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Home My WebLink AboutROUTE 149 Fig Tree Cafe r 149 Cotuit Rd ` Marstons Mills I r Barnstable Town of Barnstable M*nWcaCft w + BARN, LF_ �$Ar Board of Health ��U7a c*+� 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Paul J.Canniff,D.M.D. FAX: 508-790-6304 Donald A.Guadagnoli,M.D Junichi Sawayanagi November 29, 2016 Mr. Peter McEntee, P.E. 12 West Crossfield Road Forestdale, MA 02644 RE: The Mills Restaurant,:135 and 159 Route 149,,-rMarsfons Mills A 07,8=019 and 0787020' Dear Mr. McEntee, You are granted variances, on behalf of your clients, Nick and Robin Mahairas, to construct an onsite sewage disposal system at 135 and 159 Route 149, Marstons Mills. The variances granted are as follows: 310 CMR 15.405: To install a soil absorption system only ten feet away from an existing leaching facility (which is connected to Septic System #2). 310 CMR 15.405: To provide up to six feet of soil cover over the top of the soil absorption system, in lieu of the three feet maximum cover allowed. The variances are granted with the following conditions: (1) No more than forty-eight (48) seats are authorized according to the current food establishment permit. (2) The Orenco pumping system shall be installed and operated in accordance with the MA Department of Environmental Protection (DEP) `Certification for General Use' requirements dated March 20, 2015. (3) The septic system shall be installed in strict accordance with the engineered plans dated November 2, 2016. ( ) The g 4 designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the submitted plans dated November 2, 2016. Q;WPfrhe MIlls McEntee 2016.docx This variance is granted Lecause physical constraints at the site severely restrict the location of a soil absorption system due to the multiple buildings, three septic systems and slope of the lot. The proposed system appears to be designed to meet the maximum feasible compliance standards contained within the State Environmental Code, Title V. Sincerely yours, Paul J. Canniff, D.M.D. Chairman Q;WP/The MIlls McEntee 2016.docx Town of Barnstable BOARD OF HEALTH John T.Norman K ` Donald A.Gauda noli M.D. Board of Healthg , BARNSTABM F.P.(Thomas)Lee MASS 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, 30513, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 229 Issue Date: 04/12/2022 DBA: FIG TREE CAFE OWNER: FIG TREE EATERY LLC Location of Establishment: 149 COTUIT ROAD MARSTONS MILLS MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: 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: Q FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Nov 22, 2016 -Septic variance approved with the condition of no more thanr 48 seats '" pfrtX Town of Barnstable BOARD OF HEALTH r John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BAWNSTABM F.P.(Thomas)Lee,. y 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: 229 Issue Date: 01/01/2022 DBA: FIG TREE CAFE OWNER: FIG TREE EATERY LLC Location of Establishment: 149 COTUIT ROAD MARSTONS MILLS„ MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: i IndoorSeating: 42 OutdoorSeating: 0 Total Seating: 42 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: ` Qn FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Nov 22, 2016 -Septic variance approved with the condition of no more thanr 48 seats For Office Use Initials: Town of Barnstable Date Paid Amt Pd$ a Inspectional ServicesMAW I� 039. to Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE � NEW OWNERSHIP RENEWAL_L1 NAME OF FOOD ESTABLISHMENT: ��✓liJ �i !Lf�y� � � �J�1 f �. ADDRESS OF FOOD ESTABLISHMENT: Al MAILING ADDRESS(IF DIFFERENT FROM ABOVE): Ul3 . GEC fit' /v l E-MAIL ADDRESS: �l Cl ✓te C0A G�C{ C t�!Y1 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (1�b4 TOTAL NUMBER OF BATHROOMS: 2, WELL WATER:YES NO_V!1_1*'". (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:�� SEASONAL: DATES OF OPERATION:_/ /_ TO NUMBER OF SEATS:INSIDE: OUTSIDE: .ems TOTAL: t �- 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? _ t IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? Ak TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) V 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 {� �A lication FormsTOODAPP 2020.doc Q� PP �v V�� r 00 -OWNER INFORMATION- FULL FULL NAME OF APPLICANT A �1 q� r SOLE OWNER: ES/NO OWNER PHONE# ' D L1=�ll 6s �P ADDRESS , �� ; d C;1` lJl \ail �l 1 �'!I� 2�0-3 CORPORATE OWNER: 4`P s �Iile� Me, CORPORATE ADDRESS: SGt�'Ir� - 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. 2. " , 2 2� 'b r 2 SIGNATURE OF APPL CANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establisMn6ts,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862444 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 httt)://www.townofbarnstable.us/healthdivisionlapplications.asy. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3 1'each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q:\Application Fonns\FOODAPP REVS-2019.doc oF1HE ro,� TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: L Of 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 e3: �0� HYANNIS, MA 02601 soa-sz asaa No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT .' � �i�.cC w � Name Date -1 v Tyne of Type of Inspection Address ` Risk od Servi Re-inspectio '" ( Level Retail Previous nspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP CQ,� I In: Q Other Inspector Out: 9 Each violation checked req ires an explanation on the narrative page(s)and a citation of specific provision(s)violated. ^_ 0 y Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ C�v r Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ f.�y 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 D VUd� Cit GL/r EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives 'yam ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) (%YX101� ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating S I ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) A1,1 I/ ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations r 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 checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 9 ❑ g y ❑ ry P 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 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.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address y of receipt violations obse 7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) P within 10 days t of this order. violation,4 to Fnon-)critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Sig ture Pri t: 31.Dumpster screened from public view 1 Uq1W11_ Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's lure Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties Cooked and RTE Foods. 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 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* 7-102.11 Common Name-Working Containers A Require Reporting by Food Employees and Contamination from the Environment ( ) Roasts Held At or Above 130°F* 3-302.11(A) Applicants* Food Protection* 7-202.7-201.11 Separation-Storage*11 Restriction-Presence and Use* 3-501.16 20 Time as a Public Health Control 3-302.15 Washing 590.003(F) Responsibility of A Food Employee or An 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 7-203.11 Toxic Containers-Prohibitions* 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdultereted or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water _ 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 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-Ho[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* 3-401.1 1(A)(2) Comminuted Fish,Meats&Game Pathogens* eg rn�lnrzoor 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* aces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth*. 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140'F* (Blue Items 23-30) Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 1 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F ConvenientlyLocated 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* * 23. Mana ement and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours 9 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 5-20511 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* . Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I FC-7 .008 HACCP Plans 1 6-301.12 Hand Drying Provision 129. Special Requirements 1 .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. _ *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. OF THE low TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: - Date: Page:. 1 of �P� p OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified gy a39. .0� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item p. >, 508-862-4644 PLEASE PRINT CLEARLY E°MP+ FOOD ESTABLISHMENT INSPECTION REPORT cl - Name Date Type of t,l A�Inspection ion i outineQ L+ eYAX Address Risk ice ReAhsVeWon I 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) (,� i/�G f C / Time sed&Breakfast HACCP �- In: Other Inspector Out: P/N� Each violation checked requi es 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 r f ❑ 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 p / , FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating - t ❑ 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 1 L_ ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items 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 4 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 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.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) receipt within 10 days of recei t of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspecto s Si ature Prin 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 5igna'ure� Print: Self Service Wait Service Provided Grease Trap Size - Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness A Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties - - - 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 590.004(F) 590.003(C) Responsibility of the Person-in-Charge[0 7-102.11 Common Name-Working Containers*Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Separation Storage** 3-501.16(A) Roasts Held At or Above 130°F* - Applicants* 3-302.11(A) Food Protection* P g 7-202.11 Restriction-Presence and Use* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 590.003(E) 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 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 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 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* 3-401.11 A(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* Ef cfi a 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-101.11(A)(2) Ratites,Injected Meats=155°F 15 see* 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- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g. P � 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 3-401.11 2-301.14 When to Wash* A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices Requiremens should be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* 8 g 3 403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 3-501.14 A 3-202.18 Shellstock Identification 13 Handwashing Facilities ( ) Cooling Cooked PHFs from 140°F to 70°F * 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 * 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours 9 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Fonnback6-2doc *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.He roy� TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: Page:. of �. c OFFICE HOUR PUBLIC HEALTH DIVISION - 8:00-9,30 A.M. BARNSTARLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ,639.A _ �•� HYANNIS,MA 02601 MON.-FRI. No Reference ..R-Red Item •• PLEASE PRINT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT 508-862-4644 t cc) k� . Name coal_ Date 2 Type of a ns ection _ g Routin (,t/I Address /may Risk Food Sena Re-inspection - Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation / f Owner HACCP Y/N Temporary Suspect Illness ( l/1'`n Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP - : b I Jiv- , In: Other Inspector Out: � n, Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. � C l� F ' TMII I C" /yam 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) ❑ 1,e 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 ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives � - G ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ° J ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating - U (, ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding V✓�/sV I PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ( ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue 8�red items) Corrective Action Required: ❑ 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 [j-Q1be_U_.. checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils 6=One critical violation and less than 4non-critical violations 9 ,_. (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspector's Si. atur 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 Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g g 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 Time as a Public Health Control Applicants 3-302.11(A) Food Protection* 20 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* 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 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 HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURECONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eff"e"innoot 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3 401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Ho[Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and a ide in cater- Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-40 1.11(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 It IONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items non-critical 23-30) 3-202.15 Package Integrity � Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A 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 s Within 4 Hours* 23. Management and Personnel FC-2 .003 TagslRecords:Fish Products 5-203.11 Numbers and Capacities 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFI Made from Ambient Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S: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. j� °F. roe," TOWN OF BARNSTABLE , EALTH INSPECTOR's Establishment Nam e: /( �2 �. Date: Page: of �10 OFFICE HOURS p ° PUBLIC HEALTH DIVISION ��0•••✓✓✓ ON 8:00-9:30 A.M. BARNE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified e3. `�� HYANNIS,MA 02601 I � M 508-8 -FRI.62�644 No Reference R-Red Item PLEASE PRINT CLEARLY . FOO ESTABLISHMENT INSP TI N REPORT Name Dat a of Tyne of Inspection 77 Gr:�� I Vr / "/ _ is Routine Address Risk Food Service Re-inspection Level etail Previous Inspection Telephone Residential Kitchen Date: �. Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires n 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 or ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violatio Critical.(C)violations marked must be corrected immediately. (blue&red items) CJ"w"' 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 items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 B=One critical violation and less than 4nnn-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. 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: Inspe o s u e 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, at re I Print: � s ate/ Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-]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* 2 590.003(C) Responsibility of the Person-in-Charge to Other* ty g7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 7-202.11 Restriction-Presence and P g Use* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(?)(B)Resumed 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 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 Wazewashing-Hot Water I Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* I Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15,see* 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* eff cme riuzooi B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006 ( Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g �' 590.009(A)-(D) Violations of Section 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 andAuthority Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165*17 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 8 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 Handwashin g Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3 402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27, Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1 1.009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S: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. ALTH INSPECTOR's Establishment Name: / / Date: Pa e: P QptNE roo TOWN OF BARNSTABLE - HE OFFICE HOURS 9 of PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BAR E.,` 200 MAIN STREET 3:MON.-FP.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN F CORRECTION Date Verified MASS. `� - HYANNIS, MA 02601 Mors.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY. plFo MPS°, el 508-862 4644 FOOD ESTABLISHMENT INS EC ION REPORT Name Dal Type of Type of Inspection Routine Address Risk Food Serv' Re-inspection evel Previous Inspection Telephone r Residential Kitchen Mobile P�per. Owner HACCP Y/N Temporary Caterer General Co plain Person in Charge(PIC) Time 44, Bed�Breakfast HACCP Other Inspector 11ut Each violation checked requires an explanation on the narrative pa (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 Yp q ( ) ❑ 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 C. ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling r ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating ry P ❑ Employee ❑ p ❑ Emergency P Y Y ❑ Voluntary Compliance Em to ee Restriction/Exclusion Re-inspection Scheduled Emer enc Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than non-critical violations 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 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 rwn-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8 non-critica iol ns=C. 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspe 'S Signaturq Pri 31.Dumpster screened from public view ? Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining y N PI s nature c Pri t: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N /) /A ,� �`,� / S�►`� Dumpster Screen? Y N 0 `�/ L/ `mil 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* 6 Cross-contamination Law Cooled to 41°F/45°F Within 4 Hours* ( ) gnm14 Food or Color Additives 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Separation Storage** 3-501.16(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* 590.003(G) Reportin Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q g by Person in Charge* Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated orce,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 Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical 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. Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 16 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils an Eggs d Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E//cti-1//@001 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 Recrealiunally Caught Molluscan Contact Surfaces 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 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* 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* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 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* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification g 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3 402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 1 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 1 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:590Fonnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. Town of Barnstable John T.NormEaLTH Board of Health Donald A.Gaudagnoli,M.D. BA RNSTABLE. Paul J.Canniff,D.M.D. ifs s3 , 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: 508 790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 229 Issue Date: 01/01/2021 DBA: FIG TREE CAFE OWNER: FIG TREE EATERY LLC Location of Establishment: 149 COTUIT ROAD MARSTONS MILLS, MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 42 OutdoorSeating: 0 Total Seating: 42 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: . Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Nov 22, 2016 - Septic variance approved with the condition of no more thanr 48 seats Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. EAR NxQM Paul J.Canniff,D.M.D. Mq F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 229 Issue Date: 01/01/2021 DBA: FIG TREE CAFE OWNER: FIG TREE EATERY LLC Location of Establishment: 149 COTUIT ROAD MARSTONS MILLS„ MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 18 OutdoorSeating: 24 Total Seating: 42 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: �� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Nov 22, 2016 -Septic variance approved with the condition of no more thanr 48 seats ror-�-�itrce"ice inw iniiiais: Town of Barnstable I(( Laic-Raid �Inspectional ServicesI BARNST i639.MA'S Public Health Division RFD A ! omas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE AFOOD ESTABLISHMENT DATE .... 1211LJ1210 NEW OWNERSHIP RENEWALV/ NAME OF FOOD ESTABLISHMENT: pig ADDRESS OF FOOD ESTABLISHMENT: �al�S i�►ff tlI�y�(/"l ! I�1 Nl ► l MAILING ADDRESS(IF DIFFERENT FROM ABOVE):A ,/� DZ� � E-MAIL ADDRESS: ��{ (- TELEPHONE NUMBER OF FOOD ESTABLISHMENT: '?Ln'40- TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO_te�'...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:—Z SEASONAL: DATES OF OPERATION:_/_/_ TO NUMBER OF SEATS: INSIDE: 2D 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? IU 0 IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? O TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD- ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES... (MONTHLY LAB ANALYSIS REQUIRED) CATERING...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP REV3-2019.doc OWNER INFORMATION: FULL NAME OF APPLICANT vl FeV_WSQ V-` SOLE OWNER: NO OWNER PHONE ADDRESS ad �M' A—. O Z CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: ' 0 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 Lj 2. aid 6N l� z� SIGNATURE OF APPLIUANT 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 OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January Ist to Dec. 31$`leach calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1 st. Q:\Application FomvsTOODAPP REV3-2019.doc Town of Barnstable BOARD OF HEALTH John T. Norman Board of Health Donald A.Gaudagnoli,M.D. t' BA9 NSTABLE Paul J.Canniff,D.M.D. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 229 Issue Date: 09/18/2020 DBA: FIG TREE CAFE OWNER: FIG TREE EATERY LLC Location of Establishment: 149 COTUIT ROAD MARSTONS MILLS, MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 18 OutdoorSeating: 24 Total Seating: 42 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: QA 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: Nov 22, 2016 - Septic variance approved with the condition of no more thanr 48 seats r - - i 1 r Initials• Ito Town of Barnstable / Date Paid $ 1� : .AR,,, M,F : Inspectional Services � Public Health Division Check# �fD MAy A Thomas McKean, Director nek) 4 W, fofxurd (:6 r 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 V RENEWAL NAME OF FOOD ESTABLISHMENT: aAa-�g. ADDRESS OF FOOD ESTABLISHMENT: `C �'� l — _� /' l 1 '1f I �' 1 J I MAILING ADDRESS(IF DIFFERENT FROM ABOVE): �� W �1r�I �� ►''1�U��'a E-MAIL ADDRESS: mA K)IGI cbY� TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (%bi TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO V1.. (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: TO / /ZL) �fc�rl1 Thvrz, NUMBER OF SEATS: INSIDE: OUTSIDE: 22-k TOTAL: J. 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? QUIt- �r 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 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: DA FULL NAME OF APPLICANT �/1 � � 30 Y--\ SOLE OWNER: (@S/NO OWNER PHONE# � ADDRESS P �r D� �i( Y C%l e. J Ol✓J ail �1��r�� C7c�—`S�,p 3 CORPORATE OWNER- CORPORATE ADDRESS: S&4.111 `t PERSON IN CHARGE OF DAILY OPERATIONS: r Y� 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. 1M Q►'L1 / / o 1. I �.C7 ya 1 2. P—a.-,L, nil— 2o �-�,P�r ��`e Spa-v�. ►� 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 508-8624644 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 httu://www.townofbarnstable.us/healthdivision/applicationsasp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. QAApplication FormsTOODAPP REV3-2019.doc r BURGERS 8 oz.Always fresh.100%Angus on grilled deli rolls All American 12 Lettuce,tomato,pickle&onion Add cheese,grilled onion,or mushroom +1 ea. Add bacon or fried egg+1 Dinner Style Patty Melt 13 American and cheddar,grilled onion,house 1,000 island on griddled Texas toast Veggie Burger 11 V All natural,handmade of red and yellow beets,black beans,grilled pineapple, quinoa with MCM10 SIGNATURE SUBS On Boston baked Ciabatta loaf.Toasted. North End Italian Sub 12 Local and imported cold cuts,provolone,lettuce, LUNCH FAVORITES red onion,pickles,tomatoes and oil&vinegar SOUPS Philly Loaded Cheesesteak Sub 13 Lean,shaved steak provolone cheese,mushroom, All made in-house with 100%natural ingredients and no preservatives onions and peppers Soup of the day S cup/6 bowl The"Best Eva"Meatball Sub 12 Homemade Clam Chowder 6 cup 17.5 bowl Mark's Nonna's secret family recipe in our slow simmered marinara SALADS PRESSED PANINI SANDWICHES Our homemade dressings are Balsamic or Cranberry Vinaigrette, Italian,1000 Island,Greek,Ranch,or Caesar On Pain'D'Avignon artisan bread. The Cape Coddler 10 V Grilled Chicken Breast&Pest* 11 V 100%Organic mixed greens with dried Cape cranberries, With tomato and provolone walnuts,apple and crumbled bleu cheese Italian Cold Cut 12 Classic Caesar 8 V Prosciutto,sweet sopressato,hot capicola,provolone, Chopped Romaine,Parmesan cheese,house crouton, and Caesar dressing WRAPS Garden Salad 8 V Whole wheat.May sub toasted bread at n/c Baby greens,tomato,onion,carrot crouton BLT 10 Greek Salad 9 V Crispy bacon,romaine,tomato,and herb mayo Romaine and Iceberg mix with tomato,olives and feta Chicken Caesar I I V Cobb Salad 13 Grilled chicken,romaine,parmesan,Caesar dressing A blend of baby spinach and iceburg with grilled chicken, Tuna Salad 10 smoked bacon,tomato,bleu cheese,chopped egg ADD TO YOUR SALAD+5 Solid white albacore -Solid white Albacore Tuna or Chicken Salad -Grilled Chicken Breast MiIPs Chicken Salad I 1 All white chicken salad,craisins,walnuts. HOUSE SPECIALTIES Lobster Salad Roll(In season) 25 100%claw and knuckle Maine lobster,lightly dressed on grilled brioche Quiche du Jour 14 mom ©@ An individual 6"quiche served with a Garden Salad Grilled Reuben on Marble Rye 12 Slow cooked corned beef with fresh sauerkraut,homemade 1,000 island,Swiss cheese and side Quesadillas V i Grilled whole wheat tortilla with Pepper jack cheese,onions &peppers. Chicken II Steak 13 Veggie 11* n *Veggie—Pick 3 additional veggies of of your choice y , Boston Strong Hot Dog 12 ►`�411L�"' Kayem 114 lb.hot dog on grilled brioche bun,honey and bacon baked beans and homemade slow Chicken Salad Croissant 12 Organic baby greens,sliced apple,and choice of one side All Sandwiches,Burgers,etc.come with choice of: • homemade coleslaw,red bliss potato salad,or Cape Cod chips. Substitute a small side salad. +S ;Fan EASY PEASY GRILLED & CHEESY Mom's Grilled Cheese 10 Sharp Vermont Cheddar on white,wheat,or marble rye ^ ( � Add tomato+1 Add bacon or ham +3 Mill's Grown-up Grilled Cheese 12 ,+� ` Local smoked Gruyere,grilled tomato,and crisp Applewood smoked bacon on Pain D'Avignon artisan bread , Tuna Apple Melt 12 } Our solid white Albacore,American,grilled slices of ; delicious apple on marble Rye y Before placing your order,please inform your server if a person in your party has a food allergyc *Consuming raw or undercooked meats,poultry,seafood,shellfish or eggs may increase your risk of foodborne illness. r THE MILLS FAVORITES Mills'Own Corned Beef Hash 14 omma)= 2 farm fresh eggs arty style&choice of toast Farm fresh,three egg omelets.All served with homefries and toast Plimouth Grist Mill Organic Cheese Grits 13 The Fenway 13 2 AA Eggs your way with choice of bacon,ham or sausage&toast Boston Italian Sausage,red bell pepper,caramelized onion&provolone Two West Barnstable Duck Eggs 12 Meat Lovers Omelet 13 with toast&home fries and bacon,sausage or all natural ham Ham,Applewood bacon and sausage with Vermont sharp cheddar Hash Omelet 14 Quiche du Jour 13 individual quiche served with fresh(curt cup Our homemade corned beef hash and Vermont sharp cheddar An "The Brazilian" 13 Cotuit Croissant 13 Gaspars linguica,red pepper,onion&spicy pepperjack 3 scrambled eggs,baby spinach,ham and Vt.cheddar&home fries Egg White Omelet 13 V NY Steak and Eggs 16 Baby spinach,mushroom,and Vermont organic goat cheese 6 oz.Angus sirloin steak cooked to order with two eggs your way, Lobster Omelet(in season) 22 home fries,and toast Maine lobster,sauteed baby spinach,and Boursin cheese Pulled Pork Huevos Rancheros 14 m� � Two sunny eggs on tender pulled pork,2 flour tortillas,corn&bean salsa, 'L.l�illf:D WIM@ CI11 ' house chilled pica and queso fresco Pick any three for 12•Cheese only 9•Sub egg white+1.75 Healthy Start Breakfast 13 V Additional veggies&cheeses +1 Additional meats +2 Two poached eggs,house made granola on fat free plain Greek yogurt, Veggies Cheeses Meats fresh fruit cup and one slice of whole wheat toast Tomato,caramelized American Vermont sharp Applewood bacon, Wild Caught Smoked Salmon Platter 16 V onion,red bell pepper, cheddar,pepperjack, country ham,Hormel Toasted bagel,cream cheese,tomato red onion,capers and sliced egg mushroom,baby spinach, Swiss feta,mild provolone sausage,Gaspars' Salmon Scramble IS V black olive,pickled Premium linguica,sweet Italian jolopeno,broccoli Cheeses+1.5 sausage 3 eggs,mild organic Vermont goat cheese,chive,toast and home fries Smoked Gruyere, ONLY GRADE AA FARM FRESH EGGS Organic Vermont Goat Your eggs are cooked any style with your choice of toast and our BREAKFAST BURRITOS red bliss home fries Two/three eggs 6/7.5 w/home fries Add bacon,sausage,ham,or lean Canadian bacon 4 The Veggie Burrito 11 V Add a Specialty Sausage:sweet Italian,housemade lean turkey sausage 3 Eggs,spinach,mushrooms,tomato,and provolone patty,Gaspars linguica 5 The En Fuego Burrito 12 3 Eggs,ham,onion,sweet red pepper,house pickledjalopeno,and spicy pepper CAN'T DECIDE? jack cheese.Servedw/salsa Steak and Cheese Burrito 13 The Whole Farm 14 3 Eggs,lean shaved steak caramelized onion American Cheese Two eggs any style,Two pancakes,Two pieces Applewood smoked bacon,sausage,fresh fruit cup&home fries. Barnstable Burrito 13 V 3 Scrambled egg whites,feta,broccoli homemade,all natural turkey sausage BEAUTIFUL BEN NYS SCRUMPTIOUS SAMMIES Two perfectly poached eggs on Thomas'English muffins with hollandaise Our Famous"Millwich"Breakfast Sandwiches and red bliss home fries Two fried eggs with American cheese Traditional 12 Irish 14 •on jumbo Thomas'English. 5.5 •on Boston bagel 6 Canadian bacon Our wicked awesome ten hour corned •on Croissant 6.5 •on whole grain,gluten free toast 8 Florentine 12 beef hash ADD:bacon,ham,sausage,Canadian bacon +1•Home fries wlany sandwich+2 Fresh baby spinach and grilled tomato Lobster Benedict(in season) 22 THE LIGHTER SIDE Norwegian 15 A Classic...Thomas'English with baby Smoked wild caught Atlantic salmon spinach&hollandaise Seasonal fresh fruit 5 cup/7.5 bowl V SKILLFUL SKILLETS Fresh non-fat yogurt 4 up Greek non-fat yogurt 4 cup V Add fruits +1.5 All served with choice of toast Mills'own granola 7 bowl V The Western 13 with milk.Add fruit +1.5 Three scrambled eggs,ham,red bell pepper,anions,potatoes and Greek yogurt and granola 10 bowl V American cheese with honey and choice afore fruit The Irish 15 Veggie Bowl 10 V Our homemade corned beef hash&spinach,three scrambled eggs and Pick up to 3 veggies and we'll soutee in Evoo•Add 2 scrambled eggs+3 Vermont sharp cheddar Assorted Cereal 3.5 V The Fiesta 15 with 2%milk•Add banana +1.5 Three scrambled eggs on pork carnitas,hash browns potatoes house pico, Irish steel-cut slow cooked oatmeal S cup/6.5 bowl V and pepper jack Add banana,strawberries,almonds or dried cranberries+1.5 each. The Italian 14 Add blueberries(seasonal) +1.5 Three scrambled eggs,peppers,mushrooms,onions,home fries, and a sweet Italian sausage on a bed of our tomato sauce with Parmesan SIDES 0 Q Q V OFF THE GRIDDLE Applewood smoked baton Hormel Red Bliss Home Fries 2.5 All served with powdered sugar and whipped cream Special recipe sausage,Canadian Tomato—Chilled or Grilled 3 Bacon,Country Natural Ham 4 Broccoli,Spinach 4 Buttermilk Pancakes Turkey Maple Sausage(Housemade/ Molasses Raisin Brown Bread(2) 5 Tall Stack-three for 8 M1 All natural),Gaspars Local Unguica, Short Stack-two for 6 Italian Sweet Sausage Link 5 Corned Beef Hash 8 Mickey Mouse-one for 5 Smoked Salmon 9 Ultimate Home Fries 5 Our Signature Pancakes 12 with onion,red bell pepper,bacon, One Egg-Any style 2.5 3 buttermilk pancakes with NY style cheescake topped with fresh strawberries mushrooms&hollandaise. Duck Eggs(2) 5 Thick Cut Cinnamon French Toast 8.S Shredded Hash Browns 4 Baked or Black Beans 2.5 Apple Cinnamon Babka French Toast 13 with caramelized onion,red pepper Hollandaise 1.5 Scratched baked in Rochester,MA.,cream cheese drizzle,toasted walnuts Belgium WafflePOPULAR SWAPS &S MAKE IT YOUR OWN! I) For Home Fries_Fresh fruit,tomatoes,beans,hash browns, Add fruit,chocolate or nuts to your griddled breakfast +1.5 any item ultimate home fries +3 •Strawberries•Bananas•Blueberries(in season)•Craisins For Toast...English or bagel+1.5•Croissant or artisan bread +2 •Walnuts•Almonds•Pecans•Chocolate Chips •Gluten free whole groin +3 EXIT A '0 =� COUNTER A15LE GASHI)_R N W 70 _ CI 0 HAL r ct• ns 5T; rRA&E 149 ROUTE 149, MARSTONS MILLS, MA O2648 (clock in stamp) (TIMESTAMP ALL 3 COPIES IN TOWN CLERK'S OFFICE—LEAVE ONE TO FILE FOR OUR RECORDS-ONE TO POST IN TOWN HALL-KEEP ONE COPY FOR YOUR RECORDS). TOWN OF BARNSTABLE NOTICE OF MEETINGS OF TOWN DEPARTMENT AND ALL TOWN BOARDS As Required by Chapter 28 of the Acts of 2009 which amends MGL Chapter 30 A Licensing Authority Agenda The September 14,2020 public meeting of the Licensing Authority shall be physically closed to the public to avoid group congregation. Remote Participation Instructions Alternative public access to this meeting shall be provided in the following manner: 1. The meeting will be televised via Channel 18 and may be accessed via the Channel 18 website at: http://streaming85.townofbarnstable.us/CablecastPublicSite/watch/1?channel=1 2. Real-time public comment can be addressed to the Licensing Authority utilizing the Zoom link or telephone number and access code for remote access below. Link: https://zoom.us/i/91561574982 Telephone Number: 888-475-4499 US Toll-free, Meeting ID: 915 6157 498 3. Applicants,their representatives and individuals required or entitled to appear before the Licensing Authority may appear remotely and are not permitted to be physically present at the meeting, and may participate through the link or telephone number provide above. Documentary exhibits and/or visual presentations should be submitted in advance of the meeting to Richard.Scali@town.barnstable.ma.us, so that they may be displayed for remote public access viewing. DATE OF MEETING: September 14, 2020 Check below which one applies The Clerk's office has this meeting date already posted X This is a special meeting which has not been posted TIME: 9:30 a.m. PLACE: Via Zoom V Vote to accept Minutes: 1. Vote to accept minutes of the August 17, 2020 hearing. New Business: 1. Consent Agenda: Public Hearings: 1. APPLICATION FOR A NEW ANNUAL COMMON VICTUALLER LICENSE AND TEMPORARY OUTDOOR PATIO LICENSE Application of Fig Tree Eatery, LLC d/b/a Fig Tree Cafe, Maria Ferguson, manager, 149 Cotuit Road, Marstons Mills to be operated from 7 am to 3 pm. The seating is for a maximum of 42 seats and a temporary outdoor patio for 22 C�6�1 S� seats. rtc�- 2. APPLICATION FOR AN AMENDMENT OF AN EXISTING. CLASS I AUTO . DEALER LICENSE Application of Cape HY, Inc., d/b/a/ Balise Hyundai of Cape Cod to amend an existing Class I Auto Dealer License at 32 Corporation Street and 322 Falmouth Road, Hyannis to include the location 548 Bearse's Way, Hyannis for a maximum of 470 total spaces. Twenty seven spaces will be used for customers and service, 30 spaces for employees, 3 charging spaces, and 410 spaces for car storage. 3. APPLICATION FOR AN AMENDMENT OF AN EXISTING CLASS I AUTO DEALER LICENSE Application of 141 Stevens Street, Inc. d/b/a/ Premier Mazda to amend the d/b/a of an existing Class I Auto Dealer License at 141 Stevens Street, Hyannis from Premier Mazda to Mazda Cape Cod. 4. APPLICATION FOR A NEW CLASS II AUTO DEALER LICENSE: Application of Cape Cod Used Cars, Inc., d/b/a/ Cape Cod Used Auto Sales for a new Class II Auto Dealer License at 155 Rosary Lane, Hyannis, for a maximum of 15 total vehicles. Eight spaces inside to be used as display, 7 exterior spaces; 2 of which are employee and 2 of which are customer, the remaining 3 spaces are display.***Continued from August 17, 2020 Hearing*** 2 Licensinq Division Updates: 1. Licensing Department updates — 2. Police Department updates • Matters not reasonably anticipated by the Chair The list of matters, are those reasonably anticipated by the president/chair,which may be discussed at the meeting. Not all items listed may in fact be discussed and other items not listed may in fact be discussed and other items not listed may also be brought up for discussion to the extent permitted by law. It is possible that if it so votes, the sub-committee may go into executive session. For your information the section of the M.G.L. that pertains to postings of meetings is as follows: Except in an emergency, in addition to any notice otherwise required by law, a public body shall post notice of every meeting at least 48 hours prior to such meeting, excluding Saturdays, Sundays and legal holidays. In an emergency, a public body shall post notice as soon as reasonably possible prior to such meeting. Notice shall be printed in a legible, easily understandable format and shall contain: the date, time and place of such meeting and a listing of topics that the chair reasonably anticipates will be discussed at the meeting. Meetings of a local public body, notice shall be filed with the municipal clerk, and posted in a manner conspicuously visible to the public at all hours. 3 v Town of Barnstable Licensing Authority 200 Main Street Hyannis, MA 02601 www.town.barnstable.ma.us Telephone: (508) 862-4674 Fax: (508) 778-2412 BARNSTABLE LICENSING AUTHORITY CONSENT AGENDA August 17, 2020 Renewals: j Annual All Alcohol Common Victualler 1. Blue Moon at 430 Main Street d/b/a Blue Moon, 430 Main Street, Hyannis — sidewalk cafe license renewal Outdoor Patio Expansion Requests: 1. Puritan Clothing Company of Cape Cod, Inc. d/b/a Puritan Cape Cod, 480 Main Street, Hyannis — retail expansion of town property 2. Fig Tree Eatery, LLC d/b/a Fig Tree Caf6, 149 Cotuit Road, Marstons Mills — expansion on private property 4 s'p S$°fit r ZOO 1 I � °I � e��,b � � I f as a�zr r v1°°°5 r '"'•- �4 ...� � .�.• / ,;6�'�• 'i.e M -'•.�'`4 bZ\f °lI to I ® �� ts't J '� U •' of/! �a s� �® I A �/ r j , '' er.,) r9 L ,i 'ro \ ` \.` t;•/ {� yy av"r.A 6 e.6 Q aALS °°al'�3 d.b �i } �•' 6 DZ t'¢,� 5 L �gro It Cai arto r • 6AA&5 �. 1 t 487 (� It o a9 ft 4 fl� 9 ® ` 4" p4vc'MG�tT � {LJ � d � lea 1 a / E @RISTIN�• la �,6 I PAVE 111NY Pavacwcuy t^ro` / /tA� W }►i 1�IV mo sToo$ rJ�t 0 gv ' 0 ' _. 40. s ��r"i PA(iLt✓l.65 en5 C461E 2Uo,� v Cl- ALL,/ARouml) b' Ey,&II►& 4AUANCG BASE 1S EITiIER. ColuCt2li`f r f1c��9�n1'1 012. {a0. ;g _ ._ _. / t � 1 a r CP s- V1 T3 II 1 I ! 9E L 1 t t 1 1 It �. � i SPr*,t.�h to J �,. . . ,.....:. . ., . . .. . .. .•., . . ,. � _ Far A a INO SHEET MTLE - - - EASTING FLOOR PLAN #Ro'ECT ,THE MILLS RESTAURANT Route 149, Marstons Nfitfs, MA ty F 'BARNSTABLE INSPECTION WORKSHEET Chose TIFICATE NO: CANCELLED: MAP: 078 MILLS RESTAURANT PARCEL:. 020 j�A�MFJMANAGER: KATHLEEN VAN TWYVER P w STREET: 149 ROUTE 149 VILLAGE: IMARSTONS MILLS STATE: MA ZIP: 02648- SEQ NO: 10 tin BUSINESS TYPE: IRESTAURANT CONSTRUCTION TYPE: JUNK STORYI: CAPACITY: USE1: B Capacity Under 50: ❑� STORY2: CAPACITY: USE2: Outside Seating: ❑ STORY3: CAPACITY: USE3: y BY PLACE OF ASSEMBY OR STRUCTURE CA01: 36 LOCI: SEATING CAPS: LOC8: CAP2: 6 LOC2: COUNTER STOOLS CAP9: LOC9: CAP3: 42 LOC3: MAXIMUM SEATING CAPACITY CAP10: LOC10: CAP4: LOC4: CAP11: LOC11: CAPS: LOC& CAP12: LOC12: CAPE: LOC6: CAP13: LOC13: CAP7: LOC7: CAP14: LOC14: INSPECTION: DATE ISSUED: EXPIRATION: jb;,;ri tk�is'Scre n 0 01/05/2012 0 0 J �. `' P:n'C fc. e•of. n ectiorl COMMENTS: r Fee No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Mioponl 6pztem Construction Permit Application for a Permit to Construct( )Repair(k)Upgrade()()Abandon( ) El Complete System g Individual Components Location Address or Lot No.*/35 d 414q BIZ, 14-7 Owner's Name,Address and Tel.No. V,IhiZ57*0 b �lCL$ MIA- 19ZC 5 29bvA60 /4Rm 9C'yE_.eJj Assessor's Map/Parcel i `p 5*1 4r1r�f /2,V r epw 5 l Ce AA Installer's Name,Add�yress,and Tel.No. Designer's Name,Address and Tel.No. w 446-oa (/ �,/ p (SOX �5 Type of Building: 15�rop, 'P4_40 Dwelling No.of Bedrooms Lot Size S /S$ sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 1,96 MA `7 S -Tr-4 4 Z Design Flow 4 J��£gallons per day. Calculated daily flow 1�`3 rc`P S 5T gallons. Plan Date o Number of sheets Revision Date Nb m. F, Title Ss /e %5YQ1 Size of Septic Tank 'PLAi-i Type of S.A.S. Description of Soil 25X1 5nij(f SV!.S Zr9M Nature of Repairs or Alterations(Answer when applicable) SVE F Date last inspected: �Q Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by s and of ealt},, Signed � � Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued ! /"r§ S. x Fee Q THE COMMONWEALTH-OF MASSACHUSETTS y Entered in computer: . S 'PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACWSETTS ems..:. Rppliiatio i for Digossar *pgtem Construction Permit . Application for a Permit to Construct( )Repair(k)Upgrade(x)Abandon( ) ❑Complete System g Individual Components Location Address or Lot No.-*/.;,57 djgq Owner's Name,Address and Tel.No. f/ 4?-' � NAyU /4,t�l � � Y Assessor's Map/Parcel ?TLE 2,V'Jr2 M�t� 7$ P' 4c Z-5 /� 2O T Installer's Name,Address,and Tel.No. ,� ry Designer's Name,Address and TerrNo. *tA—06 5 CO AA -It - ' CM S S u y P 6'vX.`. `Lb 46 Type of Building: . 5P—P, FL,q ' Dwelling ,No.of Bedrooms Lot Size �S$ sq.ft. Garbage Grinder_(,.) k Other -"Type of Building No.of Persons Showers( ) Cafeteria _ � Other Fixtures S 5 r4P 1 4'Ze _* m_ Z� r Design Flow_ r Pr q gallons per day. Calculated daily flow �Gl v �''t gallons. Plan Date Number of sheets < Revision Date rj IN Title S-p r e ► A►/C— Size of Septic Tank 'fit�1t,.1 Type of S.A.S.�>ac I S F D Description of Soil ' 25K/.571NC_- Cvf�c £lam Nature of Repairs or Alterations(Answer when applicable) 1"' L AV\,) § Date last inspected: I d© f Agreement: r "" d The undersigned agrees to ensure the construction and maintenance of the afore described om site sewage disposal system rt in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by s and of ealt Signed; G L Date �j `"-��J��✓ Application'Approverd by Date � �S Application Disapproved for the following reasons ',. Permit Nd.1" Date Issued ' i 21 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY that theOn-site Sewa ge Disposal System Constructed( )Repaired (X )Upgraded Abandoned( )byt3 at 1 fr f = �l has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ated 07, Installer Designer J -> v The issuan2e /f this/ it shad not a nstru d as a guarantee that the sy %Will funs'onadesgn$c. / Date 1l�'f s C':� Inspector f ' / ,'4 Vt v . Fee , THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS Mi5po5al *pltem Construction Permit Permission is hereby granted to Construct( )Repair(Y—)Upgrade(1( )Abandon( ) System located at l e- 4 4g ",jTx-- ( �k"1 fv''I 19 ir_4; r7r3 .S M►LL 5 j x IO . ' - r and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this 'Rrrtit. Date: >� �1 " J" , Approved bq �.�" !/ ASSESSORS IIAP NO' 4V PARCL ls.w.�•�� +JY G��x _ Fsa.J... ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD , OF- HEALTH TOWN OF BARNSTABLE Appliration for Diripwial Workii Tomitrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at S- -•--------------------------•--•------•--•------------................------•--•-•-••-----•- Location-:\ css orrrLot �„„ Own VAd r ss a cz�-\�,,.- � � �� S f V1 - S �� vvl 21�y� -•--•--••-- Installer Address UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' 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 ( ) 1.4 Percolation Test Results Performed by_--------_-------- ..................................................... Date........................................ a Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ fL4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ............ ----------------------A ODescription of Soil--------- {� - --a------ rz c---------------------------------------------------------------------•---•------------ U -----------------------------------------••-------- ---------------• ••---------------------------------------...---------------------------------------------.....---------...-- ' W ----------------------------------------------------------------------------------------------- ---------------------------------- U Nature of Repairs or Alterations - Answer when ap is able.-.__.___ ______________________ -------------�..----.-................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Comp ' ce^ has been issued by the board o ealth. Signed -(— - -... a....... -��. Dace ApplicationCl .Approved By ............. -- ...... S.. Dace Application Disapproved for the ollowing reasons: ... -------------- ......"�.r_ - ............................................ ........ ... Permit No. ------ - Issued D ... .................................... S Dare U 7F Fiza. f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Diinpo!3al Murbi Tun.itrnr#inn ranfit Application is hereby made for a Permit to Construct ( ) or Repair ( �anIndividual Sewage Disposal System at: -•-----------------------------•-•----•----...-------- --•-•-------------------•----••----- \1 1�1'\_LocatioV=.\ddres�s/� y��, 4.1F9.. 1:�_C..L__--- •1( __�- .....................4 ..................................I `y:.,ti ..Lot CIJ. r l Owne Ad r ss K,. qj Installer Address UType of Building Size Lot............................Sq. feet i Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) QI 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 ( ) aPercolation Test Results Performed by......... ................................................................ Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit------.............. Depth to ground water------..-.-...._--.------ rZ4 Test Pit No. 2_--------------minutes per inch Depth of Test Pit.....--.....--...... Depth to ground water........................ a0 .......................................(...-•-•-•••••••---••••••-•-•••.......--•-•--•-•••-•--•••-•-•••......................................................... Descriptionof Soil. . . -----------------------------------------------------------------•-•------------------ U .............................................................. , ................:............................................................................................................ 1-4 Z ----------------------------------------------------------------------------------------------------------------------------------- ............................................................ U Nature of Rep 'rs or Alterations—Answer when applicable._....._ a -.1!`'.S' `` ..............1-�............................... -------------------- a ' �r _4 _.. -- - . 5 `^'mot' ---------•------•------ -----------------------........-------- 1_________________�e_.___._..__-..._.._._._...._..-.-.....-_ Agreement: ., The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board o,-health. Signed = .k��< .... .....N-urr� . - ... D.._..._.............�y...j...... \ Date Application.Approved By ----- .. ��..t�.,�,�t_ .- --- ................. -^�-5-----........................................................................... Date Application Disapproved for the ollowing rearonr: .................................................. -------- .._ _ .... --------------------------- ----------------------------------------------------------------------------------- ---------------------------------------------------------------------- --------------- ---------- ------ --1 �� Date Permit No. ...........�. ... 1.�_...(...7------------- Issued -----------------IK.---Y-- 3.............. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tiertifi ate IIf Tomplianre T,III IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ..._:..:- .''--�-.-----------7--�e_�.,.. ``�� C (L S " rInstaller at ......1. `� -C fi.�. :-`.j. 2r - ..._M_,...w� J `S> rY\c_--------------------------------------------------------------------..._----------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal.Works Construction Permit No. -_/..�..-----j_,..-.-9----- dated ----------------------_-----__--_--------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUEA AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE---- -.... .................. Inspector v ... --------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE........., O �iu�rnnttl nr�n �unutr�r#i\nn �rrmif Permission is hereby granted..•. --------- ----•------------------------------------------------- . to Construct ( ) or Repair (-/'),,,an Individual Sewage Disposal System : I e S atNo. ! = - ...............................I as shown on the application for Disposal Works Construction Permit Nae4_f��.�. Dated-----�..-�..-I. .r....... • �: 1 1 9 Board of Health DATE...&•r------ r r--<---•----r•-•--••-••••......------•-----••. FORM 36508 HOBBS A WARREN.INC..PUBLISHERS Fps.... q. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Apptiratinn for Disposal Works Tomitrnr#inn Frrutit Application is hereby made for a Permit to Construct ( ) or Repair (�Individ Sewage Disposal Sys fat• .° - m® CiS e ...... - ......... --•----------- --•---•. ...................... - :..---......... Locatio Address ]� �a i i ' ^or Lo,^n o` r 1 ' ........... ra. --- -- -- ---- - - ---- ----- ------ i caner ` nn Address Installer Address P i Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria P4 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. Seep 'Pit'No--------------------- Diameter___--__.-___.._---.- Depth below inlet.................... Total leaching area...................sq. ft. Z Other Distribution box ( ) Dosing tank ( ' ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1_____-___-_._-minutes per inch Depth of Test Pit.................... Depth to ground water........................ rZ4 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---------------- ------------ -�-._.____ {� -•----•-------------------------------------•------------- O Description of Soil.......... _______ _` V ---------------------------------------------------------------•--••------........•----•-•............._..------------------------------•--•----•-•---------- W ------------------------------------------------------------------------------------------------------------------------------------- -------------- ------ -------- ----•-- U atur of Repairs or Alterati s—Answer when applicable__1^5 -<<_._._.._-Sc `��_5`'.f� 5 � ` ------.................................. z �l� 4t ------------} `3• E 5..:................ 3 �� s. ..� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Envi nmentaI Code—The undersigned further agrees not to place the system in operation until a Certificate of Co pl nce een issug by the board o health. Signe ------------- - -------------- -r 2^- ................... ApplicationApproved By -----------N --------............................................................. 4�------ Date Application Disapproved for the following reasons: ..--_------------------------- --------------------------------------------------------------------..........__...__......... -- -- ---------------------------------------------------------------------------------- —7 � at_ _ [' q De Permit No. ----- ---"---- /---- .y--------------- ---- Issued Z ...-G Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (fertifiratE of (famplian r TH S TO CJRT{IFY, That the Irfqividual wage Disp sal System constructed ( ) or Repaired ..... --------------- at ------------------------------ has been installed in accordance with the provisions of TITLE 5 The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..... cj:.... ..�.......... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................. .. .....=---------.......-- Inspector .................:................................................... No;...��C.'�. cJ ; Fes .. . . 1 y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE App irtttinn for Uiip.aiitt1 Worko Tnnstrnr#inn Famit Application is hereby made for a Permit to Construct ( ) or Repair < Indivi� Sewage Disposal Sys at A C, � � C, , . �: .;.. .LM.... ,. 5...�.................... ..............•-----•-...---------------- - - - - - -----....-- Location.Address `(� e, or Lot No. - .C2. f-.�.. _ ......1 , oaf`.--• i 2 F :_ ....b..:--1- ..4.........�......�+`• �s.... : ... ............ , \ caner Address. 55 � nsta er Address I d Type of Building Size Lot----------------------------Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) N Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )" P4 Other fixtures ---------------------------------•-•--•-------- w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth-----__.--.----- 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........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Lz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .. Description of Soil e ............ ? -�,-=tis `� ---------------------•--••- x w U� Nnature tRepairs or Alterations—Answer,when applicable..^,, f—� k.k......._.'?Sc.M�a0...j.c,J._....S.. .:.................. Agreemen . - The`undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with - the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Co prance as been issued by the board of health. Signer- f'• �� ... 1 Site Application Approved By ---------------- - -------------- Application Disapproved for the 7ollou5i,4g reasons- -------------------------------------------------........................------------------------------------------------------------- --------------------------------------------------------------------------------- ----------------------------------...-----------------------------..........------. --------------------------------- --------------------------- Date b .13 Permit No. -;-----( - 9------�-----��--L y--------------------- Issued ..I 2 a Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cferttf rate of Cfarapti n e TH QS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by •--------- = ?.. = �` ---------------------- --------------------------------------------------------------------------------- - at -- - - q \A^-`------- ... ... �. --,... Ins f f I . ...............................................................------�c� v- has been installed�in accordance with the provisions of TITLE 5 of The State Environmental Code'as described in the application for Disposal Works Construction Permit No. ...--?.fix.............s. dated ................................................ y....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON T UED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------ ........ -----------------------------------............................................ Inspector ..................................................................._----_-------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ................. ff FEE.49,Q Dispos 1 Varkii Towitrudian ramit r Permission is hereby granted •' :=%SK-------•------------------------------------------- to Construct ( ) or Repair-(-/.) an Individual Sewage Disposal System { at No. '� S�r • ( ��, .. =--------------------- t ' Street _--as_shown on the application for Disposal Works Construction Permit o. 91... � 1-- Dated.... ......__. ------•---..... .j _ - -•-•f... ---- '�;� Board'of Health DATE. 2 -------------•--....... FORM 36506 HOBBS 6 WARREN,INC.,PUBLISHERS N• _ or FEs......v._............... t� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HE L H ApphrFation for Dhipus al Works Tonstrurtion Fautit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -- .. ._,�1�1, :... .�2 ✓!7zenz..ZX2... .................................................................................................. Location-Address_ or Lot No. Owner Address Installer Address dType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria a d 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........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ a --••----•----••--------------•----•••-•••••--•-•---••-••----•.......••••-•-•-••••-•-......_................................................................. ODescription of Soil........................................................................................................................................................................ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- W UNature of Repairs or Alterations—Answe when applicable.------------------------------.___ ------------------------------------------------ 1aL'-C� �• t'�-'�--'Q- .!1e;i �'` i�'f ---------------------•--••---•----------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI1ILE 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 hea th. Jam, Ign •-- ., ----------•- --------•----- ' `mot fi,�� -- D ... !/J ` Application Approved BIth -------- --------------------------------------•-•------------------------------.. �---`�O--- - �✓---------- Date Application Disapprovedllowing reasons:................................................................................................................ -----------------------------------------••-•------------•--•------------------......----------------•-•---•••••••••-.••----------------------•-------------------------------------------•-•-•-•_.... Date PermitNo......................................................... Issued....................................................... Date K > _.° �........... ._ Fxs....�.................4 . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE L H ....................OF....... '' r 4 AVV iration for RsVaaFal Works Tonstrnrtiutt ramit Application is hereby made for a Permit to Construct" ( ) or Repair ( ) an Individual Sewage Disposal System at: d ` ...... ._.,��.��...... .�..��.-----•---•---------------1st.�... .................................................................................................. ,p r�•-- Location-Address or Lot No. - Owner................•-•-------•�'I� -•-•--•--------•---------..._...Address..........-•---•--•----•---.......--•----•• Installer Address Q Type of Building Size Lot............................Sq. feet r U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria QOther 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 ( ) aPercolation Test Results Performed by.......................................................................... Date......................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4A Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... 04 -•-•---••-•---------•---•---•••••--•-••...••---•••-----------------------------------•--•-•-•.-•--••......................................................... 0 Description of Soil........................................................................................................................................................................ V ----•••.....----•-•-•--....--•-----------------•-.........•••-•.........•-••-----------••••-•-•-•-•--''"..--------•----•---•-•-----•--•-•-•--•------••--•---------•-----------------•---...------------. -•-----------•-•-••..................•.........g,. p.. W _ .. UNature of Repaairsp_rpAlterations—Answe when applicable ____ _ _________________,r .___............................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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. p D Application Approved By.:-C ..... .... Date Application Disapproved r th following reasons:--••--•-------•---•--------------•-•-----••------•-•---•-•------•-••-•--------............................... .........-•---•--•---•-------•---------------•-•-----•-•----•-------•---•-•---•------.......--------•---....------------------•-•----•-•-----•-•-------•--------------------------.....••---•-•---------- Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............................I..........OF..................................................................................... (Inrtifiratle of Tomplittnrr TH,S I .,.CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired («ram"""" ......... --•-----•-• ----•----- ••-•----- ----------•--- nstaller ----------•------•--------- ------- has been installed in accordance with the provisions of TI'� 5 of T e State Sanitary Code de �r>b (d in the application for Disposal Works Construction Permit No .............. '� Y' - ----------- dated-..-I. �_ _._._..--�-------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE S A GUARANTEE THAT THE SYSTE�IL,� F,ONCTION SATISFACTORY. Inspector DATE 3�.. '._._:. P --- . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 .. // OF...............•----•--........-•------•----------•....................--•.......... / % No.....................5 ... FEE/....---•--.....----- �liovo 1 oM..I&Tnntrnrtion rrmit 1 - Permission is hereby granted---- •''�---- ---------------------------------------•---••-----------------•---------•-••-- to Constru„ or a divldu evc�age Disposal System atNo.... .... .. .....: ......................- Street as shown on the application for Disposal Works Construction Permit No...... __ f - DATE............................................................................... Board Health FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS r— --- _ ----- . , '!' TOWN OF BARNSTABLE ' LOCATION SEWAGE # oZ 00 0— %G�r VII.LAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 95"yS SEPTIC TANK CAPAC=' -LEACHING FACILITY: (type) fx:rl.'si_ eqll�s f (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE- COMPLIANCE DATE: ' Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet . Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet d Furnished by h/ �A IQ a a �� s�� i Kr t LI V /,3,�/& ,M.Qf STABLE LOCATION d T A-:h o SEWAGE # 0-// VILLAGE ✓4Mg e,Sto;i S 6E1,i/_s ASSESSOR'S MAP& LOT D25_ a2Q INSTALLER'S NAME&PHONE NO. `/71- 03 2'2 d w e y Ut l��arO 0 3 SEPTIC TANK CAPACITY /5 OO LEACHING FACIL=: (type) /, S�0 �� l��i L�' (size) /2 X 40 NO.OF BEDROOMS BUILDER OR OWNER Doh ��It�c. u�Cf-er yl PERMTTDATE: � 1�1_COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachingfacility) Feet -nished by �� r�iuv l I C Pa,,,f,s GB n � G 9 a Pf 11 TOWN OF BARNSTABLE LOCATION�T , �� \S �Ps� SEWAGE # ' VILLAGE Mq�S�ovr rt\;�\lS . ASSESSOR'S MAP 6z LOT�8k,8`/ INSTALLER'S NAME & PHONE NO.CQ r(toKJ SEPTIC TANK CAPACITY 3 0 G o g A��c,,.► LEACHING FACILITY:(type) y v 4 Gg\1 r-�S • (sue) 13 ' GA ((c y S NO. OF BEDROOMS— (p _PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER�pz.,a\� DATE PERMIT ISSUED: l DATE COZIPLIANCE ISSUED: ' �' Q VARIANCE GRANTED: Yes No l GPtaje �� VeyoY• ��M�tr C S C. S t t�� 13 • Ga��E ys o TIL v. TOWN OF BARNSTABLE cw�cry LOCATION 44 cl SEWAGE # VILLAGE ASSESSOR'S MAP & LOTA-H INSTALLER'S NAME & PHONE NO. �tLC 1 E� ► SEPTIC TANK CAPACITY !c`�'�"C ( -.:r<• . t' p• ! ,. c`�' LEACHING FACILITY:(type) n, y(size) NO. OF BEDROOMS � rs PRIVATE WELL OR PUBLIC WATER, BUILDER OR OWNER GEC. DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 9 1 Res(. Ic cn .1-Se7�4�s• • c 9. LOCATION SEWAGE PERMIT NO. 17 VILLAGE I N S T A LLIRR'S NAME i ADDRESS IUILDEIt OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED W n U l y;T � r LOCATION : J � 5EWA(:StE PERMIT UC IWSTQLLER�5 U&ME ADDRESS BUILDER 5 Q &V AE ADDRESS DNTE PERWT 15SUED D ATE COMPLI W ACE ISSUED : r, 'Y � � I I I ~ - 91 { r I - MARACHUSETTS ENDORSEMENT-N0016 Waiver of Deductible It is agreed that the deductible amount stated in the declarations as applicable to such insurance as'is afforded under Option 1 of division 2 of Coverage C shall not apply when the loss to the.insured motor vehicle is caused by collision and is incurred in the following cases: (a) cases in which the named Insured would be entitled to recover in tort for such loss against another identified person except for,the exemption from liability granted by Chapter 978 of the Acts of 1971 of the Commonwealth of Massachusetts and all acts amendatory thereof or supplementary thereto;_ (b) cases in which the named Insured is entitled to recover.in tort for such loss against another identified person who is not , exempt from liability under Chapter 978 of the Acts of 1971 of the Commonwealth of Massachusetts and all acts amendatory thereof or supplementary thereto; (c) cases in which the loss occurs while the insured motor vehicle is lawfully parked and is struck by another motor vehicle owned by another identified person; (d) cases in which the loss occurs through the insured motor vehicle being struck in the rear by another motor vehicle moving in the same direction and which is owned by another identified person; (e) cases in which the operator of.the motor vehicle causing the loss to the insured motor vehicle is, as a result of his operation at the time of the loss, convicted of any of the following: (1) operating under the influence of alcohol, marijuana or a narcotic drug as defined in Chapter 94C of the General Laws of Massachusetts, (2) driving the wrong way on a one way street (3) operating at an excessive rate of speed as defined in Section 17 of Chapter 90 of the General Laws of Massachusetts, (4) any similar violation of the law of any other state in which the loss occurs, provided, however,this endorsement shall not apply with respect to this paragraph (e) if the authorized operator is himself convicted of any violation described in sub- sections (1), (2), (3) or (4) of this paragraph (e) as a result of his operation of the insured motor vehicle at the time such loss occurred. The provisions of this endorsement shall apply only to the insured motor vehicles described in the declarations of the policy. The provisions of this endorsement shall not be subject to' or reduced by the application of comparative negligence. This endorsement forms a part of the policy to which attached, effective on the inception.date of the policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent.to preparation of policy.) Endorsement effective Policy No. Endorsement No. Named Insured The /Etna Casualty and Surety Company Countersigned Hartford, Connecticut 06115 - (Authorized Representative) CAT. 340243 (15281) ED. 1-74 PRINTED IN U.S.A. L COMI'VIONWEALTH OF MASSACHUSETTS IV EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 .(617) 292.5500 , B oo° 00 o TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A / CERTIFICATION yQ 0/4? /yl,�ls��1f-�q s. //////// Property Address: , Name of Owner OpH /f��Q c��P`^ ��!Eo 'e Address of owner: Data of Inspection: —/'.3— /�// ��-. 2000 a Name of Inspector:(Please Print) �a�n #12/[a 3 am a DEP approved s ins to Section 15.340 of Title 5(310 CMR 15.000) NSTABLE Company Name: �� oflro " of TOwNI{ ��}IDFPL MaTing AddressazfS�li, y Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and • maintenance of on-site sewage disposal systems. The system: _ Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority / Fails F Inspector's Signature: (/t Date: SOD ',he System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater;the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. NOTES AND COMMENTS �► 04 tZe f�►7-ee oA .Aq--hk is M J1; T I•o� �OArh+ oT /y�1/� !s,o� /J� /.S 1 � S7 n 09kFv�� a �/r scuh, �aylr /h /i/ NGY R /YDlr/ /S Gt�O�/{ ba/,Ar✓+ t7 �!a Ale /,l S� '11%3 .S ys/{�"r pOS"s,I a 44.- lO Ao&-e—klkck�t y yet, UN /rhorvK I'/��1> dig �./i9 ea/^/-tc*� ""` ,�?ciG� ihy 9�-��tys G,rt rrhdrr �Jci•v�/rr,.rs,� aH� hw1" v�ti�•la� ��c�7� revised 9 2/98 Pagel of11 ij Printed on Retydled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ' r ' r �' s�CERTIFlCATION(corrtinued) ' Property Address: /y4'tR7`/�l4 '�a�t/vls^/�:��sl-Y��ls- /►ol/, �—��/, Owner: /�� Data of kupe�tioNn:` INSPECTION SUMMARY: 'Check A,<.B,,.C, or •D: �ry A. SYSTEM PASSES: "`I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Indicate yes, no, or not determined(Y, N, of ND). Describe basis of determination in all Instances. If "not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank whether or not metal,Is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank s ,,,,,,.failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed WE. _, distribution box is levelled.or replaced t: St t bnr - i? 1• p The'system required pumping more than,four times a year due to broken or obstructed pipe(s). The system will pass Inspection If(with approval of the Board of Health): r broken pipe(s)are replaced obstruction is removed ti c fk � ciNa revised, 9/2/98 Page 2of11 f . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A /r CERTIFICATION(co n tinued) Property Address: /yq / 4 �Y/�i�s lds.t /i rlA- owner: ,9 h MaG 2Cc c L,Q�k Date of Inspection: 3 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE W rH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. _ Y P P Y P PP Y el. i The system has-a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ Y P P Y P PP Y _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the ' well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER I revised 9/2/98 Page 3of11 • • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1 y,' I?T &g A, /eri/15 A erl, I'�7fi Owner: Date of Ins on: 3-do D. SYSTEM FAILS: You must Indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due-to an overloaded or clogged SAS or cesspool. i� Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. V Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ail oie Tr,� Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater.elevation. • _ 0 Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. c/ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ y Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no . Y; .. acceptable water.quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either "Yes".or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area:IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further infovnation. revised ,9/2/98 Page 4ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: . i /11/7/ A-rl' Owner: Pon Data of Ins on: / Check if the following have been done:You must Indicate either"Yes" or"No" as to each of the following: Yes No Pumping information was provided by the owner,occupant, or Board of Health. - — None of the system components have been pumped for-at least two weeks and-the system has;been-Teceiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this / inspection. As built plans have been obtained and examined. Note if they are not.available with N/A. — The facility or dwelling was inspected for signs of sewage back-up. — The system does not receive non-sanitary or industrial waste flow. — The site was inspected for signs of breakout. r/ All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction, dimensions,depth of liquid, depth of sludge,depth of scum. n The size and location of the Soil Absorption System on the site has been determined based.on: . �Dl — Existing information. For example, Plan'at�B.O.H. Datermined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 115.302(3)(b)) , — The facility owner(and occupants,if different from.owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised• -9/2/98 Page 5 of,ll SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM •- PART C SYS"EM INFORMATION Property Address: /�l9 .;Q1"/�19 /�ArS/aa �( te /1�1�7�c /Qet/. Owner: Data of Ins on: FLO',V CONDITIONS RESIDENTIAL• Design flow: '170 g.p.d./bedroom. Number of bedrooms(design): . ,:.Number of bedrooms(actual): Total DESIGN flow I go3 r Number of current residents: Garbage grinder(yes or no): Laundry(separate system). (yes or no)..& If yes,separate Inspection required Laundry:system inspected; yos or� Seasonal use(yes.or no): 4::. Water meter readings,if available(last two year's usage(gpd): Sump Pump(yes or no): Last date of occupancy: r2 Can14'. COMMERCIAL/INDUSTRIAL: nn Type of establishment: e t `r ed'�" S " Design flow:_[ ggd_( Bes d on 15.2 3) /1��": Basis of design flow 5D Sat* 20 G'PO 04ficW 4ffi:Ce �J 'ID Grease trap present:(yes or no)—V!f f Industrial Waste Holding Tank present:(yes or no)_ Non-sanitary waste discharged to the Title.6 system::(yes or no) • Water meter readings,If available: 'Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATICIN PUMPING RECORDS-and source of Information:: .y \ , System pumped as part of inspection:(yes or no)_ -If yes,volume pumped: gallons:,=�• •; .• •-• Reason for pumping: TYPE OF SYSTEM e Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed(if known) and source of information:_ Sewage odors detected when arriving at the site:(yes or no)_ revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C „ .'.,,,SYSTEM INFORMATION(continued) property Address: l yq //y`1' ,/✓��f S,ty t, 1WJJs /NA /Y,V As /`I.P S� � Owner: /7„yj �GrC t�Chlv�r Date of ku on: BUILDING SEWER, (Locate on site plan). Depth below grade:,_ h Material of construction:_cast Iron_40 PVC other(explain) Distance from private_.Water supply well or.suction line Diameter Comments:(condition of Joints,venting, evidence of leakage,etc.) SEPTIC TANK:_ (Locate on site plan) -3OOv Depth below grade: Material of construction: �con�retemetal_Fiberglass _Polyethylene_other(explain). If Ja s ,i metal list a e (sage confirmed by Certificate of Compliance (Yes/No) nk Dimensions: Sludge depth'- � • Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:_ Distance from top of scum to top of outlet tee or baffle:_ r� Distance from bottom of scum to botto of outlet tee or bafrfle:,�y� How dimensions were determined: Comments: ,``ocommendation for,pumping,conditi n of Inlet and outlet-tees or baffl s,depth of li uid.level in relatio. to ou et vert,structural integrity, S na ,,'�h...dence of�leakage,etc.), ,�afi!-e� T 2. /S 2 8�r b.t�vly e4a7[..C7 .. . GREASE TRAP'- JOOO G, (locate on site plan)' / /�1✓rd O�A� S 1� Depth below grade:, Material of construction: concrete_metal_Fiberglass _Polyethylene_other(explain) , Dimensions: l d y, Scum thickness:_.. rf Distance from top of scum to top of outlet tea or baffle: ' _ Distance from bottom of scum to bottom of outlet tee or baffle: Q4 Dats of last pumping Comments: (recommendation for pumping,condition of inle an outlet tees or baffl9s�depth of liquievei In relation to outlet nver=structu�ri`te rity�` evidence of leakage,etc.) Da• 7 // revised 9/2/98 Paee7of11 r ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspson _OO TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass_Polyethylene—other(explain) Dimensions: _......... _..__. Capac)ty: -gallons Design flow: gallons/day Alarm present Alarm level: Alarm In working order:Yes No_ Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,:etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Comments: 1pote'if level and distribution Is equal,evidence of.solids carryover,evidence of leakage into or out of box, etc.) PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(Yes or No) Alarms In working order(Yes or No) Comments: Inote condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 Page 9ofll SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART:C SYSTEM INFORMATION(continued) Property Address: yg Ry / �, 444` h� /V/,/l3 �� Owne : � Date of Irtspectfon�h /� — SOIL ABSORPTION SYS (SA�S)ov (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain,c' ! 1141"^ Type; H eav7, < leachlny`pits,number:_ leaching chambers,.number: leaching galleries,number:__6,5 9-gI9)s = /3 1o,TCt l,, leaching trenches,number,length: 3 leaching fields,number,dimensions: overflow cesspool,number._ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure,level of ponding, damp soil,condition of vegetation, etc.) CESSPOOLS:_ (locate on site plan) Number and configuration: Depth-top of liquid to Inlet invert: Depth of solids layer: Depth of scum layer: DiLls6sions of cesspool- Mateda1s of construction: ' Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: (note*condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) PRIVY:_ .(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) revised •9/2/98 Page yefll 0 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C .;SYSTEM INFORMATION(continued) �- Property Address: /yCl )qr 11f 10 As No, 1111^ll s )F'OsI, Owner: Date of 4upe�onP SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks �J locate all wells within 100' (Locate where public water supply comes into house) GG -� s �� GallQys �� ✓ � 3 3 6 0 7r�,7c'l�es ljr revised 9'/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C /' //�� SYSTEM INFORMATION(continued) �/ Property Address: /_f 7 /1 T /T �q/S�Oh /L�ri s IWQ. A4i/1S Owner: /� Date of Inspecti6n.V& NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater it Feet Please indicate all the methods used to determine High Groundwater Elevation: V Obtained from Design Plans on record Observed Site(Abutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers _ZUsed USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) 9 37 . ad�tist•� �� ,� rl P. 01, of N�pti wk�� 9 Atl,"s, W 5,f 5, J revised 9/2/98 Page 11of11 Town of Barnstable EVE 1p� do Regulatory Services ` * ins Thomas F. Geiler, Director BARN . •� Public Health Division • .orED MA'S a , Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 February 8,2006 Mr. Nick Mahairas Vernon Reality Trust P O Box 132 Marstons Mills, MA 02648 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. The septic system owned you located at 149 Cotuit Road, Marstons Mills, MA,was last inspected on January 13th, 2000, by Robert J. Bortolotti, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has "failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: System#1 —Wastewater level was 28" above the outlet tee on septic tank. System#2—This system was backed up with sewage to 1 %2" on the inlet pipe to the septic tank. The above system, according to our records has been in a failed state for more than two years. Several notices of failure have been sent to,you as owner of record. This system shall be upgraded or replaced before the food establishment re-opens in the future. You may request a hearing if written petition requesting same is submitted within seven (7) days. No permit shall be issued for the operation of a food establishment until after the septic i replaced o upgraded as required. of the Boar of Health A. McKean, R.S., C.H.O. Agent of the Board of Health McKean, Thomas From: Miorandi, Donna Sent: Friday, February 10, 2006 10:20 AM To: McKean, Thomas Subject: Mills Restaurant The Mills Restaurant was closed due to lack of hot water and no sanitizer in the dishwasher. In addition, the handsink in the kitchen and both the ladies room sink and men's room sink had water pouring out of the faucets. They were so old that according to the plumber they were stripped and couldn't shut them down so therefore they had to be replaced. They have never called for a re-inspection until one of the operator's of the business (who is a tenant) called regarding my orange sign posting. Matt Freitas (781-608-9954) called to state that all was fixed and I mentioned the septic which we now know was repaired in March 2000. 1 told Mr. Freitas that the restaurant needs it's own hot water heater. The existing hot water heater is located next door in the Artisan's Studio and serves the restaurant, the studio (high water user) and the two apartments above the retaurant. i McKean, Thomas From: ` McKean, Thomas Sent: Friday, February 10, 2006 11:16 AM To: Geiler, Tom Subject: FW: Wis Restaurant FYI -----Original Message----- From: Miorandi, Donna Sent: Friday, February 10, 2006 11:08 AM To: McKean,Thomas Subject: RE: Mills Restaurant -----Original Message--=-- From: Miorandi, Donna Sent: Friday, February 10, 2006 10:20 AM To: McKean,Thomas Subject: Mills Restaurant The Mills Restaurant was closed due to lack of hot water and no sanitizer in the dishwasher. In addition,the handsink in the kitchen and both the ladies room sink and men's room sink had water pouring out of the faucets. They were so old that according to the plumber they were stripped and couldn't shut them down so therefore they had to be replaced. They have never called for a re-inspection until one of the operator's of the business (who is a tenant) called regarding my orange sign posting. Matt Freitas (781-608-9954) called on February 8th to ask why the orange sticker was posted. Matt Freitas stated that all was fixed and I mentioned the septic which I now know was repaired in March 2000. 1 told Mr. Freitas that the restaurant needs it's own hot water heater. The existing hot water heater is located next door in the Artisan's Studio and serves the restaurant,the studio (high water user) and the two apartments above the retaurant. 1 Town of Barnstable sa�rr .c� Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO February 10, 2006 Mr. and Mrs. Nick Mahairas, Trs. Vernon Realty Trust P.O. Box 132 Marstons Mills, MA FAX: (508) 428-7121 Dear Mr. and Mrs. Mahairas The septic systems located at 135 Route 149 were in fact upgraded on March 27, 2000. The previous two non-compliance letters issued in 2005 and 2006 were issued in error. We apologize for the error. Sincerely, Thomas A. McKean oF114E tgtyti Town of Barnstable Regulatory Services * * * BARNSTABLE, * Thomas F. Geiler,Director 9 MASS. g 1639. a1� Public Health Division tFD MP'� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Nick Mahairas. March 1, 2005 Vernon Reality Trust P.O. Box 132 Marsons Mills,Ma. 02648 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. fA Rr 'oas �' IL-5 The septic system owned by you located at 159 Route 149 Catlin was inspected on, 1/13/2000 by John A. Aslto a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE:5 (310 CMR 15.00) due to the following: Outlet.tee on tgnk was 28 ft below water level making it 20 ft from the bottom of the tan and it is not accessible or visible below cover. Our records show that the system has been in a failed state for more than two years. You are ordered to hire a professional engineer or registered sanitarian to prepare a plan of proposed replacement septic system component(s). This plan is to be submitted to the Town of Barnstable Public Health Division Office(Regulatory Services, 200 Main Street,Hyannis),within (90) days receipt of this letter. The plan will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title V. You are a lso o rdered t o u pgrade o r r eplace t he s eptic s ystem w ithin s ix months (180) days o f y our receipt of this letter. Any person aggrieved by any order issued by the local approval authority may appeal to any c ourt o f competent jurisdiction as provided for by the laws of the Commonwealth. You have the option of requesting an adjudicatory hearing pursuant to 310 CMR 15.422 Failure to comply with this order will automatically result in a public hearing scheduled before the Board p of Health. F HE BOARD OF HEALTH Thomas A. Mc ean, R.S., C.H.O. Agent of the Board of Health CC: Board of Health J:ffsiled_septic letters MILLS RESTAURANT OLD OWNERS 1982-201 N ATT I C i :77 /All TOWN OF BARNSTABL LOCATION / 3y he /`Y� SEWAGE # VILLAGE 4-0*15 ASSESSOR'S MAP & LOT47 1 INSTALLER'S NAME&PHONE NO.—�J !�� f0 �j'��- y 9y SEPTIC TANK CAPACITY /00612 G T o?3a,2 -,5* LEACHING FACILITY: (type) - TrP�c4 rs (size) /40 L X Y V ,2 NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: ql,�?V00 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by tr/ �� cr/ � ' G/ ' S i h L 7 I h r° i r , •o 0 o , �,,��,•x, .J 9 �oaal 1. . r ��L& TO `OF B S �BLELOCATION Vo 14 J l S SEWAGE5 - 16 VILLAGE N ` � � ASSESSOR'S MAP & LO INSTALLER'S NAME&PHONE NO. w � ate c.�S 7 [ 7 —03 SEPTIC TANK CAPACITY 10100 GcaLN , Grease LEACHING FACILITY: 1�-�`n, kre� . D (type) (size) ��O �y-c_.N�-\. NO. OF BEDROOMS \ oZ x L/ w ` S`�'0 BUILDER OR OWNER 81J ck Q yM 0..L EO—C L e-4-tl1 PERMTI DATE: cS ) — 7 S COMPLIANCE DATE: '% y 1, 7 J� Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 010 NO Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) V,1 A- Feet Edge of Wetland and Leaching Facility(If any wetlands exist ^ within 300 fee-of leaching facility) p �g >�• Feet Furnished by � � i ' t T Barnstable ?�of SHE 1p�� y� o Town of Barnstable aicaCft nA LE,MASS' a Board of Health m T MASS. i639. �m OppTF0 A' 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Paul J.Canniff,D.M.D. FAX: 508-790-6304 Donald A.Guadagnoli,M.D Junichi Sawayanagi November 29, 2016 -Mr. Peter McEntee, P.E. 12.West Crossfield Road Forestdale, MA 02644 RE: The Mills Restaurant, 135 and 159 Route 149, Marstons Mills A = 078-019 and 078-020 Dear Mr. McEntee, You are granted variances, on behalf of your clients, Nick and Robin Mahairas, to construct an onsite sewage disposal system at 135.and 159 Route 149, Marstons Mills. The variances granted are as follows:. 310 CMR 15.405: To install a soil absorption system only ten feet away from an existing leaching facility (which is connected to Septic System #2). 310 CMR 15.405: To provide up to six feet of soil cover over the top of the soil absorption system, in lieu of the three feet maximum cover allowed. The variances are granted with the following conditions: (1) No more than forty-eight (48) seats are authorized according to the current food establishment permit. (2) The Orenco pumping system shall be installed and operated in accordance with the MA Department of Environmental Protection (DEP) `Certification for General Use' requirements dated March 20, 2015. (3) The septic system shall be installed in strict accordance with the engineered plans dated November 2, 2016. (4) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the submitted plans dated November 2, 2016. Q;WP/The MJlls McEntee 2016.docx This variance is granted because physical constraints at the site severely restrict the location- of a soil absorption system due to the multiple buildings, three septic systems and slope of the lot. The proposed system appears to be designed to meet the maximum feasible compliance standards contained within the State Environmental Code, Title V. Sincerely yours, Pau Can i , D.C.D.. Chairman Q;WP/The MRIs McEntee 2016.docx BATH RETAIL STORE OFFICE P 1 387 SF RETAIL STORE ENT. ON SYSTEM #3 SERVICE STATION °N sos SF ON SYSTEM #3 UTILITY & o ENT. ENT. ENT. STORAGE } RESTAURANT KITCHE UP w 44 SEATS ENT. ENT. PATRON FLOW ENT. SECOND FLOR ON SYSTEM #1 KITCHEN FLOW ON SYSTEM #3 _T APT #201 ON SYSTEM #3 » ENT. ENT. BATH BED Ea KIT. RM APT #201 APT #203 HALL �� sF ON SYSTEM #3 ON SYSTEM #1 ENT. APT #202 BED RM — BED RM BATH ON SYSTEM #3 130 SF 135 SF BATH OCCUPANT WOULD + LIVING RM DECK BED SF BED RM NOT ALLOW ACCESS 2 BEDROOMS ENT. pN 240 SF APT �204 HALL ON SYSTEM #1 LIVING DECK 2 BEDROOMS cn KITCHEN KITCHEN LIVING RM ENT. FIRST FLOOR APT #205 ON SYSTEM #1 APT #206 FLOOR PLAN 1 BEDROOM ON SYSTEM #1 2 BEDROOMS 149 ROUTE 149, MARSTONS MILLS, MA a/k/a 135 Route 149 pp1HE Tp� ' DATE: �l T �,c►.[. FEE: BAMSTABLE- MASS. �"' . 9� %639. ,�� C ris REC. BY Town f Barnstable 4 SCHED. DATE: Bo4rd=of Health 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 w; Wayne A.Miller,M.D. .FAX: 508-790-6304 Junichi Sawayanagi Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION Property Address: I`3s R'00 V2 i�t °[ Q V\a I LtCk Re-i A''E II I Assessor's Map and Parcel Number: C�7g 19 Z© Size of Lot: (0 Sr-- Wetlands Within 300 Ft. Yes. Business Name:-T')\k No L Subdivision Name: f 1� APPLICANT'S NAME: F2-�er C- C'n }'eQ P�' Phone SQ 87 'S 3 i 3 .Did the owner of the property authorize you to represent him or her? Yes ._ No . PROPERTY OWNERS NAME CONTACT PERSON Name: �i c V f`'!c< a t^cts Name: ��l�t l�'l r ,►{Q. 9:✓1kPc ex,, l/ -,r tS 1�e�',n o n i��1-y�'r.�s'1- 1 Z ttit-t C.rU ss �>•e l� t2� j hC Address: cT�� lx .an;,cQC`eaci Address:��5 M t1-6 41-41 Phone: ry -7 `l ._ ca c�_�L?:C40 ( Phone: r)K—�77—$—i 13 VARIANCE FROM REGULATION(List Res.) REASON FOR VARIANCE(May attach if more space needed) I O C M k 15-1 2 Z 'TO teed t f G2 '�T{.�(/; S i�1 C✓+ C1�� R r`Gti �$ t d-1 57 ct. NATURE OF WORK: House Addition ❑ House Renovation ❑ Repair of Failed Septic System Checklist (to be completed bj)office staff-person(eceiving variance request application) Please submit copies in 4 separate completed sets. Four(4)copies of the,completed variance request jform _ Four(4)copies of.engineered plan submitted(e.g_septic system plans) _ Completed seven(7).page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian _ Four(4)copies oflabeled dimensional floor plans.submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days priorto meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) _ Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining variance-renewals(same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) _ Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. C:\Users\decollik\ApDData\Local\Microsoft\Windows\Temporary Internet Files\Content:Outlook\BAJ9P9B7\VARIREQ.DOC i Engineering Works, Inc. 12 West Crossfield Road, Forestdale, MA 02644 Tel/Fax(508)477-5313 November 3, 2016 Re: 135 Route 149 (a/k/a 149 Route 149), Marstons Mills Assessor Map 78, Parcels 19 and 20- 1. Septic System Upgrade Dear Sir/Mam: Please be advised that:an application for variances from the Massachusetts Department of Environmental Pro i n te�.t o , Title 5, and Local Regulations have been submitted to the Barnstable Health Department for approval. The following variances are being requested: • 310 CMR 15.224—TANKS IN SERIES 1. A variance to the 48 hour detention volume required for the first tank in series to allow the existing 3000 gallon tank to remain which has a 38 hour detention volume as calculated for the approved design flow. 310 CMR 15.405(a)&(b)—CONTENTS OF LOCAL UPGRADE APPROVAL 2. Local upgrade approval is being requested for the proposed S.A.S to be located 10 ft. from the existing trench of System.#$,;� 3. A 3' variance to the maximum cover requirement of`3'to allow up to 6' of cover over the S.A.S. The S.A.S. shall be H-20 and vented. The application and plans are available for review at the Barnstable Health Department, 200 Main Street, Hyannis, MA, Monday through Friday (excluding holidays) from 8:30 a.m. to 4:30 p.m. A public hearing will be held,to discuss the proposed work, on Tuesday, Novemebr 22, 2016, at 3:00 p.m. The-hearing will be held at the following location: Town Hall Hearing Room Second Floor 367 Main Street Hyannis, MA i erely Peter T. McEntee.P.E.. USPS TRACKING# First-Class Mail Postage&Fees Paid - USPS Permit No.G-10 9590 9402 8`�9 6�04 1394 04 United States •Sender:Please print your name,address,and ZIP+4®in this box• Postal Service 'LIZ Engineering works, inc. 12 West Crossfield Road Forestdale, MA 02644 a 'I'Ilflifl�ill'Ifll')ii.tif f,ldIIIIII,],Il.liiiIf f f lll�IIII I III)! I COMPLETE •N COWLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3. A. Signature ■ Print your name and address on the reverse X ent so that we can return the card to you. ❑Addressee B. Received by(Printed Name) C. Da of elivery ■ Attach this card to the back of the mailpiece, ,� or on the front if space permits. �>= 1 4✓ G* (t � 1. Article Addressed to: __ D. Is delivery address different from item 1? 13 ibs. If YES,enter delivery address below: ❑No iProp ID:078019 I I MAHAIRAS,NICK I&ROBIN H TRS rl I VERNON REALTY TRUST PO BOX 132 MARSTONS MILLS,MA 02648 —J 3. Service'Pe ❑Priority Mau Express® II I III II IIII III I II I dill I II I I(III II I I l I I'll ❑Adult Signature 0Registered MallTm ❑Adult Signature Restricted OeUvery ❑Registered R Mail Restricted, € Certified Mail® Delivery 9590 9402 1889 6104 1394 04 O Certified Mail Res dsO Delivery O Return Recelpt for ❑Collect on Delivery Merchandiso Delivery Restricted Delivery ❑Signature Conflnnation*"r 7 015 3430 ,0001 1296 0994 , 'J Insured Mail.Restricted Delivery ❑Restricted Deliveryure —--r (over$500) I• PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt ' G _ LISPS TRACMNG# First-Class Mail } ° Postage&Fees Patd LISPS a Permit No..G-10 9590 9402 �WTt =04 1393 74 United States •Sender:Please print your name,address,and ZIP+4®in this box-, Postal Service Engineering Works, Inc. 12 West Crossfield Road \ j Forestdale, MA 02644 lll!)!!!l ,tl�.liirlgill�I.l�fll��►rrlir�l+li11�1!l11,��l1,�� COMPLETE 1N COMPLETE THIS SECTION,ONDELIVERY, ■ Complete items 1,2,and 3. A Signature ■ Print your name and address on the reverse ❑Agent so that we can return the card to you. X RCQ/,4-13 Addressee ■ Attach this card to the back of the mailpiece, B. Received by(Prin'd Name) C.Date of Delivery or on the front if space permits. 111- 9-1� 1. Article Addressed to: D. Is delivery address different from item 1? O Yes T I - If YES,enter delivery address below: ❑No Prop ID:078021 i LARSON,CAROLYN S ° 160 FLUME AVE f MARSTONS MILLS,MA 02648 3. Service Type ❑Priority Mail Express® II I III II IIII III I II I III II( II I I I II I II I IIIII III ❑Adult Signature ❑Registered Mail ❑Adult Signature Restricted Delivery ❑Registered Mail R Restricted 9590 9402 1889 6104 1393 74 ❑Certified Mall estricted Delivery ❑Reelturn Receipt for ❑Collect on Delivery Merchandise _2_Artinle_Numher_?ransfar from_seroi-A-lahall ❑Collect on Delivery Restricted Delivery ❑Signature Confirmation"^ ed Mall ❑Signature Confirmation 7 015 34311 0001 12 9 6 . 10114 ed Mail Restricted Delivery Restricted Delivery I'I PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt I J USPS TRACKING# + f Fi�sl-Class Mail (l fitPostage&Fees Paid USPS Permit No.G-10 9590 9402 1889 6104 1393 81 United States •Sender.Please print your name,address,-and ZIP+4®in this box•, Postal Service Engineering works, Inc. !� 12 West Crossfield Road I j Forestdale, MA 02644 Li SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3. 'Signature ■ Print your name`and Address on the reverse _ ❑Agent so that.we can returt`'the card to you. -X ❑Addressee ■ Attach this card to the back of the mailplece, B. Rec er", i mnte Name) C. Date of Delivery or on the front if space permits. A 1. Article Addressed to: ivegCaddress different from item 1? ❑Yes entbrdelivery address below: p No o Prop ID:078002 LEVESQUE,DANIEL P 6. %O'TOOLE,JASON A � 4309 FALMOUTH ROAD COTUIT,MA 02635 :— -- 1�_qervice Ty ❑priority Mal Expresse II I IIIIII III III I II I IIIII I II I I I II II II(�I I I I III Tm ❑Adult Signature Restricted Delivery O R%sterreed Mail Restrietedl 9590 9402 1889 6104 1393 81 rtmed Mal® oetum ❑Certified Mail Restricted Delivery ❑Retum Receipt for ❑Collect on Delivery Merchandise —9 Artir.IA_Minni-PC[Transferfmm_ServICA-label) ❑Cal act on Delivery Restricted Delivery ❑Signature Confirmationm ured Mail 7 015 3430 0001 1296 0 9 8 7 jured Mal Restricted Delivery ❑Signature Confirmation ResUlcted Delivery __ $500) il PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt , USPS TRACKING# - First-Class Mail �. Postage&Fees Paid USPS Permit No.G-10 9590 9402 ,889 6104 1394 ],1 United States •Sender:Please print your name,address,and ZIP+4®in this.box• Postal Service I Engineering Works, Inc. 12 West Crossfield Road o Forestdale, MA 02644 v .4 I I ; C, SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3. A. Sig" re _/' ■ Print your name and address on the reverse X Agent so that we can return the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, . Received by(Printed Name) C. a of elivery or on the front if space permits. (/ /& D. Is delivery address different from item 1? ❑Yes Prop ID:078062 If YES,enter delivery address below: [3No MARSTONS MILLS PBLIC LIBRY MAIN STREET MARSTONS MILLS,MA 02648 I 3. Service Type ❑Priority Mail Express® II I II�III IIII III I II I IIIII I II I I I II I III I IIII I I ❑Adult Signature ❑Registered Mail ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted 4TCertified Mait® Delivery I 9590 9402 1889 6104 1394 11 ❑Certified Mail Restricted Delivery. ❑Return Receipt for I ❑Collect on Delivery Merchandise L_2__Article_Numher_Cfransfer_frnm caroicA/ar,an Collect on Delivery Restricted Delivery ❑Signature Confirmationrm 7 015 -3 4 3 0 00011 1296 1069 ss°red Mai' ❑Signature Confirmation atloh ured Mail Restricted Delivery Restricted Delivery r$500) PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt t _ USPS TRACI(ING#., First-Class Mail Postage&Fees Paid USPS Permit No.G-10 9590 9402 1889 6104 1393 98 United States •Sender:Please print your name,address,and ZIP+4®in.this box* Postal Service —�t Engineering works, Inc. 112 West Crossfield Road Forestdale, MA 02644 � \ Iil►'lili'itlhI'itlili'fI llllrl.ill)filil1ji jlilldllI!Illgill! SENDER: CO.AAPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Cot�dpf�te ie :1,2;and 3. A. I ature ■ Pr• me;and address on the reverseµ' '► t13 Agent sti t�iafr udcari feturn the card to you. &3 # Addressee ■ Atiiach this card to the back of the mailpiece, B. Received by(Printed ame C t of elive or on the front if space permits. ArtirIA Addressed-to:— D. Is delivery addres,ss different from item 1? �1 s Prop ID:078063 If YES,enter dlivery dress mow: Y N LIBERTY HALL CLUB OF �C P MARSTONS MILLS,INC N 2150 MAIN ST MARSTONS MILLS,MA 02648� } CZ? C� II I II�III IIII III I II IIIII I II I I I II I III ii I II III 3. Service Type ❑Pri � Tess® ❑Adult Signature ❑Regj� ailT^+ ❑Adult Signature Restricte 0.livery ❑ Tst Mail Restricted 9590 9402 1889 6104 1393 98 ❑Certified Mail Restricted Delivery Return Receipt for 4 ❑Collect on Delivery Merchandise 9 ArtinIR-Ni imhar--Lrransfar_frnm_cArvira_lahall 0 Collect on Delivery Restricted Delivery ❑Signature ConfirmationT sured Mail ❑Signature Confirmation 7 015 3 4 3.0. 0 0 01 1296 1007 'cured Mail Restricted Delivery Restricted Delivery .. . ——Mr$500) PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt USPyTRA KIG# t First-Class Mail Postage&Fees Pald LISPS Permlt No.G-10 l 9, 2 1889s6104 1393 67 United States •Sender:Please print your name,address,and ZIP+4®in this box• Postal Service -iEngineering works, Inc. 12 West Crossfield Road { Forestdale, MA 02644 l lt��Iji1�l'll-i1l11l1,IjjljIIIIJri111I'fill)lilIIIIIIIII1111111 (s SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DEUVERY ■ Complete items 1,2,and 3. A. Signatu ■ Print your name and address on the reverse X` Agent so that we can return the card to you. C3 Addressee ■ Attach this card to the back of the mailpiece, • Received-b fdnted Name) C. Date ff D live or on the front if space permits. ( ( [ 1. Article Addressed to: D. Is delivery address different from Item 7? 13 Ye, If YES,enter delivery address below: ❑No j Prop ID:078018002 GLOVER,ROBERT J TR tr PATTY'S POND REALTY TRUST PO BOX 703 MARSTONS MILLS,MA 02648 3. Service Type II 13Priority Map Express®I IIIIII IIII III I II I IIIII II i I I II I I II III I I I 13Adult Signature o Registered ❑Adult Signature Restricted Delivery O Registered'Mall Restricted �Certified MaM Delivery 9590 9402 1889 6104 1393 67 13 Certified Mail Restricted Delivery q R erorhnandielf for ❑Collect on Delivery �2-Artinlw,Ah mher"f rancfnrfrnm_a mlca_raha0 O Qollect on Delivery Restricted Delivery O Signature Confirmation 7 015 3 4 3 Q 1 12 9 6 1.0 21 red Mau Rgnature Confirmation fired MaiLRestricted Delivery • Restricted Delivery a _ _ —1—jr$500) PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt Cor monwi to of Massachusetts a a Executive Office of Energy & Environmental Affairs �t Department of Environmental Protection One Winter Street Boston, MA 02108*617--292-6600 Charles D. Baker Matthew A. Beaton Governor , Secretary Karyn E. Polito Martin Suuberg Lieutenant Governor Commissioner CERTIFICATION FOR GENERAL USE Pursuant to Title 5, 310 CMR 15.000 Name and Address of Applicant: Orenco Systems, Inc 814 Airway Ave. Sutherlin, OR 97479 Trade name of technology and model number: ProStepTM Effluent Pumping Systems—PSA-X and PSB-X Biotube® Pump Vault—PVU-X and PV-X (hereinafter the "System" ). Schematic drawings of the System,.operating manual and inspection checklist are available from the manufacturer. Transmittal Number: X227956 Date of Issuance: September 29, 2009, revised March 20, 2015 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000, the Department of Environmental Protection hereby issues this Certification to: Orenco Systems, Inc 814 Airway Ave. Sutherlin, OR 97479 (hereinafter "the Company"), for General Use in the Commonwealth of Massachusetts of the System described herein. Sale and use of the System are conditioned on and subject to compliance by the Company and the System owner with the terms and conditions set forth below. Any noncompliance with the terms or conditions of this Certification constitutes a violation of 310 CMR 15.000. March 20, 2015 David Ferris, Director Date Wastewater Management Program Bureau of Water Resources This information is available in alternate format.Call Michelle Waters-Ekanem,Diversity Director,at 617-292-5751.TTY#MassRelay Service 1-800-439-2370 MassDEP Website:www.mass.gov/dep Printed on Recycled Paper • Certification for General Use Page 2 of 4 Effluent Pumping System-ORENCO I. Purpose 1. The purpose of this Certification is to allow the use of the System in Massachusetts on a General Use basis. 2. With the necessary permits and approvals required by 310 CMR 15.000, this Certification authorizes the use of the System in Massachusetts. 3. The System may be installed on all facilities where a system in compliance with 310 CMR 15.000 exists on site or could be built and for which a site evaluation in compliance with 310 CMR 15.000 has been approved by the local approving authority; or by DEP if DEP approval is required by 310 CMR 15.000. a II. Design Standards m consists of a filter cartridges mounted in a um vault that is laced in 1. The System g pump p the outlet end of the septic tank. The pumping vault is designed for use with 4 inches turbine effluent pump. The filter cartridges are constructed of an array of filter tubes. The pump vault, which is suspended from the tank access opening, functions as a separate pumping compartment within the tank, equipped with its own filter. 2. The System shall be installed in a second compartment septic tank or the last tank in two tank series. When the system is installed in the two-compartment septic tank, the tank shall be constructed with flow-through posts in the baffle separating the two compartments, to maintain an equal liquid level throughout the tank. Any tank in which the System is installed shall be cast or manufactured with opening large enough to permit the installation of the System with out modifying the tank. 3. The septic tank, in which the System is to be installed, shall comply with retention time and any applicable requirements in 310 CMR 15.223; 15, 224; 15.225, and 15.227. 4. The septic tank, in which the System is to be installed, shall have a minimum one day of flow emergency storage, which can be assessed from the high-level alarm to inlet invert as required by 310 CMR 15.231(2). i III. General Conditions 1. The provisions of 310 CMR 15.000 are applicable to the use of the System, except those that specifically have been varied by the terms of this Certification. 2. The facility served by the System, and the System itself, shall be open to inspection and sampling (if any) by the Department and the local approving authority at all reasonable times. 3. In accordance with applicable law, the Department and the local approving authority may require the System owner to cease use of the System and/or to take f Certification for General Use Page 3 of 4 Effluent Pumping System-ORENCO any other action as it deems necessary to protect public health, safety, welfare or the environment. 4. Design, installation and use of the System shall be in strict conformance with the Company's DEP approved plans and specifications and 310 CMR 15.000, subject to this Certification. IV. Conditions Applicable to the System Owner 1. The System is approved for use in the treatment and disposal of sanitary sewage only. Any wastes that are non-sanitary sewage, generated or used at the facility served by the System, shall not be introduced into the on-site sewage disposal system and shall be lawfully disposed of. 2. Prior to installation the system in an existing septic system, the system owner shall obtain approval from the local approving authority for the proposed modification of the system. If the system is a failed, failing, or nonconforming system, the system shall be upgraded in accordance with 310 CMR 15.404. 3. The System owner shall at all times properly operate and maintain the System and the onsite sewage disposal system in which the System is installed. 4. The system owner shall have a septage hauler, licensed by the local board of health in accordance with G.L.c. III s. 3 1 A and 310 CMR 15.502, service the filter regularly, at least once every year and inspect pumps, alarm and other equipment in accordance with 310 CMR 15.254(2). The system owner shall report in writing to the local Board of Health within 30 days of the date of servicing every time the pump is serviced. 5. The System owner shall furnish, the Department any information that the Department requests regarding the operation and performance of the System, within 21 days of the date of receipt of that request. V. Conditions Applicable to the Company 1. The Company shall notify the Department's Director of Wastewater Management Program at least 30 days in advance of any proposed transfer of ownership of the technology for which this Certification is issued. Said notification shall include the name and address of the proposed new owner and a written agreement between the existing and proposed new owner containing a specific date for transfer of ownership, responsibility, coverage and liability between them. All provisions of this Certification applicable to the Company shall be applicable to successors and assigns of the Company, unless the Department determines otherwise. 2. The Company shall furnish the Department any information that the Department requests regarding the System, within 21 days of the date of receipt of that request. ifi tion for General Use Pa 0 Certification e 4 of 4 g Effluent Pumping System-ORENCO 3. Prior to any sale of the System, the Company shall provide the purchaser with a copy of this Certification. In any contract for distribution or sale of the System, the Company shall require the distributor or seller to provide the purchaser of the System, prior to any sale of the System, with a copy of this Certification. 5. The Company shall prepare an installation, and operation and maintenance manual specifically detailing procedures for histallation and operation of the System. The Company or its agent shall provide the purchaser a copy of this document. VI. Reporting 1. All submittals of notices and documents to the Department required by this Certification shall be submitted to: Director Wastewater Management Program Department of Environmental Protection One Winter Street— 5th floor Boston, Massachusetts 02108 VII. Rights of the Department 1. The Department may suspend, modify or revoke this Certification for cause, including, but not limited to, non-compliance with the terms of this Certification, non-payment of an annual compliance assurance fee, for obtaining the Certification by misrepresentation or failure to disclose fully all relevant facts or any change in or discovery of conditions that would constitute grounds for discontinuance of the Certification, or as necessary for the protection of public health, safety, welfare or the environment, and as authorized by applicable law. The Department reserves its rights to take any enforcement action authorized by law with respect to this Certification, the System, the owner, or operator of the System and the Company. i -7L tt4ts rv-4��4 �y yxf ?3 s 3e4 oF� To wn of Barnstaaaaaaaaate p# Department of Regulatory Services h . az,BM Public Health Division Date �A tbff �e� 200 Main Street,Hyannis MA 02601 Date Scheduled � 2-c7 l� •. t Time Fee Pd, Soil Suitability Assessment for Se �e D poval Performed By: 1 Q�✓/g`SC5�-7 Witnessed By: ✓, n �f LOCATION& GENERAL INFORMATION 1 Location Address 13 Owner's Name 1 'W,S xloxia1 Address jo c� au ✓F_ �f' ®� Engineer's $f-- H y�yt Yt c Assessor's Map/Parcel: Name NEW CONSTRUCTION a REPAIR'-' Telephone# 5v e 7 7— 3.1 Land Use M U J S-cv Slo es % Z.' �� A)0 P ( ) -A ` Surface Stones-_ _ Distances from: Open Water Body 7 Uv ft Possible Wet Area ry/� ft Drinking Water Well f I J Uft Drainage Way f ft Property Line ft Other I ft i SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands t'n proximity to holes) I I 1 C .- yA • 121 - --� �I Z_ i AaV Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: /"a CAI-' Weeping from Pit Ptiee Estimated Seasonal High Groundwater _��' DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in, Depth to soil mottles: Depth to weeping from side of obs.bole: in, Groundwater Adjustment ,.I�f:. Index Well# Reading Date:_ _ Index Weil level Adj,factor— Adj.Groundwater Leval— PERCOLATION TEST Wte. ,.R Thne.. _ Observation Tp Z Hole# _ Time at 9" Depth of Perc d� �4j Time at 6" Start Pre-soak Time @ _ L. t 5 to R Time(9"•6") _ End Pre-soak e Rate Min./Inch, Site Suitability Assessment: Site Passed ' Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back-------;-- ***If percolation test is to be conducted within 100' of wetland,you must first:notify the. Barnstable Conservation Division at least one (1) week prior to beginning. Q:\SEPTICIPERCFORM.DOC i i ]DEEP.OBSERVATION HOLE LOG Hole#_T Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surfac�(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. _ Consistency,%Gravel) jq �� i3z c Nl s f z�s`t G c0``; '.DEEP OBSERVATION HOLE LOG Hole#—_ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA), (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) L S �o—( a Y/2 • IDEEP OBSERVATION HOLE LOG Hole# Depth-from Soil Horizon Soil Texture 5. Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) L-7 :DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency, Qmy�l)— Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 560 year boundary No--/S, Yes Within'100 year flood boundary No,!- Yes Dept of Naturall ecurrine Pervious Material Doesat least four fret of naturally occurring pervious material exist in all areas observed throughout the area O roposed fir the soil absorption system? � - If not,what is the depth of naturally occurring pervious material? Certification I cert—ify�that on _ r'�k-1(date)I have passed the soil evaluator examination approved by the Department of I3nvironmental Protection and that the above analysis was performed by me consistent with . the r uired training,expertise and experience descried in.310 CMR 15.017. Signature 1 � Date�� t (� i I QASBPTICIPERCF?ORM.DOC `�Town of Barnstable Geographic Information System November 3, 2016 078017 079017001 078069003 #72 `.078018003 ,=:. #30 078118 #66 078018 =' :"!�#:181 078069002 #105 #40 #214 078017004078018002';J #64P e► :::::#171:::`:{:::;:; is 078073 #b06 #1776 078017003 078089008 #70 #39 V 078005 0 78 0 018001 AA #71 #6 OA Y 7 0 8004 J #65 078006 �#12 078065 O 8 #2 120 'p 0 + 078003 O a o76o6a #55 _ #2134 078119 A #14 •��''078020 #139 •'#137 B 078063 A, '�•#2160 '•'• 078058 #2117 25 0.._ 078059 078081 #2135 2145 O 0780 07001 07102078060 078)(07002 1,.: 2161 #1 078076 *b' 0780611 O 078001 #2173 #_93 Q A. 077028 y #2096 077008 077009 #91 #2186 077015 56 Feet 077010 Q7 0 7014#99 #89 077016 #90 #.79 DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:078 Parcel:020 Board of Health Selected Parcel boundary determination or regulatory interpretation. Enlargements beyond a scale of Abutter List Type-Direct abutters(no set distance)and the properties located 1°=100'may not meet established map accuracy standards. The parcel lines on this map are only graphic representations of Assessor's tax parcels. They are not true property across the street. Abutters boundaries and do not represent accurate relationships to physical features on the map r 1 such as building locations. Buffer ��/ 11/3/2016 AbutterReport Board of Health Abutter List for Map & Parcel(s): '078020','078019' Direct abutters (no set distance) and the properties located across the street. Total Count: 8 I'�d'J Close Map&Parcel Owneri Owner2 Addressi Address 2 Mailing CityStateZip Country Deed LEVESQUE, %O'TOOLE,JASON 4309 FALMOUTH COTUIT,MA 078002 DANIEL P A ROAD 02635 22587/125 GLOVER,ROBERT J PATTY'S POND MARSTONS 078018002 TR REALTY TRUST PO BOX 703 MILLS,MA 12788/17 02648 MAHAIRAS,NICK I VERNON REALTY MARSTONS 078019 &ROBIN H TRS TRUST PO BOX 132 MILLS,MA 12824/158 02648 MAHAIRAS,NICK I VERNON REALTY C/O MARK H 396 NORTH HYANNIS,MA 078020 &ROBIN H TRS TRUST BOUDREAU STREET 02601 28579/216 LARSON,CAROLYN MARSTONS 078021 S 160 FLUME AVE MILLS,MA 22256/270 02648 MARSTONS MILLS MARSTONS 078062 PBLIC LIBRY MAIN STREET MILLS,MA 1461/327 02648 LIBERTY HALL MARSTONS MILLS, MARSTONS 078063 CLUB OF INC 2150 MAIN ST MILLS,MA 9094/280 02648 CONDINHO, %BARNSTABLE, C/O TOWN 367 MAIN HYANNIS,MA 078074 CRAIG H TR TOWN OF MANAGER STREET 02601 10578/106 his list by itself does NOT constitute a certified list of abutters and is provided only asan aid to the determination of abutters. If a certified list of abutters is required,contact the Assessing Division to have this list certified. The ownerand addressdata on thislist isfrom the Town of Barnstable Assessor's database as of 11/3/2016 . http://maps.tovmofbarnstable.us/arcims/appgeoapptAbutterReport.aspX.?N:)e=BOH 1/1 V Engineering Works, Inc. 12 West Crossfield Road, Forestdale, MA 02644 TeVFax(508)477-5313 November 3, 2016 Re: 135 Route 149 (a/k/a 149 Route 149), Marstons Mills Assessor Map 78, Parcels 19 and 20 Septic System Upgrade Dear Sir/Mam: Please be advised that-an application for variances from the Massachusetts Department of Environmental Protection, Title 5, and Local Regulations have been submitted to the Barnstable Health Department for approval. The following variances are being requested: • 310 CMR 15.224—TANKS IN SERIES 1. A variance to the 48 hour detention volume required for the first tank in series to allow the existing 3000 gallon tank to remain which has a 38 hour detention volume as calculated for the approved design flow. • 310 CMR 15.405(a)&(b)—CONTENTS OF LOCAL UPGRADE APPROVAL 2. Local upgrade approval is being requested for the proposed S.A.S to be located 10 ft.from the existing trench of System #3. 3. A 3' variance to the maximum cover requirement of-3'.to allow up to 6.of cover over the S.A.S. The S.A.S. shall be H-20 and vented, The application and plans are available for review at the Barnstable Health,Department, 200 Main Street, Hyannis, MA, Monday through Friday(excluding holidays)from 8:30 a-m. to 4:30-p.m. A public hearing will be held, to discuss the proposed work, on Tuesday, Novemebr 22, 2016,.at 3:00 p.m. The hearing will be held at the following location: Town Hall Hearing Room Second floor 367 Main Street Hyannis,.MA ,rSi erely Peter T. McEntee P.E. FROM PZTEC BUILDING SER S PFUNE NO. 506 730 24- Oct. 63 201.6 12:02PM P1 Engineering Works, tic. 12 West Gressf eld Rcad.Forestdale, MA 02644 TeWax(503)477-5313 October 1, 2016 Barnutable Board of Health 200 Main Street Hyannis, MA 02601 Fie; s 49 Route 149 (Parcel ID.- 07 B=020)a/Wa 135 Route.f 49, MA, TWe 5 Septic System Upgrade Representrailon Authooizatidn Dear Board members: I hereby authorize Peter McEntee PE to represent my interests for the subject pr ject. 1 / yAc MaNvIras WN OFBARNSTABLE LOC KI7L. /35� /� �� _ SEWAGE # a 000-140� A AA 1 VILLAGE IM-c•fl--Jr ASSESSOR'S MAP& LOT " INSTALLER'S NAME&PHONENO. s)A � � +rk SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Gvfs f (size) NO.OF BEDROOMS BUILDER OR OWNER OMPLIANCE DATE: PERMITDATE: C, Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) a Feet Edge of Wetland and Leaching Facility(If any.wetlands exist, within 300 feet of leaching facility) Feet Furnished by e f �3 �G j,3 TOWN OF BARNSTABLE LOCATION f 3S� ate fY� SEWAGE # 0- v1LLAGE h?.a,,)to,S 14-'115 ASSESSOR'S MAP & LOT ISTALLER'S NAME&PHONE NO. J /��i �/'O "57- q SEPTIC TANK CAPACITY /OOOy ! 7- m7S00� ST LEACHING FACILITY: (type) - Tre- �� (size) /0o L 9l 5+JV y.o2,.0 "NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Waller Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by f ipo op 6 7-- fx;s>a-It� 13 11 a0a 2k 33 3y s ��TCiWI�O B S LE 7f—.0/9 1 'LOCATION 0 1\ t" e 14 J lS SEWAGE 5 — 16 'id VILLAGEMar,40M S M4 , ASSESSOR'S MAP & L0 INSTALLER'S NAME&PHONE NO. C2 I ►v > , k S q 7 7 —03 SEPTIC TANK CAPACITY I0100 Gca6,s Geq4siJra,p. t A600qq&AJ S LEACHING FACILITY: (type) 1- eac� , (size) 130t NO.OF BEDROOMS ofJX qQ�� t00 % A �L, :S+0N'1'- 0'e) BUILDER OR OWNER'b 0 o coA , V&0...L E0.xA e,r t,1° PERMITDATE: - 9 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility c20 No Feet Private Water Supply.Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 fee of leaching facili ) p � N 14• Feet Furnished by �w � Ol...,.JC.� 060 mellow• v� , T o-f1,q (o z � a i Lt 9 1 G,5 STABLE LOCATION TW �roy SEWAGE # 9�- l0-,/ �� VILLAG ASSESSOR'S MAP &LOT 14-1- 2D INSTALLER'S NAME&PHONE NO. `/77-03 5'9 Jo.5,, D-c l��sr/o 3 SEPTIC TANK CAPACITY 1500 / �h�9 LEACHING FACILITY: (type) 4570 0 6101 1,2'14d �"n (size) 12 X G 0 NO.OF BEDROOMS � , BUILDER OR OWNER Aq0 e4-e,-4 PERMTTDATE: �� , COMPLIANCE DATE: :-7 r 11 L — Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachingfacility) Feet Furnished by � � r ,3'rat�oa 4% .Jj. G sf- • G s Pa�PJ 0 s I Y1 TOWN OF BBAR INSTABLE LOCATION , �q� 'M �`5 `\PS`� SEWAGE # VILLAGE ASSESSOR'S MAP & LOTSK.8Y P- oZ 9 INSTALLER'S NAME & PHONE NO.Ca r(to r� h�C N� r`l CSC S SEPTIC TANK CAPACITY 3 0 0 0 q, A LEACHING FACILITYAtype) 4' 4 Ga\\r- �S . (size) 13 " Ga NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNERpr.,a\� "DATE PERMIT ISSUED: O DATE COLIPLIANCE ISSUED: Q VARIANCE GRANTED: Yes No GP�agP St�.�' v�or. \�M�lt'r (�.5�'• '�I oba-I S --oTo. , TOWN OF BARNSTABLE LOCATION SEWAGE # g c d —73 q VILLAGE IM t� ASSESSOR'S MAP & LOT8-8'Y 99 INSTALLER'S NAME & PHONE SEPTIC TANK CAPACITY /00-0 Ga! g LEACHING FACILITY:(type) /-a(size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER @R5 '�k)6t,-30'-k em h' rvi g O • • DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No cn CA S� LI� l � - LOCATION SEWAGE PERMIT NO. /1 '/� �� VILLAGE INSTALLER'S NAME A ADDRESS I< 04, R U IL D E R OR OWNER DATE PERMIT ISSUED c� OAT E COMPLIANCE ISSUED 3/ � l ji7C30 [�S s 9 VT LOCATION : 5EWaC-jE PERMIT UO. VILLAGE IMSTiNI`LER'S I &I AE ADDRESS r 4, t � - - 5UILDER 5 Q oMF- ADDRESS Di!i"TE PERNAIT ISSUED z 1 D ATE COMPLI &MCE ISSUED ; �" T + _ �// � `�. I I R � �� a moo.--•-- FRE .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD PF HEALTH ......----OF.....6.a4,1V. ...'...-....... - Appliration -for Bi,ipuiitt1 Workii Tonstrurti n Vrrnfit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: J ----- •-----•--•--------------------------------------•-------••-------•---•-•---..._..._......- �� G Location-Address or Lot No. ante Owner 7 Address -----�----- -•--------LC/--:----- -�'1 .............. ---•-------•-•--•---•---••--•---•---------------........_..._._._.._.............................. Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelli —No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) aOther Type of`Building �__<..................... No. of persons---------------------------- Showers ( ) — Cafeteria ( ) PL4 Other fixtures W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter---------------- Depth.--.-_-___-_. xDisposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area------------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------- ----------------------------------------------••-•-------•------- Date------------------------------ -------.. a Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water..._-_-_.---__-_--_---.- (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...........------------- ------------------------------------------- .................................................................................................................. 0 Description of Soil_ -------- ----------------------- y � V -� �� W __ X------------------------------------------------------------------------------------------------------------------------ --------------------_- ---------- -------- ----- ----- U Nature of Pepairs or Alterations—Answer en app ' le_ ______--'J 4 . a-- --------- ----'-t�'____^P�_. ___.______-... (� Agreement: , The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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. ' I Date_ Application Approved By---- 4247 U4,.Aae.-... ------------------- Date Application Disapproved for the following reasons:................................................................................................................ •--•-•-••-•••••-•--•••-•-•-•_...••---•••-•••••----•-----------•-----•-------------•--------------•-------......•••--- -----•----••-••--••-•----•---•-----.............................................. Date PermitNo......................................................... Issued........................................................ �---- Date ------------------------------- ------------------------------- IVo........0...... FEs..,t .................... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH »,fie ... OF..... .. Applirtt#ion for Difi uml Works C onfi#rur#ion Puna # Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ----- --• ----- ---------------------------- -------------------•----------------------------------------. oc n-Address or Lot No. 1l.' ........................ ........................ .....------------........................... Owner)E� Address a + --•--------•-••-•---=---------------•------•---------...---.------------•------------------------- Installer Address Q Type of Building Size Lot............................Sq. feet U Dwellin —No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther Type of Building :!h._..................... No. of persons.__,------------------------ Showers ( ) — Cafeteria ( ) Q, Other fixtures - ----- -- - - d 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----•---------------------------------- W Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water..____________--_____ G% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...................... P4 ------- -------------- --------••-------------------------•----•-•••••-•-----•------•---•--------.................................. ......... D Description of Soil-t ---------------------------------------------------------------------- x w 1� U Nature of Repairs or Alterations—Answer en apple .. .... ........ ............................... 4 _ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI•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 e'pith. • - 'mow.+ �S L;i ed- ----- --------- ---••-- .�' .. r Date Application Approved By--- �' f ' .. _" .... Date Application Disapproved for the following reasons:----------------------_______________________________ ------------------------------------•-••----••---•------•-•-•-----•--•------------------------------••---•-----------••----•----•••--•-.•--- . ------------------------------------------------------ Date PermitNo........................................................ Issued = Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH ... 40i.............OF........ .... .. !+!j!l ' ............................................ rr#ifira#r of TlaixtPHaurr THIS IS T R' s T the Indivi ewage_.Disposa ystem cons ucted ( ) or Repaired ( ) by...:...... - - ----- � �� -------------------staner .... _ 11 Oe ---•-----•------- r has.been installed in accord, ce with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._. _ ................. dated./'.. ._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS.A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ` DATE------ . ..................................................... Inspector.----- ------- - THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALT .-�, - _ No... --............ FEE..... ..•----- �i� �rtti if ^� Permission is ereby grante • r -- - ---- ------ •e_* - //''11�� ` to Construc r Repair an Indivtd'ual ewa `'spo.al em r. e - ... Str t S as shown-on-the-application for Disposal Works Construction P m• No. __.. . _ Dated..' �� .. .. ,.� Board of Health y DATE... - ....................................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS January 16, 1975 Rea Variance for Roland' s Photo Shop Air. Wilbur Cushing Prince Avenue Marstons l�iills,` Nass. f Dear Mr. Cushing: Your request for a variance from Regulation 2.120 of Article XI Minimum Requirements for the Disposal of Sewage in Unsewered Areas, to install a separate 6 root by 5 font gravel packed leaching pit to handle 10 to 15 gallons of. . darkroom waste fluids, is granted. The proposed system rust be constructed in strict conformance with the specifications outlined in your request.. i C You are reminded that this variance is not valid after !_ January 16, 19?16o Yours very truly, Robert L. ChildS, Chairman Ann Jane Eshbaagh Gerald W. Hazards M. De LO r�gb OF HEALTH :�tlii .S srU Lc SN r IV Prince Avenue . 11'arstons Mills, Mass., 02648 .T:-inuary 4, 1975 Town of Barnstable Board of Health Main Street fiyannis, Mass., 02601 Gentlemen: This letter is a request for a variance on pro-perty I own on Route 14c, Marstons Mills, known as Roland's Photo Shop, to install a 6 x 6. gravel packed cesspool to take care of a new sink to be installed for his darkroom. Some of the chemicalsL-_he uses are not suitable for rry septic system. The amount of water used per day probably does not exceed 10 to 15 gallons. The new. 6 x 6 cesspool will go out back of the building. All of the existing systems are now in front. The new 6 x 6 will be 20' from the building and a good 40' from the property line. Yours truly, P.S. Paul Murray is familiar with the property, I believe. Town of Barnstable Barnstable Board of Health All-ftatcsNy aARrrWABLE, y MASS g 200 Main Street, Hyannis MA 02601 �p ibgq. �0 rF0 iMtA'�a 2007 Office: 508-862-4644 Paul J.Canniff,D.M.D. FAX: 508-790-6304 Junichi Sawayanagi Donald A.Guadagnoli,M.D. BOARD OF HEALTH MEETING MINUTES Tuesday, November 22, 2016 at 3:00 PM Town Hall, Hearing Room 367 Main Street, 2nd Floor, Hyannis, MA I. Hearing — Rental Sheila Perry, tenant at 170 Winter Street, Hyannis, requested a hearing. No one was present. Mr. McKean asked the Board to vote to withdraw this item from the agenda as repairs are being done. Upon a motion duly made and seconded, the Board voted to withdraw this item. (Unanimously, vote in favor.) II. Variance — Septic: A. Peter McEntee, Engineering Works, representing Nick and Robin Mahairas, owners of The Mills Restaurant— 135 and 159 (aka 149) Route 149, Marstons Mills, Map/Parcel 078-019 and 078-020, 65,158 square foot parcel, failed septic, requesting three variances. Pete McEntee presented the plans and clarified that there are three systems at this location. System#1 is a 3,000 gallon tank and handles the restaurant kitchen's flow (broken out at 15gal/seat/day). The System#2 has the customers' bathrooms attached to it at a flow rate of 20gal/seat/day. Together, these flows match the Title V calculations of 35gal/seat/day for a restaurant. Mr. McEntee stated the water usage shows they are far below that. The System#3 handles the gas station and apartments upstairs and is fine. Mr. McEntee stated he would like to keep the tank in the ground for possible overflow and avoid putting another tank and a pump chamber under the drive as there is already a lot of items under the drive. Upon a motion duly made by Dr. Guadagnoli, seconded by Mr. Sawayanagi, the Board voted to approve the three variances for the establishment with no more than 50 seats. (Unanimously, voted in favor.) Page 1 of 4 BOH 11/22/2016 �a Barnstable Town of Barnstable edca0ly Y $A . Board of Health 'c3 i6g9. 1� A'F�► '�°' 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Paul J.Canniff,D.M.D. FAX: 508-790-6304 Donald A.Guadagnoli,M.D Junichi Sawayanagi November 29, 2016 Mr. Peter McEntee, P.E. 12 West Crossfield Road Forestdale, MA 02644 RE: The Mills Resfau"rant,_135 and '159 Route.14.9;.Marstons Mills =. A 0.78 019`and Q787020 Dear Mr. McEntee, You are granted variances, on behalf of your clients, Nick and Robin Mahairas, to construct an onsite sewage disposal system at 135 and 159 Route 149, Marstons Mills. The variances granted are as follows: 310 CMR 15.405: To install a soil absorption system only ten feet away from an existing leaching facility (which is connected to Septic System #2). 310 CMR 15.405: To provide up to six feet of soil cover over the top of the soil absorption system, in lieu of the three feet maximum cover allowed. The variances are granted with the following conditions: (1) No more than forty-eight (48) seats are authorized according to the current food establishment permit. (2) The Orenco pumping system shall be installed and operated in accordance with the MA Department of Environmental Protection (DEP) 'Certification for General Use' requirements dated March 20, 2015. (3) The septic system shall be installed in strict accordance with the engineered plans dated November 2, 2016. (4) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the submitted plans dated November 2, 2016. Q;WP/The NUN McEntee 2016.docx r, This variance is granted because physical constraints at the site severely restrict the location of a soil absorption system due to the multiple buildings, three septic systems and slope of the lot. The proposed system appears to be designed to meet the maximum feasible compliance standards contained within the State Environmental Code, Title V. Sincerely yours, Paul J. Canniff, D.M.D. Chairman Q;WPfrhe MIIIs McEntee 2016.docx , 00 GENERAL NOTES: co ft N Z N 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL <S .�� o BOARD OF HEALTH AND THE DESIGN ENGINEER. CN 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF � J M THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BY VARIANCE. L!J J vi 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 0 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE , Q 4 DESIGN ENGINEER. ��F< of (n c 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING i v, 4 S 0 Z 0 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN f'iL e 41 CL ENGINEER BEFORE CONSTRUCTION CONTINUES. F� y 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. o ~ 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF I > THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF MA/N ST � 0 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. LOCUS N v 8. THERE ARE NO PRIVATE WELLS WITHIN 150' OF THE PROPOSED S.A.S. LOCUS MAP 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS NOT TO SCALE 'd' r•) AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. U CV 10, IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE F— Lv v THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING a- CONSTRUCTION. _ Ld o 1 1. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS N-46'13'59 t' E (n O s IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND .� - - - - - - - - - - - - - - - REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE 312.1 7' 0 � Z INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. /,� �pc (n 13. ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC SYSTEM p� �' I O 0 a COMPONENTS NOT SHOWN ON THE PLAN. i i Q o v ASSESSOR MAP 78 M PARCELS 019 & 020 65,158f SF '0 d r� o z w 1 C6 W O 00 f- 2� 00, EXIS ING MULTIPLE USE BUILDING 00 a -_- _-=------- m _ =--_ _____ __ 0 0 II \ Z 0 01 SYSTEM #3 CAS PUMP == ----_------------ 0 rn (TO REMAIN) SYSTEM #1 r--- - - TO BE UPGRADED , to . ( - ) PARKING LOT --`---- 0 � � _____- , CONCRETE ----_ N o o it ---- -------, ; SYSTEM #2 0 Cry r 1 _____-- `---------- _ i i (TO REMAIN) I < ----"---- g4, 243.83' I 110• , L---J 49.50' � CU 45„ W S 32 3 S 44'00'10" W S 44'00'10" W S 37-17'23" W ~ OF MqS �— s9�yG VARIANCE REQUESTS LROUTE - 149 - - - - - - - - - SEE SHEET 2 J 0 o PETER E -310 CMR 15.224: TANKS IN SERIES 20 SCALE W Mc TEE 1. A variance to the 48 hour detention volume required to allow a 38 v CIVIL hour detention volume provided in the existing 3000 gallon tank. T. No. 35109 OWNER OF RECORD L. m r� �p -310 CMR 15.405(1)(a)&(b): CONTENTS OF LOCAL UPGRADE APPROVAL MAHAIRAS NICK I & ROBIN H TRS 0, W ° j� £G1S1E� 2. Local upgrade approval is being requested for the proposed S.A.S. VERNON REALTY TRUST c v Oar P9 PP 9 q P P SI N� to be located 10' from the existing trench of System #3. C/O MARK H BOUDREAU (U •� 396 NORTH STREET ^ 3. A 3' variance to the maximum cover requirement of 3',ito allow up 0, 00 i 1Z' to 6' of cover over the S.A.S. The S.A.S. shall be H-20 and vented. HYANNIS, MA 02601 w LU N 0 .� LEGEND z00 _ —�— x 99.98 EXISTING SPOT GRADED- N 46'13'S9" N EXISTING CONTOUR _ E 0 ---p H.W. OVERHEAD WIRES _ 312.17' � _ C- J � U UNDERGROUND WIRES '1-4g 1_ W J G EXISTING GAS SERVICE 52,50 0 yy EXISTING WATER SERVICEcn TEST PIT '-_ i� (n v BENCHMARK 46-_ ` ASSESSOR MAP 78 z PARCELS 019 & 020 D 48.15 65,158±SF , - Ld a OF ygss -, �S U - x 50 31 x 50:75 i5� N o PETER T. PROP IC8 ---------_� - 4 m McENTEE /.: �.�- _ ` DB-9 Aft w CIVIL 43 _ — -- (� .' �� ------- No. 35109 4-P- -' _ 1 X 0 O %2._.•,. �� -L 5 x 47,16 ( -• W- vi p /SZERE <c �► ;r O O �► 2.5, -4 6- Q :�'_••• `_ 5,00 - ----- (1J ~ o x ��_ ►.,• s Or " - _�•�.. "'�.� 4 x 44.88 0 36.56 - ` �_ � ,. pR _ O O SHED 36,61 �SED S q s p .. _ ��` 05 - - N z 37,3 } O ;�� _ _ 36:5 N ` P- 2�' �'�y--12' PROPOSED 0 `o x `... i. ,` .,:s. VENT Y w CONC. CL WA 37.29' _ �.; ;' '"�Q v 36,5 LK Q: I po v G .. _ In :::,;:.`:; �'�`� $may- :..:. 4 � EX/STING MUTI-USE BUILDING :,,,:..�,. . : .. ;. .. . .. ...:...... . _ M v, _1 d OFFICE RETAIL & RESTAURANT lst FLOOR �' —,. w o APARTMENTS 2n d FLOOR/ o...:.':.:, 3 g' cfl o r� o , - m z I T -4 7 O.F. 5. 5 ,.. 0 DECK Ed w (above) - ---- -- --- o N - - - - 6. 04 c:. O 05 EXISTING z � Y : 3 ,.. ... : . ... . .:. .: ,. .. . .,... VENT O �. s M `PARKING LOT, � a o- O.: ..3' o U : 36, i ca - _ 1 36:43 - - - 0 36.56 ' - O - , , , M H -- 36,58 - II N 3 ,7 \6 0 I N - A - C.. M 0 0 C E k , ��TBM PK SET'" v _ Q U Q D I .. `SYSTEM 2: , N O r SMH I. I.. 0 TO REMAIN t ' 04 6. I. x � >I C T AS/IN' � ,08 :36 A, L ti 6 AT, AS!N x. .0 I EEF CATCH A N � - B SI I. , .. 5,5 �: v , , , 66 �. 35 1 4, : , 3 4 J : 3.8 .. U G� 3 6a4:8'' S- 4'00 V W �Er 36,00 edge p em t 36.65 ,66 36 6 59. 50 —,23„ UP S : e of en ;• 4 �o EXISTING SEPTIC TANK CATC BASIN _ 37'17 a: (TO REMAIN) 35.90 36 36.20 36.42 36.56 a)v_ INV.(IN) =32.65.E C INV.(OUT)=32.40E ROUTE 149 °' �' BENCHMARK PROPOSED SEPTIC TANK MAGNETIC NAIL EXISTING S.A.S. TO BE ABANDONED OR USED EL.=36.44 7 /PUMP CHAMBER � p�� 3500 GALLON CAPACITY AS OVERFLOW TO PUMP CHAMBER � w W 04 0 NOTE: TO PREVENT BREAKOUT, THE PROPOSED ' FINISH GRADE SHALL NOT BE < EL:36.5 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. PROPOSED PUMP CHAMBER PROPOSED D-BOX INSTALLD 20 RISERS, FRAMES & COVERS SOIL LOG INSTALL H-20 RISERS, FRAMES & COVERS INSTALL WATERTIGHT RISER & OVER ALL CHAMBERS AND SET TO FINISH OVER INLET AND OUTLET MANHOLES AND COVER SET TO 6" OF GRADE GRADE, TO SERVE AS INSPECTION PORTS. DATE: AUGUST 29, 2016 (REF.# 15,141) EXISTING SEPTIC TANK SET TO FINISH GRADE. SOIL EVALUATOR: PETER MCENTEE PE, CSE F.G. EL: 43.5t F.G. EL.=38.5 TO 43.1 t WITNESS: DAVID STANTON RS, CSE MANIFOLD AND VENT F.G. EL.=36.58t F.G. EL.=36.5t CHAMBERS Elev. TP- 1 Depth EleV. TP-2 Depth 41.0 0" 39.0 0" L - 90'(MAX) FILL FILL ® S=1% (MIN.) 39.0 24" 37.8 15" C 40 Pv 4"SCH40 PVC q q p aB LOAMY SAND LOAMY SAND 6 aaaBeaa 1OYR 4/2 10YR 4/2 O SL1� (MIN.) THROA`L BENDS aaaaaaa 38.7 8 37.5 8 2 " 1 " B B s 58" LIQUID LEVEL Al PROPOSED INV.=37.00 4' 4.8, 4 LOAMY OA 110YR 5/4 D L110YR 5/4 SAND 4'SCH40 PVC �10" 3 FLOATS D BOX EFFECTIVE WIDTH = 12.8 38.0 36" 36.5 30" ALARM ON SET 26" INV.=37.17 INV.=36.00 H-20 RATED C C PERC EFFLUENT INV.=32.40 • OVERRIDE SET @ 24" 5 G ON LEACHING CHAMBERS 30"/48' / FILTER INV.=32.60t SYSTEM ON/OFF @ 22" [ 7 U T SHOWN EXISTING INLET HOLE HT. 0 19" - VAULT BASIN RECOMMENDED (VERIFY) 2" LAYER OF 1 8" TO 1/2" EXISTING 3000 GALLON (H-20) SEPTIC TANK DOUBLE WASHED STONE (OR APPROVED FILTER FABRIC) MED. SAND MED. SAND PROPOSED 3500 GALLON (H-20) SEPTIC TANK TOP CONC. ELEV.=37.10 2.5Y 6/6 2.5Y 6/6 NOTES: WIGGIN PRECAST CORP 35STKH2O BREAKOUT ELEV.=36.50 BaBa =36.00 ELEV. ease 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE PROPOSED DUPLEX PUMP SYSTEM INV. aaaBa eases ®aaB eases 30.0 132" 28.5 1 1126" INVERTS, PRIOR TO INSTALLATION. 1) ORENCO BIO TUBE PROPAK PVU84, S1, BOTTOM ELEV.=34.00 2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND FLOATS, & DISCHARGE ASSEMBLY 4' 4 X 8.5'=34.0' 4' PERC RATE <2 MIN/IN. ("C" HORIZON) TRUE TO GRADE ON A MECHANICALLY COMPACTED 2) ORENCO MVP-DAX PANEL, MVP-DAX1 DMHTSA 5' MIN. ABOVE BOTTOM OF EFFECTIVE LENGTH = 42.0' No GROUNDWATER OBSERVED SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN 3) TWO PF100511 1/2 HP 10 GPM EFF PUMPS T.P. EXCAVATION OR G.W. 10 CMR 15.221(2). 4) ORENCO B1806-CON VAULT BASIN LEACHING SYSTEM SECTION 3) INSTALL INLET & OUTLET TEES AS REQUIRED. SUPPLIED BY: CAPE COD WINWATER COMPANY NO G.W., EL.=28.5 - 3/4" TO 1-1/2" DOUBLE 4) AN EFFLUENT FILTER SHALL BE INSTALLED ON THE 174 AIRPORT RD, HYANNIS, MA 02601 WASHED STONE OUTLET TEE AND SERVICED QUARTERLY. (508)862-0166 SEPTIC SYSTEM PROFILE N.T.S. DESIGN CRITERIA (SYSTEM #1 ) BUOYANCY CALCULATIONS NOT REQUIRED. PUMP CHAMBER NOT IN GROUNDWATER. DAILY FLOW: 1903 GPD BUILDING AND WATER USAGE DESIGN FLOW: 1903 GPD DOSING & STORAGE REQUIREMENTS SOIL TEXTURAL CLASS: CLASS I DESIGN FLOW OF 1903 GPD DESIGN PERCOLATION RATE: <2 MIN./INCH BUILDING USAGE (310 CMR 15.203): - APPROVED ON FILE STORAGE PROVIDED PER FT. = 724 6 GALLONS GARBAGE GRINDER: NO RESTAURANT: (50 SEATS) - 50 SEATS x 20 GPD/SEAT = 1000 GPD INVERT(IN) = 61" (5.08') APARTMENTS 7 BEDROOMS x 110 GPD/BEDROOM = 770 GPD ALARM FLOAT = 26" (2.17') LEACHING AREA REQUIRED: (1903 GPD) = 2572 SF OFFICE: 1770 SF x 75 GPD/1000 SF = 133 GPD STORAGE PROVIDED= (5.08'-2.17')x724.6 GAL/FT.= 2108 GALLONS .74 GPD/SF TOTAL FLOW = 1903 GPD 1) PROPOSED DOSING SHALL BE AT TIME INTERVALS OF 1 HOUR WITH A EXISTING SEPTIC TANK: 3000 GALLON CAPACITY BUILDING USAGE (310 CMR 15.203): - CURRENT USAGE DOSING VOLUME OF NOT LESS THAN 20 GALLONS PER CYCLE. FLOW STORAGE PROVIDED: 38 HOUR USING DESIGN FLOW - VARIANCE RESTAURANT: (44 SEATS) - 44 SEATS x 20 GPD/SEAT = 880 GPD RATE SHALL BE SET AT 10 GPM PER CYCLE. 72 HOUR USING EST. ACTUAL FLOW-SEE COMMENT APARTMENTS 7 BEDROOMS x 110 GPD/BEDROOM = 770 GPD 2) OVERRIDE FLOAT SHALL BE SET NO HIGHER THAN 24". PROPOSED SEPTIC TANK & PUMP CHAMBER COMBINATION UNDER OFFICE: 387 SF x 75 GPD/1000 SF = 29 GPDRETAIL 586 SF 50 GPD/1000 SF = 29 GPD 3) THE HIGH WATER ALARM ACTIVATION FLOAT SHALL BE SET AT 26" TO : x GENERAL APPROVAL TRANSMITTAL NO. X227956: 3500 GALLON TANK PROVIDE 24 HOUR STORAGE TO THE INLET INVERT (ACTUAL=2108 GALLONS STORAGE PROVIDED: 26.6 HOUR USING DESIGN FLOW TOTAL FLOW = 1708 GPD OR 26.6 HOUR STORAGE). 50.7 HOUR USING EST. ACTUAL FLOW PROPOSED SOIL ' ABSORPTION SYSTEM UPGRADE PROPOSED D-BOX: 1 INLET, 9 OUTLETS (MINIMUM), H-20 RATED ACTUAL WATER USAGE FOR 149 ROUTE 149: USE 17-500 GALLON LEACHING CHAMBERS IN SERIES 2016 (1ST HALF) - 236,000 GALLONS - AVERAGE DAILY FLOW = 1293 GPD 1 35(a/k/a 149) ROUTE 149, MARSTONS MILLS MA SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 2015 (ANNUAL) - 484,000 GALLONS - AVERAGE DAILY FLOW = 1326 GPD 2014 (ANNUAL) - 369,000 GALLONS - AVERAGE DAILY FLOW = 1025 GPD Prepared for: Nick Mahairas, 213 Mistic Drive, Marstons Mills, MA 02648 SIDEWALL AREA: 2(12.8' + 152.5') X 2 = 661.2 SF COMMENT: THE AVERAGE DAILY FLOW IS SHARED BY BOTH SYSTEMS #1 & #2. Engineering b Surveying by: SCALE DRAWN JOB. NO. BOTTOM AREA: 12.8' x 152.5' = 1952.0 SF 9 9 y� MAXIMUM WATER USAGE FOR BOTH SYSTEMS SHOWS 1326 GPD (AVE.). Engineering Works WARNER SURVEYING NTS P.T.M. 204-16 TOTAL AREA:............................................................ 2613.2 SF EXCLUDING KITCHEN FLOW, THE DAILY FLOW TO SYSTEM #2 IS LIKELY 12 West Crossfield Road 22 Long Road DATE <1000 GPD. THE RECORD DESIGN FLOW, 1903 GPD, WAS USED. Forestdole, MA 02644 Harwich, MA 02645 CHECKED SHEET NO. TOTAL CAPACITY = 0.74 GPD/SF x 2613.2 SF = 1933.8 GPD (508) 477-5313 (508) 432-8309 11/2/16 P.T.M. 3 Of 3 ,X Z7' 0 7 L I a a 4. c/40 c� (o 41 k w . .......... c)(:- 13 24AA-i A;/ 5y, 0 Air 4 7 7W 1 �) A ST 13:� 1 C4& 4h 491 4� 2 PA�:e-1 k3 r �4 AO 0000 A4k kc- 'rA ,o K AA Oc 4)w 1p 4Fg.#.Sr s CAW-" ti a, Mhu 0 1 F, Am (ode —A -k-A f 71;e s Le 4 cj4 R4, Ar 4kA Y-lTC#.4&. CAM eA," $A 7 si Z 34.8 �.49 4j ;W-A Y �Tc .4,-f ft-kV� HAVE A-T-Y Ml T14 7 -re M St DA I A f ALL."YU-rPLACAVO n-H cA-CA Q 's-A Aj C) p Z Jjr Z , P. 0 r 1 1 1 1 00 e.STA 9-A Q Ou sc F '770, p b C- L-A&) -T APAP HiekSTS W cr 13 F-D rzo�0' ms 0 G.P. L WITH I 4Z 110t b HIT5 3C)o C> 16 (M) �AWA C juSTiAjC- C-ESS Poo �A PkVS &S IEN41 , sf 14L%.ZE PAN 48-0' U&MA MAf4 Ho%ff V :.e, lA---J A -7 -rorA L ZA ILY . F T c 7 5EPT WW 3 7 V96S ' SSO C�A,^,re f C. el 4.4 -------------------- &ALL c oo '41-G' qf 6" 3 OF Le A c-kA i Q C', GA LLA-rz-A e 13 4, PS A STO n c 4. LOP,4+ i btW4 LL, A Z A 4 V-1 U PETER 6 C) p ULLIVAN G4 A fZ�C- F L 4 v ITO rA Vo* 29733 4-� -72 Y, 0 6 �t> 7Z 'p b." 6_ 7 JA3 RA tv-5 . ......... TEN — .s -r,4) "'5'Y'S�t t6 - ",i"--;, .I::,�� : .'1� i I, ,I...,I , ': C �I&AJ 7r6 b ewr -7- -.7,41- b,9 ICY Flo%A/ 7S o 4.4j 7ro 6-1� I F, 7#1.IAJ,e, 1600, Atc, (/40 p 0 C>0 %V 17 1p I' - CO I 0"C C=, LL%EP-t S -7 4=- -LVAL-L A MC- A 7 1+ DIST T Ir -."u -4 mit 7,o 47.6 Z S- Z Ow V. e.S�T� t, LL% Tw- ........to Aj F TA Q, KI A Lt),, -r -rr AC MjV, 41. t>ts I&Q JAN 474' 47.2- Z& A 't)A I Ly W ZO 00 )g z S I A L C> BAY 7: 7.4� S11-MAJ LLZ m A I K) A k-) -N v5 PILAQ IS k3a T A 46D::�TH e C)��S S r-NsT --si'2A C-A Lc— !p Cl' :5 Hmvj 0 H-cuL-O -0 'y j tab L,c a-q A4 C, 5 MARSTONS MILLS op EDPASp � HALT� -- � 20'jf7DE ACCESS � EASEMENT LOCUS AS/LOT 18-2 159. 35, 90 15' LL 28 0 1 0J� 62 67 N DONALD MA CEA CHERN, TRS DEBORAH SCHILLING COE ,TRS MARSTONS o vE DEED 7449149 MILLS AREA= 65,158fSQ.FT. *'3Ar 16 TOP OF FLOOR Mpg g Ag 108. 4 24 0, EEV. _ 50.2YSTEM LOCUS MAP MOBIL VILLAGE' A 61. 6'' �7 1000 GAL. GREASE TRAP \ A E REPAIR _ A 'p p O CAR ' FREEZER 2,500 GAL. GREASE TRAPS.. T p p7, �, 26. 8 MILLS CONCRETE T 112WAY TO BOTTOM I1 o0 0- ASSESSORS MAP 78 LOTS 19 N22�gq o BAYS �, 21 a' REST K c >7E EpT & 20 . GAS 27 8' 4' zv o� RIM=49.9 4 , EFf D RES. ZONE. »VRA „ p 52 0 I 6� R:v "P LINE 1 2 TANK p �� 49.43 RIM= . 35 O VERLA Y DISTRICT "AP" WA GE 9 SANITARY T 1 SAS PUMPS s000 GAL O CONCRI_'TE �o_ 1 M BOTTOM 65'LINE ,#•2 ro# PROPOSE 1 PLAN REF.` ,295/99 SEPTIC SEPTIC TANK ° ° �' = 84 29 YSTEM TANK �, (COVERS ® GRADE) LOCATE COVERS & n B EXISTING 65 - 1 ING TO GRADE RIM 49 74 `3`5 12' L. C. PETITIONERS PLAN o ,C_ONCRETE D a 5z ° , PAVEMENT RAM=49.95 1 1/2-2 PLUGS ON ALL #40946' 60 S A•S. r ,_; 13 GALLEYS WITH 4. OF STONE / Co-);VERS .© GRADE D B OUTLETS wv . D/B ■ D4 '� - Iz f PA VEMENT GRA VEL PARKING AREA AS/LOT CATCH 2-DM CATCH 21 \_ 11�31'45„E, BASIN BASIN 234. 83 - N32 CATC# N44 0010 "E 59, 99' 49, 50 6- 500 GAL BASI11' N3717'23' LEACH CHAMBERS(INCL UDING STONE) ��57 -BARN ST4 BLE_ -M0� A D SEPTIC S REPAIR O UTE 14 9 ( PREPARED FOR. SYSTEM #2 A9ATALD MA CEA CHERN EXISTING INVERT ELEVATIONS - (TO BE CHECKED AND RESET AS NECESSARY) _ L O CA TED AT THE MILLS RESTA URA NT FOUNDATION OUT UNK D/B(LINE #1) OUT 47. 64 2 PLUGGED OUTLET GRAPHIC SCALE MARSTONS MILLS, MA. I000GAL G/T IN 48. 6 D/B(LINE#2) OUT 47. 64 2" PLUGGED OUTLET 30 15 30 60 120 IOOOGAL G/T OUT 48.23 D/B(LINE#3) 0 UT 4764 2" PLUGGED OUTLET FEBRUA R Y 9, 2000 2500GAL G/T IN 48.1 LINE #1 IN UNK el 2500GAL G/T OUT 4 7. 76 LINE #2 IN UNK DIE IN 4764 LINE #3 IN UNK I N FEET I inch = 30 f t. DESIGN DA TA SYSTEM #1 SYSTEM #1 REPAIRS DESIGN DATA SYSTEM 112 SYSTEM #2 REPAIRS 1978 TITLE V 1978 TITLE V RESTA URANT WITH 50 SEATS ® 20 G.P.R=1000 G P.D 1).RAISE DIE CO VER TO GRADE RESTA U?ANT KITCHEN WITH 50 SEA TS © 15 GAL/DA Y/SEA T _ 750 G.P.D 1).REMO VE EQUALIZING PLUGS FROM APARTMENTS WITH 7 BEDROOMS © 110 G.P.D.=770 G.P.D 2).LOCATE AND RAISE S.A.S TOTAL LAIL Y FLO W = 750 G.P.D. DIE AND SET OUTLET INVERTS OFFICE SPACE = 1770 SF 975 GAL/1000 S.F.=133 G.P.D CO VERS TO GRADE FOR EACH GREASE TRAP = 750 G.P.D X 1507. = 1125 GAL. RQ D 2"-3" BELOW INLET INVERTS TOTAL DAILY FLOW = 1903 G.P..D LINE FROM DIE, ALL LINES EXISTINC 1000 GAL GREASE TRAP AND 2500 GAL GREASE TRAP SEPTIC TANK = 1903 X 1507. = 2855 -GAL. ` FROM DIE TO BE LOCATED LEACHINg TRENCH - 65' LONG X 4' WIDE X 2' EFF DEPTH 2).ADD 35' TO EXISTING TRENCHES SIDEWAj AREA = 260S.F. AND PRO VIDE VENT 260 X 45 = 650 G.P.D. EXISTING (1)-3000 GAL SEPTIC TANK BOTTOM AREA = 260 SF LEACHING GALLEYS -EXISTING 13 WITH 4 STOA'E, 260 X 1,0 = 260 G.P.D. 3).CLEAN AND RESET EXISTING ,�MW3 2/01/88 I SIDEWALL AREA = 864 S.F. TOTA.6 DESIGN = 910 X 2=1820 G.P.D. PERFERATED PIPE & REPLACE PERFORMED BY K- V ASSOCIA TES, INC. TOTA. DAILY FLOW = 750 G.P.D. W/ 4'PERFERATED PIPE IF 864 S.F X 2.5 =2160 G.P.D. LOCATION NOT VERIFIED EXISTING PIPE IS SMALLER BOTTOM AREA = 720 S.F. GR. EL. =49. 5 720 S.F. X 1. 0 = 720 G.P.D SAND & GRAVEL FILL TOTAL DESIGN = 2880 G.P.D. EL= 48. 5 1' DESIGN DATA SYSTEM #2 4). CLEAN PLUGGED STONE OR WITH REPAIRS REPLACE AS NECESSARY TOTAL DAILY FLOW = 1903 G.P.D. VARIO US LA YERS ' 1995 TITLE V OF SAND & GRAVEL 5).PUMP AND PRESSURE WASH GREASE I 0p UL '1 TRAPS AND DIE BEFORE PUTTING jRESENT 50 SEATS © 15 GAL/SEAT " =- mem = r. REPAIRED SYSTEM INTO OPERATION L SIGN FLOW 50 X 15 = 750 GAL/DAY � ", 4��'.- 41 °r EL= 18. 5 31 c IOn' TRENCHES 4'W X 2' DP NO GROUND WA TER ENCOUNTERED E f vt L 1(ASSUMED PERK RATE <2 MIN/INCH) SIDE BOTTOM A - 2 X (100 X 2 X 2)+(100 X 4) NOTES: 1. S.A.S. LINE #3 NOT INCLUDED IN CALCULATIONS A = 2 x (400 + 400) Gx A = 1600 YANKEE SUR VEY CONSUL TAN TS 2. SYSTEM #3 PASSED- NO REPAIRS REQUIRED FLOW = . 74 x lsoo 1184 G/DAY PRO PILED P.O. BOX 265 3. ALL CONSTRUCTION TO BE OF H 20 STRENGTH UNIT 5, 405 iNOUSTR r ROAD 10B No. 52257 MARS TONS MILLS, MA. 02648 4. LEACHING FIELDS' LOCATIONS ARE FROM PROPOSED PLANS Pv.(508)428-0055 FAx(508)420-5553 SHEET of i r