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HomeMy WebLinkAboutMORNING GLORY CAFE - FOOD Morning Glory Cafe 211 Rte. 149 Marstons Mills D1 g'baa I fi y AWE T BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Gaudagnoli,M.D. ¢ARNTrABLF. F.P.(Thomas)Lee,. MA6. Daniel Luczkow,M.D. Alt. tz¢. . 200 Main Street, Hyannis, MA 02601 gran ° 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: 783 Issue Date: 01/01/2022 DBA: MORNING GLORY CAFE OWNER: WIN WIN FAMILY LLC Location of Establishment: 211 ROUTE 149 MARSTONS MILLS„ MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 5 OutdoorSeating: 0 Total Seating: 5 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: APPROVED VARIANCE ON 12/09/2015. 1- No more than 5 total seats allowed. Outdoor picnic - tables and outdoor benches are not authorized. 4 Adirondack Chairs allowed for waiting purposes ONLY. 2- Disposable paper plates and plastic utensils are to be utilized. O'l For Office Use Initials: r 'Town of Barnstable Date Paid BABNSTABM ; Inspectional Services MASS. Public Health Division 'OrFu a Y 41 Thomas McKean,Director (�w 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE l NEW OWNERSHIP 4 RENEWAL NAME OF FOOD ESTABLISHMENT: `I t OA ADDRESS OF FOOD ESTABLISHMENT: QI I ©� � yews MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: oe A TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (D(36) TOTAL NUMBER OF BATHROOMS:_ WELL WATER:YES NO K... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:_ SEASONAL: DATES OF OPERATION:_/_/_ TO NUMBER OF SEATS: INSIDE: 9 OUTSIDE: TOTAL: r'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. (�I IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? No o 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/freezes) _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 rovyla(pw ' E 7N A0 FANNY ?LC OWNER INFORMATION: y►,�Pe �16�O FULL NAME OF APPLICANT SOLE OWNER: YES/NO DAB � G� I�530WNER PHOM# ADDRESS Pu ISe e Loivwqc2 673 CORPORATE I'MER: �f 1 0� F�tl�..�U.G CORPORATE ADDRESS: `4 �� , 02 6T p PERSON IN CHARGE OF DAILY OPERATIONS:4466� 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 Do wd LMMIj - 2.hV 1 f Re. ��r 0MA r 1 l frd /Z"— Z•�p�1u. 4� v M.12,10 I fMOW A ° I� �`► � SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,� including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townotbai-nstable.us/healthdivisioii/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3 I s`each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPP REV3-2019.doc OWNER INFORMATION- FULL fJ� y�/� y� I i 1 FULL NAME OF APPLICANT I � '1I T 11"*01�oy �k Wi+I ��`l l `� ` t,( SOLE OWNER: YES/NO D 0• OWNER PHONE# �6$2�4 ADDRESS �I CORPORATE OWNER: r =)velmw V U)1(1 ),� CORPORATE ADDRESS: 211 (), M CP M qy 1WS 5 9 n b`(b PERSON IN CHARGE OF DAILY OPERATIONS: Noib@? Ita'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 i g/1 I 2. ����rrdl e , 20�� SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec. 3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. I Q:Wpplication FormsTOODAPP REV3-2019.doc V r f O�tt�E Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. �aaee Paul J.Canniff,D.M.D. MAM F.P. Thomas Lee Alternate � 9. 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 783 Issue Date: 01/01/2021 DBA: MORNING GLORY CAFE OWNER: JOSHUA SODEKSON Location of Establishment: 211 ROUTE 149 MARSTONS MILLS„ MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 5 OutdoorSeating: 0 Total Seating: 5 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: 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: APPROVED VARIANCE ON 12/09/2015. 1- No more than 5 total seats allowed. Outdoor picnic tables and outdoor benches are not authorized. 4 Adirondack Chairs allowed for waiting purposes ONLY. 2- Disposable paper plates and plastic utensils are to be utilized. r ' Town of Barnstable BOARD OF HEALTH John T.Norman a Board of Health Donald A.Gaudagnoli,M.D. BAPZMABM Paul J.Canniff,D.M.D. �e 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 30513, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 783 Issue Date: 12/10/2019 DBA: MORNING GLORY CAFE OWNER: JOSHUA SODEKSON Location of Establishment: 211 ROUTE 149 MARSTONS MILLS, MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 5 OutdoorSeating: 0 Total Seating: 5 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: APPROVED VARIANCE ON 12/09/2015. 1- No more than 5 total seats allowed. Outdoor picnic tables and outdoor benches are not authorized. 4 Adirondack Chairs allowed for waiting purposes ONLY. 2- Disposable paper plates and plastic utensils are to be utilized. For Office Ust,Only: Initials: Lys°�,THE"° Town of Barnstable �A Date Paid Amt Pd$a NAM : Inspectional Services Public Health Division cheek# QED MA'S 0 A.dl Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 €= Office: 508-862-4644 Fax: 508-790-6304 410 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: '! (A ADDRESS OF FOOD ESTABLISHMENT: 7W ('c4b-,0-'- A koA-SAv6S, Mkb 1 MAILING ADDRESS(IF DDIFFERENT FROM ABOVE): E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( - TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO_Z.:-. (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: X SEASONAL: DATES OF OPERATION:-( 7c:TO (.-I—/)I/ NUMBER OF SEATS: INSIDE: —�c OUTSIDE: TOTAL: ` SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 QAApplication FoansTOODAPP 2020.doc OWNER INFORMATION:FULL NAME OF APPLICANT (aj��l(jZJ� � 3- cqA-PAcsc() SOLE OWNER•�ES0 OWNER PHONE # ADDRESS_ 3?) �dC�`���(J11�"�+•� < c�J � "�. F 1V10� CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: 6y—\ List(2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2.Ca t`e— S VL/ 1 / ?162® J ATURE PPI.ICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to ovenine!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.as]). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. ():Application FormsTOODAPP REV3-2019.doc I X Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. w BARNSTAB.L John T. Norman MIAS F.P. Thomas Lee Alternate .o � 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: 783 Issue Date: 12/20/18 DBA: MORNING GLORY CAFE OWNER: JOSHUA SODEKSON Location of Establishment: 211 ROUTE 149 MARSTONS MILLS MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 5 OutdoorSeating: 0 Total Seating: 5 FEES T FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - MOBILE-FOOD: MOBILE-ICE CREAM: �� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Seating assigned by Board of Health 3/20/2015. OpIME TO{y� Initials: o� Town of BarnstableiT—� �_ • Date Paid �� Amt Pd$ �- �,�^BrE.MAM Inspectional Services ;' 16 9. Public Health Division Check# Thomas McKean, Director Loe /`1 � Qzlj r • 200 Main Street,Hyannis,MA 02601 X: Office: 508-862-4644 Fax: 508-790-6304 ;` i APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE l NEW OWNERSHIP RENEWAL . NAME OF FOOD ESTABLISHMENT: 2n (Cyy ADDRESS OF FOOD ESTABLISHMENT: Id ;OMT ftyZ/,-1p,5 l .Pt►-GW�r MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: aO&e-,�—�� TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( ') TOTAL NUMBER OF BATHROOMS: l WELL WATER: YES NOG ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: //9 TO l 2, ///,r NUMBER OF SEATS: INSIDE: OUTSIDE: .V TOTAL: Jr SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q:\Application FormsTOODAPPREV2018.doc 1p Town of Barnstable BOARD OF HEALTH �! John T.Norman Board of Health Donald A.Gaudagnoli,M.D. 4 BAR:ISTAOL . = F.P.(Thomas)Lee Mn 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D.,Alt. 1 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: 783 Issue Date: 09/01/2021 DBA: MORNING GLORY CAFE OWNER: WIN WIN FAMILY, LLC Location of Establishment: 211.ROUTE 149 MARSTONS MILLS, MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 5 OutdoorSeating: 0 Total Seating: 5 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Qn FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: APPROVED VARIANCE ON 12/09/2015. 1- No more than 5 total seats allowed. Outdoor picnic tables and outdoor benches are not authorized. 4 Adirondack Chairs allowed for waiting purposes ONLY. 2- Disposable paper plates and plastic utensils are to be utilized. DIME For OM • Initials: tiI Town of Barnstable ii Date Paid�l Amt Pd$ ,AR : Inspectional Services ASS* Public Health Division Check# ArED MAy� 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 NAME OF FOOD ESTABLISHMENT: Wwv�`m 1 CJ•I' g=_ _ADDRESS OF FOOD ESTABLISHMENT:_Z � /, J - i U1� S ►"\ �ls , o�� g MAILING ADDRESS(IF DIFFERENpT FROM ABOVE): ,* E-MAIL ADDRESS: C L TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: j l� WELL WATER:YES NO_& ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION:�/ /0TO J? /_n/ 2 / NUMBER OF SEATS: INSIDE: _25�: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICkN9ING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? �_ IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?_a�k 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 Forms\F00DAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT com SOLE OWNER:6 NO D.O.B 1 OWNER PHONE# 5 Ca- 1 -7 1Sr— ADDRESS. 21aC\°Mt9tm,,— * 2q CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2. ( n O / / Z3 f ( /--10 S A UR F APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.3I't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Apphcation FormsTOODAPP REV3-2019.doc oF. row TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of t _ ti OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSfABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. g. MON.-FRI. .6,59• .0 HYANNIS,MA 02601 sos-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY 'EON1P`' FOOD ESTABLISHMENT INSPECTION REPORTCe Name �/ 1� Date �� Type of Tyne of Inspection s Ro l✓1 v� Address Risk Food Servi e-inspection Level Re ai spection U L� Telephone Residential Kitchen Date: -7Nr Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness I�"" Caterer General Complaint -/ Person in Charge(PIC) VIU( Time Bed&Breakfast HACCP L � (/(it. 3 ki%. (` C7� ] In: /� Other _ Inspector / Out: / 1�„ 1 Each violation checked req res 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 Itemsl Anti-Choking 590.009(E) ❑ fir/ 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 / �" 0 EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ,r1Q ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives 114 O d !M d ❑ 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 1/1 ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations �"( Critical(C)violations marked must be corrected immediately. (blue&red items) l� u Corrective Action Required: ❑ No Non-critical(N)violations must be corrected immediately or X within 90 days as determined b the Board of Health. Overall Rating Y Y � ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Schedul d ency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical, results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 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 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector' 'Signs re�..._. Pri t: 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 Si ture� Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N l'.._...��_'t._-° .•-- ---'-'a..-r..n ..y_._ _..r..r,�_._-,,.-y.._.e.'-.-,:�-i-^..__.P....-.,.....��. - �-- -"----. __ s.-. .... - -�__� ._y _ _-� - - - �•ram.. u...-...� ..w- .�-_�-s._._... .. �«--. - - - ... ..... w -'..--���. - ,. 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) JDemonstration 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.* -in PHF Hot and Cold Holding 2-103.11 Person-in-Chazge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 75 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition 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 F9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* y Pe 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* Eggs 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef criv 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Ho[Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* in mobile food,temporaryand residential Sources* 10 Proper,Adequate Handwashing g' 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* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good]Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package.Integrity y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A Coolinglooked PHFs from 140°F to 70°P 3-202.18 Shellstock Identification ( ) l Item Good Retail Practices FC $90.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F[o 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* V25. Equipment gement and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F pment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* r,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices ical Facility FC-67 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability onous or Toxic Mater als FC-7HACCP Plans 6-301.12 Hand Drying Provision ial Requirements3-502.11 Specialized Processing Methods* r 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. p`oft ror� TOWN OF BARNSTABLE HEALTH INSPECTOR-s Establishment Name: Date: Page:. / of OFFICE HOURS PUBLIC HEALTH a,RNS Aa�E. 200 MAN STREEETSION 3:30-4:30A.M. 0- :30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified :3 67q. �0� HYANNIS,MA 02601 MON.-FRI. , No Reference R-Red Item PLEASE PRINT CLEARLY p n 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT r_ j���•� 13- I�^4L �?-,A_ wee Name C-1^ Date IWI'b-L Tyl2e of !Xpp.,qf Ins action era n outine Address Z (� Aug Risk ce nspection 1 Level Retail Previous Inspection Telephone Residential Kitchen Date: Pj:y: Mobile Pre-operation � ��e� Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint N Person in Charge(PIC) 0 hv� �� Time Bed&Breakfast HACCP (6/l> - {9 SIN: In: Other /Inspector �� Out: ..I .L,b Each violation checked requir s 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) ❑ r a Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands �� �V1 ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS YQ 2_ /7 &Z C(f 1}l ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives0 S Sr ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals , n I�v1 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 S ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULAT NS(HSP) L4 - mu ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY 11 11.Good H❑ 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 �C1J� 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 g ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical, results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 6=One critical violation and less than 4non-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 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to"on-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Si at a Print: 31.Dumpster screened from public view Permit Posted? L YY N Grease Trap Previous Pumping Date Grease Rendered Y N PIC's QatUe Print: 0 #Seats Observed Frozen Dessert Machines: Outside Dining Y N Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N I` Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) e 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 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 15 Poisonous or Toxic Substances O EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004 F 2 590.003(C) Responsibility of the Person-in-Charge to Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 7-102.11 Common Name-Working Containers* 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 1 Separation-Storage*g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and ReserAdulterated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated g � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff"nvc mnooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces 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* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and 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 underll29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * (Blue Items 23-30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbore 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 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 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. `�ptME Tay TOWN OF BARNSTABLE: HEALTH INSPECTOR'S Establishment Name: Date: .Page:. �: of 1 OFFICE HOURS P PUBLIC HEALTH DIVISION - 8:00-9:30 A.M. i SARNSTABLE. ` 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified t; e3q: �• M-8N. RI. -FRI. No Reference R-Red Item HYANNIS, MA 02601 PLEASE PRINT CLEARLY 508- IMA FOOD ESTABLISHMENT INSPECTION REPORT Name n�j/� / ) Date �({ T e of T of Ins ection a i k.� I'1W YU l l outs ' n(s) Address . �/) � Risk ood Servic ection T Level Previous Inspection r Telephone Residential Kitchen Date: Mobile Pre-operation V Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other '_ Q / Inspector M Out: /l " Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. / Violations Related to Foodborne Illness Interventions and Risk Factors Red Items I '`� t 1 t ( ) Anti-Choking 590.009(E) ❑ i 'n ' Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ O'0 k)cs- ` U�h in c Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Handsj ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities ILAt EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives 171-3.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 Wln Pi. Vtt'��ft',( . ❑ 5.Receiving/Condition ❑ 17.Reheating ^ ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling , ✓ ; / �� 1 ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding (�3 V PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control 'dtiV�I ❑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 ( 3,q 1= � COD f Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes f'1\1? Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating ❑ VoluntaryCompliance p liance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emer n S son C N Official Order for Correction: Based on an inspection today,the items Embar o checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical vio atwns, � 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 9 ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than non-critical violations re 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 C=2 critical violations and less than non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. violation,4 to -critical violations C. 29.Special Requirements (590.009) within 10 days of receipt of this order. = 30.Other DATE OF RE-INSPECTION: Inspector's"Sig atur Pri t: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N pIC's Si a r Print: #Seats Observed Frozen Dessert Machines: Outside Dining Y N Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen'I 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 7 5 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* y 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 Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage*g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer � 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.I IA(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* Equipment* gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eff°rive 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 nun* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements.radicsshould be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commerciall Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 . 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 * 5-205.11 Accessibility,Operation and Maintenance 3-402.12 Records,Creation and Retention Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients" Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S: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. .t `gyp INC rok, TOWN OF BARNSTABLE _ HEALTH INSPECTOR'S Establishment Name: Date: Page: _Of v �,( OFFICE HOURS BARNSTABLE. ' PUBLIC 2 0 MAN STREET 3 30-4:3SION - _ a 00-s:30 P.M.A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 2639. �0� HYANNIS, MA 02601 MON.-FRi. No Reference R-Red Item PLEASE PRINT CLEARLY 508-862-a6a4 FOOD ESTABLISHMENT INSPECTION REPORT Name �/yl,� I Date Type of Tyue of Insoection -y O -sl Routine I Address l G� M(� Risk Se Re-inspection Level Retail Previous Inspection ✓l Telephone Residential Kitchen . Mobile e-operatio Owner HACCP Y/N Temporary Suspec ness " Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: i Other Inspector Out: Ke, Each violation checked re wires 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) ❑ t 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 t' a V"t cl ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives , ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals ' FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating - ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violatio s , Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No El Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined b the Board.of Health. Y y � ❑ Voluntary Compliance ❑ Employee.Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 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 9 ardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 6=One critical violation and less than non-critical violations re 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 non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's S' n�ture Print- 3 1.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N PIC's Si nature Print: #Seats Observed Frozen Dessert Machines: Outside Dining Y N 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 Addifives* 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 F 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* 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants - 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 590.003(G) Reporting by Person in Charge* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q � Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* _ 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions��] Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( _ P _ _ 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 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. 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 E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* Equipment __ - * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Utensils and Food 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E_ry eye 11112001 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* Animals-155°F 15 sec* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs = SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing kitc mobile food,temporary and residential 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* ( )( ) P appropriate ria a sections above if related - Raw Animal FMicrowavethe pp op t sect o s bo e e ted to Regulatory Authority 3 401.12 a Foods Cooked in a 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°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C CommerciallyProcessed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-403.11E Remainin Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 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 TagsiRecords:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 02.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-4 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 1 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 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 lConformance,with Approved Procedures* 4 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. ( 3 °F� rok TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: �l Date: Iq It Page: I of Z v` OFFICE HOURS ° PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNWABLE, ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified a39. �e� HYANNIS, MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �0reo MPS° 508-862-4644 FOOD ESTABLISHMENT INSPEIPTION REPORT Name l Date 3 21 Type of T Inspection outin V` OD Address ( Risk Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: 0 00 Mobile Pre-operation S Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Cad Q l Person in Charge(PIC) c Time Bed&Breakfast HACCP O^- J0&�,' In:. (C7 V, Other Inspector KANyivi 5o Out:?,'WS P Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. - 1 Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ vv-ttl- Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands tV (:� S � ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ �r 13.Handwash Facilities r�S vo,EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives MAP az?Q ❑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 - ` f ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding k `� PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control v I���/�l(� t cep ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 6VI�-'. �- ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP Z �y ��I ,y �^ •/ s �iuy ❑ 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 Violations1.4 - C �` _ Critical(C)violations marked must be corrected immediately. (blue&red items) Q Corrective Action Required: ❑ No ❑ Yes / Non-critical(N)violations must be corrected immediately or Overall Rating v within 90 days as determined by the Board of Health. 4 ❑ 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 4non-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 ( )( ) 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. 28.Poisonous or Toxic Materials FC-7 590.008 g = 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violations C. 30.Other DATE OF RE-INSPECTION: Inspector's Signatur Print: 31.Dumpster screened from public view Permit Posted? 4��n �Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signa6re/,/�,�( ►n\I)( 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 7 5 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 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* 7-102.11 Common Name-Working Containers* 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control 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 Washin Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated g Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources F9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 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 * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 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 IS 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* Effect-/nnoo/ 4-602.1'1 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165'F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 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* 3-403.1 l(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g 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 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 - Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205:11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590A00. 1V� / e: Z oF. ,ok TOWN OF BARNSTABLE T HEALTH INSPECTOR'S Establishment Name: 2( Pa�`' _Date: . g of Z 4 OFFICE HOURS P ° PUBLIC HEALTH DIVISION 8:00-9:30A.M- an MASSA LE. 200 MAIN STREET 3:30 N.-F I. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified, MAs` HYANNIS, MA 02601 08-8 -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �A .a;q•s` 508$62-0644 lE°M� FOOD ESTABLISHMENT INSPECTION REPORT Name �[ Date 3 L Tyne of ns ec ion outine Address !C (/►i( Risk Food Serv' e-Inspection Level al _ Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint ^L \ Person in Charge(PIC) Time Bed&Breakfast HACCP F� �. In: Other Inspector Out: �` A Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ b (�S Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing 17121.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 F[] Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health, Overall Rating Y y � ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ go Other: Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Emergency Closure ❑ Voluntary Disposal ❑ 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. B=One critical violation and less than 4non-critical violations re 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 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 Signer re 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 Sign rreJ^ 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 1 q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to * 7-102.11 Common Name-Working Containers* Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* 590.003(G) Reporting by Person in Charge* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reted of Food Produce,Criteria* HSP HIGHLY SUSCEPTIBLE POPULATIONS 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or or Contaminated 7-204.12 Chemicals for Washing � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.1](A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* q Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of Eggs 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effe ctiw 1112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing Ratites-165°F 15 sec*3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practiRequices should be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercial) Processed RTE Food-140°F* Blue Items 23-30) 3-202.11 Package Integrity Y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140'F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF.HE roe, TOWN OF BARNSTABLE . HEALTH INSPECTOR'S Establishment Name: q Date: Page:."4 OFFICE HOURS of"' """"' 0, / PUBLIC HEALTH DIVISION 8:00-9:30A.M. eaeNSTnsLe. v 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified mass. MON.-FRI. `rF2639. 0 HYANNIS,MA 02601 sos-ss2�s4a No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTABLI MENT INSPE TION REPORT Name Date e o Tyne of lnsoection i Routine tj Address Risk - Food S Re-inspection C ® Level tail 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 7W er Inspector &/afiffi P/1 Each violation checked requires an explanation on the narrative pa e(s)and a citation of specific provision(s)violated. v 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 A Ad ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS . ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives c7 ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals Q 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 Lo -D 6 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical ViolationsOr I Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action u1r6jJ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating. I within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,-the items ❑ go Embar checked indicate violations of 105 CMR 590.000/Federal Food Code. 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 re ardiess of the number of critical,results in an F. 25.Equipment9 and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 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 non-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8 non-critical viol tions=C: 29.Special:Requirements (590.009) y P 30.Other DATE OF RE-INSPECTION: Inspect 's ' nature 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 Signatu 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.* * - i9 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives - Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 7-102.11 Common Name-Working Containers*2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* P g Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage* Applicants* 3-302.11(A)' Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 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 _ 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 or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 17.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg L1Ve rurzooz 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish,and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 - Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-0Ol.11 Eating,Drinking or Using Tobacco* *- Requirements. 5 Receiving/Condition - - g, g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 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* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* .3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°17/45°17 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 I.P09 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. ' ftM1N `oF�NEror TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page: of v do OFFICE HbURS PUBLIC DIVISION8.00-9.30 A.M. : BAR E. 2 0 MAN STREET Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. �p 6;.e�0 HYANNIS, MA 02601 M-8 -FRI. No Reference R Red Item PLEASE PRINT CLEARLY tF0 MP'� 508-862-4644 FOOD ESTABLISHM NT INSPE TON REPORT Name lvh Date yne of Type of Inspection - s Routine Address Rislk food Serv' Re-inspection Level Previous Inspection Telephone, Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires an xp anation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a'Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food.Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY D 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating y y ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction Order for Correction:Based on an inspection today,the items F] Embargo Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations re ardiess of the number of critical,results in an F. Equipment and Utensils (F 590.005 25.E C-4 B=One critical violation and less than 4non-critical violations 9 q p )( ) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations_observed,7 to 8non-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8 n-cr'ical violations=C. 29.Special Requirements. (590.009) y P . 30.Other DATE OF RE-INSPECTION: Insper?g 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 Sign2 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 I 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* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F P Y7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation-Storage Applicants* 3-302.11(A) Food Protection* P20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* -- - Variance Requirements * 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* 590.004(11) q 590.003(G) Reporting by Person in Charge Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* - REQUIREMENTS FOR. 3-306.14(A)(B)Returned Food and Rrated or of Foam* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Ho[Water 7.206.12 Roden[Bait Stations 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 8g 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E//cti-11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved B 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Regulatory Authority y 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. radicsrho ld be debited under#29-Special 5 ReeeivingiCondition 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 PreventingContamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* g 3-403.11(C) Commercially Processed RTE Food-140°F 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodbome 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 TagsiRecords: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 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I Fc-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S.590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590:000: n oF1HWE TOWN OF BARNSTAB,LE HEALTH INSPECTOR,s Establishment Name: / I V�1 V (� Cj ate: 43 Page: of P. q OFFICE HOURS - �. BAR E.O` 4- PUBLIC 2 0 MAN STREET 3:30-4:30 P.M. DIVISION : 0- :30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MgSS. D,`rFn MP MON.-FRI.+a�O HYANNIS,MA 02601 508-862-4saa No Reference R-Red Item PLEASE PRINT CLEARLY FOOD ESTA13LISHIKAENT INSPE OttTI N REPORT Name Date 101A,014y vipe of T f Ins action O er ins Ine Address Risk o Ct n Level Retail Previo In p qqn� Telephone es! ential Kitchen Date: 1 Mobile Pre-o ati n I Owner HACCP Y/N Temporary Suspect Illn s Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP 1 Other InspectoI MOM) ----------- _j f3 Each violation checked requires an explanatio on the narrativ s and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and iisk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures it tv <___11 ❑ 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 SP) ❑ 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 IUnJ a ((J 7 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 ite Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ 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 6=One critical violation and less than n-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot C=2 critical violations and less than non critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical iolations. If 1 critical refrigeration. 11rpiftiqn,4 to 8non-critical v' ions C. 29.Special Requirements (590.009) within 10 days of receipt of this order. l . 30.Other DATE OF RE-INSPECTION: I s I or's ignature t 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 C's Signature Prin Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N 614 `, Dumpster Screen o 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 2-103.11 Person-in-Charge Duties - 3-302.14 Protection from Unapproved Additives* ' PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Se 3-501.16(A) Roasts Held At or Above 130°F* Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 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 Wazewashing-Hot Water 17.206.12 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* 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(l)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of Eggs 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef d-11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* Shellfish* 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 a 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 Held 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 1 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. radicsshould be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15., Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 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 Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:fish Products 5-203.11 Numbers and Capacities* * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 * 5-205.11 Accessibility,Operation and Maintenance 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006. 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S.-S90Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF.KE► TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: Date: -7 Page: of ., � PUBLIC HEALTH DIVISION OFFICE HOURS8:00-9:30A.M. BARNSfABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 63q. �0� HYANNIS,MA 02601 - MON.-FRI. No Reference R--Red Item PLEASE PRINT CLEARLY 508-862-4644 Ma+" FOOD ESTABLISHMENT INSPECTION REPORT. Name - Date a of of Ins ection JJ` outin Address Risk od Servic a-ins "ction ` Level Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other �GPh�LM'T�i L� f 1 Inspector Out: Each violation checked requires an explanation-on the narrative page(s)and a citation of specific provision(s)violated. jA Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ f \ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco .590.009(F) t' Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands416E - ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating At lo" r /� ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling , C ll�� ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control `� _ ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories J Violations Related to Good Retail Practices(Blue Itemsl Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) a Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall RatingI I �� within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑.Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items Embar o checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g _ ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. B=One critical violation and less than 4 non-critic al violations g 25.Equipment and Utensils (FC4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6ntin-critical violations=B. 1 . • 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7 590.008 9 violation,4 to 8ntin-critical violations=C. - 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Duumpss creened from public view Permit Posted? V Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Pr Self Service Wait Service Provided Grease,Trap Size Variance Letter Posted Y IN 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 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additiveg* L 9-9-- PHF Hot and Cold Holding._. Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-10211 Common Name-Workin 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* Storage* - Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 3-304.11 F od Contact with Equipment and Utensils * 590.004(11) Variance Requirements Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ _ REQUIREMENTS FOR > 3-306.14(A)(B_)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) -Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* _ 4-501.111 Manual-Warewashing-Hot Water 17.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.1IA(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 - Drinking Water.from an Approved System*_ * Eggs Not Otherwise Processed to Eliminate Equipment 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eb°"°e uirzom 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4=702.11 Frequency r f Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* - Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Chemical Stuffing ContainingFish,Meat,Poultry 3-201.15 Molluscan Shellfish from NSSP Listed * g try or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec*- Sources* 1 p Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165*F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* _ 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES *. 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical.and non-critical violations,which do not relate to the foodbome * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 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 IF 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste .006 590.004(J) Labeling of Ingredients• Supplied with Soap and hand Drying Devices 27. Physical Facility .007 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials .008 . HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 1.05 CMR 590.000. NUMBER FEE 162 THE COMMONWEALTH OF MASSACHUSETTS $100.00 TOWN OF BARNSTABLE Win Win Family, LLC d/b/a, Morning Glory Cafe Thisis to Certify that...................................................................... ............................................................................. ........................................................................................................................................................................................................................ IS HEREBY GRANTED A COMMON VICTUALLER'S LICENSE in said. MarStonS Mills and at that place only and expires December 31, 2021 unless sooner suspended or revoked for violation of the laws of the Commonwealth respecting the licensing of common victuallers. This license is issued in conformity with the authority granted to the licensing authorities by General Laws,Chapter 140,and amendments thereto. HOURS: Monday through Sunday, 7am to 3pm RESTRICTIONS: 5 seats In Testimony Whereof,the undersigned have hereunto affixed their official signatures. NOT VALID unless issued in conjunction with a Licensing Food Service Permit """' "' Authorities k7 I.J�s1......• ---........ ... Issue Date: 10/18/2021 THIS LICENSE MUST BE POSTED IN A CONSPICUOUS PLACE UPON THE PREMISES. Town of Barnstable Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Mr. Joshua Sodekson Ms. Callie McCarthy Morning Glory Restaurant P.O. Box 363 Sagamore, MA 02561 RE: Variance to Operate a Food Establishment With Five Seats At: Morning Glory, 211 Cotuit Road, Marstons Mills, MA Dear Mr. Sodekson and Ms. McCarthy, Barnstable A14Io �.F 2007 Wayne Miller, M.D. Paul Canniff, D.M.D. JunichiSawayanagi December 9, 2015 You, as leasees of this property, are granted a variance to utilize the existing toilet facility (or facilities) for the operation of a food establishment at 211 Cotuit Road, Marstons Mills. The variance granted is as follows: Section 322-4 Toilet Facilities To utilize one unisex restroom in lieu of the requirement to two provide separate male and female toilet facilities for male and female patrons and employees. However, if the State Plumbing Code does not allow for the use of a unisex bathroom at this building, both existing onsite restrooms shall be utilized, with the closest restroom to the patrons assigned to use by females only and the further inconveniently located restroom assigned to use by males only. The variance is granted with the following conditions: (1) No more than five (5) seats total are authorized for dining purposes. The existing outdoor picnic tables and outdoor bench are not authorized and must be removed. For waiting purposes, four (4) Adirondack chairs without a table may be allowed outside. Indoors, two settee (soft seats), without a table in between them, may be allowed. This condition is in effect because of the limited capacity of the existing septic system onsite. (2) Only disposable paper plates and plastic utensils shall be utilized. This condition is in effect because this particular establishment does not possess a mechanical dishwasher for washing plates and utensils. Q:\WPFILES\MomingGLoryVariance2015.doc Page 1 of 3 �E: Variance to Operate a Food Establishment With Five Seats at 211 Cotuit Road, Marstons Mills, MA (3) This variance decision letter shall be posted on the wall adjacent to the food permit in an area which is easily accessible to be read by a health inspector anytime routine inspections are conducted. (4) This variance is not transferable to a different leasee. In the event that this building and/or business is sold or transferred, both the owner of the building and the licensee have the duty to inform any and all potential purchasers of the existence of these variances and the fact the Board has. explicitly made them non -transferable to another owner. Sincerely yours, Wahine M Iler, M.D. Chairma Board of Health Town of Barnstable cc: John Kenney Esq. 1550 Falmouth Road Centerville, MA Q:\WPFILES\MomingGLoryVariance2015.doc Page 2 of 1. of IHME BARNSTABLE, y MASS. i659 Office: 508-862-4644 FAX: 508-790-6304 Town of Barnstable Board of Health 200 Main Street, Hyannis MA 02601 VARIANCE REQUEST FORM LOCATION Property Address: 211 Route 149, Marstons Mills, MA 02648 Assessor's Map and Parcel Number: 078/022 DATE: r /� FEE: �S r REC. -BY.=k a�,•.� SCHED. DATE:IZ Wayne A. Miller, M.D. lunichi Sawaymiagi Paul J. Canniff, D.`-1.1). Size of Lot: 0.37 acres Wetlands Within 300 Ft. Yes BLISiness Name: Morning Glory Cafe No X Subdivision Name: _ Joshua.Sodekson and APPLICANT'S NAME: C'alli P McCarthy Did the owner of the property authorize you to represent him or her? Phone 508-524-1715 Yes No PROPERTY OWNER'S NAME CONTACT PERSON John Falacci, Trustee, Name: Mountain-Ash-Rea1-t_y Trust Name: John W. Kenney, Esq. 119 Route 149 1550 Falmouth Road Suite 12 Address: MarGtQns Mi 1 ls_,_MA D2L_4fi Address: ---Center3ai1-e, MA 0632 Phone: 774-238-9869 VARIANCE FROM REGULATION(LisIRcV.) Section 322-4 Toilet Facilities Phone: 508-771-9300 REASON FOR VARIANCE (May attach iflnore space needed) Unisex Toilet Change of Ownership - NATURE OF WORK: House Addition ❑ }-louse Renovation ❑ Repair of Failed Septic System ❑ Clreclrlist (la be completed by v,)ice stcl=1,70"SOtr rec•ei 41'19 variance r-equest a13j)1ic•a6on) Please stibmtit copies in 4 separate completed sets. Four (4) copies of the completed variance request form Four (4) copies ol'enginecred plan submitted (e.g. septic system plans) Completed seven (7) page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian — Four (4) copies of labeled dimensional floor plaits submitted (c.g. house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted (fir grease trap variance requests only) Variance request application ice collected (fit) ice for lifeguard modification renewals, grease trap variance renewals [same owner/lessee only], outside dining variance renewals [same owner/Ieasee only], and variances to repair tailed sewage disposal systems [only if no expansion to the building proposed)) — Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED N01.APPROVED _ REASON FOR DISAPPROVAL C:\Users\decol1ik\AppData\Local\Microsoft\windows\Temporary Files\Content.Outlook\BAJ9P9B7\VARIREQ.DOC Wayne Miller, Chairman Junichi Sawayanagi Paul J. Canniff, D.M.D. Internet 'Ync-n Glwd cam. Arb SALADS I S7.95' Spinach Salad — Baby spinach with grilled chicken, baby spinach, hard- boiled egg, goat cheese Chef Salad — Mixed greens with sliced ham, turkey & Swiss cheese, and hard-boiled egg The Lina — Nifised greens with humus, tahoub, feta cheese, kalamata olives & Bermuda onion The Beckett — Mixed greens With grilled chicken, goat cheese, sweet craisins & toasted walnuts "Make Your Own" — Mixed greens with tomato, cucumber & olives with choice of chicken or tuna salad, roasted turkey or grilled chicken and choice of cheese Dressings: House Balsamic Vinaigrette - Greek - Honey Mustard - Russian - Blue Cheese (add .75) VEGETARIAN WRAPS I $7.65, South of the Border — Refried beans, 1b4ontcrcy Jack, tomato & avocado The Medi — Humus, tabouli, lettuce, tomato & onion Very Veggie — Avocado, lettuce, tomato, kalamata olives, mushroom, sunflower seeds, feta cheese tossed with Greek vinaigrette GLUTEN FREE I $7.6s .Served in crisp lettuce ujraps • Grilled chicken, Swiss cheese, tomato, & spicy mayonnaise • Tuna fish salad, tomato, cheddar cheese & mayonnaise • Hummus & tabouli, feta cheese, onion & tomato • Oven roast turkey, tomato, cheddar cheese & mayonnaise THE GOULET FAMILY TRADITION 117helherit1.r for break:&rl or Mild), eijoy a relaxing Cape Cod alirrosphelc. Moruiu� G D, Caje .peciali,er in flesh baked mugbu.r, sandwiches 6 b>nnilos for bieat:.fasl. Or join us jor huncb n4lh unique pressed sanduicbes, bolverrrarde soups, chon,- der and flash saladr. Be sure to grab .route of our sin f d cookies and baked goods to round oul )'our hip. -PETER & COLLEEN GOULET, CHEFS & OWNERS TAKE-OUT I CATERING ~ - t • i ;. !w • �10 00* ° x � a � a t t i • a � s a • AFE t x * i EST. 2Q12 � ♦ ++ i t C'fii��,�zirr;;Glot y cot' � ♦ e ♦♦ w w s � FIND US ON FACEBOOK , YELP I FOURSQUARE 2II COTUIT ROAD, RT. r+9 I MARSTON MILLS, MA HOURS: -7AM 3PM, DAILY PHONE: 5-08.+7-8.III5- EMAIL: CCMORNINGGLORYCGMATL.COM WWW.CCMORNINGGLORY.COM MORNINGGLORY CAFE BEVERAGES We reproud to feature jim r Organic Coffee —Dark, Ilght d� Mahan Roasts Coffee & Tea $IAA 1 $I.8f Iced Coffee & Iced Tea $1.9371 $2•¢1 Bottled Beverages $1.5.0 1 $I.95. BAKED GOODS & QUICK BITES Homemade Muffins $I.91 Fresh Croissants $2.2f Bagels (Plain & Everything) $I.71 with cream cheese, add.fo Yogurt with Colleen's Homemade Granola $3.91' Quiche of the Day $6.9 f with fresh fruit, add $2 On the Go Egg Sandwich — Southern -style biscuit or English muffin, egg any style, with your choice of Swiss or American cheese, & bacon or ham $3.9 S BREAKFAST BURRITO Ad brrakfast burritos served with hvo eggs unless requested. Morning Glory Burrito — Eggs, bacon or ham, cheddar or American $4..9s Working Man's Burrito — Eggs, roasted red peppers, mushroom, onion, chorizo and cheddar cheese $495, The CoCo —Eggs, spinach, tomato, feta cheese & olive tapenade $+9 f The Veggie Burrito — Eggs, spinach, tomato & goat cheese $49s The Italian - Eggs, imported ham, pesto, tomato & Mozzarella cheese $1!.91' The Golfer - Eggs, apple, imported ham & cheddar cheese $f•9 i The Debutante — Eggs, bacon, spinach, mushrooms and Swiss cheese $1-.9i Olive Oil — Eggs, spinach, tomato, bacon & cheddar cheese $5'-9 i Sausage — Eggs, sausage, eggplant, tomato & Swiss cheese $5•9 f SOUP & CHOWDER Soup of the Day 83.95 1 $¢9S Pete's Wicked Fish Chowder $499 ( $1•91T PRESSED SANDWICHES' $7.61 The Melted Tuna — Tuna fish salad, Swiss cheese and Rye bread The Californian — Grilled chicken, fresh sliced avocado, baby spinach, tomato, Monterey Jack cheese & bacon The Rueben — Corned beef. Sauerkraut, Swiss cheese and Russian dressing on Marble Rye The Landscaper — Oven roast turkey, bacon, baby spinach, Monterey Jack & honey mustard The Gardener — Grilled eggplant, roasted red pepper, onion, tomato, olive tapenade & feta cheese WRAPS 1 $7.63- The Pilgrim — Oven roast turkey, lettuce, cornbread stuffing and cranberry mayonnaise The Popeye — Grilled chicken, baby spinach, craisins, walnuts and goat cheese tossed in our sweet balsamic vinaigrette Pine Island — Oven roast turkey, feta cheese, roasted red peppers, lettuce, olive tapenade and cucumber tossed with Greek vinaigrette Caesar Wrap — Grilled chicken, Parmesan cheese & Romaine lettuce tossed in Caesar dressing The Land or Sea— Our own chicken salad or tuna fish salad with lettuce & tomato Please inform us beforr placingyour order ifyou bave a food allergy. Corrsumirrg rare er undercooked rmeats, eggs, poultry, or seafood may innraseyour risk of food home illnesses. TAKE OUT Call us today for the freshest thing on sliced bread (literally): fo 8.42 8. 11 I f CATERING Wlbetber it's a sales presentation, luncheon, birthday or feeding the entire wedding party - we'll will take care of all the details with custom menus tailored toyour needs. 2I1 COTUIT RD. (RT. 149) I MARSTON MILLS, MA o264.8 1 108.+28.1111 1 CCMORNINGGLORY@GMAIL.COM I W`WW.CCMORNINGGLORY COM ASSET PURCHASE AGREEMENT Agreement made thus _jq�day of November, 2015, by and between Peter Goulet and Colleen Goulet, d/b/a Morning Glory Cafe, of 61 Redwood Circle, Mashpee, Massachusetts 02649, (hereinafter referred to as "Seller") and Joshua Sodekson and Callie McCarthy of P.O. Box 363, Sagamore, Massachusetts 02561 (hereinafter referred to as "Buyer"). At the Buyer's option, Buyer may elect to have Buyer's nominee acquire the assets from the Seller, in which event all obligations of Buyer's nominee sliall be those set forth herein as the obligations of the Buyer. WHEREAS, Seller operates a business known as Morning Glory Cafe in the premises located at 211 Cotuit Road (Route 149), Marstons Mills, Massachusetts 02648; and WHEREAS, Buyer desires to purchase the assets of Morning Glory Cafe business, and Seller desires to sell the same, all on the terms and conditions set forth below. NOW, THEREFORE, the parties agree as follows: I . Purchase and Delivery of Assets a. Buyer agrees to purchase, and Seller agrees to sell the following assets of the business: i. All of Seller's tangible personal property used in connection with Morning Glory Cafe located within the premises at 211 Cotuit Road (Route 149), Marstons Mills, MA, including but not limited to equipment, furniture, fixtures, furnishings, shelving, and other improvements, software, the company website, customer data base, vendor lists, decorations, and accessories, all as set forth on Exhibit "A" attached hereto. Excluded from the sale is a hutch and two (2) sea glass pictures. Mountain Ash Realty Trust P.O. BOX 1224 HYANNIS, MA. 02601 November 16, 2015 Dr. Wayne Miller, Chairman c/o Thomas McKean, Director of Health Town of Barnstable 200 Main Street Hyannis, Ma. 02601 RE: 211 Rte 149, Marstons Mills — Morning Glory Dear Mr. Chairman: Please accept this letter as authorization from Mountain Ash Realty Trust (the owner and Landlord of the property located at 211 Rte. 149, Marstons Mills, MA) which grants permission to Peter and Colleen Goulet, the managers/ owners of Morning Glory (current tenants) and to Joshua Sodekson and Callie A. McCarthy (new tenents and future managers/ owners of Morning Glory) to represent Mountain Ash Realty Trust before the Barnstable Board of Health to request approval for the transfer of the business and to request a new variance to allow for one unisex bathroom. Please feel free to contact me at 1-(774)-238-9869 if there are any questions. Sincerely, u�� tiusi� John M. Falacci, Trustee Mountain. Ash Realty Trust EXCERPT FROM THE BOARD OF HEALTH MEETING MINUTES ON MAY 13, 2014: I. Hearing Show Cause — Food Establishment: Peter Goulet and Craig Larson, Morning Glory Cafe — 211 Route 149, Marstons Mills, violation of variance decision, failure to comply with order, insufficient septic system capacity, located within a saltwater estuary district. Upon a motion duly made by Dr. Canniff, seconded by Dr. Miller, the Board voted to grant a change in the variance letter dated 12/13/13 so that the first condition will read: 1) No more than five (5) seats total are authorized for dining purposes. The existing outdoor picnic tables and outdoor bench are not authorized and must be removed. For waiting purposes, four (4) Adirondack chairs without a table may be allowed outside. Indoors, two settee (soft seats), without a table in between them, may be allowed. (Unanimously, voted in favor.) EXCERPT FROM THE BOARD OF HEALTH MEETING MINUTES ON DECEMBER 10, 2013: II. Food Variance (Cont): Peter Goulet, Morning Glory Cafe — 211 Route 149, Marstons Mills, status regarding installation of a grease trap, seating. (continued from October 2013). Upon a motion duly made by Dr. Canniff, seconded by Mr. Sawayanagi, the Board voted to grant the food establishment with seating for 5 with the following conditions: all disposable paper / plastic plate ware and silverware, toilet variance to one unisex toilet for patrons provided allowed by the plumbing inspector; otherwise, the front toilet facility will be female and the rear toilet facility (accessed from outdoors) will be permitted. The variance letter for toilet facility will be granted to owner and will be posted next to food permit. Adirondack chairs will be allowed outside. (Unanimously, voted in favor.) Office: 508-862-4644 FAX: 508-790-6304 Mr. Craig Larson, and Mr. Peter Goulet 119 Route 149 Marstons Mills, MA 02648 Town of Barnstable 11 arnstable Board of Health Hyannis MA 0260 �l 200 Main Street, H D D r y S 2007 nno_ l Wayne Miller, M.D. Paul Canniff, D.M.D. Junichi Sawayanagi December 13, 2013 Revised Jan. 28, 2014 RE Variance to Operate a Food Establishment With'Fiv6,Seats 3at'211 Cotuit Road, MarstonsiMills, MA Dear Mr. Larson and Mr. Goulet, You, as the owner of this property, are granted a variance to utilize the existing toilet facility (or facilities) for the operation of a food establishment at 211 Cotuit Road, Marstons Mills. The variance granted is as follows: Section 322-4 Toilet Facilities To utilize one unisex restroom in lieu of the requirement to two provide separate male and female toilet facilities for male and female patrons and employees. However, if the State Plumbing Code does not allow for the use of a unisex bathroom at this building, both existing onsite restrooms shall be utilized, with the closest restroom to the patrons assigned to use by females only and the further inconveniently located restroom assigned to use by males only. The variance is granted with the following conditions: (1) No more than five (5) seats total are authorized for dining purposes. Outdoor picnic tables are not authorized. A waiting bench or an Adirondack chair may be allowed. This condition is in effect because of the limited capacity of the existing septic system onsite. C:\Users\wamdoc\Downloads\Excerpt BOH Multiple 2013-2014 211 Route 149 Morning Glory.doc Page 4 of 5 (2) Only disposable paper plates and plastic utensils shall be utilized. This condition is in effect because this particular establishment does not possess a mechanical dishwasher for washing plates and utensils. (3) This variance decision letter shall be posted on the wall adjacent to the food permit in an area which is easily accessible to be read by a health inspector anytime routine inspections are conducted. (4) This variance is not transferable to a different owner. In the event that this building and/or business is sold or transferred, both the owner of the building and the licensee have the duty to inform any and all potential purchasers of the existence of these variances and the fact the Board has explicitly made them non -transferable to another owner. Sincerely yours, Wayne Miller, M.D. Chairman Board of Health Town of Barnstable C:\Users\wamdoc\Downloads\Excerpt BOH Multiple 2013-2014 211 Route 149 Moming Glory.doc Page 5 Of 5 Morning Glory, 211 Route 149, Marstons Mills Excerpt from Board of Health Meeting Minutes on 08/20/13: I. Food Variance (New): A. Peter Goulet, Morning Glory Cafe — 211 Route 149, Marstons Mills, grease trap variance, seating for 8. Peter Goulet, owner of Morning Glory Cafe, was present and is requesting a grease trap variance. Mr. McKean stated the a letter dated 2003 stated no cooking or grilling of food allowed on the premises and if the business is sold or transferred, both the licensee and the owners of the property, Craig Larson and John Falacci, have the obligation to notify potential purchases that these conditions apply. Currently the food establishment has a 30 gallon grease trap which Mr. Goulet assured the Board that he is monitoring and cleaning. Mr. Goulet said he has two handicap bathrooms available to the rear of the building and he did have the landlord install a door up front so people can enter the hall and access the bathroom. Dr. Miller said they need a grease trap because they are in the groundwater protection zone. He said the grease trap is most important and with that installed, the bathroom variance can be addressed later. The whole building is permitted for 440 gallons/day. The building has a two - bedroom apartment upstairs so the allowable septic flow for the food establishment would only allow three seats. The engineer wrote a letter calculating the use for the building but based it on 572 gallons/day and the permit only allows for 440 gallons. For the regular menu (not being fast food), the regulations are based on 35/gal/seat. Therefore, only three seats are available unless the use for the office in the building or the apartment uses changes. Dr. Miller asked Tom McKean if he would be comfortable with a trapzilla grease trap at this location. The Board informed the applicant that the Barnstable Market by the Courthouse has one and he might speak with them and determine whether it would be less expensive for him. Mr. Goulet mentioned a number of his patrons are elderly and would appreciate a place to sit while waiting. The Board said he can add a bench and take out the excess seats, leaving a table and three seats. The outside seats may exist without a table there so people can wait. They recommended visiting Nirvana in Barnstable to see how they are set up. C:\Users\wamdoc\Downloads\Excerpt BOH Multiple 2013-2014 211 Route 149 Morning Glory.doc Page 1 of 5 Mr. Sawayanagi said there are ways to reduce the grease in the meantime. Mr. Goulet will adjust his ingredients and will use only pre-cooked chicken or deli chicken for now. He'll buy pre-cooked bacon, as well. Upon a motion duly made by Dr. Miller, seconded by Mr. Sawayanagi, the Board voted to continue this to the October 8, 2013 meeting with the condition that (1) the owner develop a revised menu to reduce the grease level until the October 8 meeting then will discuss whether a trapzilla will be installed or revise the menu permanently, and (2) reduce the seating to three seats and will allow waiting benches for the customers. (Unanimously, voted in favor.) Excerpt from Board of Health Meeting Minutes on 10/08/13: B. Peter Goulet, Morning Glory Cafe — 211 Route 149, Marstons Mills, status on grease trap, seating for 8 (continued from August 2013). Peter Goulet said he looked into the different types of grease traps. The Trapzilla was an issue because it could not be installed in the parking lot. They a going to install a conventional 1,000 gallon grease trap as it will be able to be installed in the parking lot. Yankee Land Surveying is in the process of drawing up plans and Peter hopes the permits will be approved next week. Dr. Miller and Mr. McKean acknowledged that, once completed, the cooking issue will be resolved. Mr. McKean said the seating is another issue and has two separate parts. One is to determine exactly how many gallons are available in the septic system after all the other uses in building are calculated and the other is that there is one bathroom inside and one bathroom outside and he doesn't know if the Board will approve any seating if the people must access a bathroom outside. Dr. Miller said the Board had talked about three seats plus a bench for people waiting. Mr. McKean said that was just a quick calculation. Dr. Miller suggested Mr. Goulet have an engineer determine the usage of the other spaces in the building and a more accurate calculation for the food establishment's space. Mr. Goulet said he will do that. Peter Goulet said the Board had recommended going to Nirvana. He said he had done that and he has since taken out two sets of tables and put in a settie with a lamp table to lessen his seating. Upon a motion duly made by Mr. Sawayanagi, seconded by Dr. Canniff, the Board voted to grant an extension until November 12, 2013 meeting. (Unanimously, voted in favor.) C:\Users\wamdoc\Downloads\Excerpt BOH Multiple 2013-2014 211 Route 149 Moming Glory.doc Page 2 of 5 Excerpt from Board of Health Meeting Minutes on 11/12/13: D. Peter Goulet, Morning Glory Cafe — 211 Route 149, Marstons Mills, status regarding installation of a grease trap, seating. (continued from October 2013). Peter Goulet must return to the December meeting to present the engineer's daily flow calculations which the owner of the property had done. Depending on what the engineer's daily flow shows, there may be availability for more seating. Mr. Goulet said the owner, Craig Larson, was heading to the Health Division to obtain the permit for the grease trap. The Board said with the grease trap installed, he will be able to return to his full menu. Upon a motion duly made by Dr. Miller, seconded by Dr. Canniff, the Board voted to continue to the December 10, 2013 meeting. Excerpt from Board of Health Meeting Minutes on 12/10/13: II. Food Variance (Cont): Peter Goulet, Morning Glory Cafe — 211 Route 149, Marstons Mills, status regarding installation of a grease trap, seating. (continued from October 2013). Upon a motion duly made by Dr. Canniff, seconded by Mr. Sawayanagi, the Board voted to grant the food establishment with seating for 5 with the following conditions: all disposable paper / plastic plate ware and silverware, toilet variance to one unisex toilet for patrons provided allowed by the plumbing inspector; otherwise, the front toilet facility will be female and the rear toilet facility (accessed from outdoors) will be permitted. The variance letter for toilet facility will be granted to owner and will be posted next to food permit. Adirondack chairs will be allowed outside. (Unanimously, voted in favor.) C:\Users\wamdoc\Downloads\Excerpt BOH Multiple 2013-2014 211 Route 149 Moming Glory.doc Page 3 of 5 Morning Glory Cafe 211 Cotuit Road Route 149 Marstons Mills, MA 02649 May 1, 2014 To: Sharon I wish to appeal the violation on 5/1/2014. 1 would like to request getting on the docket for a hearing on June 10, 2014 at the Board of Health meeting. Sincerely Peter Goulet ye� AL&'6- NAP o06 13ARNSTABI,E. 9 MASS. . Town of Barnstable Board of Health Office: 508-862-4644 FAX: 508-790-6304 LOCATION Property Address: 200 Main Street, Hyannis MA 02601 VA ikNCE REQUEST FORM Assessor's Map and Parcel Number: 010 /" Size of Lot: FEE : 4 K 4,.qj REC. BY SCHED . DATE Li Wayne A. Miller, M.D. Junichi Sawayanagi Paul J. Canniff, D.M.D. Wetlands Within 300 Ft. Yes Business Name: mnrf?/f 6/(JL[,,l �-o No Subdivision Name: V APPLICANT'S NAME: 'R/er rnCscsu� Phone 60,?j1 ?� 5,V& Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON Name: r;f Name: Address: %�� �� 4/9 Moj� -� '7 ml II SAddress: Phone: 56F, Phone: VARIANCE FROM REGULATION (List Reg.) NATURE OF WORK: House Addition ❑ REASON FOR VARIANCE (May attach if more space needed) House Renovation ❑ Repair of Failed Septic System ❑ Checklist (to be completed by office staff -person receiving variance request application) Please submit copies in 4 separate completed sets. Four (4) copies of the completed variance request form Four (4) copies of engineered plan submitted (e.g. septic system plans) Completed seven (7) page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian �— Four (4) copies of labeled dimensional floor plans submitted (e.g. house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request AApplicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense ----(for Title V and/or local sewage regulation variances only) Full menu submitted (for grease trap variance requests only) t" P r--.) ---I L/ Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance rerre _ als [same owfler/lessC-only], outside dining variance renewals [same ownerfleasee only], and variances to repair failed sewage disposal systems [only if nq;:expansion'to the building proposed]) Variance request submitted at least 15 days prior to meeting date .] 6 VARIANCE APPROVED Wayne Miller, Cljairman NOT APPROVED Junichi Sawayan4gt REASON FOR DISAPPROVAL Paul J. Canniff, D.M.D. i.) C:.\cache\Te 03 , mporary Internet Files\OLKAE\VARIREQ.DOC 4( a, i Town of Barnstable Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Mr. Craig Larson, and Mr. Peter Goulet 119 Route 149 Marstons Mills, MA 02648 Barnstable 2007 Wayne Miller, M.D. Paul Canniff, D.M.D. Junichi Sawayanagi December 13, 2013 Revised Jan. 28, 2014 RE: Variance to Operate a Food Establishment With Five Seats at 211 Cotuit Road, Marstons Mills, MA Dear Mr. Larson and Mr. Goulet, You, as the owner of this property, are granted a variance to utilize the existing toilet facility (or facilities) for the operation of a food establishment at 211 Cotuit Road, Marstons Mills. The variance granted is as follows: Section 322-4 Toilet Facilities To utilize one unisex restroom in lieu of the requirement to two provide separate male and female toilet facilities for male and female patrons and employees. However, if the State Plumbing Code does not allow for the use of a unisex bathroom at this building, both existing onsite restrooms shall be utilized, with the closest restroom to the patrons assigned to use by females only and the further inconveniently located restroom assigned to use by males only. The variance is granted with the following conditions: (1) No more than five (5) seats total are authorized for dining purposes. Outdoor picnic tables are not authorized. A waiting bench or an Adirondack chair may be allowed. This condition is in effect because of the limited capacity of the existing septic system onsite. (2) Only disposable paper plates and plastic utensils shall be utilized. This condition is in effect because this particular establishment does not possess a mechanical dishwasher for washing plates and utensils. (3) This variance decision letter shall be posted on the wall adjacent to the food permit in an area which is easily accessible to be read by a health inspector anytime routine inspections are conducted. Q:\Variances\MomingGloryCafe20l3.doc (4) This variance is not transferable to a different owner. In the event that this building and/or business is sold or transferred, both the owner of the building and the licensee have the duty to inform any and all potential purchasers of the existence of these variances and the fact the Board has explicitly made them non -transferable to another owner. Sincerkly yours, Wayne I /Viller, M.D. Chairman Board of Health Town of Barnstable Q:\Variances\MomingGloryCafe20l3.doc Barnstable Town of Barnstable,, Board of Health `�/,,`A .0 Dm 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 FAX: 508-790-6304 Mr. Craig Larson, and Mr. Peter Goulet 119 Route 149 Marstons Mills, MA 02648 RE: Variance to Operate a Food Establishment With Five Seats at 211 Cotuit Road, Marstons Mills, MA Dear Mr. Larson and Mr. Goulet, Wayne Miller, M.D. Paul Canniff, D.M.D. Junichi Sawayanagi December 13, 2013 You, as the owner of this property, are granted a variance to utilize the existing toilet facility (or facilities) for the operation of a food establishment at 211 Cotuit Road, Marstons Mills. The variance granted is as follows: Section 322-4 Toilet Facilities To utilize one unisex restroom in lieu of the requirement to two provide separate male and female toilet facilities for male and female patrons and employees. However, if the State Plumbing Code does not allow for the use of a unisex bathroom at this building, both existing onsite restrooms shall be utilized, with the closest restroom to the patrons assigned to use by females only and the further inconveniently located restroom assigned to use by males only. The variance is granted with the following conditions: (1) No more than five (5) seats are authorized. This condition is in effect because of the limited capacity of the existing septic system onsite. (2) Only disposable paper plates and plastic utensils shall be utilized. This condition is in effect because this particular establishment does not possess a mechanical dishwasher for washing plates and utensils. (3) This variance decision letter shall be posted on the wall adjacent to the food permit in an area which is easily accessible to be read by a health inspector anytime routine inspections are conducted. (4) This variance is not transferable to a different owner. In the event that this building and/or business is sold or transferred, both the owner of the building Q:\Variances\MomingGloryCafe20l3.doc r and the licensee have the duty to inform any and all potentia l purchasers of the • existence of these variances and the fact the Board has .explicitly made them non -transferable to another owner. r Sincerely yo s, W yn Miler, M.D. Chair an Board of Health Town of Barnstable v- Od& • E + BARNSTAES 9 MASS. m 039. QED Mp'l.a Bard ®f Health 200 Main Street, Hyannis MA 02601 Office: 508-862 4644 FAX: 508-790-6304 CE REQUEST FORM LOCATION Property Address: Assessor's Map and Parcel Number: Size of Lot: aZ /064 ae 1.3 FEE: � '� (,.re,e REC. SCHED Wetlands Within 300 Ft. Yes Business Name: MOM /f�,/ /ao CO& No Subdivision Name: I BY _9q_111 DATE a001;4/3 Wayne A. Miller, M.D. Junichi Sawayanagi Paul J. Canniff, D.M.D. APPLICANT'S NAME: kr - .&Ujc-� Phone 5ag,31 �, 5q& Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PE RS - N Name: Name: t Address: / 19 R+ I LI7p —�` (}n �" / IICAddress: C./ ), �. - Phone: 56 9 - Yd 9 - q/ 9,57_ Phone: VARIANCE FROM REGULATION (List Reg.) NATURE OF WORK: House Addition ❑ REASON. FOR VARIANCE (May attach if more space needed) t&el"r, t -�3 oe" A,. ft' , we House Renovation ❑ Repair of Failed Septic System ❑ Checklist (to be completed by office staff -person receiving variance request application) Please submit copies in 4 separate completed sets.. �! Four (4) copies of the completed variance request form nKfj/r'i,�tj Four (4) copies of engineered plan submitted (e.g. septic system plans) Completed seven (7) page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian _,- Four (4) copies of labeled dimensional floor plans submitted (e.g. house plans or restaurant kitchen plans) L-- Signed letter stating that the property owner authorized you to represent him/her for this request qf, Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) _u11 menu submitted (for grease trap variance requests only) ry Variance request application fee collected no fee for lifeguard modification renewals, p "a eq PP ( g grease trap variance rerie,��s [same o���e�/lessee�nly], outside dining variance renewals same owner/leasee only ), y], and variances to repair failed sewage disposal sysfetps,„[only if no expansion°t4 the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED NOT APPROVED REASON FOR DISAPPROVAL • C:.\cache\Temporary Internet Files\OLKAE\VARIREQ.DOC Wayne Miller, Chairman Junichi Sawayanagj Paul J. Canniff, D?M.D. 1 To: Wadlington, Ellen Subject: Morning Glory Hi Ellen, Their permit has 0 seats listed on it. I dug through their file, it looks like the Board of Health gave them 5 seats, which is what Tom wants the permit to say. Note: they can also have 4 Adirondack chairs and 2 soft chairs...) but Tom just wants 5 on the permit. Once we update it, could you please mail them a revised permit. Thanks, David 3/20/2015 tlxdhisive Brokerage ltx4g G. La son 119 Rt. 149 Marstons Mills, MA 02648 P: 508-428-9198 Ext. 12 F: 508-420-5553 Craigglarson @comcast.net Town of Barnstable Board of Health 200 Main Street Hyannis, MA 02601 August 5, 2013 Dear Sirs, This letter is to confirm that Peter Goulet has my permission to represent myself in the request of variance of in ground / above ground grease trap requirements. If you have any questions please feel free to contact me at any time. Many Thanks, Craig Larsen �� Morning Glory Cafe, 211 Route 149, Marstons Mills: Excess seating complaint narrative History: Several Board of Health hearings. On December 10, 2013, the most recent Board of Health Hearing, The Board voted to allow a variance for 5 seats and Adirondack chairs. Complaint Investigation: -On April 16th, 2014 The Health Division received an anonymous complaint about the Morning Glory Cafd having too many seats. -On April 181h, 2014 Health Inspector David Stanton, RS conducted a complaint investigation about the Morning Glory cafe having too many seats. David spoke with the owner of the business, Peter Goulet, about the complaint of too many seats. Peter explained that the Board of Health said he could have all the Adirondack chairs. David explained to Peter that after reviewing the variance and consulting with the Health Director, they could have 5 seats indoors and 2 Adirondack chairs for waiting customers outside. Seating observed during the complaint investigation: Outside: 2 waiting benches, 2 chairs and a table, 4 Adirondack Chairs, 2 picnic tables and a garden bench Inside: 10 seats observed inside -On April 291h, 2014 another anonymous complaint came in stating the Morning Glory Cafe still has too many seats and a photo was submitted showing patrons eating at one of the picnic tables. -On May 1st, 2014 Health Inspector David Stanton, RS investigated the complaint of too many seats still present at the Morning Glory Cafe. David Spoke with Colleen and Peter Goulet about the complaint again of too many seats and provided them with the photo submitted showing patrons eating at the picnic table. Seating observed during the complaint investigation: Outside: 2 waiting benches, 4 Adirondack Chairs, 2 picnic tables and a garden bench Inside: 11 seats total (9 "hard" seats and 2 "soft" seats) Order was issued on the inspection report stating "You must remove all additional seating which is not authorized before Monday May 5th, 2014 or $100/day tickets and/or show cause hearing on food permit violation." Furthermore it states "You may only have 5 (five) seats indoors and either 2 (two) Adirondack chairs or 1 (one) waiting bench for customers waiting." -On May 5th, Health Inspector David Stanton, RS followed up with the order issued on May 1St to have all additional seating removed. Seating observed during the follow up investigation: Outside: 2 waiting benches, 4 Adirondack chairs, 2 picnic tables Inside: 5 "hard" seats and 2 "soft" seats. ': Peter asked David to include in the report that the extra indoor "hard" seats were removed, which David included. David contacted the Health Director, Thomas McKean, RS, CHO to let him know of the follow up investigation status and that most of the additional seating outside was still present. Thomas asked David to remind Peter that he must remove the addition seats per order of the Chairman of the Board of Health. Peter did not wish to sign the report, so David noted this and handed him the order. It was determined that a show cause hearing will be held. lqe) i% N W E S YANKEE LAND SURVEY CO. INC. .119 Route .149, Afarstoi6 Milk MA 02648 phone: (.508)428-0055 fax: (508)420-.5553 Yankeesurve conicastatel I yO wsvw.yankeesu,rveVxotn Thomas Mckean Town of Barnstable -Health Division 200 Main street Hyannis MA October 8, 2013 This letter is to confirm that thisfifm is in the process of designing a 0 1000 gallon grease trap plan for the property at 211 Route 149 Marstons zn . P Mills. The design will beready ]or permitting, at. the en,d of this week. z­ Because of the existing building and existing sys tem. we had to look at a. 1 4:1 number of optious, bUt fee] We have the answer today. Man. y Thank--,, o c k . I M.00i-e Message Page 1 of 2 McKean, Thomas From: McKean, Thomas Sent: Monday, December 09, 2013 4:06 PM To: Crocker, Sharon; 'Wayne Miller'; 'Paul' Subject: RE: BOH Dec 10, 2013 - Food - Morning Glory Restaurant I was informed this afternoon that Mr. Larson called and he does not want to attend this meeting. I suggest he should be there to answer any questions which may arise from the Board. SEPTIC CALCULATIONS I compared the latest calculations on the November 2013 grease trap plan signed by David Mason, R.S. (Sandwich Health Agent) versus a submitted 2003 document signed by William Lieberman, P.E. (now deceased) and Stephen Doyle, RLS 2003 calculations. (NOTE : In 2002, the septic system was designed for a four bedroom dwelling. The system, consisting of four chambers, [42' X 13.2' X 2] can apparently handle up to 572 gpd). a. The amount of office space does not match up (2,400 sq. ft office space in 2003 versus only 708 sq. ft. now) . b. The amount of retail space does not match up ( 714 sq. ft. in 2003 versus zero now?) c. The number of bedrooms do not match -up ( zero bedrooms in 2003 versus two now?) Did this building go from four bedrooms in 2002, to zero in 2003, then to two bedrooms today? d. Are the apartment rooms offered for rent? If yes, they must be registered with the Health Division. CONCLUSION The November 2013 grease trap plan was designed by a Registered Sanitarian and usually we accept the information submitted as being accurate, however- I do have a number of questions that. could only be answered by the owner and/or the engineer. -----Original Message ----- From: Crocker, Sharon Sent: Monday, December 09, 2013 1:10 PM To: McKean, Thomas Subject: FW: BOH Dec 10, 2013 - Food - Morning Glory Restaurant -----Original Message----- From: Paul Canniff [mailto:canniff.paul@gmail.com] Sent: Monday, December 09, 2013 12:16 PM To: Crocker, Sharon Cc: Jimmy Sawayanagi; Wayne Miller, M.D. Subject: Re: BOH Dec 10, 2013 - Food - Morning Glory Restaurant I meant "Does all the staff think these figures are correct" ? PJC On Mon, Dec 9, 2013 at 12:14 PM, Paul Canniff <cannif£paulggmail.com> wrote: Does all PJCthe staff think that these figures are correct ? E 12/9/2013 Auq.20.2013 08:30 AM Lady Slipper Stationery AN ADA&Sip INTEGRATFO PRST NIANAUMF.NT PR0111.F.m ANIMAL CONTROL A(;E.NT Craig Larson Exclusive Brokerage of Cape Cod 119 Route 149 Marstons Mills, MA 02649 5083946161 Site Location: Morning Glory Cafe, 211 Route 149, Marstons Mills To whom it may concern: Ants, etc. Is treating and monitoring the property at 211 Route 149, Marstons Mills For Ants, etc. John J. Leone, President SERVING ALL OF CAVE COD NIARSIONS M11.1.S, MA 02648 5, or Mice. (508) 428-3086 (S08)255-3113 (SOS)540-4554 �io Office: 508-862-4644 FAX: 508-790-6304 LOCATION Property Address: Assessor's Map and Parcel Number: Town of Barnstable Board of Health. 200 Main Street, Hyannis MA 0260 VARIANCE REQUEST FORM Size FEE:- REC. BY , 2434 SCHED. DATE49 i ayne Miller, M.D. u Sa . aul 1. Ca ff, D.a Wetlands Within 300 Ft. YesBusiness e: /ULC 1 No Sub sion Name: AYYLICANT'S NAME: % Phone Did the owner of the property authorize you to represent him or er. es _ PROPERTY OWNER'S NAME CONTACT PERSON Name: j/sn Name: Address: 119 R+ 149 9 mbz-T()f7 c / ��Address: Phone: �� p " �! �� Phone: VARIANCE FROM REGULATION (List Reg.) NATURE OF WORK: House Addition ❑ No REASON FOR VARIANCE (May attach if more space needed) g 3got —'3 House Renovation ❑ Repair of Failed Septic System ❑ Checklist (to be completed by office staff -person receiving variance request application) CPlease submit copies in 4 separate completed sets. Four (4) copies of the completed variance request form Four (4) copies of engineered plan submitted (e.g. septic system plans) Completed seven (7) page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian Four (4) copies of labeled dimensional floor plans submitted (e.g. house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request H Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense —,---(for Title V and/or local sewage regulation variances only) Full menu submitted (for grease trap variance requests only) r j Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance re iais [same 6214erIles©only], outside dining variance renewals [same owner/leasee only], and variances to repair failed sewage disposal 7s.t,4s [only if nd-dkpansiorr'to the building proposed]) ' { Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller, Cgairman NOTAPPROVED Junichi Sawa an' i REASON FOR DISAPPROVAL Paul J. CannifT g.M.D. 9 eJ C:\cache\Temporary Internet Files\OLKAE\VARIREQ.DOC C0 /-'?I ,.1p Excerpt from the Board of Health Meeting Minutes on August 20, 2013 I. Food Variance (New): A. Peter Goulet, Morning Glory Cafe — 211 Route 149, Marstons Mills, grease trap variance, seating for 8. Peter Goulet, owner of Morning Glory Cafe, was present. Mr. McKean stated the owner of the property was suppose to inform all new owners of the condition that no food was allowed to be cooked on the premises. Currently the food establishment has a 30 gallon grease trap which Mr. Goulet assured the Board that he is monitoring and cleaning. Mr. Goulet said he has two handicap bathrooms available to the rear of the building and he did have the landlord install a door up front so people can enter the hall and access the bathroom. Dr. Miller said their need a grease trap because they are in the groundwater protection zone. He said the grease trap is most important and with that installed, the bathroom variance can be addressed later. The whole building is permitted for 440 gallons/day. The building has a two - bedroom apartment upstairs so the allowable septic flow for the food establishment would only allow three seats. The engineer wrote a letter calculating the use for the building but based it on 572 gallons/day and the permit only allows for 440 gallons. For the regular menu (not being fast food), the regulations are based on 35/gal/seat. Therefore, only three seats are available unless the use for the office in the building or the apartment uses changes. Dr. Miller asked Tom McKean if he would be comfortable with a trapzilla grease trap here. The Board informed the applicant that the Barnstable Market by the Courthouse has one and he might speak with them and see if it would be less expensive. Mr. Goulet mentioned a number of his patrons are elderly and would appreciate a place to seat while waiting. The Board said he can add a bench and take out the excess seats, leaving a table and three seats. The outside seats may exist without a table there so people can wait. They recommended visiting Nirvana in Barnstable to see how they are set up. Upon a motion duly made by Dr. Miller, seconded by Mr. Sawayanagi, the Board voted to continue this item to the October 8, 2013 meeting. (Unanimously, voted in favor.) Q:WIINUTES\EXCERPT OF MINUTES\Excerpt BOH Aug 2013 Morning Glory Cafe Rte 149 MM.doc a EXCERPT FROM THE BOARD OF HEALTH MEETING MINUTES ON AUGUST 20, 2013: I. Food Variance (New): A. Peter Goulet, Morning Glory Cafe — 211 Route 149, Marstons Mills, grease trap variance, seating for 8. Peter Goulet, owner of Morning Glory Cafe, was present and is requesting a grease trap variance. Mr. McKean stated the a letter dated 2003 stated no cooking or grilling of food allowed on the premises and if the business is sold or transferred, both the licensee and the owners of the property, Craig Larson and John Falacci, have the obligation to notify potential purchases that these conditions apply. Currently the food establishment has a 30 gallon grease trap which Mr. Goulet assured the Board that he is monitoring and cleaning. Mr. Goulet said he has two handicap bathrooms available to the rear of the building and he did have the landlord install a door up front so people can enter the hall and access the bathroom. Dr. Miller said they need a grease trap because they are in the groundwater protection zone. He said the grease trap is most important and with that installed, the bathroom variance can be addressed later. The whole building is permitted for 440 gallons/day. The building has a two - bedroom apartment upstairs so the allowable septic flow for the food establishment would only allow three seats. The engineer wrote a letter calculating the use for the building but based it on 572 gallons/day and the permit only allows for 440 gallons. For the regular menu (not being fast food), the regulations are based on 35/gal/seat. Therefore, only three seats are available unless the use for the office in the building or the apartment uses changes. Dr. Miller asked Tom McKean if he would be comfortable with a trapzilla grease trap at this location. The Board informed the applicant that the Barnstable Market by the Courthouse has one and he might speak with them and determine whether it would be less expensive for him. Mr. Goulet mentioned a number of his patrons are elderly and would appreciate a place to sit while waiting. The Board said he can add a bench and take out the excess seats, leaving a table and three seats. The outside seats may exist without a table there so people can wait. They recommended visiting Nirvana in Barnstable to see how they are set up. Page 1 of 3 C:\Users\stantond\AppData\Local\Microsof3\Window8\Temporary Intemet Files\OLK103\Excerpt BOH Multiple 2013-2014 211 Route 149 Morning Glory.doc a OCTOBER 8, 2013: -e Mr. Sawayanagi said there are ways to reduce the grease in the meantime. Mr.Goulet will adjust his ingredients and will use only pre-cooked chicken or deli chicken for now. He'll buy pre-cooked bacon, as well. Upon a motion duly made by Dr. Miller, seconded by Mr. Sawayanagi, the Board voted to continue this to the October 8, 2013 meeting with the condition that (1) the owner develop a revised menu to reduce the grease level until the October 8 meeting then will discuss whether a trapzilla will be installed or revise the menu permanently, and (2) reduce the seating to three seats and will allow waiting benches for the customers. (Unanimously, voted in favor.) FRAM TNF BOARD OF 111i1_1LI II 1VLl. L1111N%J 1V111V U LLo L/1V PA B. Peter Goulet, Morning Glory Cafe — 211 Route 149, Marstons Mills, status on grease trap, seating for 8 (continued from August 2013). Peter Goulet said he looked into the different types of grease traps. The Trapzilla was an issue because it could not be installed in the parking lot. They a going to install a conventional 1,000 gallon grease trap as it will be able to be installed in the parking lot. Yankee Land Surveying is in the process of drawing up plans and Peter hopes the permits will be approved next week. Dr. Miller and Mr. McKean acknowledged that, once completed, the cooking issue will be resolved. Mr. McKean said the seating is another issue and has two separate parts. One is to determine exactly how many gallons are available in the septic system after all the other uses in building are calculated and the other is that there is one bathroom inside and one bathroom outside and he doesn't know if the Board will approve any seating if the people must access a bathroom outside. Dr. Miller said the Board had talked about three seats plus a bench for people waiting. Mr. McKean said that was just a quic ca cu a Ion. `­Dr.iller suggested Mr. Goulet have an engineer determine the usage of the other spaces in the building and a more accurate calculation for the food establishment's space. Mr. Goulet said he will do that. Peter Goulet said the Board had recommended going to Nirvana. He said he had done that and he has since taken out two sets of tables and put in a settie with a lamp table to lessen his seating. Upon a motion duly made by Mr. Sawayanagi, seconded by Dr. Canniff, the Board voted to grant an extension until November 12, 2013 meeting. (Unanimously, voted in favor.) Page 2 of 3 C:\Users\stantond\AppData\Local\Microsoft\Windows\Temporary Intemet Files\OLK103\Excerpt BOH Multiple 2013-2014 211 Route 149 Morning Glory.doc . ,! M THE BOARD OF HEALTH NOVEMBER 12, 2013: G MINUTES ON "CO C. Peter Goulet, Morning Glory Cafe — 211 Route 149, Marstons Mills, status regarding installation of a grease trap, seating. (continued from October 2013). Peter Goulet must return to the December meeting to present the engineer's daily flow calculations which the owner of the property had done. Depending on what the engineer's daily flow shows, there may be availability for more seating. Mr. Goulet said the owner, Craig Larson, was heading to the Health Division to obtain the permit for the grease trap. The Board said with the grease trap installed, he will be able to return to his full menu. Upon a motion duly made by Dr. Miller, seconded by Dr. Canniff, the Board voted to continue to the December 10, 2013 meeting. EXCERPT FROM THE BOARD OF HEALTH MEETING MINUTES ON DECEMBER 10, 2013: q(/�i �odgLli ck-i rt ov4ik II. Food Variance (Cont): Peter Goulet, Morning Glory Cafe — 211 Route 149, Marstons Mills, status regarding installation of a grease trap, seating. (continued from October 2013). Upon a motion duly made by Dr. Canniff, seconded by Mr. Sawayanagi, the Board voted to grant the food establishment with seating for 5 with the following conditions: all disposable paper / plastic plate ware and silverware, toilet variance to one unisex toilet for patrons provided allowed by the plumbing inspector; otherwise, the front toilet facility will be female and the rear toilet facility (accessed from outdoors) will be permitted. The variance letter for toilet facility will be granted to owner and will be posted next to food permit. Adirondack chairs will be allowed outside. (Unanimously, voted in favor.) Page 3 of 3 C:\Users\stantondWppData\Local\Microsoft\Windows\Temporary Internet Files\OLK103\Excerpt BOH Multiple 2013-2014 211 Route 149 Morning Glory.doc J Mr. Craig Larson Exclusive Brokerage of Cape Cod 119 Route 149 Marston Mills, MA 02648 RE: Title V Flow Calculations for 211 Route 149, Marston Mills Proposed Residential @ 2 bedrooms = 220 GPD Proposed Office Use = 708 sq.ft. Proposed Retail Use = 714 sq.ft. Total Proposed office and Retail= 1422 sq.ft. @ most restrictive flow rate = 1422/1000 = 1.42 x 75 = 106 GPD Total Existing System Design Capacity = 572 GPD (Per System Installation of 2003) Total Required Flow = 220+106 = 326 GPD Total Reserve Flow = 246 GPD Sincerely, William Liebgxrhan PE Stephen Boyle PLS Wi r^LwjvrH. MA G7d036 506 640.4t53s F—. So* 54o 2 s 34 (c..,_6 r.,%Ti Mq 29. 2003 Mt. Craig Larson Exclusive Brokerage of Cape Cod ll9ItOutt 149 Mrustons Mills, MA 02648 RF., Tide V Flow C'Ieubhoas for211 Route 14e, Marmas Miib Proposed Ofee Use 2400 sq_R. Proposed Retail Use = 714 s4A Total Proposed - 3114 sq. (t. r, must WAtrictive flow rate 3114//000 %- 3.11 x "S = 234 GPU Total Exudes 4yrtem Dmign C'opaelty - 572 GPD (Per System lnstansdad of 2003) Tote) Required Floo — 234-GPD T*W Reelrtie Film + IM GIRD Stephen Doyle SD/tf i0 3naa S..Lviocsst/ 3-1f.Oc ve9io175eo5 ECG:az-Iowez; 5i 1*4 Fro J� f l Town of Barnstable Bard of Health P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 FAX: 508-790-6304 Ms. Patricia Mitrokostas 30 Preakness Way Marstons Mills, MA 02648 Dear Ms. Mitrokostas: Susan G. Rask, R.S. Sumner Kaufman, MSPH Wayne Miller, M.D. November 21, 2003 On November 18, 2003, you appeared before the Board of Health to request a variance from the Board of Health Regulation PART II, Section 1.00, Regulation #3- Plumbing, which requires inground grease traps at all food establishments (with a minimum capacity of 1,000 gallons). You are granted a conditional variance from this Board of Health Regulation in order to operate a food establishment, without connecting sinks into a minimum 1,000 gallon grease trap as required. The variance is granted with the following conditions: (1) No cooking or grilling of food will be allowed. Only store-bought "pre - made" cookies, bagels, buns, and bread may be heated. (2) Only disposable single service paper, plastic,. and other disposable dishes and utensils are authorized. (3) An under -the -sink grease interceptor shall be installed in accordance with the State Plumbing Code. (4) . The under -the -sink grease interceptor shall be cleaned monthly. (5) This variance decision letter shall be posted on the wall adjacent to the food service permit for future viewing of health inspectors during inspections. , Q: Nibbles-n-Sips In the event that this business is sold or transferred, both the current licensee and the owner have the duty to inform any and all potential purchasers of the existence of these variances and the fact the Board has explicitly made them non -transferable. This variance may be revoked anytime unsanitary conditions are observed. BOARD ,OF HEALTH TOWN OF BARNSTABLE Q: Nibbles-n-Sips SALADS 1 $8.s'o Spinach Salad — Baby spinach with chicken, baby spinach, hard-boiled egg, goat cheese Chef Salad — Mixed greens with sliced ham, turkey & Swiss cheese, and hard-boiled egg The Lina — Mixed greens with humus, tabouli, feta cheese, kalamata olives & Bermuda onion The Beckett — Mixed greens with grilled chicken, goat cheese, sweet craisins & toasted walnuts "Make Your Own" — Mixed greens with tomato, cucumber & olives with choice of chicken'or tuna salad, roasted turkey or grilled chicken and choice of cheese ' Dressings: House Balsamic Vinaigrette - Greek - Honey Mustard Russian - Blue Cheese (add .75) VEGETARIAN WRAPS I $7.9f South of the Border — Refried beans, Monterey Jack, tomato & avocado The Medi — Humus, tabouli, lettuce, tomato & onion Very Veggie — Avocado, lettuce, tomato, kalamata olives, mushroom, sunflower seeds, feta cheese tossed with Greek vinaigrette GLUTEN FREE I ,$`8.1'o Served in crisp lettuce wraps Chicken, Swiss cheese, tomato, & spicy mayonnaise Hummus & tabouli, feta cheese, onion & tomato ikoast turkey, tomato, cheddar cheese & mayonnaise THE GOULET FAMILY TRADITION Whether it's for breakfast or lunch, enjoy a relaxing Cape Cod atmosphere. Morning Glory safe speciali-Zes in fresh baked muffins, sandwiches & burritos for breakfast. Or join us for lunch with unique pressed sandwiches, homemade soups, chowder and fresh s5Flads. Be sure to grab some of our sinful cookies and baked goods to round out your trip. -PETER & COLLEEN GsOULET, CHEFS & OWNERS TAKE-OUT I CATERING 2II COTUIT ROAD, AT. I4.9 IMARSTON MILLS MA.. HOURS: 7AM 3PM, DAILY PHONE: f08.4.2,$.IIIf EMAIL: CCMORNINGGLORY@GMAIL.COM W W W.CCMORNINGGLORY.0 OM Morning -Glory Cafe BEVERAGES We're proud to feature Jims Organic Coffee — Dark, Light & Italian Roasts Coffee & Tea $z.611$I.81' Iced Coffee & Iced Tea $1.9S' I $2 +.f Bottled Beverages $2.00 ' BASED GOODS & QUICK BITES Muffins & Fresh Croissants $z.95, Bagel $1.75' - with cream cheese, add. S o Yogurt with Colleen's Homemade Granola $3.91' Quiche of the Day $6.91, with fresh fruit, add $2 On the Go Egg Sandwich - English muffin, egg any style, with your choice of Swiss or American cheese, & bacon or ham $3.95- Toasted Bagel, add $.po .' BREAKFAST BURRTTO All breakfast burritos served with two eggs unless requested. Morning Glory Burrito — Eggs, bacon or ham, cheddar or American $¢9:' Working Man's Burrito — Eggs, roasted red peppers, mushroom, onion, chorizo and cheddar cheese $¢9S' The CoCo — Eggs, spinach, tomato, feta cheese & olive tapenade $¢9r The Veggie Burrito — Eggs, spinach, tomato & goat cheese $¢91, The Italian - Eggs, imported ham, pesto, tomato & Mozzarella cheese $1'•93' The Golfer - Eggs, apple, imported ham & cheddar cheese $3'.91' The Debutante — Eggs, bacon, spinach, mushrooms and Swiss cheese $5,91, Olive Oil — Eggs, spinach, tomato, bacon -& cheddar cheese $1,91, Sausage — Eggs,!sausage, eggplant, tomato & Swiss cheese $S93' Portuguese —,Eggs, Chorizo, caramelized onions & cheddar cheese $3.91- SOUP & CHOWDER Soup of the Day $3.93' I $493' Wicked Fish Chowder $¢95' 1 $3,91, PRESSED SANDWICHES I $7.91' The Californian — Chicken, fresh sliced avocado, baby spinach, tomato, Monterey Jack cheese & bacon The Rueben —.Corned beef. Sauerkraut, Swiss cheese and Russian dressing on Marble Rye The Landscaper Roast turkey, bacon, baby spinach, Monterey Jack & honey mustard The Gardener — Eggplant, roasted red pepper, onion, tomato, olive tapenade & feta cheese WRAPS 1 $7.91' The Pilgrim —Roast turkey, lettuce, cornbread stuffing and cranberry mayonnaise The Popeye'— Chicken, baby spinach, craisins, walnuts and goat cheese tossed in our sweet balsamic vinaigrette Pine Island — Roast turkey, feta cheese, roasted red peppers, lettuce, olive tapenade and cucumber tossed with Greek vinaigrette Caesar Wrap — Chicken, Parmesan cheese & Romaine lettuce tossed in Caesar dressing Please inform us beforeplacingyour order ifyou have a food allergy. Consuming raw or undercooked meats, eggs, poultry, or seafood may increaseyour risk of food borne illnesses. TAKE Ol1T Call us today for the freshest thing on sliced bread (literally): 1,o8. +28.IIIp CATERING Whether it's a sales presentation, luncheon, birthday or feeding the entire wedding :y . party - we'll will take care of all the details with custom menus tailored to your needs. 211 Cotuit Rd. (Rt. 149) 1 Marston Mills, MA 02648 1508.428.1115 1 ccmornin to mail.com I www.ccmornin221ory.com Morning Glory Cafe BEVERAGES We're proud to feature Jim-, Orgdnic Co�ee — Dark, Light & Italian Roasts Coffee & Tea $i 6y Iced Coffee & Iced Tea $19s $2.4s Bottled Beverages BAKED GOODS & Q&x: BITES is & Fresh Croissants $11.93' with.cream cheese, add.3'o Yogurt with Colleen's Homemade Granola $3.9p Quiche of the Day $69S with fresh fruit, add $Z On the Go Egg Sandwich - English muffin, egg any style, with your choice of Swiss or American cheese, & bacon or ham $3.91 Toasted Bagel, add $3•o BREAKFAST BURRITO All breakfast burritos served with two e�gr unless requested. Morning Glory Burrito — Eggs, bacon or ham, cheddar or American $¢9S Acing Man's Burrito — Eggs, roasted red peppers, mushroom, onion, rizo and cheddar cheese $4.93' The CoCo — Eggs, spinach, tomato, feta cheese & olive tapenade 491' The Veggie Burrito — Eggs, spinach, tomato & goat cheese $493, The Italian - Eggs, imported ham, pesto, tomato & Mozzarella cheese $3'.93' The Golfer - Eggs, apple, imported ham & cheddar cheese $p.93' The Debutante — Eggs, bacon, spinach, mushrooms and Swiss cheese $1.91 Olive Oil — Eggs, spinach, tomato, bacon & cheddar cheese $T-9-T Sausage — Eggs,: sausage, eggplant, tomato & Swiss cheese $3:95 Portuguese — Eggs, Chorizo, caramelized onions & cheddar cheese $S93' N SOUP & CHOWDER Soup of the Day $3.95' $49S Wicked Fish Chowder $¢9p $3:95 PRESSED SANDWICHES ( $7.91, The Californian — Chicken, fresh sliced avocado, baby spinach, tomato, Monterey Jack cheese & bacon The Rueben — Corned beef. Sauerkraut, Swiss cheese and Russian dressing on Marble Rye The Landscaper Roast turkey, bacon, baby spinach, Monterey Jack & honey mustard The Gardener — Eggplant, roasted red pepper, onion, tomato, olive tapenade & feta cheese WRAPS 1 $7.95' The Pilgrim —Roast turkey, lettuce, cornbread stuffing and cranberry mayonnaise The Popeye — Chicken, baby spinach, craisins, walnuts and goat cheese tossed in our sweet balsamic vinaigrette Pine Island — Roast turkey, feta cheese, roasted red peppers, lettuce, olive tapenade and cucumber tossed with Greek vinaigrette Caesar Wrap — Chicken, Parmesan cheese & Romaine lettuce tossed in Caesar dressing Please inform us before placingyour order if you have a food allergy. Consuming rare or undercooked meats, eggs, poultry, or seafood may inaraseyour risk of food borate illnesses. TASB OUT Callus today for the freshest thing on sliced bread (literally)::'o8.+28.a1rs CATERING Whether its a sales presentation, luncheon, birthday or feeding the entire wedding party - we'll will take care of all the details with custom menus tailored to your needs. 211 Cotui.t Rd. (Rt. 149) 1 Marston Mills, MBA 02648 1508.428.1115 1 ccmorningglory(a,Qmail.com I www.ccmorninfzglory.com SALADS I $8.f0 Spinach Salad — Baby spinach with grilled chicken, baby spinach, hard- boiled egg, goat cheese Chef Salad — Mixed greens with sliced ham, turkey & Swiss cheese, and hard-boiled egg The Lina — Mixed greens with humus, tabouli, feta cheese, kalamata olives & Bermuda onion The Beckett — Mixed greens with grilled chicken, goat cheese, sweet craisins & toasted walnuts Chicken Caesar Salad —crisp Romaine lettuce, shaved parmesan cheese tossed in creamy Caesar dressing topped with Grilled Chicken Dressings: House Balsamic Vinaigrette - Greek - Honey Mustard, Russian - Blue Cheese (add .75) VEGETARIAN WRAPS ( $79s South of the Border — Refried beans, Monterey Jack, tomato & avocado The Medi — Humus, tabouli, lettuce, tomato & onion Very Veggie — Avocado, lettuce, tomato, kalamata olives, mushroom, sunflower seeds, feta cheese tossed with Greek vinaigrette GLUTEN FREE 1 $7.91, Semed in crisp lettuce wraps ■ Grilled chicken, Swiss cheese, tomato, & spicy mayonnaise ■ Tuna fish salad, tomato, cheddar cheese & mayonnaise ■ Hummus & tabouli, feta cheese, onion & tomato ■ Oven roast turkey, tomato, cheddar cheese & mayonnaise THE GouLET FAMILY TRADITION Whether it's for breakfast or lunch, enjoy a relaxing Cade Cod atmosphere. Morning Glory Cafe .specializes in fresh baked muffins, sandwiches & burritos for breakfast. Or join us for lunch with unique prrssed sandwiches, homemade soups, chowder and fresh salads, Be .cure to grab some of our sinful tookies and baked goods to round o4 your trip. TAKE-OUT I CATERING 2II COTUTr ROAD, RT. I4.9 IMARSTON MrLLS, MA HOURS: 7AM 3PM, DAILY H PHONE' f0$.4.2$.III5' II EMAIL: CCMORNTNGGLORY@GMAIL.COri I -PETER & COLLEEN GouLET, CHEFS & OWNERS WWW.CCMORNINGGLORY.COM R Morning Glory Cafe' BEVERAGES We're proud to feature fims Organic Coffee — Dark, Light & Italian Roast Coffee & Tea ,$I.61,1,$i.8T Iced Coffee & Iced Tea ,$1-91' 1$'L4 Bottled Beverages $L93- ( $zzs BAKED GOODS & Q_uICK BrrES Homemade Muffins & Fresh Croissants (baked fresh daily] $I.91' Homemade Biscuits $i.To Bagel $L91 witb cream cheese, add.so Yogurt with Colleen's Homemade Granola $3.91' Quiche of the Day $6.91, with fresh fruit, add $2 Fresh Fruit Cup $3.9f On the Go Egg Sandwich - English muffin, egg any style, with your choice of Swiss or American cheese, & bacon or ham $3•9S Toasted Bagel, add $.so BREAKFAST BURRITO All breakfrut burritos served with two eggs unless requested Morning Glory Burrito — Eggs, bacon or ham, cheddar or American $491, Working Man's Burrito — Eggs, roasted red peppers, mushroom, onion, chorizo and cheddar cheese $¢9s The CoCo — Eggs, spinach, tomato, feta cheese & olive tapenade $49f The Veggie Burrito — Eggs, spinach, tomato & goat cheese ,$`491, The Italian - Eggs, imported ham, pesto, tomato & Mozzarella cheese $i93' The Golfer - Eggs, apple, imported ham & cheddar cheese $1,.9S The Debutante — Eggs, bacon, spinach, mushrooms and Swiss cheese $s:91' Olive Oil — Eggs, spinach, tomato, bacon & cheddar cheese $f 9S Sausage — Eggs, sausage, eggplant, tomato & Swiss cheese 4.91. Portuguese — Eggs, Chorizo, caramelized onions & cheddar cheese 4.91, SOUP & CHOWDER Soup of the'Day $3.95 $+91' Pete's Wicked Fish Chowder $¢gf $1,9S PRESSED SANDWICHES 1 $7.91- The Melted Tuna — Tuna fish salad, Swiss cheese and Rye bread The Californian — Grilled chicken, fresh sliced avocado, baby spinach, tomato, Monterey Jack cheese & bacon The Rueben — Corned beef. Sauerkraut, Swiss cheese and Russian dressing on Marble Rye The Landscaper — Oven roast turkey, bacon, baby spinach, Monterey Jack & honey mustard The Gardener — Grilled eggplant, roasted red pepper, onion, tomato, olive tapenade & feta cheese WRAPS I $7.9r The Pilgrim — Oven roast turkey, lettuce, cornbread stuffing and cranberry mayonnaise The Popeye — Grilled chicken, baby spinach, craisins, walnuts and goat cheese tossed in our sweet balsamic vinaigrette Pine Island — Oven roast turkey, feta cheese, roasted red peppers, lettuce, olive tapenade and cucumber tossed with Greek vinaigrette Caesar Wrap — Grilled chicken, Parmesan cheese & Romaine lettuce tossed in Caesar dressing The Land or Sea— Our own chicken salad or tuna fish salad with lettuce & tomato Please inform us beforr placingyour order ifyou have a food allergy. Consuming raw or undercooked meats, eggs, poultry, or seafood may inctraseyour risk of food borne illnesses. TAKE OvT Callus today for the freshest thing on sliced bread (literally):-'o8.428a x i 1, CATERrNG Whether it's a sales presentation, luncheon, birthday or feeding the entire wedding party - we'll will take care of all the details with custom menus tailored to your needs. 211 Cotuit Rd. (Rt. 14911 Marston Mills. MA 02648 1508.428.1115 1 ccmorningult)rv(a—)gmaii.com I www.cemorninuulorv.com Catering, Platters, ETC. We offer our entire menu as catering options. But of course we can also provide a custom menu tailored to your needs, whether it's a sales presentation, luncheon or feeding the entire wedding party, give us a call and we will take care, of all the details. Morning Glory Cafe 211 Cotuit Road Rt 149 Marston Mills, MA 508-420-1518 The Goulet Family Tradition Whether it's for breakfast or lunch, enjoy a relaxing Cape Cod atmosphere. Morning Glory Cafe specializes in fresh baked muffins breakfast paninis, homemade soups, chowder and fresh salad.. To satisfy your taste buds, have a piece of our famous "mile high" apple pie or any other of our sinful desserts Thank you Peter & Colleen Coffee &Tea Small $1.95 . Medium $2.25 Large $2.95 Beverages Our beverages are located directly in front of the entrance Breakfast Muffins (freshly baked and warm) Bagels $1.95 (with Philadelphia cream cheese $3.00) Greek Yogurt with homemade granola Breakfast Sandwiches: Soup & Chowder Soup of the Day (just ask) cup $3.25 bowl $3.95 Pete's Wicked Fish Chowder cup $3.95 bowl $4.75 Panini $7.65 The Californian —fresh grilled chicken, fresh avocado, baby spinach, tomato, Monterrey jack & bacon The Big Pete — char grilled herb flank steak chimmi churri, boursin cheese, Bermuda onion, baby spinach & tomato $2.00 The Landscaper — thinly sliced turkey, Monterrey jack cheese, bacon, baby spinach & honey mustard The Gardener —Grilled eggplant, roasted red peppers, onion, tomato, kalamata tapenade & feta cheese $3.95 The Farmer — sliced ham, bacon, sliced apples, Monterrey jack cheese & brown mustard Served on a toasted bagel, English muffin or in a single egg any style, with your choice of Swiss cheese, Havarti cheese or American, and choice of bacon, ham or sausage $5.95 Breakfast Panini Veggie Breakfast Burrito - 2 scrambled eggs, spinach, tomato and Havarti r cheese in a soft tortilla wrap $5.95 Meat Lovers Burrito — 2 scrambled eggs, bacon & ham with cheddar cheese in a soft tortilla wrap s $6.95 Breakfast Panini — 2 scrambled eggs, your choice of Swiss, cheddar or Monterey Jack cheese, & bacon or ham grilled on Italian Panini Bread ' $6.95 Wraps $7.65 The Popeye — fresh grilled chicken, baby spinach, craisins, walnuts, and goat cheese tossed in our balsamic vinaigrette Chicken Salad — our own chunky chicken salad, apples, crasins & walnuts The Very Veggie, avocado, lettuce & tomato, olives, mushrooms, sprouts, sunflower seeds & feta cheese tossed with Greek vinaigrette The Land or Sea— our own chunky chicken salad or tuna fish salad with lettuce, tomato & sprouts Salads $7.95 Spinach Salad — baby spinach topped with hard-boiled egg, goat cheese and choice of herb flank steak or fresh grilled chicken Chef Salad- a large field of mixed greens topped with sliced ham, turkey, hard-boiled egg & Swiss cheese The Lina, -a large mixed green salad topped with humus, tabouli, feta cheese, kalamata olives & Bermuda onion The Beckett— Fresh grilled chicken, goat cheese, sweet craisins & toasted walnuts atop a large mixed green salad The "Make Your Own" a large mixed green salad with tomato, cucumber.• & olives topped with choice: Chicken Salad or Tuna fish Salad or Sliced Turkey & cheese or Fresh Grilled chicken Dressings: House made Balsamic, Blue Cheese (.75 extra) Greek, Vinaigrette, Honey Mustard o° Fire & Water — Cleanup & Restoration - Like it never even happened.® SERVPRO® of The Mid and Outer Cape 508-778-7378 Tom & Lisa Balcom Ind pendently Owned and Operated rm. YV3 . ...-..�..••.,,,., v im°-.^. - All ........... . ...... •^.�'"?,'..wXtFseY'E�n`:,...aRisx •z:*,T:"�'•,'. .,�ih w- ._� .v ,. :3r. ._...fr.^. sA�a.... *a: w+, a �,,,-vcra•�xw+.a� .. _.. W `Iio. - Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Wood *pgtem Construction permit Application for a Permit to Construct (. ) Repair ( ) Upgrade) Abandon ( ) ❑ Complete System ❑ Individual Components Location Address or Lot No. _ 2 Aoi Y� IY y �'1cr )t�� S ✓Q'f- / S �%� OaGy� Owner's Name, Address and Tel. No. Lie t+oa /��� �7� .7/ems %" Assessor's Map/Parcel 7,F - a z Installer's Name, Address, and Tel. No. Designer's Name, Address and Tel. No. YES OaG `/� Gr vN s , NI�I Type of Building: Dwelling Other Other Fixtures No. of Bedrooms / Lot Size /✓r���� sq. ft. Type of Building No. of Persons Garbage Grinder-0 Showers ( ) Cafeteria( ) Design Flow 1-1ff7 gallons per day. Calculated daily flow 5- 7,12 gallons. Plan Date Number of sheets / Revision Date Title Size of Septic Tank /rOlo Type of S.A.S. Description of Soil Nature of Repairs or Alterations (Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on -site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu th' Board of Health. Signed Date Oa Application Approved by Date unn Application Disapproved for the following reasons Permit No. �� �� Date Issued �k 1111_100ftw_-,, Application fora Permit to Construct .Y Ij r { Fee / THE C©MMONWEAL=TOF MASS�ACHUSETTS Entered in computer. E/ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Migpogal *pgtem Congtruction Permit Repair ( ) UpgradeX) Abandon(, ) ❑ Complete System ❑ Individual Components Location Address or Lot No. a r �O�fE / 7 �U/ i!!i� S .�'i" /�/7! /•'i l/ 0o� ti �o Owner's Name, Address and Tel. No. `.ti f Oh Assessor's Map/Parcel 7� a Installer's Name, Address, and Tel. No. -v,i, — , -,)ti //0 Designer's Name, Address and Tel. No. 7- PO /3,,x 339 '.'Z Ayl�/ram Type of Building: Dwelling Other Other Fixtures No. of Bedrooms 0 "7 Lot Size X fS9,2- sq. ft. Type of Building No. of Persons Garbage Grinder 041&� Showers ( ) Cafeteria( Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets / Revision Date Title, Size of Septic Tank l ra <7 Type of S.A.S. y e-4­ +X -r5 zwx /3••2 X -Z �7' Description of Soil s. r��a % // — rW) Nature of Repairs or Alterations (Answer when applicable) Date last inspected- _ Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on -site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issueYd"6 thi§ Board of Health. t, Signed Application Approved by OP' Q_ Q Application Disapproved for the following reasons Permit No. 'f , Ka- ),:�i ' 1 —1 \ Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance 7 .2I b THIS IS TO CERTIFY, that the On -site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded (\",/) at -31 \ Val, \ `LA 1-4 , �\ c i \ � has been constructed i acc/on with the provisions of Title 5 and the for Disposal System Construction Permit No.. �7115� N Sdated t a Installer Desiener The issuance • f this permit shall not be construed as a guarantee that the syst will ft9n tion as defin Date1. e-/ "'� U Inspector �"� No. -�. �`I<, Fee so — THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Digpogar *pgtem Congtruction Permit Permission is herebydgranted to Construct ( ) Repair ( ) U System located at __) t 1 r1 _� • S] Kl( . � ) Abandon ( ) 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. A.` Provided: Construction must be completed within three years of the date of this permit. Date: `7 /cam Approved by �� P " �� 1 r TOWN OF BARNSTABLE F L LOCATION rk.a /` ? SEWAGE # 1415- VILLAGE 2*, r1Y0, f AP ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. 0 ✓6 h C, 19V A We - SEPTIC TANK CAPACITY LEACHING FACILITY: (type) y r5190 9,1 -J t 3 (size) '1a Y13..1 A' 02 , NO. OF BEDROOMS -/ BUILDER OR OWNER r f,? PERMITDATE: LI' 8 `O;Z- COMPLLANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 115 fte o �' �AA) No. 'U `[ [ 7 Fee U THE COMMONWEALTH OF MASSACHUSETTS Entered in co pater: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplitation. for Disposal *pstem Construction Permit Application for a Permit to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) ❑ Complete System ❑ Individual Components Location Address or Lot No. oC�� Ro a0 c. r[►� Owner's Name, Address, and Tel. No. G° i411� Assessor's Map/Parcel 0 A au_r. Installer's Name, Address, and Tel. No. Designer's Name, Address, and Tel. No. " V4e, Lft 61 N& C Type of Building: Dwelling No. of Bedrooms Other Type of Buildi Other Fixtures Design Flow (min. required) Plan Date Title Size of Septic Tank %5G Description of Soil Nature of Repairs or Alterations ( Lot Size sq. ft. Garbage Grinder ( ) —� No. of Persons Showers ( ) Cafeteria( ) gpd Design flow provided J gpd Number of sheets ate Type of S.A.S. wer when plicable) -,,. Date last inspected: _ d n Agreement: / T dli- 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 nQt to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. � Application Approved by _ Application Disapproved by for the following reasons _ Date Date Date Permit No. C2t Date Issued No. ~ Q ( / ? Fee f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9ppliLation for MIsposal 6pstem Construction. Permit Appl c on for a Permit to Construct ( ) Repair ( ) ;,Upgrade ( ) Abandon ( ) ❑ Complete System ❑ Indiviidual Components .��41 d Location Address or Lot No. �11 0 Owners Name, Address; and Tel. No. 14l� ,� Assessor's Map/Parcel --p Installer's Name, Address, and Tel. No. !�Q/�1Aa ► ne. �h� �� V-4/.p -OW Designer's Name, Address, and Tel. No. A -A 4.9, L#m el yway do. Type of Building: Dwelling No. of Bedrooms Other Type of Build* Other Fixtures Design Flow (min. requked) Plan Date Title Size of Septic Tank Descrintion of Soil Lot Size sq. ft. Garbage Grinder ( ) No. of Persons Showers ( ) Cafeteria( ) t 7� �gpd Design flow provided gpd Number of sheets ate Type of S.A.S. s �t` ►i„ 1 11 r 11ni1. k", r, f*gj'V 4,rc4 , ni4.[Vion_ 11v(,_e Nature of Repairs or Alterations ( when 7 f Oprno, ' ,� Date last inspected: , 0 n ��� 7 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 n t to place the system in operation until a Certificate of s' Compliance has been issued by this Board of Health. S' ed , 4r Date / Application Approved by 1 Date / Application Disapproved byx Date' for the following reasons Permit No. vn (3 . C��f Date Issued ------------------------------------------------------------------------------------------------- - - - -- - - - - - ��,� THE COMMONWEALTH OF MASSACHUSETTS ot�l 1 If / , �j �P BARNSTABLE, MASSACHUSETTS PULP �� �� -DJ. )I)(7 certificate of Compliance THIS IS TO CERTIFY, that the On -site Sewage Disposal system Constructed ( ) Repaired ( ,Upgraded ( ) Abandoned ( ) by /) y at �/ /�/� /l%i�j%1 S ��r has been constructed in accordance with the provisions of le 5 and the for Disposal System Construction Permit No� U - l/l f 7 dated / i Installer %r7 S Designer # bedrooms / / J4— Approm The issuance of this permit shall not be con tru d as guarantee that the systerr Date Inspector ---------------------------------------------------------------------------- No. 3 d C Fee D'O - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Misposal 6psteniXonstruttion Permit Permission is hereby granted to Construct ( ) Repair (y�� Upgrade ( ) Abandon ( ) System located at // f/�� /!/� /fi/ r A/i 11,_(•• f and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date / 3 Approved by On��'r(IU G �%/u�(>} /ul �l °L✓f���v��v} • �cc. TOWN OF BARNSTABLEi C. LOCATION oZ lI rte. /Y? x SEWAGE # VILLAGE Al,,, 57�k+ f Zf /l ../ /R ASSESSOR'S MAP & LOT %� a INSTALLER'S NAME & PHONE NO. 6-049�95- SEPTIC TANK CAPACITY % f—D 0 LEACHING FACILITY: (type) S00 yy �`iw.� 6rf s (size) `s'a Y!3•� NO. OF BEDROOMS , BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE:1- _ r Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 -fig . � ¢Q� •' LO C US MA_R T,E G'l>T� Dempster (on parement) Existing Contour - -46- - Spot MVGrade pmza 5' high post and lantern light J Ladder sign with lighting a� Site Triangle Line.._______ Proposed Burled Miter Serr. -7p- Proposed Buried Cas. Serr_-G_ . Proposed Overhead Elea -oEE- IPotex �' / r � - �' - .:.POA ..: �/\,���� •,�1 U' // �9, ; 7 Of FOIL lights sba17 be shielded �54 and not more than 8' above grade. 20- r �' c `;,�str " b yp Q Budding down -spouts shall be A 52. r •' / �^ 5� 0`4/ conducted to proposed drainage systsm ` 50 48 r S'- Sae building plans for additional p1'-'Yalct` Affht Yc3 Y6 d RetDi&mg -11 design by others ' 44 ,//.( J/ )r hfaple. t4_ta' \ `r% _ % / i cB �: " � en ruild - fi>ih :-, Fri l� ,/ A v rat f} � T , t b�Y , -i^�\ � � � � � \\ f r• i i �_ • r -CJ OIVI✓ERfAFPLICART I. I NOU. > `r �� J7�rlA U,: 119 ROUTE 1,fq .�- -- f 4 If4RSo ' . , J./ 4 5C?8/d28-9Y91 ._:,''• .., ,y.`", ti >-1 .. , _ •t> / iltzlrl r � /f �. F' :�p,3rc a FJ - - J y- � r i ,�_ c 4 - e trv.cd't .,tact . 1 _... ,. .:: ... . -. .•: U. b.jiPf (c - _ `: i ._ - . DUV. 1-b t : .. -C U^ '•%. 2 _i.l :i1• � ,•7; 1'`f 001Cc IV;::hed �to,,� I .ji1�lES 7`lJ—t2�f°.1. � !7J�-•, _[dii,.f <J,.J. J 1 per.3l10 s;:fG,� -t siut •.. t .. � , ,. ! 480 s•_r �f e ^ t Ic,ar Ins � R r aired � e _ ff hetall ® l per eOO Sgif-i-41- ut i i `I. " n. u !' pojGE3 V - r �. t - c Can n r < • v v .. � n .:�tcs ,r.�-ems i� t .�:� r 3 + , D ' '� i. ram- '. r.: g;c 3.e v-'...+ ,. 1 -k6r �:-�:M .•_- - .,. .. .. r �.. t. { S" - f 4•.. ,_ , :, ro s_. :. t t tom,:., -- ._.._ � - I. : - - - k ` t g.. Pr hat be ._.,,:vc - k _ r: Y , - ,. . r r- sue rt�wr — — EL-JA „L 0. zj oi �; . �ii i __— p'• b - . �,�'� -Z__ry'� y-� _ _ __— _ __ �G,--SC'lt l K- c'i �JL.1Fnay- _ � � � - - - - DATE r — .. ! jllj16— N 42S 9T I @ust® m signs r� if r r,,, ?Yr9'at is Mie 71 — is j I — j ' 9.14 GR I Ij. Y - r- 4s_ , . TOP OF FOUNDATION EL. 41.5' FIN. GRADE EL. 40't INVERT EL. 38.76' INVERT EL. 37.64' MID DEPTH 20' C.I. BOLTED COVER @ GRADE EL. 39.07' INVERT EL. 37.8' 1.Oftj ' ' , . :• 6" STONE. •.... '. PROPOSED 1000 GALLON GREASE TRAP TEES SHALL BE CONSTRUCTED OF SCHEDULE 40 INLET TEE SHALL EXTEND MID DEPTH APPROX. 24" OULET TEE SHALL BE WITHIN 1' OF BOTTOM OF TANK. THE INLET PIPE ELEVATION SHALL BE NO LESS THAN 2" NOR MORE THAN 3" ABOVE THE INVERT ELEVATION OF THE OUTLET PIPE. GREASE TRAP WITH TWO 20" MANHOLES WITH READILY REMOVABLE IMPERMEABLE COVERS OF DURABLE MATERIAL SHALL BE PROVIDED WITH ACCESS PORTS. GREASE TRAPSHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL, STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON WHICH 6" OF CRUSHED STONE HAS BEEN PLACED TO ENSURE STABILITY AND TO PREVENT SETTLING. 6 �'^ nr r L ��cl( /DESIGN DATA: TOTAL EXISTING SYSTEM DESIGN CAPACITY= 572 GPD EXISTING OFFICE USE= 708 SQ.FT.= 35.4 GPD. 1� RESIDENTAL USE 0 2 BEDROOMS= 220 GPD PROPOSED RESTAURANT USE 5 SEATS ® 35 GPD= 175 GPD TOTAL REQUIRED FLOW= 35.4+220+175= 385.4 GPD TOTAL RESERVE FLOW= 186.6 GPD tr GREASE TRAP: �P��N OF MAs`r-9 KITCHEN FLOW: 175 GPD ?� DAVID �y FIN. GRADE EL. 40'f ST. INVERT ) REMAIN EXISTING 1500 TANK TO REMAIN ss 6' {jam lca a B y} �6k 9 11 12 1s Parcel 22 14 7 15,882 fsq. ft B 5 4 3 � 1600 � cauaN' rum i onl o .� j1? � •. `'':��'- 'fir y .� kaQ, O� .d% :'.; ; .• _ y; : �} � sae PROPOSED TANK: 1000 GALLON z MASON r 175 GPD X 2 DAYS= 350 GPD g m j6'r MEETS 24 HOUR DETENTION PERIOD v 9 No.1066 0 may. s Fad TE�� . 4V 0 0 a�ef a r 0` Feet LOCUS MAP DEED REF: 16139-005 ASSESSOR'S MAP: 78-22 ZONING: MMVD SETBACKS: SETBACKS: FLOOD ZONE: C . PANEL NUMBER: 250001 0015 C DATED: 08/19/1985 OVERLAY DISTRICTS: AP, MASS ESTUARIES PLOT PLAN OF LAND LOCATED AT: 211 ROUTE 149 MARSTONS MILLS, MA PREPARED FOR: MOUTAIN ASH REALTY TRUST CRAIG LARSON NOVEMBER 12, 2013 REV: T REV: REV: YANKEE LAND' SURVEY CO, INC. 119. ROUTE .,-149 MARSTONS MILLS, MA TEL: (508)428-0055 FAX: (508)420-5553 yonkeesurvey0comcast. net www.yankeesurvey.net SHEET 1 OF 1 JOB#: 54824 JM V s s o- -Y -- `f�'pe ^� . r L O C Ux5 MAP 1 � C-fl .,.E -ZV -ZJ I Dumpster (on pa vemezg.' Existing Con tour - 46 - - Spot Fin/Grade 8' high post and lantern light �E I � germ -Pavement \ N/F -r- " ORAM & FAY DUBEY Base•• 1. 10" grave4 1wrdening or dense grade beloir pavement. 2. Bituminous I�oncrete paveing with 2" binder co me and I" finish. S All pa vemen t shall ha ve 12" Cape Cod Ber. 2n Ladder sign with lighting Site Triangle Line -----`--- � 4 124) f 1V'Uies.' _ i Pole lights shall be shielded 54 and not more than 8' above, grade. ,•� i �' - i :. Building down -spouts shall be , conducted to proposed drainage system. ` %Prl va to '�, 50 4e � � ���,�' r � . See` building plans for additional lighting: paved Way �: - - Retaining wall design by others 44 ------------------------------------ See drainage calcs for soil conditions G 42 TO �RtiJ 1 01 s /lam `4�`. I Raze OWNER/APPLICANT _--------------------- - I Dwvelling f t• f�O 54 52 Raze 50 Remains of block Founda tion 'I Iwo l; I r s w; I l re vn o, , .7 Llen6S lNiI he Pry^•-( To re—ove �►`\agec�jdea�iwooc(� Tq Allow C�DhSl'rgart6r1 - Three propo5aj CV-Wsor 41"t MaPle �( QtoG r✓1ero�la� Gree✓) Arb, C 3- 4 FT ,.n hev;1r) Fai r or •r`o t- C214'') Sr,,- 'A,, }/C, � �f �u +T � $ d e e � C E/otT i O►� 5� Loa, Seed t-aw✓1 ProPos�( Foot�c�+iP urea wiTh 1 gIae ► a y SorniPe,-s /0, cefRe/ sed 15 Isc pepropo54 LAMP .fo JT5 C' ! a1 base anal (o �l1'r. ' .. Or?e prvfosd LotPor 51 Cpe.5;,�,j aaie) 5-e 77r;cal 4T.;I I VOTC : On I etrea 5 neCr55crr?- Feu pro posel c aviSTr-CTiC90 Shall be ��ST�er%edi S�,aIt remA;ry ;n;es. /I ,T.4roLl "e� r re-t Cove„(;T;oej AiI O bn! a�CuS Cpenw.e�e/ BM A7 ZONING DISTRICT VE—A EL 41.25 DATUM N'GVD 0 tiZRLA Y AP El. 41.62' 42�/ FEMA DATA: ZONE „C,�, ASSESSORS DATA: 78--22 REFERENCE DEED: 2239-273 LOCUS NOT IN ACE'C - Fxisting ,� `• ' ' / Catch Basin I T tiq 3 1 - 2003 o 0� A. 5 '� Building _ I ��,�•'> �� 0 Under construction E 4 Z�b MAY 15 2003 �y TOWN OF BA'ASTABLE 0 4tiV �; BUILDING , 27 CHUCKLE'S' WAY MARSTONS LELS,NA 02648 5081428-9198 Proposed lot Coverage: Use 4 Precast Leach Pits ' o Buiding Cover 2,500 sq. ft = 16Z (4'Dia. x 4' Eff. Depth) , p C 5 015 ParkingPa_rking Schedule Retail 0.1 per 200sq.ft + 1 suit 714/200 f 1 5 Required Use 3/4" Washed Store All Around El. 3RZ 91 a vemen t over ft Equalizer In v.37.40 •� Total Cover 4790 El. +9.46' ,f GRAPHIC SCALE 0 10 20 A0 oaf q�6STI�ry �, s STEPHEN N J. { DOYLE ^ ( IN FEET ) ti No.37559 1 inch = 20 ft o� Office Townhouse 0 1 per 300sq.ft -,�•• 1 suit 24001300 + 1 = 9 Required 14 Spaces Required - 15 Spaces Designed of v Note: All drainage pipe shall be reinforced concrete as followrs• Class V, with ASTM spec C76 & AASHO Spec. M170, Wa11 B, with Bell & Spigot joints sealed with a removable rubber gasket in accordance Frith ASTM spec. C443. 'Site, De velopme-2 t Plan Prepared For: ,2 _R O Z- t o 1 4-0 Ia Mars tons Mills, Massa ch use t is Scale: I' = 20' Date. October 14, 2002 Prepared B,y. Stephen T. Doyle And Associates 42 Canterbury Lane, R Falmouth, MA 02536 Telephone: 5081540-2534 Re vision BZoc � lo-2'C-o'L 12aJ. :7n...w.+.krc. � i�•�wt�„scl �J 1- 05106103 SPR Re visions 41 NO. DATE DESCRIPTION 8Y 0 Se Wa�geSYPS te=_r o.z,7eVie wii IV T,,, S14% f..-=`..r.."alo""._,MA;1: Gtav�1Z :d`!C-st2. S�S'C�M G:eM7t�NtaNTSS . `t.I.��e�1'C�:1j�N'C...•-- .-'—•.---�.�j. Ll zlmb " WATER TIGHT COVER re r FLOW LINE 2' LEVEL _ _ _ _.__.._.� ... ---�-- -----� Tntal Treoc11 Length 10 MIN. 8 t/2 Pestone t4" INV. EL. 3ti 3j/4" - 1-'-1%,< Plashed G'rushed Stone r ocus; •° '' a e fits_ �•: � r � , ( °o° y 0ji_l .O ��• k-ace e 10' MIN. UCUID DEPTH MIN6" . 4 `,ti' • a SUMP .�:. pd"y b �3 Q - -0 ' tr7 C-•1 C..:� G'7 C'J a j • ; `!k ""ZO t�A'j� INV: EL. .III K EI 36. S ; o NV EL c� -_� L INV. EL. 3 No. of Ti•enobes 1 ?S•eztcb indth 13- 1500 GALLON PRECAST REINFORCED CONCRETE SEPTIC TANK :No, of 500 Gallon Precast Members . A $• 3/4 1--If2 Mashed Crus ed Stone PRECAST REINFORCED CONCRETE ,,: M DISTRIBUTION BOX 3/4 1 1%2 hashed .Crushed .Striae.. PROPOSED ,S. A. S. ' TR.ENCFI SECTION MINIMUM CONSTRUCTION MATERIALS PER 310CMR 15.226(2) = TEES SHALL BE CONSTRUCTED OF SCHEDULE 40 PVC AND INSTALL ON A LEVEL BASE SHALL EXTEND A MINIMUM OF 6" ABOVE THE FLOW LINE MINIMUM WALL THICKNESS = 2" OF THE SEPTIC TANK AND BE ON THE CENTERLINE OF THE SEPTIC TANK LOCATED DIRECTLY UNDER THE CLEAN -OUT MINIMUM INSIDE DIMENSION 12" MANHOLE. OUTLET INVERTS SHALL BE EQUAL TO EACH THE INLET PIPE ELEVATION SHALL BE NO LESS THAN 2" NOR OTHER AND AT 2" MINIMUM BELOW INLET INVERT. MORE THAN 3" ABOVE THE INVERT ELEVATION OF THE OUTLET PIPE. THE DISTRIBUTION LINES FROM THE DISTRIBUTION BOX " SHALL ALL HAVE EQUAL INVERTS AS DETERMINED BY FLOODING SEPTIC TANK SHALL BE INSTALLED LEVEL AND TRUE TO GRADE THE DISTRIBUTION BOX TO THE HEIGHT OF THE DISTRIBUTION ON A LEVEL STABLE BASE THAT HAS BEEN MECHANICALLY LINE INVERT AFTER ALL LINES'. HAVE BEEN SEALED IN PLACE. COMPACTED AND ON TO WHICH SIX INCHES OF CRUSHED STONE INVERT ADJUSTMENTS SHALL BE MADE BY FILLING WITH DURABLE 54 HAS BEEN PLACED TO ENSURE STABILITY •AND TO PREVENT AND NON• -REFORMABLE MATERIAL PERMANENTLY FASTEND TO THE SETTLING. LINE OR RECONSTRUCTING THE UNES UNTIL ALL INVERTS ARE OF JJ i 50 EQUAL ELEVATION. I" / i 48 SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 . mmove exfst1hg cea8pool / or _ 48 . - and all coutamina tad soila� - J J , .01 THREE 20" MANHOLES WITH•READILY REMOVABLE IMPERMEABLE Fill wltb clean course send. JJ /� // �� - 42 COVERS OF DURABLE MATERIAL SHALL t3E PitOVIDED WITH ACCESS PORTS BEING PLACED AT THE CENTER AND OVER THE INLET AND /J // / OUTLET TEES. /� Jul rj/ THE OUTLET TEE SHALL BE EQUIPPED WITH GAS BAFFLE. ? s c , r r �� / / /We of General Construction Notes ti / / J / / of block �. - • r. w / _ r�unaa Iron ��� ° ?�8 BJf c' BL. 41.25 0 1. All the workmanship and materials shall conform to D.E.P. Titls 5 and the Town of t t t t t t @ DATUM NGVD Barnstable rules and regulations for the subsurface disposal of sE;wage. � �,_... //slla t 1 t 0 T� •` t ° " 2. At least one access port over tank tees shall be accessible within 6 inches of finish grade, / t t ti "`a' Parcel 42, % with any remaining access ports brought to within 12 inches of finish grade. / / / / �t f 2 '4r 40 15,882 -ksq,ft. 3 f he sanitary system shall be capable of withstmdin H 101 in ,� / / / i / J All components o t tart' Y p . g loading 0 / , J / , ; � 1 p+� / unless they are under or within 10 feet of drives or parking. H-20 loading shall be used •� / : •� r- under or within 10 feet of drives or parking unless noted. / J/ , 147' / , of t cirti 1, of 4. The excavator/contractor shall verify the location of all site utilities prior to any r �J JJ , �� , , ,5� 4 ti��• excavation. / / / / / / / / / c� ! �: `c- �'• Existing / t, , _ . v c ,; 19 Ca tcb Basin 5. Sewer pipes shall be 4-inch Schedule 40 PVC laid at 0.02 slope // �/ �/ / �i , ._� r L p 7 d. An masonry units used to bring covets to Made shall be mortared in place. /! r/ /J �/ / B2 0� •� o , GM TV] _Drive 4 Y mYJo of of 7. Finish grade shall have a minimum slope of 0.02 feet per foot. / r / �r /o do / o ✓: r 54 of� ��;: ZONING DISTRICT.' VB—A / , f .q�; O VERLA Y AP ` / / r O ti� \ 52 Note:sewage i 4 / / / r fl . Should soils be encountered during installation of sewn e ` r / •9FEMA DATA: ZONE C 8 g system . � `,� 50 48 � � j• � � • >� not consistent with soil logs, contact the designer and/or your local Health Department . , i PrI , , / is 'Tara i Existing �•$ ,' o before proceeding. r gay s �' 'a ed .Y 46 �zo t Dwelling ,yo ASSESSORS DATA: 78-2,2 of 44 �� fy ----------------- ------ �., t y 1 '�' �• ; Q g9ti vy REFL�'RENCE DEED: 2239—,273 It 42 L `'�`• ! t TO MAiLk.;I WS 14� 1 qaMYMtiAM ------ -- - _ '`'� tCy� i LBERMAN M CD No. 93971 SOIL LOGS ¢g o, IS1 At TEST DATE.SIDIVA 0,2--1�2--02 O , , `� Util ol@ EVALUATOR- S. DOIZE . j' r., /p j, C� SOIL F _ .E'XCA T ATOR.• AALTO • MIN INCI� DESIGN DATA: PERC RATE �2 ,, ��6+SI:��f® `\ STRUCTURE �s L, �� �p `�IE'PHI:1 TEST HOLE' 1 (EL 40.09 TEST HOLE 2 (EL 40.02 r �i�wN DOYLE TYPE N0. BEDROOMS. GARBAGE OISP+7SAL �� 0j, 0 No. 37559 DESIGN FLOW x 1� D ``�a '0�1 vc Aw SL 10YR 3/2 SL 10YR 3/2 t4 �o � D 12" 12" LS 10YR 4/6 L4 10YR 416 If SEPTIC TANK las= ' asp �s" GRAPHIC �1CAIZ 20 0 10 20 40 ao LEACHING FACILITY SAS_ G.t�/�•N�'CaT�•1L "rll;�lt.�•! FINE FINE, sib .mlev - SAND SAND x A--r 2.5Y 614 2.5Y 614 tea �- �Sg� o.`t �•T`L c.�pv c�c1�L. - s�c,�� { IN FEET } 1 inch = 20 & Sewage System Repair Plan Prepared For. z•z t e_=_ -4- rn Harstons Mills, Massachusetts Scale: i" = 20' Date: February 12, 2002 Prepared By: Stepben wr Doyle And Associates 42 Canterbury Lane, R Falmouth, ,HA 02538 Telephone: 6081540--2534 R S I o c .— [_N70, DATE DESCRIPTION 8Y "\. � I M N. Z N t i Yvv-- lr_u I I r• - 'top P4-Pj 46 LJ 2) 1 0 H IT13 IP L S. ................ .0 - . *I I ------ 71 ----------- ---- — - 7 . I��I�IO� NEIIDS I��� N���I ��III _q. 30 30 A) OiLr -J T J-- du -TT 0 COME rAAJ- Aft ALE 0 DATE • SAA 508-428-6191 COFF 16 O 1 ICRAM S eviia4A--eO. Fw n. LO @uStOm d esigns I, EIA L- k L- copyright c 2ow 111 "T -F A All Rights Reserved —" K_ r 0" C-1 pis 6 Play` A XAM 4 T-*It 5.0" 9 JO .0 331-0" Preliminary plans and IaYOUIS by O.C.D.aie for the use of their customers onI.Any other use is stllctly prohibite I