *''€ '�{{ R'. .- - ' ', .f✓7 3 .*h x . ,Y i r ?vp ,,r� +S 5 Ry+` �''�.r 't4 A4 e';Ir�' a ~ fir 1 'I" .. , r ' � v -a ;n e,'r Yltyr a�, 4 - y�" �, �r�Nutter;McClennien & 'Fish `r � , r.i � z i," ,,� , iG•.« ry -. ,++-- .T--_ s § '`i,',[sa 4:. {.y , t1' t ay .t' � wyy 1.�'�'" , Y rtr r.+ ','+. ', i r w429'1 North. treet ; f, [ °.: ' , �� , ,fi.,. _' - ` t "fi ".r `1: of rev ' .,[*q r !e "1 $.... , ar P s r Hyannis, MA: 02601 x,F,: ?, ,;,d � y, _.a 'r �' Fr ,, ". t�jI< ' : L �_ ; ': ,, t�?Z:, .� s °* ,..r. '' C .' 1 4 ,y.... A`�,,- V. t"yi'I y„t " t+{[+F Rpe` ySt. ;fi'y' y4i ��•`+'t.r.Y.r{ i h rt ..1R * I. ✓ 1. •' .;r '` +�� '1X s '. ,�' ..i ?+� ar, ri_ 4 7 fir. 'a5 `".w'?a� key,`wy`'+",- 1. y ,r.y.yF.r a�'d �, •.. Y d v,'I` ' r.+ 4:,,S x, ! 14 v .• y„r, ry' 3"', x +t Y r - T '^ 1 .4. ,�DearIr Butler ,' f '4r !� , ,i. - * + �_ ✓� , . r -. s :��, �. J �,, _ I.•i.*a_ x i e, r ,oy f " A i .,. (:".r 1r,a�4 r s, }s. ' 'r.r�' � _� t ,+. s #,{ % s: r Nwt, < +r 0 `'- r n�* j !S` � fi >^ � _ I" Vie`#{.t r J+i.: a �s �, 1P ++C , p. �� n b�,rr-�a�• y s F (e: r s .,�(f,!' , t b• f- ! r } � ,.:,�r r '�s :.t I .� + .. :� tt' I. v d "f .; .' A*r y ,, The;Board;: at lts;'meeting 'July •1; 1986, rnodf ied its,variance~conditions x granted ,.( I. ._%'I ' ".:the,Vest �Beacti Bathing Company," Dale and,li wth"oine `Str.eet; Hyannisport,,'in �" ! ,._ ',.. i,t,,. t to :. �I r to '_ �' ,- g., F ;[ _ ~, kits letter of,.J une+4,; 1986� �. ' . " !Y�► .y d, ;, ��; t� , �: i r ti lr d ' t<9` r ^}N x €? Y. o �' .. F r ax r Y� n,I t i. •, ra. 1'�"•k'' q �a 441; + w. . ytu, C".r'`d*.,te a °x s ✓ ' r, .. �(,7 .1 n� trl �l` t <s N " °'y, r'.+V�. ran a.. aA `�4r �� x .' ° Jy# s, • i" ..t'I L'(w n _ -Lt f+. i V;�t y �' ;' Condi"tionK3 is�changed � e+,will�atlow+ttieasale of pie-packaged-foods-( I ato,chips,'I, k '_��r , „�} , �: 9;. ,-, . „cookie It .donuts,etc ) and ice cream piovided by a licensed food dealer71 I. _ I f s. t.#' ..a s'+ +'a rt: _$,:^i7 ;. L f sh i `-,� *�«.>* �`5 ''_n �, _: t . a � ,,. iSr .[ ,.111,°`I�i'I� {�: j ,�• i'y '•r •* r l +C '!, ,.`�4 ^• •,.., � „ �:,.;vr' l .'f'-+"L '"" 'Y` '#a' 3Y :, h.' i � ¢ s r $ �`' -'' a .,Pre-packa' d .sandwiches pare knot authorized: tI The rprepdration'.and the serving 4 =t r .%N r'of,food"isr not�author`ized egaidless of whether there::is:a r charge, 'however,'prior -" '` ,' ,*aa ' ; I to-anyrysale nor �di'stributiozl zof rfood,,you; clients must 2,com.plete the 'enclosed,, ,`.` r ; 1.' r.: r lt''M t7'L,,.appl cation.m.`r i�' +, yL .,.±'Si.` 'V`y t-h, z'*f v P�,,is+� y.. +'' 9 :S+M fi '"f, :y Efx fp , . "r ''S tc ., �; s r 31"fi t,,'r.~ y s :b t� t... 1-11 ;h i, -�. A,, t + i " i 1l.+ A t`3 1 i r'L -° !v P Vi.. -1 t L 3 .i t a Y. ( ! s t.. , .j q r { s. 'y k-I r '4,..�, I. '`a-- . -;y r ;. ~ .t._7r J T. C a 1. '} s :. .. 5, irtt , d"'' ,• ,, F. x- '#i . v y r4 ` t The facility must'{be inspected and approved °by 'the Board,�prior,u to_issuance of x a'r �1 01 . * <. 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" 1� tv ' �i* -"- . � .'iI-� ,. � , - _ e1� ,,__,�_,.,' 6* - , 'IN 'it , I " -!j"-�,�0 , u -,4� SO .Pj - - . IL " O%.P - . '.7--;( , r-,I , G, ."4�-.> A " ,L, _. �r -, 11 �." "`%_ 4Y � , - "..i, I i 4 ;S,j� ,� 41 � '6ir .,,,,t ,� , e , , 4- f W.I IV - S" .i , I IV W I I I I- I r , 1,-.11 4 � < _. I 'r't.� �0, , ,'I- - -�, .Ik', ", " -�. ,,, -I!:�-7,...'\ _;. I 11, 11 V , �_ _4 I ZAR,Z .�f�-��,-,,�;, --: � �', ! '! -I..�I,. r " j6 "�k 11 -.� - e- I J, . " ., It� -�'-�.�4''1'4 � ' - I .1� - A , , ��, ;!� :,4 �*I` �;,R - -� - �; V �i�? IN i -,, , , '� , - , . " . ..,A I " -f ., �' ' I � PM Ot ,V.,- !�A.",*4 4_--;*C1Ldt1'1. K, , � , , , ,f, .., , I � ,r, , �. '.,.'�' f , ',�;I-, ,4j�',''��' . i,,7 ' - - I. _,%A�, I �,- �04 , 04-.1-1 4, I :i .1, . .-: - 0-I. , I �,,,I# A� . f, 5,4 I,,-,X - & P _ �� ,� - , - 'I 4, ,_ ���,,��"t 3', ",A f THE WEST BEACH BATHING CO. Dale and Hawthorne Avenues Hyannisport, MA Board of Health Variance Request Variance From Regulation: 15 . 12 . ( 2 ) Ground water Variance Requested: Maximum ground water elevation of 3 feet below the bottom of the ex- cavation in lieu of the required 4 feet . Reason for Variance: Based. upon existing regulation the present system is underdesigned, the proposed upgrade will provide an adequately sized leaching field, spetic tank and grease trap. Additionally, there will be 3 feet of dry suitable material below the bottom of the leach field. The beach club is seasonal and is not located within a Zone OF Contribution to . a public water supply. A large portion of the water. usage is for rinsing salt water off bathers. T elv ,bo R T , Gc.G• �/r� �j?1�i1ic i< h✓vr co } `. THE To TOWN OF BARNSTABLE w` e. OFFICE OF i BaaII 'L : BOARD OF HEALTH.� YADR pj 1639.a Mar x 367 MAIN STREET k' HYANNIS, MASS. 02601 Date 19 TEMPORARY FOOD SERVICE PERMIT Permission is hereby granted to Address to serve at in the Village of on TOWN OF BARNSTABLE BOARD OF HEALTH John M. Kelly Director of Public Health VALID ONLY ON ANTICIPATED NUMBER REMARKS All food must be kept at 150 degrees F. or below 45 degrees F. during preparation, transit and serving. APLICANT MUST CONFORM TO ALL ZONING REGULATIONS; IN ADDITION, IF SOCIAL GATHERING IS ON TOWN PROPERTY, PERMITS MUST BE SECURED FROM APPROPRIATE AGENCY. L t sue. C� L �l3 � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH NOTICE TO ABATE A NUISANCE r-" U>^� � is { 1 ,� l As occ pant of •r�, �. 1�b you are hereby notified to remedy the conditions na d below within 24 hours of the service of this notice, according, to Massachusetts General Laws, Chapter III,Section 123: In, , ' y 68, Ca+eCL k L�r. _ 1 h`_.8 C. rf.'�` "� -s`a r;l.! �,_-R{ � �� #r'i..='�^s -.::+ .l:.+i, �.G't rfi'•�"�". If at the expiration of time allowed these conditions have not been remedied, such further action will be taken as the law requires and a fine of$26::00 per day may be charged. By Order of the Board of Health spector FORM 600 HOBBS&WARREN,INC. REVISED 1979 July 2, 1986 Mr. Patrick It. Butler Nutter, McClennen & Fish 297 North Street Hyannis, UA. 02601 Dear Mr. Butler: The Board, at its meeting July 1, 1986, modified its variance conditions granted the West Beach Bathing Company, Dale and Hawthorne Street, Hyannisport, in its letter of June 4, 1986. - Condition 3 is changed. Vie will allow the sale of pre-packaged foods (potato chips, cookies, donuts,etc.) and ice cream provided by a licensed food dealer. Pre-packaged sandwiches are not authorized. The preparation and the serving of food is not authorized regardless of whether there is a charge; however, prior to any sale or distribution of food, your clients must complete the enclosed application. The facility must be inspected and approved by the Board prior to issuance of a food establishment permit. Verylr ly ypa-r ert L. Cfiildg -Chairrnan Ann Jane 'sh, augh over C.M. Parrish, M. D. BOARD OF HEALTH TOWN OF BARNSTABLE JMK/mm cc: Baxter & Nye Conservation Commission Mr. Fred Filoon - Box 362, Hyannisport j € % f NUTTER,McCLENNEN &FISH r VILLAGE MARKET PLACE II BOSTON 297 NORTH STREET COUNSEL WASHINGTON HYANNIS,MASSACHUSETTS 02601 / LONDON SAN FRANCISCO n 1 PARIS AMSTERDAM (617)771-4100 / TOKYO TELECOPIER(617)771-8079 June 23, 1986 Board of Health Town of Barnstable Barnstable Town Hall Hyannis, Massachusetts 02601 RE: West Beach Club, Inc. Ladies and Gentlemen: e As you are aware, construction is presently ongoing to provide for an upgraded septic system to meet the requirements of Title V of the State Sanitary Code. The West Beach Club, Inc. operates the club premises during the summer season under a lease agreement with the Hyannis Port Civic Association, successor in title to the West Beach Bathing Company. In addition, pending completion of final plans for upgrading and rehabilitation of the club premises, the kitchen area of the club will not be in operation this summer . In accordance with your recent correspondence, I am writing on behalf of the Board of Directors of the West Beach Club, Inc. to request a specific permit to allow the club to sell packaged goods ( ie: potato chips, canned soda, packaged cookies and packaged sandwiches) in a restricted area of the premises; and in conjunction therewith, to allow the use of one refrigerator and one freezer for the sale of packaged ice cream products. All goods and products would be prepared off premises, and this request would be for this season only. In addition, I am writing to request permission to place two (2) portable toilet facilities on the premises for use by the club members, pending completion of the septic system.- Thank you for your consideratio of the foregoing. Ver tr o s, P is ler PMB:pbd 2482B NUTTER,McCLENNEN &FISH VILLAGE MARKET PLACE II BOSTON 297 NORTH STREET COUNSEL WASHINGTON HYANNIS,MASSACHUSETTS 02601 LONDON SAN FRANCISCO PARIS AMSTERDAM (617)771-4100 TOKYo TELECOPIER(617)771-8079 July 22, 1986 HAND DELIVERED Board of Health Town of Barnstable 367 Main Street Hyannis, Massachusetts 02601 RE: West Beach Club, Inc. Dear Ladies and Gentlemen: Enclosed please find an application for permit to operate a food establishment, duly executed by P. Louis DeRose, President of the Corporation. This is to allow for the selling of ice cream and pre-packaged food products (cookies, chips et cetera) , as well as soda and juice drinks. I am informed that a notice to abate was served on the Club on July 16, 1986. All sales of any items ceased immediately, and will not be allowed until the Board of Health has had an opportunity to inspect the premises and act upon the enclosed application. The club is available for inspection at your convenience. As I have previously indicated to Mr. Kelley, the club has retained the firm of Joseph P. Macomber and Son, Inc. , to install the new septic system. Unfortunately, there has been a delay in the initiation of installation due to problems surrounding the obtaining of a plumber to do the necessary related work. We are hopeful that construction and installation will commence in the very near future, and the club making all best efforts in the regard. Should you have any questions concerning the enclosed application, please do not hesitate to contact me. V y ru r , P trick M. 1 e r PMB/sr Enclosure cc: P. 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OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER Ll/fs7 13�,ac f/ ��Zf A. -Soe , DATE PERMIT ISSUED: :! 77) DATE . COMPLIANCE ISSUED:� VARIANCE GRANTED: Yes 1Z No 33 JS c�D J [ 5 A/�Lt3��/Jj1�iDC Z?44 ��� SESSORS MAP NO: ' THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .-- a..........`. ...................OF.......... ApplirFation for %ipmFal Workii Tiatutrurtion Prrutit Application is hereby made for a Permit to Construct 4 or Repair ( } an Individual Sewage Disposal System at: , ................_...----- --•- ------------............---.........--- Loc tion-Address or Lot No. .. r�....-----w .r...i C. .................................Co .......... .... ... ............. ��p)) owner Address Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ................................. WDesign Flow.............................................gallons per person per day. Total daily flow:._.........................................gallons. WSeptic Tank—Liquid capacity-______--..-gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... bate........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �74 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -------•--------------------•-•---•--•-----••------------.....--•-------._.....-••-•----------------......................................................... 0 Description of Soil--------- -- - -----------------------'....................................................................------••----------•-----•---------•------------------- x W UNature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------------------------••---------------------------------------------------._..........•-----------------------------•---------•------•-----------•-•--•--•---•--•••--•-•--------.......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T= p 5 of the State Sanitary Code—The undersigned further agrees not to puce the system in operation until a Certificate of Compliance has been issue by t�4offvd�of al Signe �� �— -----•-- •- -- -----••----••----•-- // Date Application Approved By........... ---------- ..................................... ... Date G' Date Application Disapproved for the f ollowin reasons:----•--------------------------------------------------•-----------------------•------------------.....---.... ...................................•••------------•-.........--•••---------...-•--•-•--•--...._...-••-----•---------•---•-----•------•--••--. •---•---------•---•-•-•...••---- e Date Permit No..... �. l0 J ._ Issued - r)� to t Jli Fizz............................_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1.. OF........... .......................,.4 Appliration for Disposal Works Tons rur#inn Prrmit Application is hereby made for a Permit to Construct �r Repair ( ) an Individual Sewage Disposal System at: t /'�> ;. T ................—....----....;................._.:a :.%.. ..----------.............---... ...............................'.r:..ft..---------•-----•----,_....-------------------...........-- Locattion-Address or Lot No. /r c l C/. .T L '�•'`� �%.�?-7 .�i.: ::........P ..........--...................................................................................... W Owner Address ........... ! C.....................•---••---------••.............................. Installer Address Type of Building Size Lot----------------------------Sq. feet �--� Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures .____._.___. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter__-__-__-._..... Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.___•----_--.-_____ Diameter.................... Depth below inlet.................... Total leaching area......._----------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_-____-__-______--____-. G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 -•••-•--•-••------------•-•-•••-•-•••••••-••••••....••-------•-...••----•-------•---------•---------•-----------•--•----•-•--••-•.............••---•---.----- 0 Description of Soil........................................................................................................................................................................ W UNature of Repairs or Alterations—Answer when applicable................................................................................................ ----------------------------•------------------------------•---•---•----------------.......----------------....--------------------------------•-------------------•--------••••••••-•••...........----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i?T p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. , C . - �.........=� ~ Date Application Approved By....... .,,�,. --------•-- `�--•-------•--------------•--........ -'� =-- -------- Date Application Disapproved for the f ollowin reasons-------------•-------------------------------------------------•-------------------------------------------•--- ---------•-•••-•-•••.......... -••...................•--•-•.....-.--•;-----•••••..._..----••---...--•-••..........-••••-•--•-------------•---------••••-••••--••••-••----------•-••••---•----------- Date Permit No...`)'L.._J .. .... -_ Issued. �U .... bate THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i... 0.. .... .....................0 F.....:1.. /.Z/�.�. ?.%z..r� ................................ Tntif irtt#.e of Toutpliaurr THIS IS TO CE ,,TIFY, That the Individual Sewage Disposal System constructed or Repaired ( } ,A- �;L e-/J by...............................................................................................•-------••-.._..-------------•-•-......_....---------•-••---•••-•••----••----••--•----............•. �� /� /)G/G Installer at•------------------••••-----••••-••••-•••-----------•-•--•--••-•...•-•-------•------•----••-•••-...... has been installed in accordance with the provisions of TiTi.E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.1, ��:.. J-L.1............. dated----------r THE ,•} - � - ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® S A GUARANTEE THAT YHE SYSTEM WILL FUNC /SATISFACTORY. DATE..................•---••.__., '.. ....j 01.................. Inspector-------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH l� ............................. ............................... N ....................... FEE........................ Disposal Narks Tnn#rnrtion rrntit Permissiois hereby granted dLc y••-••.......-•--•-..-••...-•-••....-••••---•••••••-•--••--•••••.....-••--•••..............•...........••..------- to Construct or Repair ( ) an Individual Sewage Disposal System at No.------1�.� /Y /�d E �'I J 'lc 1 b'�t�- � ----------------- .- ( Sueet as shown on the application for Disposal Works Construction Permit NQ� _-�' ... Dated..___.... ._...�............... ............. �. ...._._.._. c-----•-•_.---••••-•-----------------» / G ........ / ] Board of Health DATE----t-- -----•I........ -------------------------- ( ' FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS S BAXTER & NYE, INC. Registered Land Surveyors and Civil Engineers 7 Parker Road/Osterville,Massachusetts 02655/Tel.(617)428-9131 NVIII IAM C.NYE,R.L.S.-President RICHARD A.BAXTER,R.L.S.-Vice President PETER SUI.LIVAN,P.E.-Vice President-Engineering May 28, 1987 Town of Barnstable Board of Health P.O. Box 534 Hyannis, Ma. 02601 Attn: Thomas McKean RE: West Beach Bathing Co. Hyannisport, Ma. Dear Board: In accordance with your request I did provide construction supervision throughout the installation of the septic system for the West Beach Bathing Company. All components have been installed as per the approved plan. On this date I inspected the tees in both the grease trap and septic tank. All tees are in accordance with State and Local requirements. If,there are any questions, please do not hesitate to call. Very truly yours, Peter Sullivan, P.E. Baxter and Nye,Inc. � J:s PS l Q SUL Lid�nns p =d N10. 29733 `�U fS. . s MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS I AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETTS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS I xy` �1,��F j W Tin 5 p2M �, � 2-0 C l�', r a _ 1 r As' __ _. 9 E i -Z -11/1- ----1 2 Z C�.r��/� KRQifSX Fiz�azrcw-'-�(/© KRFF/SM KtT�N� v A/U /�arfroa✓�/ Siii�G c.'�o�b�` of . `r�xo�io/-/6•a5S-/236-a-(9 3D /c¢ Cr�arr. c�hiri�f, /t/9 6DF Gas rareq¢ c.�/o✓ar�. 24 Grio6�la 2 l�r.�^n¢.^s /� '1/9"T/S� Siri/G-�/Z-/6-/ /&•�3,SS,- k}A+rt?wwrrrs�{ Sn►�'i .36 `A0.4M/CA Wk Tb/ w/4�4v,,:;)ah a 61 L!no/ai'sha/f dG¢ S ^ bracad- 7 e4 iu 'Z "Sh ¢o/ /FoRM/CA Togo, G2* X /64-" 44( 7b4r) 4 d„S9/ashSh 41 Za:5 hr�Cs�y u�0"U6Ocu x/Z0"FWM/CA Xq;� 'Of U�6ad.6D,vzury ni/s DScgo� Sir�lG ' ,SS'.11-6-s6/65 D//2INEI4 -� !� Z4iu x ?4Y FQRiVI/CA Wt 7b/ 4`Sp/a"• b%7, G ��ihO�Gr Sfd/i F LQ� S � �X�Qx � I i ,36" •,c 48 • SS hfpgal u.�u�� sha6/a <%'ars, /�hf'r �r<i suf �� i'a sscon sysfarr�� !2 Mr� S¢rricc 6-ps/o JC24 a/ IV.Sc, /X.je -&rac al, aria/ sm^_aCQf !ri/��cuum b�aakar. M56 3C24• - /Odj� 13 z4,.x S4"i27RM/C4 . V/,c �/.^-AV -4 �-c¢d. �< .s4 ".c 42 h r/arii �a ( �� f an¢ / D(ZAVI ; c7 4//e� au ItS7 /Z''x GO• !%G/Tian- GI 6Va//, h¢/VrS u / 'ac/lafs V ►6 /Z'� "L "Sha/ara� 06/ 7, ¢. GI,O,/g/ 4a/v¢s CO•v GO { / / �i'xtc.ra. Sur ace. cam 'ap/a x , u•J o� �au /f �r�n/ a� c¢ �u I'la / ZO 19 A-/,iaiace P/crg Stri`o �. ao%cZ Jco','Zr 20 ,G¢c¢ss¢.a("A//•/VA% Li�hf cam di�ma- >wilcr, I� 2! ti4 X 36 Frn�a of Cor/C/jp�ro% 71 �� /y/ T¢ 23 Scu.ny -U� ShuNar. Lhz�.?••/ 4 Z4 �g6L9 Tab/ds �2) 3S Ur7c/a r-�h-2Ile la . s D M� s" r 0 -)Z6,4- 0 h L H NJV ; GENERAL NOTES Members: 143 Families ncluding 44 Children - ages 2 to B yrs. - Favd Hours: t t.-00 AM to 2-00 PM— tce Cream served up tO *00 PM. Currently served at four (4) outdoor. tables. Witb new i kitchen and Ocean Room, capacity will more than double. Menu. Hamburgers Hotdogs Grilled Cheese Salads Pita Bread Sand. Peanut Butter Send., etc Baking: Brownies, Cookies, etc. Beverages_ Ice Tee Lemonade Canned Soda Ice Cream: Cones & Dishes TGtt l\l a 'GQ,2 5 Abe E-,MA NAA RVAm—* to D n P'y . Spa.? �-Aj>`!C� �V SE(�'. \H WEST L irvf�: i No.1267 ! iro.1301 ti DOLE RUENUf G O5T£Rb'I�LE r� , HY:,",iViS. w NYANNISPOf{T MA pN rf4<r�: ar i_t-rl li�r,C TI F. 'aH ALL ' EF tF �' ALL F r , j �c.t (J , �*�i�titry OE � ' '' ++�s+s�R`' DIMENSIONS ?, CONI9Th�t!_ +_�i'!'=1TE '•� , . I rA'ALOER and OUNN ARCHITECTS 396 Main Strut - P 0 Box 369 Hyannis i Msssachus*ttz 02f-,jl \S A r 'T_ .0 T E 2- F-AC F Eli[) � _� C—, V_ GENERAL NOTES Members: 143 Faniilie-_, including 40 Children - ages .1 to 8 qrs. Food Hours- j I iOO Art to 2i00 PM - Ice Cream 3.erved up tO 400 PM. Currently served at four (4) outdoor tables. With new kitchen and Ocean Room, c,--jpacitqwill more than double. Menu: Hamburger-, Hotdog--, Grilled Cheese Salads Pita Bread Sand. Peanut Butter Sand., etc Baking: Brownie,, Cookies, etc. Beverages: Ice Tea Lemonade, Canned c-0-idd Ice Cream: Cones 8 Dishes Its M ARC,4,; AL rLRA rA9N_q to ��ED Owl THE WEST HERCH CLAID WE ORLE RVIENUE 1 0. 1267 l 14 o 13 01 ti tiYANN- HYRNN I SPORT MR MASS. J 1 -