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HomeMy WebLinkAboutTAVERN ON THE GREEN - FOOD (2) TAVERN ON THE GREEN 1460 ROUTE 149 -J04-003=C00 MARSTON MILLS, MA. 02648 FORM:PHILBRICKS FORM:FLYING FAIRWAYS i Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli, M.D. aARNSTA LL F.P.(Thomas)Lee,. q MIAS Daniel Luczkow,M.D. Alt. $ 639. 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: 1074 Issue Date: 01/01/2022 DBA: TAVERN ON THE GREEN OWNER: THE TAVERN ON THE FAIRWAY LLC. Location of Establishment: 1460 ROUTE 149 MARSTON MILLS„ MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 96 OutdoorSeating: 35 Total Seating: 131 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: CQ� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: v For Office Usqonu. Initials: Town of Barnstable 0*AmtPd$ DatePaid ,,STABLE : Inspectional Services MARA s6 9. Check 1 n k# �` I 'AiEp ,ta`� Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4544 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATER Z"6 �� NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ��V r).& 4 C VK- if/\ ADDRESS OF FOOD ESTABLISHMENT: (4� `r"l AAlivA i I 1 S MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: 4 "\ WELL WATER: YES NO ✓ ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:y— SEASONAL: DATES OF OPERATION: /0(/27—TO IZ/_1�0/ a T NUMBER OF SEATS: INSIDE: OUTSIDE:�TOTAL: l ;2 Lp 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 APPL BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** _REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc ,T OWNER INFORMATION: \\ FULL NAME OF APPLICANT W�w1/�/UI �' C [l►f��(�i+`•I SOLE OWNER: VE /NO OWNER PHONE# 02-24 �C ADDRESS /' !�( t ) 4 h J/�{/jr), T2 Pi, CORPORATE OWNER: �I/fin t CORPORATE ADDRESS: �j� 4—kli 1)rr PERSON IN CHARGE OF DAILY OPERATIONS: IA) 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 Lu 1. 1. 2 KA4A&,o � ��� 24 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 httt)://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 I st to Dec. 3I't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:\Application FormsTOODAPP REV3-2019.doc i r Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. NSTAaL Paul J.Canniff,D.M.D. MA Mi . F.P. Thomas Lee Alternate ` 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 1074 Issue Date: 01/01/2021 DBA: TAVERN ON THE GREEN OWNER: THE TAVERN ON THE FAIRWAY LLC. Location of Establishment: 1460 ROUTE 149 MARSTON MILLS„ MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 96 OutdoorSeating: 35 Total Seating: 131 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: GQ/ FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: I J IME� OF tp�� Town of Barnstable For Office Use • Initials: Date Paid Amt Pd$ : .Ur,srnB . : Inspectional Services q 1639. MASS.lEo�� Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE /I NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: A Q�lE G1 !�6/ ADDRESS OF FOOD ESTABLISHMENT: I q�,o R 14 , n Af5 81�i Q 2646 MAILING ADDRESS(`IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: W t fJ /5r� 9 MSAf`43CYPI TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: V SEASONAL: DATES OF OP TION: 3 / /2l TO I2/L /� 460) NUMBER OF SEATS: INSIDE: 610 OUTSIDE: _4E TOTAL: Q0tdX/ S7AGQ5 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? Y-e7 IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?YE�_ TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) V FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT t 1 DP=1 T y SOLE OWNER: YES/NO OWNER PHONE # StAZ- 9274 ADDRESS 34 5WALtoO wl.L Oda, ���7`��511��1� HA 02 3O CORPORATE OWNER: 1(JCeI� 07�? 'r?-I6 to 1(LaN ,az CORPORATE ADDRESS: .34 6'W LioO ( 111,L I)R(6E PERSON IN CHARGE OF DAILY OPERATIONS: kj [a,<,/-Xrl List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. W ILLIAM 7 �-1 icy 2- / 4 /2-z- I. Uji-Lom 122/ 3 12-4 CA 2. KAIT)L6W per,d�k 4 /1(c, / 24 c4-'LC/ U / 0 l 2D2 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to''do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q:\Application Forms\FOODAPP REV3-2019.doc 3' Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,JUMABL& Paul J.Canniff,D.M.D. f8sq. � 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate oc+° 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: 1074 Issue Date: 12/10/2019 DBA: TAVERN ON THE GREEN OWNER: THE TAVERN ON THE FAIRWAY LLC. Location of Establishment: 1460 ROUTE 149 MARSTON MILLS, MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 96 OutdoorSeating: 35 Total Seating: 131 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: G FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: of rq� Initials: Town of Barnstable For OfficeDate Paid Amt PdPd$ BAMSPABLE. : Inspectional Services D-1 Check# s6,y. ♦ Public Health Division QED MAC a 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 V NAME OF FOOD ESTABLISHMENT: Ayt'w ffku nit;.`7RCet ADDRESS OF FOOD ESTABLISHMENT: /YGO &0-ry- 141 . H,4951W5 w1IL`5, KA MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: Id}(1� JIf�LFU MSnr (y��f'! TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: 4- WELL WATER: YES NO X ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: I/ f / 20TO 12 /31 /20 NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: I. Po Iflw62Y AS 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)? J�5 TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE &NEW FOOD ONLY*** _REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 QAApplication FormsTOODAPP 2020.doc OWNER INFORMATION: qq FULL NAME OF APPLICANT W(L 4)cV 1 SOLE OWNER:(YES/NO OWNER PHONE # VIGtJ�"/l2'S27Q ADDRESS 34 5 JALb&j 01.4- 0 & fF'!Fl 62fv30 CORPORATE OWNER: 1 A j"—,W 0.j -,)4-G— CORPORATE ADDRESS: �>7"(1� PERSON IN CHARGE OF DAILY OPERATIONS: C�1Z[1AM l E(E,t15G�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 Awarenesss,, Expiration Date UU k ut 10.rV1 �i S� I I. w l wm -r• 06N 5cC Z l (P l ZZ 2. ,��a iJ y,�rrcc--rz- _ l Ito /24 O!T) 12- / ! / 201 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec. 31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-2019.doc I 1-7 1 , rt HE r� Town of Barnstable BOARD OF HEALTH allPaul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. aAnNgrABm John T.Norman �a F.P. Thomas Lee Alternate 9, tb1s. 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: 1074 Issue Date: 12/20/18 DBA: TAVERN ON THE GREEN OWNER: WILLIAM T HENSLEY Location of Establishment: 1460 ROUTE 149 MARSTON MILLS MA 02648 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 96 OutdoorSeatin : 35 Total Seating: 131 g FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: — - -- MOBILE-FOOD: MOBILE-ICE CREAM: C,�A FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: $85.00 FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: �i THE rp� Town of Barnstable For Office Use Only: Initials: "o Date Paid 1Z g Amt Pd s 38 fJ' 9�ST"LE. Inspectional Services 3b�a gs-tD6. MAM 'Ec►u�+° Public Health Division Thomas McKean, Director 1 Z 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 'I rAPPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE I.2in 618 NEW OWNERSHIP RENEWAL{✓ � NAME OF FOOD ESTABLISHMENT: I Ao6ad ®/J Twc, 6� ADDRESS OF FOOD ESTABLISHMENT: 1�f Io4 Pzxc (49/ M.44TVA6 All US MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: MSN-OOM TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 1L�q TOTAL NUMBER OF BATHROOMS: 4 WELL WATER: YES NO )� ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: V SEASONAL: DATES OF OPERATION:2/j_/LI TO L/,:Ll /_a NUMBER OF SEATS: INSIDE: OUTSIDE: 45 TOTAL: 1.3Z. 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)? V TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) V FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) 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 PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT � 6(&Jaj aC W iWAq T SOLE OWNER: /NO ' OWNER PHONE# ��r 9/2- 5214 ADDRESS_ 34 S�Or tj PIW- C�,WE , 9a=L)9 &e MA 624930 CORPORATE OWNER: A600& FEDERAL ID NO. : CORPORATE ADDRESS: 5�me PERSON IN CHARGE OF DAILY OPERATIONS: Olk"Ati List (2) Certified Food Protection Managers AND at least(1) Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. [ DDL-IiA VA` w)VA 3 /Z6 / 2-9- 1.q�aW YAMwoyA 4.1 2a, /2- 2. /�z SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** c 2 <�-�ce SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1st to Dec.315S each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsT00DAPPREV2018.doc ZHET Town of Barnstable For Office Use Only: * Inspectional Services Date Paid Amt Pd$check# Cash � BARNSTABLE, * � MASS. �m� Public Health Division IN 200 Main Street, Hyannis MA 02601 Office: 508-790-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Fee: $85.00 MAIL TO: TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION 200 Main Street HYANNIS,MA 02601. FAX 508 790-6304 PLEASE INCLUDE THE REQUIRED FEE OF$85.00 APPLICATION FOR A TOBACCO SALES PERMIT ESTABLISHMENT NAME (DB/A) ADDRESS OF BUSINESS MAILING ADDRESS (IF DIFFERENT FROM ABOVE) EMAIL PHONE# FEDERAL ID# Do you currently possess a state license to sell tobacco products? Yes No Each employee who sells tobacco products must receive and understand Chapter 371 of the Town of Barnstable Code (copy provided herein) and the Massachusetts General Law Chapter 270, Section 6.00 (a copy is provided on the next page). Each employee who sells tobacco pr•.oc ucts must sign the Employee Signature Form (provided herein). Signatures - �� Date (Z��3/1b) Q:\Application Forms\TOBACCO APP2019 dob.docx ESTABLISHMENT'S NAME TOBACCO SALES Employee Signature Form This form is for official use to indicate that the employee(s) of this establishment received and understood Chapter 371 of the Town of Barnstable Code and Chapter 270 Section 6 of the Massachusetts General Laws which describes the penalties for selling and/or giving tobacco products to any person under the age of twenty-one (21). Below is Section 371-9. of the Town of Barnstable Board of Health Regulation: Sales to Minors—&371-9. Sale and Distribution of Tobacco Products. 1. No person shall sell or provide a tobacco product, as defined herein,to a person under The minimum legal sales age. The minimum legal sales age in the Town of Barnstable is 21 years of age. 2. Identification: Each person selling or distributing tobacco products, as defined herein, shall verify the age of the purchaser by means of a valid government-issued photographic identification containing the bearer's date of birth that the purchaser is 21 years old or older. Verification is required for any person under the age of 27. The following employee(s) received and understood Section 371-9 of the Town of Barnstable Board of Health Prohibition of Smoking Regulation and Chapter 270 Section 6 of the Massachusetts General Laws:, Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Signature Printed Name Date Q:\Application Forms\TOBACCO APP2019 dob.docx `pp IME r, TOWN OF BARNSTABLE , HEALTH INSPECTORS Establishment Name: - Date: Page: Of , Z 'GYP " Yoe OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARN ABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified a� 50 -8 q: �0� HYANNIS, MA 02601 8-8 62-4-FRi. No Reference • R-Red Item PLEASE PRINT CLEARLY prED MPS° 644 FOOD ESTABLISHMENT INSP CTION REPORT dD Name Ve M d t j-"�� Date3 u Type o s -Type of Inspection - Address ( ( /%�� Risk 'food Se Re-inspection I ` Level Retail Previous Inspection Telephone Residential Kitchen lA� la d4< Mobile re-operate Owner HACCP Y/N Temporary Suspec Illness a _ �y Caterer General Complaint Person in Charge(PIC) - Time Bed&Breakfast Other ` r kq Inspector ��,� Out: J!' vl� " '4L 7S Each violation checked re fires an explanation on the narrative page(s)and a citation of specific provision(s)violated. VN � 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 CI i Cat ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities fi EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives VIJj tA-J �r- ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals f n 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 o PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ""t- J' / oLS 4fi ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP a ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY (]�� ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories D !4� �v 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 ❑ rY ❑ ❑ P ❑ 9 Y P C N Official Order for Correction Order for Correction:Based on an inspection today,the items Embargo 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. 25.Equipment and Utensils 6=One critical violation and less than 4non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) y P 30.Other DATE OF RE-INSPECTION: Inspector's Sign at E Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N t. �... .� � .. �......`. -.�.r.�...-...�..:..-`. �.� � � --,. -.•.- .-, ,- .--+-•-.--w. - ... ...�.,� - ti..-...ram-r..� .s.._.......... � __�.. - _ _� 1 --� .,-"��_._ .- .-rr-_w.�.-x-. ^. .. y � ti -� 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* S 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 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.1](A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Conta 7-102.11 Common Name-Working Containers* iners* 590.004(F) * 2 590.003(C) Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 7-201.11 Se 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* Separation-Storage*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 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 F 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 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products 4-501.112 Mechanical Warewashing-Hot Water Monitoring 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/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-I55°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef c'i"11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan" Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g Ratites-165°F 15 sec* 590.009(A)-(D)- Violations of Section 590.009(A)-(D)in cater- 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 practices should be debited under#29-Special Requirements. g 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 12 Prevention of Contamination from Hands 3-403.11 Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated* �) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°17 item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 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 690.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: Page: L,- Of -. PUBLIC HEALTH DIVISION OFFICE HOURS8:00-9:30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ''A M63: �. HYANNIS,MA 02601 sos-s2 aRsaa No Reference R I. -Red Item PLEASE PRINT CLEARLY 'EDN1 FOOD ESTABLISHMENT INSPEC ION REPORT P - Name /��, Date Tyne of Type of Inspection J I� v p Routine Address Risk ood S Re-inspection L r �� Level etail Previous Inspection wl�rn u"�a -( 2`� Telephone Residential Kitchen D Mobile Pre-o erati Owner HACCP YIN Temporary Suspect Illness 3 Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP L.IL (tJ� r In: Other LL Inspector Out: 1 l Zoe S �7�'IS� Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures �UC o Aaq, G ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ✓ ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No El Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction, Based on an inspection today,the items Embar o checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ g ❑ Emergency Closure El 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 4n6n 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 6non-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 8non-critical violations. If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 n-cri cal violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Si ture 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 Si natur Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N L- Dumpster Screen? Y N Violations related to Foodborne Illness Violation Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to *4 H 41°F/45°F Within d t l Cooe o n ours 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law ` 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 5 Poisonous or Toxic Substances 590.004(F)3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Separation e* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and AdulteReserrated for of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 27 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* q Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical 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* 4-601.11(A) Clean Utensils an Eggs d Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eff cfiw 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* 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 at,P 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* ( ) ( ) ( ) ( ) Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 0 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 7 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 * (Blue Items 23.30) 3-201.11 Package Integrity ( ) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the Foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention onta inatiotion 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* g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A Cooling Cooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) g 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 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 Labeling of Ingredients* Supplied with Soap and hand Drying Devices 590.004(J) 9 9 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 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. (" `� F� r TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name:/A IkTWOt� ^ J Gf ate✓ Page:, of OFFICE HOURS i nnNsrne�e.° PUBLIC 0 MAHEAL W ST TH RETSION 8:00-9:30 A.M. 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. �. `0� HYANNIS, MA 02601 508-8MON -FRI.62-4644 No Reference R-Red Item PLEASE PRINT CLEARLY 8-8 iOrFD MP�� FOOD E TABLISHME T INSPE TON REPORT Name Dat ype of pection Routine` Address ff/ n Risk Food Servi = pe ion Level Previo Telephone J Residential Kitchen Date: �yy Mobile Pre-op ti ' Oq Owner HACCP Y/N Temporary Suspect Ilness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other e InspectorU"N Ze 0 11 QU O �.' In Each violation checked requires Sin explanation on the narrati p ge Sand 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) ❑ N 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 G 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 ,`�y�`)/-�J Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations TKAI Critical(C)violations marked must be corrected immediately. (blue 8 red items) ` ��� Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension - C N Official Order for Correction: Based on an inspection today,the item checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo Other: 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 B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6,non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 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 2on-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-cri'cal vio tions. If 1 critical refrigeration. 28.Poisonous or Toxic Materials. FC-7 590.008 9 ,4 to 8nori-Critical viol nS= 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Ins re m Pint: 31.Dumpster screened from public view _P71 Jlk's Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signat - 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 1q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 ii 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* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130'F* * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and AdulteReserrated for of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 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 Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 4-501.114 Chemical Sanitization-Temp., H. Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.14 Eggs and Milk Products,Pasteurized* P P 16 p g p 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155'17 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* Eff crave 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 sec* faces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 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* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11 C Game and Wild Mushrooms Approved By * ( )(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* 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 ( )( )( ) 3-2201.17 Game Animals* 11 Good Hygienic Practices 1 T. Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g, g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165'F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C 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 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 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70'17 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70*F to 41'F/45'F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41'F/45'F 25. Equipment and Utensils FC-4 .005 3-02.12 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 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. Qw� r7 Jj� °FINE r TOWN OF BARNSTABLE HEALTH INSPECTORS Establishment Name: � � ate: Page: of v` ° OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ' 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS MON.-FRI. �p .639.s�0� HYANNIS,MA 02601 508-8624644 No Reference R-Red Item PLEASE PRINT CLEARLY 'FDN1P' OOD ESTAPLISHMENt INSPE TI N REPORT Name 11AVOU1 Date n e of - ns a io / ra s outin IF Addressff, Risk F ervice � spectio Level etai Previoumpl I a ®0 411 Telephone Residential Kitchen Date:-Mobile Pre-opOwner HACCP Y/N Temporary Suspe Caterer General Complaint Person in Charge(PIC) D Time Bed&Breakfast HACCP 0 Wxz Other / Inspecto ut:MAlh ZOMIL)m v . I 12IN Each violation checked requires an explanation on the narrati We 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) ❑ o 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) ❑ j 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 N- ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals /7 FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) v ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling_ ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time Asa Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS( SP) 1719.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY lbf I ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the Wm 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. 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 if no critical violations observed,4 too 6 von-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 ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-c itical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 9 violation,4 to 8 non-critical viol ions C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: In for Signature d " Print: 31.Dumpster screened frorri 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' Signatu Print: Self Service Wait Service Provided Grease Trap Size Variance Lett_er,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* F 8 Cross-contamination LL4 Food or Color Additives L'aw 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 PHFs4 Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding- - 2-103.11 Parson-in-Charge Duties 3-302.14 Protection from Unapproved 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* Other* - 590.004(F) 2 590.003(C) Responsibility of the Person-in-Charge to - - 7402.11 Common Name-Working Containers* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) 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 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 ind 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 Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 . Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. L16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11- Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathogens* e//cr;vc ritrzoot 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish* 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 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. S Receiving/Condition g• g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination WhenTasting* * Blue Items 23-30) 3-202.15 Package Integrity* g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3 402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention* Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 1 Hand Drying Provision 29. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S: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. HEALTH INSPECTOR'S Establishment Name: Date: Page: of e°p SNE lok� TOWN OF BARNSTABLE - OFFICE HOURS /- g PUBLIC HEALTH DIVISION 8:00--9:30A.M. BARN57'ABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified mAss. eg HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY �A .679• ♦ - 508-862-4644 - 'FD"""`' FOOD ESTABLISHMENT INSPECTION REPORT Nam Dat / T e o I s ec ion t O er Routi / Address Risk Service pe Ion Level ion Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness r Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector kyll, Out: u / Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling f*C� �' Zp ❑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(H ) ❑ 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/v �1 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical C violations marked must be corrected immediately. blue&red items v^ ( ) y ( ) � Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating t �lg within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion El Re-inspectionScheduled ❑ 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. ❑ 9 ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than o 6 non-critical violations 9 26:Water;Plumbing and waste (FC-5)(59b.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 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 ( )( ) 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 = 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8 non-critical violations C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si re 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 F15.,.:.,., .• I 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* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-202.11 Separation-Storage* 20 Time as a Public Health Control 7-20 .11 Restriction-Presence and Use* 590.003(F)- Responsibility of A Food Employee or An 3,302.15 _ Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 590.003(G) Reporting by Person-in Charge* Contamination from the Consumer 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q - - 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 Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition of Adulterated or Contaminated - - Food' 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.1-3 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* Effective 11112001 4-602.11 _ _ Cleaning Frequency of Utensils and Food. Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source _ _ 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11- Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* - _ " 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS n 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- Ratites-165*F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,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* ( )( ) Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under 929-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition 8, 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 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 ' 3 402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 6-301.11 Handwashing Cleanser,Availabili 27.8. Physical Facility FC-6 .008 7 Conformance with Approved Procedures/ g ty 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 1 30. 1 Other 3-502.12 Reduced_Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. HEALTH INSPECTOR'S Establishment Name: Date: a of °p tNE Tok, TOWN OF BARNSTABLE .9 .-�-- q OFFICE HOURS j R E PUBLIC 0 MAWSTREET SION 8:00-9:3o'A.M. 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF C RRECTION Date Verified MON.-FRI. �p ,,}9,a a� HYANNIS, MA 02601 sob-8sz as4a No Reference R-Red Item PLEASE PRINT C EARLY 'FDN1Ay FOOD ESTABLISHMENT INSPECTION REPORT Nam Dat a of Inspection RoutineOt> !R: t M14 Address Risk ood Sery ection .� Level Previous Inspection Telepho 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 explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco . 590.009(F) ❑ Action as determined by the Board of Health. Allergen AwarenoSsdousFoodls) 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 Additives3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic ChemicalsFOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Ha ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating L ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling LCA [ �S j, ❑ 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) 1 b �- ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY �44 ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories �W 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 l O within 90 days as determined by the Board of Health. l ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an in ection 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 B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed;4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 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 Snon-Critical violations=C. 29.S pecial Re irements (590.009) within 10 days of receipt of this order. 30.Other PATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumps 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 Sig ture Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N `'AH S Dumpster Screen? Y N �^'fC`�6 l ✓ 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.* i * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties '- 3-302.14 Protection-from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41'F/45'F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to- 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590,004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) q 590.003(G) Reporting by Person in Charge* - _ , 7-203.11 Toxic Containers-Prohibitions Contamination from the�Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Adulterated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g � ) Disposition ofAdulterated or Contaminated Food - 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004A-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-Hut Water Monitnring* 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 3-262.16 Ice Made From Potable Drinking Water* Concentration and Hardness* I 3-401.11A(1)(2) Eggs-155'17 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 - Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145'17 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* Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155'F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source __ 3-401.l l(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) 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 s 3-201.15 Molluscan Shellfish from NSSP Listed, Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- _ ._ Sources* 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 Piesent* - 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-145'17 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 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Conditidn '-' - - -- g• g g 3-403.11(A)&(D) PHFs 165'F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165'F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11E 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* 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`17 to 70°F * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F_ Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained 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 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 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. °F�r+E, TOWN OF BARNSTABLE. HEALTH INSPECTOR'S Establishment Name: Date: Page: of ° OFFICE HOURS • BARNSSANLE.° PUBLIC 0 MAN HEALTH EETSION - 8:30 4:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. �p a,679.a e� HYANNIS,MA 02601 - MON.-FRI. No Reference R.-..Red Item PLEASE PRINT CLEARLY rFD MP'� 508-862-4W FOOD ESTABLISHMENT INSPECTION REPORT WIA _ Na Date /� a of c io v or Routine AddresLM s Risk Service ion "S' Level Previous Inspection zF 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 04 In: Other IkLt-r D Inspector Out: -1-7V4.4 E� A LjP - A )7!�_ 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) ❑ u po 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 �S 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 vo (� 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 4# ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time Asa Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE.POPULATIONS(HSP) r ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP + d ❑ 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) - Corre ive n Require ' Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. Voluntary Compliance ❑ Employe ' estriction/Exclu n ❑ Re-inspection Schedule ❑ Emerge cy Suspension. C N Official Order for Correction: Based on an inspection tod , e items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical, results in an F. 25.Equipment and Utensils B=One critical violation and less than 4non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 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 = ' EF29.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 Signature Print: - 31.Dumpster screened from public view A Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Sig re Print: Self Service Wait Service Provided Grease Trap Size_ Variance Letter.Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness - Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION'FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* L 8 Cross-contamination 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 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 15 Poisonous or Toxic Substances 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* 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 Separation-Storage** 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-3021 l(A) Food Protection* P g 20 Time as a Public Health Control . 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 590.004(11 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- Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions ) Variance Requirements 590.003(G) Reporting by Person in Charge - - - a 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 of Adulterated or Contaminated g Food' 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* _ 4-501.111 -- Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* ` 3-201.13 Fluid Milk and Milk Products* - 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13. Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - Concentration and Hardness* 163-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.1.1 Drinking Water from an Approved System* -- -- Equipment* gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish.From an Approved Source.,__ _ 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 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 s° 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 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. * 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 keceived at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose anti Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Pieventin Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 12 Prevention of Contamination from Hands 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the g Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 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 ShellstockfIdentification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3402.11 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. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S: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 INE Tok, TOWN OF BARNSTABLE HEALTH wSPECTOR's Establishment Name: Date: _ Page: of q OFFICE HOURS oi PUBLIC HEALTH DIVISION : 0- :30A.M.3:3o-4:3o P.M. BARN STABLE. 200 MAN STET Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified .639.s�0� HYANNIS,MA 02601 M-8 -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY EEO MPS 508-862�644 FOOD ESTABLISHMENT INSPECTION REPORT Name Date - yue of T ection outine C Address ( Risk ood Se pection / Level -a Previous Inspection l-. Telephone „/� / Residential Kitchen Date: Yy6 l Mobile Pre-operation Owner �p 1 HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) <w6j ¢ lS/'Y ` Time Bed&Breakfast HACOther CP (r In: Inspector Out: - Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. VV\ LO 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) ❑ AAA_kI:::0 I Action as determined by the Board of Health. Allergen Awareness 590.009(G) f _ VL 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 i PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP s ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP C ❑ 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 0todayhetems 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 inspectio checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo Emergency Closure Voluntary Disposal F] Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically o la hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. 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 anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 9 violation,4 to 8non-CritiCal violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: �/�`�/�1 n,� 31.Dupmperer screened from public view V2_ ` ✓ ` Permit Post V N Grease Trap Previous Pumping Date Grease red Y N ed . Y p p 9 Rendered #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Sig r Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted . Y N j 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) [Demonstration gnment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) 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_.1_4 Protection from Unapproved'Additives - - Contamination from Raw Ingredients 15 Poisonous 6eToxic 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* g g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility-of-the Person-in-Charge to- - 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A)- Roasts Held At or Above 130°F _ 7-201.11 Separation-Storage* - ! Applicants* -- 3-302.11(A) Food Protection* 20 Time as a Public Health Control, 7-202.11 Restriction-Presence and Use* 590.00.3(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 I1 Variance Requirements 3-304.11 Food,Contact with Equipment and Utensils * ( ) q 590.003(G)- Reporting by Person in Charge* - 7-203.11 Toxic Containers-Prohibitions " Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food*, 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions J 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* 590.004A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P - - 4-501.111 - Manual Warewashing-Hot Water - 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.]1(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 E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* _ gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef-'° 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 3-401.1](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 ca[er- 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 2-30111 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* * Other 590.009 violations relating to good retail 590.004 C) Wild Mushrooms* 3-401.11(A)(1)(b) All Other PHFs-145°F l5 sec ( * 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 3-201.17 Game Animals Requirements. 5 -' - Receiving/Condition - 2 401.11_ Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165*F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) g 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* 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* Supplied with Soap and hand Drying Devices Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' 7. 6-301.11 Handwashin Cleanser,Availability 28. Physical Facility FC-6 .008 7 Conformance with Approved Procedures/ g ty 28. Poisonous or Toxic Materials FC-7 .008 . HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 1 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 1 Conformance with Approved Procedures* S:590Forrnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. t F tHE 1p� t t v rl s_U oo DATE: -3— O MAR 2 4 20 FEE: »ARNST" E MN U BpRP]STABLE �� 039. `��MASS. TrUVjM-mDEPT. REC. BY �FD1�yA Town of Barnstable S CHED. DATE: Board of Health 367 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION Property Address: Assessor's Map and Parcel Number: Size of Lot:Wetlands Within 300 Ft. Yes Business Name: /!1 E C '19&,VJ(' 9-7 Q1 4- & �h�� No Subdivision Name: APPLICANT'S NAME: A. F, �� C Phone---1LZ--j2,7F,9 Did the owner of the property authorize you to represent bh—b No PROPERTY OWNER'S NAME C NTACT PERSON I Name: /O G(i o f &WL0 S,Tr�3 L1e- Name: Address: X 7— A/, S ram..s / 114-Address: /l60 /T% Phone: Phone: /o20��/y/ VARIANCE FROM REGULATION(List Res.) REASON FOR VARIANCE(May attach if more space needed) _o OfJ/ S/sty CoL , og A.MIA no �� �y r'1 Lj 7 Checklist(to be completed by office staff-person receiving variance request application) Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of floor plan submitted(e.g. house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applic ant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same ownertleasee only],outside dining variance renewals[same owner/Ieasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Ralph A. Murphy,M.D. Q:/WP/VARIREQ h>_ ya pf Q `\„++ nn DATE vl �QV1J + PR 2 4 FEE ► RAMSTABLE.KAM * pF BPPNStA81x 9� 039. �m� tc HFALDEPS. REC. BY Town of Barnstable y t I i, t a_ - S CHED. DATE: Board of Health 367 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION /,,� Property Address: ��U ��/ ��/ i/i✓�2 S�� ��'//LL s Assessor's Map and Parcel Number: Size of Lot: I Wetlands Within 300 Ft. Yes Business Name: 7l,;e C4,,GAl--se AT C)20&A SAg-!y No K_ Subdivision Name: / APPLICANT'S NAME: �ccpL Fn_ lo PhoneSC) 5�'Z Did the owner of the property authorize you to represent him or her? Yes N�o PROPERTY OWNER'S NAME CONTACT PERSON Name: �u h iJ3a,1-5 A/3 6K Name: (9 y L11 G/j6t/C 1 VG T may, / / - /�9 /% !��Gr t Address: 6 ��T/�/ //��N�s .CGr-Address: ��G ��-ST�s � Phone: Phone: q40 — //1// VARIANCE FROM REGULATION(List Res.) REASON FOR VARIANCE(May attach if more space needed) .9,3 L-e 5 t% W/Aldo- S G6i- 7 - 4Lc n Checklist(to be completed by office staff-person receiving variance request application) Four(4)copies of engineered plan submitted(e.g.septic system plans) Four(4)copies of floor plan submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals(same ownerneasee only),outside dining variance renewals(same ownertleasee only),and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G. Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman, M.S.P.H. REASON FOR DISAPPROVAL Ralph A. Murphy,M.D. Q:/WP/VARIREQ TH E TOWN OF BARNSTABLE �pF T�4 `rQ c OFFICE OF d = EAWSTAEL BOARD OF HEALTH NAM 0 �p 1639. 367 MAIN STREET Ufa MIR HYANNIS, MASS. 02601 June 10, 1999 Mr. David R. Brackett, Manager Mr. Fred Walker, President Olde Fairgrounds Golf Course 1460, Rt. 149 Marstons Mills, MA 02648 Dear Mr. Brackett and Mr. Walker: You are granted permission to operate a retail food establishment("shed") adjacent to the tenth tee at the Olde Fairgrounds Golf Course in Marstons Mills, with the following conditions: 1. Electric refrigeration shall be provided inside the "shed". 2. Screens, including sliding screen units shall be provided at all windows and doorways(s). 3. The foods which may be sold from this "shed" are limited to the menu submitted by the applicant dated 6/7/99. No other foods are authorized to be sold from this shed. 4. Foods shall not be prepared inside the shed. All sandwiches shall be prepared and thoroughly wrapped inside the existing licensed food service establishment located inside the main building. 5. All unsold sandwiches shall be disposed of at the end of each day. 6. This retail food establishment shall operate during the late spring, summer, and early fall seasons only. This permission is granted because only packaged foods will be offered for sale from this "shed". It is the opinion of the Board of Health that adequate food protection will be provided, if all of the above conditions are strictly adhered to by the applicant. Sincerely yours, Susan G. Ras c�, .S. Board of Health, Chairman brackett/wp/q/Is f E7J"CJ4"`r77t5 L�S�marli r1:ol-�TttircuRt�c.n u.� uc�. ..� +..r� .. . —IN TOWN OF BARNSTABLE OFFICE OF 2AU BOARD OF HEALTH y RUIL 1679• . 967 MAIN S'TAMT rw HYANNIS,AMASS.02001 January 16, 1992 David Curley, Director Barnstable Recreation Department 141 Bassett Lane Hyannis, MA 02601 Dear Mr. Curley: You are granted a conditional variance from Regulation 14, of the Town of Barnstable Health regulations, to have outside dining at the tilde Barnstable Fairgrounds Golf Course located off Route 149, Marstons Mills. (I) The applicant must meet all of the criteria in paragraphs A through n of the Board of Health criteria for variances For outside dining. Failure to do so will result In revocation of the applicant's outside dining privilege. (2) The applicant must install air curtaf r, at all doorways, serving windows, and apertures used in serving food or drink. (3) The total seating capacity shall not exceed 48, both indoors and outdoors. (4) The applicant must receive the approval of the Town of Barnstable Licensing Authority, if applir..Able. This variance is not transferable and will be voided if the establishment has a change in use or change in ownership, other than the applicant. The Board reserves the right to terminate the applicant's outside dining should any unsanitary conditions be obeetved. A copy of the criteria for granting variances fox outside dining is enclosed. Strict compliance with this criteria is required. Ver truly, J eph C. Snow, M.D. G�hatrman BOARD OF HEALTH TOWN OF BARNSTABLE JCS/bcs Enclosure Copy: Gary Philbrick TOTAL P.01 ICU. o;i�Ir 7UWM OF UI1fiNSTABLE DATE. .J orrlcE or FEES V e- l r��nrinR = 130AIlD OF HcALTH RECn Fn-AY�"'� ti r M1.. P. 361 MAIN SInEET i I IYANNIS,MASS,02601 z k8 a ti � MAR 7 VARIANCE REQUEST FORK - 1996 ALL VARTANCES MUST FIR, SUFIMITTFt) FIFTEEN L 15) ►Y.6 PRIOR_ '11117" s(:rirDUItED 110AIM OF�� iiEATAII MEETING. 8 car J NAME OF APPLICANT Fatry O- h) TEL. NO. ADDRESS OF APPLICANT ►" fyyIfst�(15 rn►��� �� ��l��X NAME OF OWNER OF PROPERTY SUBDIVISION NAME DATE APPROVED J ASSESSORS MAP AND PARCEL NUMBER LOCATION OF REQUEST aaMp a S C ho�I SIZE OF LOT SQ.FT WETLANDS WITHIN 200 FT.YES VARIANCE FROM REGULATION(List Regulation) NO REASON FOR VARIANCE Ma attach � VARIANCE(May if more apace is needed)r� J1 oI Ae, Q refa& W''bvn JZL �n��-5 � �J��c7T5 w%� �-►.id r-e.S�b�MS PLAN - FOUR COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. VARIANCE APPROVED NOT APPROVED REASON FOR DISAPPROVAL BRIAN R. GRADY, R.S. , CHAIRMAN SUSAN G. RASK, R.S. .,JOSEPH C. SNOW, M.D. HOARD OF HEALTH TOWN OF BARNSTABLB wi The ClubHouse at Olde Barney April 12, 1999 Please consider this letter as a request to operate a "Snack Shed". This shed will be located near the tenth tee. We would like to serve soda, candy, crackers, and prepackaged sandwiches. The prepackaged sandwiches will be prepared in our own kitchen. The purpose in operating this "Snack Shed" is to expedite the flow of golfers leaving the ninth green and going to the tenth tee. Anyone waiting for their tee time could utilize the "Snack Shed" and be ready to go to the first tee. Also, during the summer months the 350 junior members would not have to enter the clubhouse to purchase candy and soda, alleviating the heavy traffic in the bar area. Because of its proximity to the driving range, it would be convenient for those players hitting golf balls to also use this facility. Finally, the players who have finished playing the golf course could sit and enjoy the food and drink offered in the clubhouse without the congestion normally seen in the clubhouse during the golf season. Attached is a sample of what the "Snack Shed" would look like that we would like to install. Thank you for your attention in this matter. Fred Walker President, Poor Fred, Inc. David R. Brackett Manager, ClubHouse at Olde Barney G: Ct� hl Werome t0 9" Yh' The Barney . ti ytfi u�0 trfi � a IL A McKean Thomas From: Seymour Steve To: McKean Thomas Cc: Curley David; Mullen Tom; Obrien Robert; Philbrick Gary; Rutherford Warren Subject: RE: Septic Project Date: Friday, September 15, 1995 12:OOPM The septic system installed during the initial construction of the clubhouse was designed to accommodate 38 seats at the request of the Original Golf Committee. The restaurant has expanded their seating by placing additional tables and seats on the outside deck. Due to the increased seating the water usage at the clubhouse has increased over the years to the point that the existing system is no longer adequate. To bring the septic system into conformance with title V of the state environmental code either the seating needs to be reduced to the capacity that was originally specified (38 seats) or the system must be upgraded. The requirements of the state sanitary code,title V , regulating the installation of septic systems were revised in the spring of 1995. Under the revised code the system upgrade would need to be much larger and more expensive than was required under the previous version of Title V. Fortunately we designed and applied for the permits to upgrade the system at the Golf Course prior to the effective date of the revised regulations. Otherwise the system upgrade would cost approximately twice what this upgrade will cost. The permits are only effective for another two and one half(2 1/2)years. After March of 1998 an upgrade of the system would need to conform-, to the newer regulations. The proposed system upgrade includes capacity to accommodate functions attended by 100 people. This would include functions in the lobby of the building, in the basement of the clubhouse after if it is finished off or outside on the golf course grounds. The cost of the septic system capacity to accommodate these functions will cost approximately four(4)times what it will cost under the bids we received this summer if the capacity is not installed under this expansion but is installed at a future time. The expansion will be more expensive in the future due to the title V code revisions as well as the increased demolition and restoration costs. In other words it will be much less expensive to accommodate those functions now than at any time in the future. The seven bids that were received were clustered together with only two (2)thousand dollars separating the four lowest bidders. This indicates that the bid specifications were very clearly written and understood by the bidders. The low bid is reasonably and realistically priced. From: McKean Thomas To: Philbrick Gary Cc: Bart' Ed; Curley David; Rutherford Warren; Seymour Steve Subject: RE: Septic Project Date: Friday, September 15, 1995 10:17AM I am in receipt of your electronic mail message dated September 14, 1995. As we discussed by telephone last evening, you would have to remove approximately 42 seats or more from the food service operation. The existing septic system is capable of handling only a maximum of 38 seats. You stated there are currently more than 80 seats at this establishment. Also, the professional engineer who designed the septic system, Stephen Seymour, informed me that actual water usage records data indicates increased sewage and wastewater discharges each year, at or above what the existing septic system is capable of handling. The existing septic system is not adequate and will, at some point, become dysfunctional and become a public health threat. If you plan to continue operating with more than the number of seats allotted, the septic system must be upgraded. Page 1 By the way- Health Inspector Edward Barry stated to me today that he does not remember talking to anyone named Norman Bradley. From: Philbrick Gary To: McKean Thomas Cc: Curley David; Rutherford Warren; Seymour Steve Subject: Septic Project Date: Thursday, September 14, 1995 12:35PM At the last Golf Committee Meeting, Norman Bradley, Golf Committee member stated that he had talked to Ed Barry at the Health Department and asked about the need to complete the planned septic upgrade. Mr. Bradley stated that Mr. Barry told him that it wasn't necessary. If this is correct, would you please confirm. I have talked to Steve Seymore and he advised me that your department is expecting this work to commence ASAP. Please advise me of our requirements for the septic upgrade project if there has been any change. Page 2 1 TOWN OF BARNSTABLE Sr"B'X ' STABLE RECREATION and HUMAN SERVICES v03 RECREATION �Fv a ECEB E® DEPARTMENT MANAGER David Curly DAVID CURLEY SENIOR SERVICES MAR ? 2 1995 141 Bassett Lane Marie Saunders Hyannis, MA 02601 VETERAN SERVICES WEALTH D07Z Tel: 508-790-6345 Sidney Chase TM OF BARN usm Fax: 508-775-5742 COMMUNITY YOUTH SERVICES To: Robert Smith, Town Attorney Norma Holder-Hall Tom McKean, Director of Health Dept. SANDY NECK Ralph Crossen, Building Commissioner Anthony Troiano Steve Seymour, DPW Project Engineer GOLF COURSE From: David Curley, Director of Recreation and Human Services Gary Philbrick Subject: Golf Course Restaurant-proposed basement renovation Date: March 22, 1996 The Town of Barnstable has contracted with Fairways Inc./Daniel Fay to operate the Olde Barnstable Fairgrounds restaurant. This agreement was performed through an RFP Process under Chapter 30 B of the Procurement Laws. As Director of the Recreation and Human Service Dept. and responsible for the Golf Course operation, I am excited about the new tenant and his innovative ideas with respect to the restaurant operation. Fairways Inc. has proposed to renovate the basement area to accommodate golf course functions along with outside activities. In the past four years, this type of use has been consistent with the restaurant operation. The finished basement would contribute to a Town Facility financially and would provide an additional space for community programming. In booking tournaments and functions,the concessionaire would be required to submit all activities for the basement area and must have these approved by the Golf Course Pro/manager. The concessionaire would certainly be required to adhere to all Town regulations with respect to the hours and content of said functions. As Director and responsible for the Golf Division, I am recommending Fairways Inc. be allowed to renovate this basement as indicated on the enclosed plan. I am requesting to the Town Attorney, Building Commissioner, Board of Health, and the DPW Project Engineer to supply me with your concerns and possible restriction or suggestions to this proposal. Under the past license and practices at Olde Barnstable Fairgrounds Golf Course, the basement has been considered as a dedicated space for the Food and Liquor operation. I will be intending to submit to the Town Manager all of your concerns with hopefully a positive recommendation. Completion of this basement area would be a major contributor to the success of the overall operation. I would request your immediate attention to this matter as time is extremely important as we are moving into the busy golf season. I thank you for your assistance. Respe lly submitted David Curley, Director of Recreation and Human Services r FAIRWAYS INC. March 20, 1996 Mr. David Curley, Director Recreation & Human Services 141 Bassett Lane Hyannis, MA 02601 Dear Mr. Curley, We would like to take this opportunity to thank you, your committee, and staff for awarding the concession at Olde Barnstable Fairgrounds Golf Course to us. We look forward to this new and exciting opportunity, and working hand and hand with Gary Philbrick and yourself. In conjunction with our bid proposal, we would, at this time, like to begin the renovation work for the Banquet Room. This would consist of two (2) handicapp equipped bathrooms, carpeting (commercial-fire code) for downstairs banquet room, a small dance floor, all wall painted, and the supporting columns encased. We have obtained the necessary permits for this work. (See Attached Plan). Obviously these improvements would be permanent, and would add to the enhancement of the golf course. We would also furnish the tables and chairs to accommodate the capacity of the Banquet Room. We would only utilize this room for Golf Tournaments, charity groups, weddings, rehearsal dinners, social activities, i.e.: Dinner Dance Functions, Buffets, etc. This could also attract many more golf tournaments to Olde Barnstable Fairgrounds Golf Course. Our goal is to create one of the best golf course food concession/banquet facility on Cape Cod. Thank you for your consideration. It is our pleasure in working with you. Sincerely, n wnn J. Daniel Fay, President, Fairways Inc. SEE PLAN HANDICAP PLAN) ELECTRICAL RM STORAGE EXISTS BATH BATH EXISTS PROPOSED PROPOSED BOILER RM STORAGE EXISTS EXISTS STORAGE EXISTS HALF WALL with DECO SCREEN PROPOSED STAIRS UP N DINING AREA \\\ EXISTS r, i I STORAGE EXISTS BAR DANCE FLOOR PROPOSED PROPOSED Ii i 6914" FAIRWAYS RESTAURANT OLDS 5ARN5TABLE FAIRGROUNDS GOLF COUR5E FUNCTION ROOM floor drain floor drain 10� wet vent ------------- 1 van�ty I , vent vent 3-Ox6-8 3-Ox6-8 SCALE: 1"=2"-O" 1� FROF05ED RE5TROOM5 FAIRWAY5 RE5TAURANT 13APN5TA13LE FAIL GROUND5 G.C. LOWER LEVEL FUNCTION DOOM TOE OF BARNSTABLE Uwe r BARNSTABLE RECREATION DEPARTMENT DEPARTMENT MANAGER RECREATION DAVID CURLEY. David Curley, anaivsznsi> 141 Bassett Lane Director. y MASS Q� ib39 �0� Hyannis,MA 02601 Patricia Machado, Dt A Tel: 508-790-6345 Assistant Director Fax: 508-790-6279 SANDY NECx Email:barnrec@capecod.net Steven Tucker, Chief Ranger. - GOLF COURSE Gary Philbrick; Pro Manager Barnstable Golf Committee Meeting Minutes August 13, 1998 Commission Members In Attendance: Joseph Cordeiro- .'Chairman David Barber Vice Chairman Joseph Chilli,Ben Perry;David Pina,Frank Thomas,Liz White A quorum being duly noted,Chairman Joseph Cordeiro called the meeting to order,at 6:30pm. A motion was made by David Barber and seconded by Joe Chilli to accept the July meeting minutes as previously submitted. So voted. Old Business Pursuant prior queries regarding the age of staff tending bar at the OBFGC Fairways Restaurant It has been established that at.eighteen years old,it is legal for Fairways Staff to tend bar. It was inquired as to whether or not the Town/OBFGC could obtain its own h of license. Recreation Director David.Curley stated that it may be possible to obtain a lessor license which would accommodate the serving Of beer and wine. A subcommittee(David Pina,Ben Perry and Joe Chilli)presented their research regarding tee time automation. The subcommittee members,stated that they felt strongly about further pursuing the matter,and suggested that an open meeting be held and that the public,members Town Manager and Town Council be invited,as well as a Golf Management System(GMS)representative. Subcommittee members stated that the system would be best "plemented in the winter season. The system answers questions regarding fees,times;directions to he facility and offers a menu of options(maintenance,restaurant,pro Shop,etc.)from which Callers,may make their selections. The system costs approximately$20,000 and may be leased for up to two years. The ystem must be installed on a line with touch-tone service,and is accessed by touch-tone telephones. Some questions regarding the new systerii are as follows: Q: if the,system isle,ased for two years,and tlie`decision.is made to purchase the system at the end of the Tease term,will the costs paid be applied to the total purchase price? A: This was unanswerable by the GMS representative and would have to be forwarded to management for consideration. Q: How many complaints have been received regarding the existing tee tithe reservation method? A:. Tee Time Automation was not pursued in response.to complaints,but in an attempt t0 better the OBFGC facility. Q: Is touch-tone service available on a.Town-wide basis? A;-- This is riot known'by members of the Committee at this time,., Q: Will the bid process be used,in order to.make this purchase? A: Pending approval by the Town Manager,the system would be subject to the bidding process. . t - A motion was made by David Barber and seconded by Ben Perry to hold an open public meeting witlaS GMS representative in attendance,and invite the Town Manager,Town Council,at which questions may be asked and to offer the opportunity for discussion. Action: Four(4)in favor,Three(3)abstentions: So voted. Gary Philbrick,Pro Manager of the OBFGC,was present to discuss the current state of the facility. i Philbrick stated that FY98.ended at approximately 1.7 million. The.course is in the middle of its busy'eason and that they are,fiscally;in a.gmat position. Mr.Philbrick also stated that this month will see the Mass Public Links finals on the 1,7th&18th. Almon August 18th,will be a clinic for the physically challenged. Next year,the OBFGC seeks to hold the Est ever Cape-wide tournament for the physically challenged.August l6th will be the Camp Benefit Day,and aY proceeds generated that day will benefit the Barnstable Recreation Summer Camps. The recent.chanoians of the Men's&Women's Clubs were Jason Holt.and Annette Gaiotti. Mr.Philbrick stated that the greens will be aerated,and during that time,Monday-Wednesday-Friday fees will u well over the course of the season,and the:gaff is lions. The site has held. .. be reduced due to course disruptions. P P doing a great job. Mr.Philbrick stated that the OBFGC staff continues trying to maintain open lines Hof communication with the Fairways vendor,whose contract expires on 12/31/98.. The bid/RFP will heieevisited -in the very near future;Mr.Chilli.&Mr.Cordeiro will be asked to sit with OBFGC management at thattime. Public Comment Q: Does the$20,000 for the GMS include software,hardware and modem? A: This is not certain at this time,but is believed to be the case. Q: Why aren't the meetings held at the OBFGC facility? A: Meetings have been moved to that site upon request on different occasions and audience nunibers have been lower than usual at those times.&the last time,the site was in unacceptable condisiim Q� What advantages does the GMS offer? A: Prefer to leave that question until the public meeting with a GMS representative in attendanoi~ Q. What precipitated the search for an automated system? A: A sincere desire to help make the OBFGC the best facility it can be. Will informat ion ursuant to course expansion:be available.prior to the land bank vote? Q: W pursuant, A. IT to speak to that matter at this time;the Golf Course expansion project is not dead,however, and that the matter o additional holes is still being pursued. Q: Why don't Golf Committee members belong to the OBFGC? A: Mr..Chilli stated that he does not belong any longer due to injury. Mr.'Pina stated that he no longer belongs because he had difficulty obtaining a tee time during the times he was available to play Mr.Cotdeiro stated that he remains a member at OBFGC. A motion to adjourn was made and seconded at 6:50pm. So voted. . tt za G Si = 4•��f-T - =BSA *2.F i-- ` • me/µ✓•.v � •'. Eyqiafr. A 43 G�fA l lam= No. Dco---5 "/�^' ` 4✓' . � `,/" Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in co —i/ U(l��A , Yes � PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ,o 3\a;� Appricattou for Miopo.5ar *potem �lComaructton Vertu IrA� cation for a Permit to Construct Repair Upgrade X)Abandon Com lete System ❑Individual Components �r PP ( ) P ( ) Pg ( ( ) � P Y_ P Location Address or Lot No. �-k tqq. \ Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. L4_3e_U v .6 Ass ec— b • GOY _ 7S e--0 e v_v L5_ rmpt 6,-2l0�/I. 1.(�ti5 �cs,�r..o o .el 3 St,�xrt� q C Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons LS Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date A•-Z R-ebb) Number of sheets '\ Revision Date Title Size of Septic Tank ASOQ Type of S.A.S.C ]] 56n qoV Description of Soil Nature of Repairs or Alterations(Answer when applicable) !Sk_2. tar Date last inspected:iU AVtNO3 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 i s i B d of He t . S' ned Date Application Approved by Date Application Disapproved for the following reasons Permit No. r2003 �6 Y� Date Issued /01 3D.o No. ` 'C...,;- .�. �/ d Fee ',THE COMMONWEALTH OF MASSACHUSETTS Entered in comp;u �(5_ vi.7_�er: � PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes ZIpprication for Migpool *pgtem Congtruction-f ermit ���4 s ,,,bApplication for a Permit to Construct( )Repair( )Upgrade( )<)Abandon( ) [Complete System ❑Individual Components fir$ n Location Address or Lot No. fee —*-%ie, 141` 2� � Owner's Name,Address and Tel.No. S v YG�wc�p Assessor's Map/Parcel WO U IT (I r O n � Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ✓ '?•o • GOk 775_E- 0e-t­t.t5_ rmA cQ4y )109� 5.- ,1.e yc rA Q ®3 _ Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day.'Calculated daily flow gallons. Plan Date A—Z R-2cxn-_75 Number of sheets 1 Revision Date Title Size of Septic Tank 1500 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Q�cir� s Date last inspected: ton 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 i sued is Bofrd of He th. Si ned / Date Application Approved by Date `a�,3�✓©3 Application Disapproved for the following reasons Permit No. ;�nd /n , Date Issued 3elel ---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded(\) Abandoned( )by ':�• %� rr� . Tr.C. at 11W,,0 :�,4a 1419 has been constructed ih accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. )U — 90 dated 1 2I 3WO 3 Installer Designer eA; C The issuance bf ts permit shall not be construed as a guarantee that the system ill hction s designed 7,)� Date 1 l Inspector q\) A No. � Wo Fee �C9 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS Migoof *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(X)Abandon( ) System located at PY(o C> '_k4e /,Yg and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructio must be completed within three years of the date is Date: rcd °' Approved by TOWN OF BARNST •ABLE yv�fn�n�OVnAtt QJ��V' /! // LOCATION �`� �� SEWAGE # 2003, D OLr��[32A/9T�1dfG 1 l�iiCf��'Jvr9$ f5G Q Woo 13A.2�sTrg. ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.. �� �� A� SEPTIC TANK CAPACITY.- LEACHING FACILITY: (type) (size) ��X NO.OF BEDROOMS BUILDER OR OWNER / � PERMPTDATE: %2-3©_-92:3,--COMPLIANCE DATE: i Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist r; on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlan exist within 300 feet of leachi acility) Feet Furnished by ' .. 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Gr o L� �c7 2 SE y-Zo c l3 Cy ,Li.,iE S�„w SEPARATION - • 1500 GALLON �0 -- g8,� s•9-,�� SEPTIC TANK - ` C> sy /sue Goc � s (o" STONE SASE �orroM of TEST PIT @ ELEV. z 3 z.sy /� yz,3 /3i 'f . �' / y TC—/IZI> ---- �3ffPT G 1�5Y6TEM PROS�f_ �o� F� .�'.�A.D/c�5 f��o✓.- :.� TNT A �LPT 16 �5Y�5TEM Pf 5 I CAN DATA PAILYI=LOW(/y) //O 5EPTIG TAN K: Z/O yA- SOIL A13S0RPTbN SYSTEM: /as USE: (3)500 COAL.PRECAST PRYWELLS LI NEP W/4'OF DOU]3LE WASHED 1 STONE ALL AROUND GAPAG(TY: !' / 1 y .30 z. 3 � z• feria TG 1345 4.9/0 G�v6rL ��/z Z ' vv T ' /, // I !_?,"•� A` o� IN , /' ' `\ � \ l'' ,��' �N/s� L�f3�E tXc•C T fi�5 �/OT�.o. .� .�i�7/,SE' /-�� � � � •., I i \� ��! . ,,,. • „j; .S�jOT/C 7?-�i`//C' h�/�/.t� �.D-•�d X ' j'v .C3� /n/STi9GGE,� .C3 t��/='G�' z� D v 7G�T TIC 7, c��✓�/a cT�� Td 8, r�/�' ` LOc�T/o,.,,/ off• /�GL Ci7%G/T/�"s l�-...�,.�,�. / \'--'� / , v ��,o���,���,•�..o �,��oz In .9 y cx�.��T�o� <e3. c �r /88 Co,--�f-OG/�9r./c..:_ C• (u/T// 3/C� C,.��1Z /S, OD a 77T� !� � Tb ,94S00 v SEa �O.� pev�E.�TY Toc,-- � O /,' //, Go�,/T• r?C;'ar Tv ,v/eo��ac' zy.yo�r� /yor-i`��� \\ I " I; 1 ,I ij I; I� �-,1T E PLAN OF Lf yN; _. OGAT 161�: ya�PLI" OF PPl=PARI FOR 9 UMBA r 35791 SURV��� ------ II >> 2_Z WELLER & A�5�306.I AT ! F,E0I5TF-F P LANi1 9Pv,=Y0F PAI �F_ ,ter,:_ rn F rFR PATL I 1645 FALWI TH RP ti SUITE 4G GENTERVILLE, NIA Grp- TEL: (5625) 775-07�5 - —FAX: (508) 775-0754