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NORTH SISTER CAFE-FOOD - FOOD
owl lyl - ol (p II Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. VARNSTAMA = F.P.(Thomas)Lee MAft 200 Main Street, Hyannis, MA 02601 Daniel Luczkow,M.D.,Alt. Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 602 Issue Date: 06/03/2022 DBA: NORTH SISTER CAFE OWNER: THE NORTH SISTER CAFE INC Location of Establishment: 15 WEST BAY ROAD OSTERVILLE MA 02655 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 0 OutdoorSeating: 0 Total Seating: 0 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: - MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: • _ _ Town of Barnstable Initiate: 1AR?18TA{li Inspectional Services- At& 'lot •� Public Health Division Tn©r ,D: ! _ v I ;,;s�r. :::can ai�.C'tvi a 1�` 200 Main Street,Hyannis,N4A 02601 Office;: 508-862-4644 Fax: 508-790-0304 A tL,CAT ^^I FOR PERMIT TO L'.^.''.RATE A FOOD ESTABLISHMENT DATE-2-0 Z7- NEW OWNERSHII?X RENEWAL_ NAPE OF F1091-1 ESTr PILISI'..^. EN'T: N�� J�1 �r C ( "' ADI)RCSS OF FOOD ESTABLISHMENT: \N ,a nAAjLj wf A'•"'.ESA(IF I'jccE'IENT Fj:('PI.A"('VE): U�-� /� T N F,-MAIL ADDRESS: TELEPHONE NUP41'.EI'.OF FOOD ESTAEI.ISH1%!EN:T:t�Ip�I '©2-t�� TOTAL NUMBER OF BATHROOMS: 'AIEL L WATER:YES Ni o). ..(ANNUAL WATER ANlALYSIS REQUMED) ANNUAL: SEASONAL: DATES OF OPERATION:_/_l_ TO NUMBER OF SEATS: INSIDE:, OUTSIDE: j TOTAL: _`� SEATING:MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTS..DtJ C..NTINC RtJl`UNDYJI\*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING '.IE0UIIM"9ENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? j' r ` ' `( IS Al`.'AIR CURTA MI PROVIDED'AT WAITSTAFF SERVICE DOOI:(S)? tV f TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) I YF(;OD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) _BED&UP.EAKFAST _CONTINENTAL'BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) +_"."CMLE FOOD _FROZEN DAIRY DESSERT MACHINES...(MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) ' *�** ALSEA.SO,N&L R V [LE& NEW FOOD ONLY' REoUH2FD To CL HFALTH DIV FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 598 S62.4644 i Q\Application ronns\F00DAP11 2020.doc OWNER INFORMATION: FULL N A M r Or APPLICANT SOLE OWNER YE /NO D.O.B OWNER PHONE 11 ADD FSs ?© SCE No rY10 (\A � CORPORATE,OWNER: COP ORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: DA(L4 ' 0 U List(2)Certified Food Protection Managers AND at least(I)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 r4'7_ SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERM:,`E:All seasonal food establishments,including mobile trucks must be inspected by the IIcallh Div, prior to openin>Y!! Please call Health Div,at 508-8624644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAi'.MY 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 htill:Uwwvw.townofb:irnst<iblc.us/he:ilth(livisioni:iipnlia►(ions.,isi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: 11cntlits rim annually frcm January I st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE,COMPI TED APPI.ICATION(S)AND REQUIltED Frf;S BY DEC Ist, QMpplici;:ion Foam'TOODAPP RBV3.2019.doc x YcsS MC4 16 LO Raab 0 sec �or6- 21N - 02 � C 1 9 d C) �aaY d " O U Z-2 VN- r °p IKEr, TOWN OF BARNSTABLE. -. - HEALTH INSPECTORS Establishment Name: Date: Page:.• of / .. -'I- OFFICE HOURS .. .. ,. .. wa E PUBLIC O MAIN STREET SION . soo-'9:3o.A.M. 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified mwss. 8. MON.-FRI. �p ,639,a 0 HYANNIS,MA 02601 soa-862-464a No Reference ..R-Red Item PLEASE PRINT CLEARLY kw'EON1P� FOOD ESTABLISHMENT INSPECTION REPORT Name -.- Date% �e of Type of lnsoection (lam s Routinee Address J� � �. Risk ood.5ervlce ' Re-ins ection _ Level a al Previous Inspection 4 IL c&4 Telephone. Residential Kitchen Date: Mobile re-opera Owner HACCP' Y/N Temporary spe ness Caterer General Complaint Breakfast& . HACCP - Person in Charge(PIC) Time Bed In: Other U ,YV1 C�� Inspector Out: Each violation checked req Tres'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) y p Anti-Choking: 590.009(E) ❑ Violations rri&ked ma ose an Imminent health.hazard and req uire.lmmediate.corrective Tobacco 590.009 IF) ❑ - Action as determined by the Board of.Health. Allergen Awareness. 590.609(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑,4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑,7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION{ ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP , ❑ 10.Proper Adequate-Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consurrier 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 Regwred: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or -- within 90 days:as determined b the Board of Health. Overall Rating Y Y � ❑ Voluntary Compliance. ❑ Employee Restriction/Exclusion ❑ Re-inspection.Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspec on today,the,items Checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or morenon-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 Orion-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 susperision or revocation of the food if no critical violations observed;4 to 6-non-critical_violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot C=2 critical violations and less than 9 non-critical If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(596.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.'Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8 -critl al violations=C. - 29.Special Requirements (590:009) within 10 days of receipt of this order. 30.'Other DATE OF RE-INSPECTION: Inspe4sSiture Pri t: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's 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* F 8 Cross-contamination L14 Food or Color Additives Law Cooled to 41'F/45'F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 _ PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* Contamination.from Raw Ingredients 15 Poisonous orToxlcSubstanc®s 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 - "'� `= "'" ' ' ` 7-102.1.] 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 Ti 7-202.11 Restriction-Presence and Use* me as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and,Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 590.003(G) Repo ing by Person in Charge* 3-304.11 Food Contact with,Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q rt 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 Re or 7-20 of Food* 4'.12 Chemicals for WashingProduce,Criteria* HSP HIGHLY SUSCEPTIBLE POPULATIONS 590.003(E) Removal of Exclusions and Restrictions Disposition,of Adulterated ted 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 y. Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Not Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145'F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Not Otherwise Processed to Eliminate Equipment* ( )( ) Pathogens 590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meats&Game * 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* t 4-702.11 Frequency r f ces of Equipment* of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS' RUI:.r: 'Z .' 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP'Listed Chemical* g 590.009(A)-(D) Violations of Section temporary and - ide in cater- Sources* Ratites-165'F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145'F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3 401.11(A)(1)(b)All Other PHFs-145'F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11 A&D PHFs 165°F 15 sec* 5 Receiving/Condition ( ) ( ) 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and.Mouth* 3-403.11(B) Microwave-165'F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity Critical and non-critical violations,which do not relate to the foodborne 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 590.004(E) Preventing Contamination from Employees* 18 Pro Cooling Proper 6 Tags/Records:Shellstock P 9 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/Record e: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 2T. Physical Facility FC-6 .007 590.004(J) 9 9 Y� tY 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. 1 Other 3-402.12 Reduced-Oxygen Packaging Criteria* 8403.12 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: °F,�►q, TOWN OF BARNSTABLE, .. �.. ;, . ,...- ,.. ,, ..:. Page: � .. of - ry OFFICE HOURS ° PUBLIC HEALTH DIVISION 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified BARNSrAB,E. j MASS g MON.-FRI. HYANNIS, MA 02601 508-862-4644 No Reference_ R-Red-Item PLEASE PRINT CLEARLY QED MIX ..FOOD ESTABLISHMENT.INSPECTION REPORT ,, - Date Z Type of Type of lnsuection ,,, / Name.. //'' r ,}� . . _ e on s Routine Address bS�- Risk ood Serwce Re-inspection �I Level a ai Previous Inspection Tele hone �^ A p Residential Kitchen; Date: AMC D Mobile eratio 1 L Owner HACCP Y/N Temporary Suspect Illness /' i���1'I I %����/ Caterer General Complaint S Person in Charge(PIC) jy,�/ Time Bed&Breakfast HACCP v ", � _ .. Other _ _ Inspector Out: Each violation-checked Yeq ires'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.corre'dive Tobacco .590.009(F) ❑ c Ol -� Action as determined by-the Board of.Health. = Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination'from Hands S ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities w, EMPLOYEE HEALTH PROTECTION FROM.CHEMICALS _ , - 2.Reporting of-Diseases b Food Em to ees and PIC 14.Approved Food or Color Additives ❑ P 9 Y- P Y ❑ PP _ .❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑-4.Food and Water from.Approved.Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved:Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control I / A ❑8.Separation/Segregation/Protection. REQUIREMENTS FOR HIGHLY,SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food.Preparation for HSP f � ❑,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. (blueAred items) Corrective Action Required: - ❑ No 'FM Non-critical(N)violations must be corrected immediately or r� within 90 days as determined by the Board of Health O . verall Rating I� El Voluntary.Compliance ❑ Employee-Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency.Suspension C N Official Oder for Correction:Based on an inspection today;the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed'below by a Board of Health member or its agent A=Zero critical violations and no more than'3 non-critical violations. F=3 or more critical violations.9 or'more.non-critical violations, 24.Food and Food Preparation (FC-3 590,004 )( ) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 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 Gaon-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. 8 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,T to 8 nor-critical iolatnviolations. If 1 critical refrigeration. 29.Special Requirements.:;_ (590.009) within 10 days of receipt of this order. violation,4 to 8 n-critical violations=G. 30.Other DATE OF RE-INSPECTION: Inspector's Si 'na re Pnn: tRV-J.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 S' atur 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* F8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 5 C f 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.1 ooling Methods or PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding + 2-103.11 Person-in-Chazge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 590.004(F) 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* * 2 . 590.003(C) Responsibility of the Person-in-Charge to Other* _- ..- .. . . ,.. 7-102.11 Common Name-Working Containers* 3-50L.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* 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 Requirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) - Contamination from the Consumer 3 590.003(1)) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 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 88 Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* Equipment* 3 401.11(A)(2) Comminuted Fish,Meats&Game 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* Pathogens* Eg crave tnnoo1 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* i^ 4-702.11 Frequency r f Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs `SPECIAL'REQUIREMENTS ±:+ 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* * Ratites-165`F 15 sec* in mobile food,tem or and residential Sources 10 Proper,Adequate Handwashing g' P 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* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements. radicsrho ld be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* * (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 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°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 5-205.11 Accessibility,Operation and Maintenance 3-402.12 Records,Creation and Retention* Within 4 Hours 26. Water,Plumbing and Waste FC-5.. . .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 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 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. SANDWICHES - $9.95 (GF+ $2) BURRITOS OR BOWLS - $11.95 The Fat Tony My Thai Two eggs, spinach, avocado,tomato White rice, peanuts, carrots, red pepper, and garlic aioli on toasted multigrain purple cabbage, green onion and bread cilantro with peanut sauce What's UP? Yummmm Two eggs, provolone, avocado, arugula, Brown rice, pinto beans, avocado, and spicy love sauce on toasted cheddar cheese,tomato, shredded multigrain bread carrots, green onion, black olives, sour cream and yummm sauce Zen Two eggs, mixed greens, avocado, garlic Tropical aioli and spicy love sake on toasted Two eggs, avocado, black beans, brown multigrain bread rice and mango-corn salsa The Jane Two eggs, cheddar cheese on toasted Easy Breezy multigrain or white bread. Two eggs, pinto beans, white rice, avocado, arugula and spicy love sauce Stan the Man Peanut butter, banana and honey on Keep Your Headphones On multigrain or white bread. Brown rice, pinto beans, cheddar cheese, mashed avocado, and lime-cilantro sauce The Sloth Two eggs, brown rice, black beans, avocado, cheddar cheese and spicy love sauce You Get What You Get When you're feeling adventurous! SALADS - $11.95 SMOOTHIES - $7.95 The Problem The Emily Romaine, marinated chickpeas, sun Banana, peanut butter, cocoa powder, dried tomatoes, artichoke hearts, chocolate plant based protein powder, walnuts and parmesan with liquid gold almond milk and mini chocolate chips dressing For the Boys New Caesar Apple juice, banana and mixed berries Romaine, sliced almonds, house made croutons, shaved parmesan with caesar But Make It Green dressing Apple juice, banana, mixed berries and spinach Taco Tuesday Romaine with purple cabbage, black Chocolate Covered Berries beans, tomato, avocado, cilantro,tortilla Banana, mixed berries, cocoa powder, chips with lime-cilantro dressing and almond milk Gula Love BAGELS - $7.95 Massaged arugula, avocado, roasted Veggie corn, red onion, red pepper, mango, Whole wheat bagel, plain cream cheese, walnuts with love sauce tomato, carrots, spinach and cucumbers North Sister Salad Vampire Slayer Mixed greens with brown rice, shredded Everything bagel, roasted garlic cream carrot, tomato, cucumber, avocado, cheese, cucumber and tomato walnuts, red onion with liquid gold dressing Rajun Cajun Plain bagel, cajun cream cheese, shredded carrots, spinach, cucumber and sriracha drizzle That's My JAM Plain Bagel, plain cream cheese and jam The Blues Blueberry bagel, plain cream cheese, green apple slices and maple drizzle B00000ring Plain bagel with plain cream cheese Consuming raw or undercooked eggs may increase risk of food borne illness Before placing your order,please inform us if you or anyone in your party has a food allergy _ } -17 -77 ..... ......... 9 � f i f I I 1 ....•_ r_ r v e j f -�.i'.�+•w.--'°--.....ate_ a � � i�� _ � n rc \" { E 7 } i S d r 3 1 �— r ! 6 a + t ! l 41 1 44( I ti. I t r w E� 1 a� 7 i i SANDWICHES- $9.95(GF+$2) BURRITOS OR BOWLS- $11.95 The Fat Tony My Thai Two eggs,spinach,avocado,tomato. White rice, peanuts,carrots, red pepper, and garlic aioli on toasted multigrain purple cabbage,green onion and bread cilantro with peanut sauce What's UP? Yummmm Two eggs,provolone,avocado,arugula, Brown rice, pinto beans,avocado, and spicy love sauce on toasted cheddar cheese,tomato,shredded multigrain bread carrots,green onion, black olives,sour cream and yummm sauce Zen Two eggs, mixed greens,avocado,garlic Tropical aioli and spicy love sauce on toasted Two eggs,avocado,black beans, brown multigrain bread rice and mango-corn salsa The Jane Two eggs,cheddar cheese on toasted Easy Breezy multigrain or white bread. Two eggs,pinto beans,white rice, avocado,arugula and spicy love sauce Stan the Man Peanut butter,banana and honey on Keep Your Headphones On multigrain or white bread. Brown rice,pinto beans,cheddar cheese,mashed avocado,and lime-cilantro sauce The Sloth Two eggs,brown rice,black beans, avocado,cheddar cheese and spicy love sauce You Get What You Get When you're feeling adventurous! r k. = Puri i SALADS-$11.95 SMOOTHIES-$7.95 The Problem The Emily Romaine,marinated chickpeas,sun Banana, peanut butter,cocoa powder, dried tomatoes,artichoke hearts, chocolate plant based protein powder, walnuts and parmesan with liquid gold almond milk and mini chocolate chips dressing ' For the Boys New Caesar Apply juice,banana and mixed berries Romaine lettuce,sliced almonds,house made croutons,shaved parmesan with But Make It Green caesar dressing Apply juice,banana, mixed berries and spinach Taco Tuesday Romaine with purple cabbage,black Chocolate Covered Berries beans,tomato,avocado,cilantro,tortilla Banana, mixed berries,cocoa powder, chips with lime-cilantro dressing and almond milk Gula Love BAGELS- $7.95 Massaged kale, avocado,roasted corn, Veggie red onion, red pepper,mango,walnuts Whole,wheat bagel, plain cream cheese, with love sauce tomato,carrots,spinach and cucumbers North Sister Salad Vampire Slayer Mixed greens with brown rice,shredded Everything bagel,roasted garlic cream carrot,tomato,cucumber,avocado, cheese,cucumber and tomato walnuts, red onion with liquid gold dressing Rajun Cajun Plain bagel,cajun cream cheese, shredded carrots,spinach,cucumber and sriracha drizzle That's My JAM Plain Bagel,plain cream cheese and jam The Blues Blueberry bagel,plain cream cheese, green apple slices and maple drizzle B00000ring pond Plain bagel with plain cream cheese 3 Con ur tying ravl or.lf)dercooked eggs m?V i crease risk Of food borno,,'11nr ss ectlore p=raf,inrl yn,try rl^r,peas e inform us if you or anyone in your party his a food able,ryy 3, , _ PM= SANDWICHES - $9.95 (GF add $2.00) The Fat Tony Two eggs, spinach, avocado, tomato and garlic aioli served on toasted multigrain bread What's UP? Two eggs, provolone, avocado, arugula and spicy sauce on toasted multigrain bread The Jane Two eggs, mixed greens, avocado, garlic aioli and spicy love sauce on toasted multigrain bread. The Oliver Peanut butter, banana, honey and granola on toasted white bread BURRITOS - $11.95 (GF available) Tropical Two eggs, avocado, black beans, brown rice and mango-pineapple salsa Easy Breezy Two eggs, pinto beans, white rice, avocado, arugula and spicy love sauce Slow Slow Sloth Two eggs, brown rice, black beans, avocado, cheddar cheese, and spicy love sauce YUMM m Brown rice, pinto beans, cheddar cheese, red pepper, shredded carrots, green onion and black olives and yummm sauce Stan the Man Peanut butter, banana, honey and granola wrapped in warm tortilla BUILD YOUR OWN SANDWICHES & BURRITOS - $9.95 any 3 toppings BREAD TOPPINGS CHEESE SAUCES White Carrots Provolone Garlic Aioli Wheat Spinach Cheddar Spicy Love Tortilla Arugula Pesto Red Pepper Mayo Pickled Red Onion Mustard Pinto Beans Pineapple-Mango Salsa Chickpeas Lime Cilantro Black Beans Avocado 2 Eggs Brown Rice White Rice Peanut Butter Jelly Salads - $11.95 North Sister Salad Mixed greens with shredded carrot, cucumber, avocado, walnuts, red onion and brown rice with liquid gold dressing. Healthy Bowl Mixed greens with pickled red onion, avocado, walnuts, red pepper and chickpeas with tangy red dressing. New Caesar Romaine with almonds, house made croutons and tahini caesar dressing Wink wink Mixed greens with almonds, candied pecans, green apple slices and goat cheese with liquid gold dressing. BUILD YOUR OWN SALAD (Spring Mix Base choose four toppings) - $11.95 NUTS/SEEDS CHEESE OTHER DRESSING Almonds Cheddar Green Apple Liquid Gold Walnuts Goat cheese Avocado Tangy Red Candied Pecans Provolone Chickpeas Tahini Caesar Sunflower Seeds Black Beans Honey Mustard Pinto Beans Avocado BAG E LS - $7.95 Veggie Whole wheat bagel, plain cream cheese, tomato, carrots, spinach and cukes Vampire Slayer Everything bagel, roasted garlic cream cheese, cucumber and tomato slices Rajun Cajun Plain bagel, cajun cream cheese, shredded carrots, spinach and sriracha drizzle That's My JAM Plain bagel, plain cream cheese and raspberry jam The Blues Blueberry bagel, plain cream cheese, tart green apple slices, and maple drizzle BUILD YOUR OWN BAGELS - with CC $6.95 - with any 3 toppings $7.95 BAGEL CREAM CHEESE TOPPINGS Plain Plain Lettuce Everything Garlic Lovers Tomato Whole.Wheat Cajun Spinach Blueberry Arugula Carrots Peppers Cucumber SMOOTHIES - $7.95 The Emily Banana, Peanut Butter, Cocoa Powder, Chocolate plant based protein powder and Almond Milk For the Boys Apple juice, banana, mixed berries But Make it Green Apple juice, banana, mixed berries and spinach Chocolate Covered Berries Banana, mixed berries, cocoa powder, and almond milk DESSERTS - $3.00 Cookies Monster Chocolate chip PB Oatmeal raisin Chocolate chocolate chip Weekly Special Lemon blueberry cupcakes Coconut cupcakes QUICK BITES - $4.00 M uffi ns Homemade Granola Bars ESPRESSO BEVERAGES (choice of almond, skim or whole milk) $3.95 Latte Mocha Americano • TQWN OF ARNSTAELE Xlv v — LOCATIONJS��'/ SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1"At.� LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER'\lr�C�l� PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and,.Leaching Facility(If any wetlands exist within 300 fee i}'l cility) Feet Furnished i G 04 10 op m G 3,3 No. -Lee Fee THE COMMONWEALTH OF MASSACHUSE17S Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Miooml *potem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Add res or Lot N Owner's Name,Address id TeL No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Addres an Tel.No. f r My / � /w 41 Ii rll-a�nl s U 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 yL C ��� gallons per day. Calculated daily flow gallons. Plan Date :Z- 22— 2 ` Number of sheets Revision Date Title Size of Septic Tank ,/o �!� Type of S.A.S. 3 5_06 Description of Soil _ Nature of Repairs or Alterations(Answer when applicable) 42 ` x i3 Y_ Z Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss d by is Board o ealt Signed Date w Application Approved by Date 3 Zi U Application Disapproved for the following reasons Permit No. Date Issued -- -- - —————————————————————————————— No. �/C/�d f 3.3 W Fee s� •.-. Y I THE OCETH OCE MMONWEA:L{ ASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Ye / 0[pprication for Migponfj tent Construction Vermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Indiy`dual Components Location Addres or Lot No. Owner's Name,Address d T 1.No. w ae Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. IUD A- b If 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 7 G 6 G/,g�� gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1400 Type of S.A.S. 3 5_06 Description of Soil 1 Nature of Repairs or Alterations(Answer when applicable) 3yx Date last inspected: Agreement: The undersigned agrees to ensure the constr\ction and maintenance of the afore_described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance'has been issu d by t is Board of ealt Signed Date Application Approved by I&M An i Date 3 Z 0 / Application Disapproved for the following reasons Permit No. / Date Issued TM V n ——————————— —— —— ——————— THE\COMMONWEALTH OF MASSACHUSETTS i BARNSTABLE, MASSACHUSETTS Certificate of Compt ante THIS IS TO CERTIFY, that the On-site,Sewage Disposal System Constructed( )Repaired Upgraded( ) Abandoned( )by AX rU at GfJ e s / 0 < has been constructs�/m ccordance with the provisions of Title 5 and the or Disposal System Construction Permit No. "1-*�� 3 dated �/ L 0 Installer Designer The issuance of this pe 't hall not be construed as a guarantee that the syst �I 111 fu`nctio/n//a�s,designed Date 3 /1 J �b Inspector 1� . l /V/,Y / VIJ d --.—.-----_--- ---;-- NO. 11 0 — Fee 0 1 ` I J ' THE COMMONWEALTH.OF MASSACHUStETTS PUBLIC HEALTH DIVISION - BARNS'AB�L-E, M ASSACHUSE tr7 ; u �,r 4 wlig;pogal 6potem Congtructio n permit �� Permission is hereby granted to Construct( )Repair.( (AUpgrade ] )Abandon(� ) � System located at /� UI�S-� 4+� Qof �Il i and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this p t. Date: 3 / L 0/ Approved by : _ TOWN OF BARNSTABLE t: LOCATION ( � �i SEWAGE # ZoC4-1 j 3 VILLAGE i ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY a s i LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDAT$: — l Z a/ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundvsfater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Teaching Facility (If any wells exist on site or within 200.feet of leaching facility) Edge of Wetland and.Leaching Facility(If any wetlands.exist di its tr within 300,feet of.lea chi n` fac Feet g ility) I LJb cU Feet Furnished by i 1z 0 � . F LS -z Z 1/6i99 'NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTTFICTION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PEINIII (W=OUT DESIGNED PLANS) hereby certify that the application for disposal works construction pernit signed by me dated 3- conceruns the propery located at /S LfJe e meets all of the following criteria: fr • Tne failed sgste'r is coane^ed to a residential dwelling only. T nere are no commercial or business uses associated with Che dwellins. • • The soil is classified as CLASS 1 and the percolation rate is less than or equal to j minutes per inca. • There are no wetlands within L00 Fee;of the proposed seutic sysem • There are no private wets within L:o Fee;of the proposed septic Sys-e-n • There is no increase in flow and/or c:range in use proposed • There are na variances reques<ed or needed_ • The bottom of the proposed leacain;facility will not be located less than five Fee;above the ma.-draum adjusted groundwater table-!c-aaon_ (Adjust the zoundwater table using the Frimptor method when applicable] • 1f the S._�.5. will be located with'_50 Fea;of any vegetated wetlands, the bottom of the proposed lenc:dng facligl will not be lcca(ed!ess than tauneen(1 Y) tee;above the cn Lxc mum adiusted Q*aundwater table e!evaaori Please complete the following: A) Too of Ground Sur:ace =!evation(using GiS information) 8) G.W. Eleiation -the NLk.: h G.W. Adju_rment = D T-: ERE`i CE 8 E7,VE-N' a,and 3 c l (ShetCh proposed on back-1. q: csich iaidc.-:_-t P '3 x' 2 RECEIVED Op THE IAN 3 2000 Tpw TE:RECEIVED � o . � I snRrtsTnB>E TOWN OF BARNSTABLE EE: oo S -00" - y MASS. HEALTH DEPT. E1)MA't 1% CTOMR.OF B NSTABLE Town of Barnstable SCHED. DATE: Board of Health 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Ra►ph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION Property Address: Assessor's Map and Parcel Number: Size of Lot: Wetlands Within 300 Ft. Yes Subdivision Name: L Business Name: No v *P& 61011 (-� APPLICANT 1- CONTACT PERSON Name: h e Name: Mar,4 PI,e,I Address: q i I �/"t dress: t od(, 0,1 Phone: �� Phone: d � FAX: FAX: VARIANCE FROM REGULATION(List Res.) REASON FO VARIANCE(May attach if more space needed) - - T�. SL�C-7 01V 1 r Qv �n �2r15 i♦� — �l.�el - 1`C Ulm In —�/YH� re'n� �n ° 6j&kw cz "Ofv1oCr�SR- Checklist(to be completed by office staff-person receiving variance request application) J -PPU-10 , Four(4) copies of plan submitted(including septic system plans and/or restaurant floor plans) rr Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's ex ense for Title V and/or local sewage regulation variances only) Frill fitted(for grease trap variances on y Variance request application fee co ec e (no fee for i eguard modification renewals,grease trap variance renewals(same owner/leasee only),outside dining variance renewals[same owner/lessee 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 RECEIVED OF THE Tp� IAN 3 Z000 TE.RECEIVED . � BAMSTABM TOWN OF BARNSTABLE EE. �� y MAC• 0g HEALTH DEPT. i659 C`r0;$ OF BARl :;TF,BLE Town of Barnstable HEALTH DEP 1. SCHED. DATE: Board of Health 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 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 Subdivision Name: No Business Name: APPLICANT 1 CONTACT PERSON Di Name: r 2 t Name: MarA V #Ie Address: I de Val dress: )q UoCK a 1 rdD bvY/yQt III Phone: 5� S��b�jI Phone: -SCA 'S��/ 03� J v�� FAX: FAX: VARIANCE FROM REGULATION(List Reg.) REASON FOK VARIANCE(May attach if more space needed) _ . 5cf-C7;nN 1 , vv 17?.1 es'latllais l �n •lrCdc� �l� �fts ° C k�SneSS S-e- Checklist(to be completed by office staff-person receiving variance request application) 4-1zLP, Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's ex ense for Title Vand/or local sewage regulation variances only) Full itted(for grease trap variances on y Variance request application fee co ec e (tm fee for deguard modification renewals,grease trap variance renewals(same owner/leasee only),outside dining variance renewals(same owner/lessee 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 RECEIVED r �p1HETpw TE:RECIEI Y ED� IAN 3 Z000 y HARNSrABLF. TOWN OF BARNSTABLE F1EE: 0D E 9 MAS g HEALTH DEPT. I� s6gq. A�0 rO:AY�C)r 3A�",,,).A E Town of Barnstable HEALTH DEP . , SCHED. DATE: Board of Health 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,INI.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 Subdivision Name: No Business Name: r APPLICANT CONTACT PERSON Name: r h e Name: MarA Ftie 1 Address: I l�Vt dress: �� �CGtI.Cocy- 0,1 r(k'tJ ,� CQ01 �40 CGc. y� �C Phone: �fD�� Phone: �(] S�j�-'�37 J v� FAX: FAX: VARIANCE FROM REGULATION(List Res.) REASON F03 VARIANCE(May attach if more space needed) r —77 t)N rn " r ,V J fJSrl /isinWk �St22sS ct h o ✓L°Ca.S-e- Clrecklist(to be completed by office staff-person receiving variance request application) Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's e�c ense for Title Vand/or local sewage regulation variances only) Frill fitted(for grease trap variances on y Variance request application fee co ec e cno ree for i eguard modification renewals,grease trap variance renewals[same owner/leasee only 1,outside dining variance renewals(same owner/lessee 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 � I RECEIVED �FtME Tp� TE,RECEI`ED .IAN 3 'Z000 EE: .Od • snRrtsrABLF, - TOWN OF BARNSTABLE ! 9 ;Hass. 0�* HEALTH DEPT. ( f �ArECMAI139. A1 Town of Barnstable I HEALTHY—f3TABLE SCHED. DATE: Board of Health 367 Main Sheet, Hyannis MA 02601 Office: 508-790-6265 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,NI.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 Subdivision Name: _ No Business Name: APPLICANT 1 CONTACT PERSON / Name: r e- l Name: mar,4 PAW �< Address: L 1 I t1✓� dress: )`1 Or 0.112k'� "sae L#a Phone: S t� �j b7�'17 Phone: FAX: FAX: VARIANCE FROM REGULATION(List Reg.) REASON FOP,VARIANCE(May attach if more space needed) T Stf C-77 ON I -- 2c r}(a hs�cesS ho reckS-e- Checklist(to be completed by office staff-person receiving variance request application) Four(4) copies of plan submitted(including septic system plans and/or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's ex ense for Tide V ancL'or local sewage regulation variances only) Full itted(for grease trap variances on y Variance request application fee co eC a (no fee for i eguard modification renewals,grease trap variance renewals(same owner/leasee onlyl,outside dining variance renewals(same owner/lessee 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 r EXCERPT FROM THE BOARD OF HEALTH MEETING MINUTES ON 1/10/12: A. Attorney David Lawler representing Mary Phelps, owner of Earthly Delights — 15 West Bay Road, Osterville, Map/Parcel 141-016, request for two variances: toilet facility and outdoor dining. Attorney David Lawler and Mary Phelps presented their variance. David Lawler,_Esq. said the property has had benches and seating much before Earthy Delights — probably for at least 20 years. Mary Phelps never realized it was viewed by us as outdoor seating with the increased toilet facility. The owner did write a letter stating the seats are not exclusive to Earthly Delights. They do have employee bathrooms. The menu is take-out. They presented a petition with 240 signatures as well. Upon a motion duly made by Dr. Canniff, seconded by Mr. Sawayanagi, the Board voted to approve a toilet facility variance to allow the 12 outdoor seats. (Unanimously, voted in favor.) 1 ` I sd,nSla✓Z J� j ,�' i-v �✓ 6 �d �eco,,dS �,.� �,tc In a-r- � e r'r'-/v of Q:\MINUTES\EXCERPT OF MINUTES\Excerpt BOH Jan 2012 Earthly Delights�Ost. oc DATE: , 3/•6/•99 PROPERTY ADDRESS: 45 Wr'st Bay' Road' Ostertille ,Mass . r U2655 On the above date, I Inspected the septic systom at the above address. Thla ayatem conslsts of the following: `ZX1 �, 1 . 2-1000 gallon septic tanks. 2 . 1-1000' gallon grease trap , 3. 1—Distribution box. 896 0& W99M t78h nAAI�Ihe following condlCions.:.^ 5 . This is a 'title •five ' septic system. (,•••7,8 rC.ode ) E � 6. The septic systems are in proper Working order O - at the present -time . 81GNATUFR!r7,Y Coma ;on, p �y: ,l J, P_Macopber & ;onac , _ Address' RECRV 'd __C e nup r v� 1 L e Au.,y 3.2 Tc;WN P=URZTdKE , Phone: THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY XSEPH P, MAMBER '& SON; INC, T4nkPC@wpoo4-Lsachf1sIds . Pump+d L Inst IIW Town S+wst Connictlons P.O. Box 66 ' Centervllle, MA 02632.0066 77.5.3336 775-6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B. STRMc Governor Cornmigsionel SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 15 West Bay Road Name of Owner)a c k Cotton Osterville ,3���0902655 AddressofOwner: 851 Main Street Date of Inspection: O s t e r v i l l e ,Mass . Name of Inspector:(Please Print)J o s e ph P .Macomber Jr . (���,5 5 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR T5:OW1 company Name: J . P.Macomber & Son Inc . Ma,,TaVAddress: BOX 66 Centerville , Mass . T2632 Telephone Number: 5 O$—7 7 5—1.3 3 8 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: asses — Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: Data: The System Inspect,r hall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty (30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the Inspector and the system owner shall submit the report to the appropriate regional office of the Department ofrEnv)ronmental Protection. The original should'be sent toZlte system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 Pagel of11 `�} Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 15 West Bay Road 0 s t e r v i l l e , Mass . Owner: Jack Cotton Date of Inspection: 3/6/9 9 INSPECTION SUMMARY: Check A, B, C, or A A. SYSTEM PASSES: I have not found any Information which indicates that any of the failure conditions described in 310 CMR 16.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: q3�gremg hasp hppn mai ntai nprl on a mai nt-pn�nnCe pilmPi no B. SYSTEM CONDITIONALLY PASSES: 142 One or more system components as described In the "Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes,no, or not determined(Y,N, or ND). Describe basis of determination in all Instances. If "not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance (attached)Indicating that the tank was Installed within twenty(20) years prior to the date of the Inspection; or the septic tank, whether or not metal, is cracked,structurally unsound, shows substantial Infiltration or exfiltration, or tank failure is Imminent. The system will pass Inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box Is due to broken or obstructed pipe($) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced - The system required pumping-more than fourtmes is yeardue to broken or obstructed pipe(s). The aystem vAtlmss— Inspection if(with approval of the Board of Health): - - broken pipes) are replaced obstruction is removed revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PropwtyAddre": 15 West Bay Road Osterville ,Mass . Owrw: Jack Cotton Date of ku"Cdon:3/6/9 9 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health In order to determine If the system Is falling to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WITH 310 CUR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING W A MANNER WHICH.WILL.PRQ1ECT THE PUBLIC HEI1LDLAND SAFETY AND THE EN1a8ONMEM: Cesspool or privy Is within 60 feet of surface water Cesspool or privy is within 60 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS Is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS Is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS Is within 60 feet of a private water supply weU. 1411) The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 60 feet or more from a private water supply well,unless a well water analysis for coiiform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the press ce of ammonia nitrogen and nitrate nitrogen Is equal to or less than 6 ppm. Method used to determine distance_, (approximation not valid).- 31 OTHER revised 9/2/98 Page 3ofII SUBSURFACE SEWAGE DISPOSAL AYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertyAddress:15 West Bay Road Osterville ,Mass . Owner: Jack Cotton Date of Inspection: 3/6/9 9 D. SYSTEM FAILS: You In,ust Indicate either'Yes" or"No" to each of the following: �lL I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination Is Identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No f` Backup of-sewage irrtoiacility�or•-eTstemcomponent•duo tto an overloaded orckg god SAS--orcesspod. =�•--'- ' ` Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distr�i ution box above outlet Invert due to an overloaded or clogged SAS or cesspool. ; Xg r!r�' • . Liquid depth in ceeeprwGis less than 6" below Invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped L.Ay�f z fYl Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. " Any portion of a cesspool or privy Is within 100 feet of a surface water supply or tributary to a surface water supply. / Any portion of a cesspool or privy is-within a Zone I of a public well.. Any portion of a cesspool or privy is within 60 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for •►coliform bacteria, volatile organlo•compounds, ammonia nitrogen•and nitrate nitrogen. - E. LARGE SYSTEM FAILS: You must indicate either "Yes" or"No" to each of the following: The following criteria apply to large systems In addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes Z�C the system is within 400 feet of a surface drinking water supply ,!e/d the system•Is-witWn 200 feet o�ar"o-asurfsoa. 4nk4wg•wator--supply.�••- the system is located In a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further infor,(nation. revised 9/2/98 Page 4orii f i. i i SUBSURFACE SEWAGE DISPOSAI,SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:15 West Bay Road Osterville , Mass . Owrwr: Jack Cotton Darts of Inspection: 3/6/9 9 Check if the following have been done:You must Indicate either "Yes" or'No" as to each of the following: Yes No ,3•/ Pumping Information was provided by the owner, occupant,or Board of Health. _ ..None of the systemcompoaants.Maaabsan pun►ped4opat-Jaasttwo•awaakaaadtba•rystsm hasbaeoaatcais 6,4g"6 W flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this Inspection. As built plans have been obtained and examined. Note If they are not available with N/A. _ The facility or dwelling was Inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The she was Inspected for signs of breakout. //k -- — — All system components,�Ciuding the Soil Absorption System,have been located on the site. _ The septic tank manholes were uncovered,opened, and the Interior of the septic tank was Inspected for condition of baffles or tees,material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System orrths site has been determined based on: Existing Information. For example, Plan at B.O.H. _ Datermined In the field(if any of the failure criteria related to Part C Is at Issue,approximation of distance is unacceptable) +/ 115.302(3)(b)) Y _ The facility owner.(and.oCe-pant_ar.if difiaraat Infnrmatioa.Dn the prnnur maiptan nC. .,f SubSurface Disposal Systems. I i revised 9/2/98 Page Sof11 r I , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ! SYSTEM INFORMATION Prop"Addre": 15 West Bay Road Osterville ,Mass . owner: Jack Cotton Date of I"ape`oon: 3/6/9 9 FLOW CONDITIONS RESIDENTIAL: Design flow:_,-dog.p.d./bedroom. Number of bedrooms(design):�� Number of bedrooms(actual): f Total DESIGN flow wQ��vF/, Number of current residents: Garbage grinder(yes or no): Laundry(separate system) (yes or If yes, separateinspection.required Laundry system inspected (yes o o) Seasonal use(yes or no):_" z Water meter readings,if available(last two year's usage(gpd): � *Sump Pump(yes or no): r / �lO'�3�Dl�(1 ✓� Last date of occupancy:1 r COMM DUSTRtAL:, . p Type of establishment: h'4�))l11,3 ;31q 2 & 94/1 Design flow:_ qpd ( B d on 15.203) Basta of design flowyy !rIt .✓Z. Grease trap present:(yes or no)' / Industrial Waste Holding Tank present: (yes or no b Non-sanitary waste discharged to the Title 5 system: (yes or not !V4 Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: 1 GENERAL INFORMATION PUMPING RECORDS and source of information: e System pumped as part of inspection: (yes or no) O If yes, volume pumped: d,4 gallons Reason for pumping: TYPE SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool ,4,)Q Privy ,z23 Shared system(yes or no) (if yes, attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract �CLL Tight Tank .tbfi" Copy of DEP Approval Other a 11YL ��s-z. I Af APPROXIMATE AGE of all components, date installed{if known)-and source.of4oformation: - - - - Sewage odors detected when arriving at the site: (yes or no) revised 9/2/98 Page 6of11 Macomber Customer History Screen 3/8/99 Customer number 1605 g m tr x�Create �Iew,n�nV�lce Company Name .. Cotton--Realtyf Customer Name r �, , fro rvaca � JobAddress { ,� r JobcIty a � CIStOtri r JobState MA � dr�itlrng Addes J o b Z i p ��•RKll�t�-tl�toi'�(� � r a'x' Tel ,.._.., 4,1 Fax N OEM 11��107W l ffl Billing Address PO Box 68 BIIIIngClty �- P,Tint z sterville BIIIIngState BIIIIngZlp Notes a,•3 �p�-�},.� u.�'r �{�r x+�i,�a°fin. vAt �'4 jS'�i� . i�� �* � ` } S 'S 1 R� i� � 4 t a S3 � , x " t1'r:�°.' ;a+a Wept ��k �'" a+Pa�.• ° ' a T It 7 ni: i .. i ?a,� �� 4t i• �,: I qB IP �''�,aw3.wqR�°"T�s' pr F i ." �. e,`�a�............ ,;y '•,°r"`.'"-- 'e,_�`� w.s -i ti'++.., p1".�L4 d."Ms�k7 !j P'7 f.. "-� 3 `.�. ' Ll i r t � � Y.i• Y .. S t` 5 1 � d`t�_� •�° ° .,.r,s,^� 5 rk i � P !f.5 .'.P j,r,; ,. f 1, -f{ be r�-"'�,., :� a° .t. :+ ,ii�, a.�.t l,.1<.�...✓. '��:9d "s� • RESIDENCE t .:�d t `t,�r;�1�.i ';•'f..` �ir -�`•t.i�2f/' .•t / Is / /I / / I / / // • I FEATURES ADDRESS PROPERTY INFORMATION 15 West Bay Road Osterville, MA Building One under eve storage; full bath with shower and stacked washer and dryer; bedroom has sliding drawers to UNIT A: 650 square foot street front unit currently tree enclosed deck; heat pump; central air being used as a catering/fine food establishment. conditioning. Barnboard wainscotting; cathedral ceilings; ships staircase to office loft; gas warm air heat; central air UNIT H: 300 square foot lower level unit with conditioning; includes kitchen fixtures and windows and separate entrance; wall to wall equipment per separate schedule. carpeting; suspended ceiling; electric baseboard heat. UNIT B: 650 square foot unit with partial cathedral UNIT G: 300 square foot lower level unit with ceilings; wall to wall carpeting; warm air heat by gas; separate entrance; wall to wall carpeting; suspended central air conditioning. ceiling; electric baseboard heat; common half bath; automatic exterior lighting; storage closet under stairs BATH A&B: Half baths off common hallway. currently rented to local answering service. UNIT C: 650 square foot lower level unit with GENERAL: (Both properties) acres of land; suspended ceiling; forced warm air heating system; two separate septic systems; one with service grease wall to wall carpeting; private bath and utility room. trap; additional land for extra parking available. MISCELLANEOUS: Full poured concrete basement; underground irrigation system; automatic There are several methods of measuring square exterior lighting. footage. The figures stated herein can vary from actual square footage. Rear Building UNIT D: 350 square feet; two rooms; reception area with chair rail raised panel pickled pine wainscotting; glass French doors leading to large office with private bath; heat pump; central air conditioning. UNIT E: 350 square feet; two rooms; reception area with chair rail raised panel pickled pine wainscotting; glass French doors leading to large office with private bath; heat pump; central air conditioning. UNIT F: 650 square foot 2nd floor apartment; great room with kitchen; living area; custom oak cabinetry; SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) • 15 West Bay Road Ost rv ' Pr Address. y e i 11 e Mass . �Y . owner: Jack Cotton Date of Inspection:3/6/9 9 BUILDLNG SEWER: (locate on site plan) Depth below grade:PP�%0T 1 V r/ Material of construction: cast iron Z0 PVC_other(explain) Distance from p ivate water supply well or suction line 0 Diameter 11yy//n Comments: (condition of joints, venting,evidence of leakage,-etc.) - Jonits appear tight No Pvidpnrp of laakaaso SEPTIC TANK:r/ OW �� D / ►-et7T r%�ryl, /-��"D /,G %rl.� '�� (locate on site plan) Depth below grade:4) e- Material of construction: concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age �J-s..age.cconfumed by Certificate of Compliance.1/ (Yes/No) �" 1 �/ Dimensions: (�/ vC�/7���� !�0'',�`6� (�'��y!(/ G (�1`/!i/'' Sludge depth: Distance from top 921sludge to bottom of outlet tee orbaf e-,& Scum thickness: Distance from top of scum to top of outlet tee or baffle:. Distance from bottom of scum to bolt of outlet t or baffle:_�:��/ How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and•outlet.tees or-baffles, depth of liquid level in relation to outlet invert, structural-integrity, evidence of leakage,etc.) P u m I2 s lI t i r r a n k s and U n l l y l a 1 o r Q . , z r(,pc arp in place Liquid Jeve� a aut1e-te�- _ are struetttrally sound . Tanks show no signs Z3f leakage . GREASE TRAP: Alocate on site plan) / Depth below grade: yA Material of construction:�oncrete_metal_Fiberglass _Polyethylene_other(explain) Dimensions: ' �� Scum thickness.212--&Ck Distance from top of scum to top of outlet tee or baffle:'&Llrie'� Distance from bottom of scum to bottom of outlet tee or baffle; e'41 Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) Pump tank every -3 months TnlPt R out 1pt t-ppc arp in place Liquid ' TPVP1 at nutlpr inyprf- i -, fift�T nue Jnsh®s . into the leaching area . revised 9/2/98 Page 7ofII f A SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ProwtyAd&"s:15 West Bay Road Osterville ,Mass . Ownw: Jack Cotton Date of k specf-: 3/6/9 9 TIGHT OR HOLDING TANK:��t(Tank must be pumped prior to, or at time of, Inspection) (locate on site plan) Depth below grader Material of cons truction:ic//lconcreteli2metal Fiberglasas&4 Polyethylene other(explain) Dimensions: Capacity: N,.4 gallons AlDesign flow'- oe gallons/day Alarm present Alarm level:_Alarm In working order:Yeses NoN�_ Date of previous pumping: 144 _ Comments: (condition of inlet tee, condition of alarm and float switches,etc.) ig t or holdin2 tanks arP not =rPCPnt DISTRIBUTION BOX: (locate on site plan) Depth of Uquid level above outlet Invert: ND Comments: (note-if level and distribution Is equal, evidenoe of solids carryover, evidence of leakage Into or out of box, etc.) — — Distribution box has one lateral . No PyidpnrP of enlidg carry nvPr Nn Pvi dPUCn 9f 1,A&kage into 6£ Aut A the b6-i" . PUMP CHAMBER-,Ul (locate on site plan) Pumps In working order:(Yes or No) NH Alarms In working order(Yes or No)� Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) ump chamber is not present . revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) P►opertyAddreae: 15 West Bay Road Osterville ,Mass . Owner: Jack Cotton Date of Inspection: /6/9 9 SOIL ABSORPTION SYSTEM(SAS):.:2-WD ?A �`r6 (locate on site plan,If possible:excavation not required,location may be approximated by non-Intrusive methods) If not located, explain: Type: leaching pits,number:, leaching chambers,number: leaching galleries,number: leaching trenches,number, length: T leaching fields, number, dme2sions: Cj _ overflow cesspool,number: Alternative system: —��L�Gi C/ Name of Technology: � Comments: (`�ots condition of ail, signs of h draulic failure,level of ponding, damp soil, condition of vegetation, etc.) oamy san� to medium fine sand . No signs of hydraulic failure or ponding Snil .g ara nnr dnm= yPOPrar; nn is -tsar-ip a j- . CESSPOOLS: (locate on site plan) Number and configuration:_ Depth-top of liquid to Inlet Invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: .414 Materials of construction: Indication of groundwater: _ A11q Inflow (cesspool must be pumped as part of Inspection) Cesspools are not present - Comments. (note condition of soil, signs of hydraulic failure,.level of ponding,condition of,vegetation, etc.) Cesspools are not present PRIVY:/V� (locate on site plan) ,f �t Materjals of construction: �rI Dimensions: y� Depth of solids:-a. Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation;etc.) Privy is not present , revised9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contirwed) NopeMAddress: 15 West Bay Road Osterville ,Mass . Ownw: Jack Cotton Cotton Real Estate Date of kupovd ":3/6/9 9 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locals where public water supply comes Into house) ' II y /, o °o - TAAJk + Cx 0 �' •J 3 I + p ' /0q, revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(corrtirwad) P.otyAaar : 15 West Bay Road Osterville , Mass . Owrwr: Jack Cotton Cotton Real Estate Date 014" 3/6/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmark& locate all wells within 100' (Locate where public water supply comes Into house) 1t4 OLIO ivdl ` 41 '4 revised 9/2/98 Page 10of11 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Prop"Addreas: 15 West Bay Road Osterville ,Mass . Owner: Jack Cotton Cotton Real Estate Data of I"spe"tiion: 3/6/9 9 NRCS Report name Soil.Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High GrOLMdwater Elevation: Obtained from Design Plans on record bserved.Site (Abutting prope y, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevruon. (Must be completed) Used water contours map . Gahrety & Miller Model 12/16/94 I revised 9/2/98 Page 11 of 11 y •mnrn.--nirr—.rr ern:mr•nmra"nr.ztrrrr..rs-nr+:vnrtrs•rn•rrrn tnnv•ra'sr�sr.rrn 'TOWN OF Barnstable BOARD OF HEALTH SUIlSU[iFACF SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I �- �•••�,•••T••.-'.'t��.ttT.�.�T Tt T..n'R.TTl rnrtR'TTtTT'1't—•.•I rltlSTf lrRlvf-TRRTa1TJ�Ri"RrR'itTRT7 mtlnTRrnT.t4•Tf'Tr1•r.•.rrrr•T-•�. •�..A -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 15 West Bay Road Osterville , Mass . ' ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Jack Cottolt Cotton Real Estate PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J. P.Macomber & Se-h' Inc . COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street Town or City State LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 _ 1578 R A CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of ,inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : ; /� System PASSED The inspection iihich I have conducted has not found any information which indicates that the system fails to adequately protect public health or, the environment as defined in 310 CMR 16 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection w)lic)I I have con ircted has found that the system fails to Protect the public health and the environment in accordance with Title .5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . le - Inspector Signature Date _ One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF IIEALI'll. * If the inspection FAILED, the owner or"'oparator shall u within one year of the date of the inspection , unless allowed dortrequiredm otherwise as provided in 3.10 CHR 16 , 305 , partd . doc t No., t� , .�f..yn...W--- Fps ...........f............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Di►ipwial Hi orkfi Cnontitrurtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair (4-1�'an Individual Sewage Disposal System at: ------------------------------- o 0 �ritioi ddre �e' or Lot No. ............•.................. ............... .... ...•--............................._. __............................. �Qa-nc - ddress Installer Address dType of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms----------------------------------------- -Ex ansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ------------------------------- - - W Design Flow............................................gallons per person per day. Total daily flow......................._-_..................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter................ Depth................ x Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area-----_..............sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .._.... v ..�t.. �:.�.� /Y'�e.C-� j�z�c 3.��.T __ . . 7. .. � -_... .su�e-----•----....... ---- --------- - U Nature of Repairs or Alterations—Answer when applicable._.. .._ �i.............. -- �_� :'�:�:�....... �.-r..................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliant has?bD , y the board f health. Signed �,9 � .. ........sued... ................ ... ............................. (..:.. ........... �re Application Approved By .............. �. ......... ....... .2..--...` g7' Application Disapproved for the�611�owing reasons: ........................................................................................................................................ .................................................................................................. . ... ............................................................................... ........................................ r Dare PermitNo. ....... .. ......;©7 -------------------- Issued .........................................................I)a........ Dace .f 41V^' v • '-V`j". "`- •"J'• "ti�V N L.r c. i.-+: s•-^y�j`�.__'_ti%v. —_V_.. --_. . -�.s —T.vim___ ___— �� —v_-->4��! _ _._� t,� / ox e) o THE COMMONWEALTH OF MASSACHUSETTS BOARD'' OF HEALTH TOWN OF BARNSTABLE Appliratinn for Di ipwiul Work.5 Tvastrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair (41"an Individual Sewage Disposal System at:—(-PjFSf0� _.. -- -------------------------••-- ••-•-----•- a ------------------_---•••---•-•-- -- ----- - -•- ...' .•--•-•--••-•----• -:...•--•......_. 'y Location-: ddre s or Lot No. `--�~ 1 --•--------------------------•-•--•-••---....------------.....---•-•--------.........---.......-- I F0-n) ' Address Installer F-Address Type of Building Size Lot_.........................Sq. feet V Dwelling— No. of Bedrooms______________________________ __ _Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons____________________________ Showers ( ) — Cafeteria ( ) a' Other fixtures W Design Flow_...........................................gallons per person per day. Total daily flow............................................gallons. 04 Septic Tank—Liquid capacity............gallons Length________________ Width-------_........ Diameter................ Depth................ I Disposal Trench--No. .................... Width.................... Total Length.................--- Total leaching area....................sq. ft. 3 Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I... ............minutes per inch Depth of Test Pit.................... Depth to ground water.___._.__..._.______.__. # L14 Test Pit No. 2................minutes per inch Depth of�Test Pit.................... Depth to ground water........................ p4 ....--•-••••...................•-•••---••--•----•--•----••-••-••-•---•-••••-_•••- I)e'srr�ption of�S'ailN-!/.! ! � .. . - ..... ___'_ ____________________________rv< __._.__._...__-_--______.........__ - -- - U Nature of Repatr�Alterattons—Answer when applicable.... _..t) ?.�f-..�`_�>_j.'....___. �. .../� .. ''�� Agreements --•--•f -�`----�--••----------------------------- The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b-erl issued 'y the board f health. Signed ....... ........:... ... a:.........�r� - . ..--- .y / Dare Application Approved By ................ , a .............. - / Date Application Disapproved for the ollowing reasons: E pp Dare Permit No- -----...1. ......a-O_Q-- ------------ Issued ........ -..._.....----.......................................... Dare - _-__-..__——_.— -� r -�,� -•-.�„�..-.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Tertificttte of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by .......� %... ........ ... w �.5.. _------- ------------------------------------ ---------------- ----....-.......-....------------------.----------.....---- .. at .....1.�a`�......... ..... ....1.1.. ...................... . ............... ........................................... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ...... ---...._—. .�'.. ..._... dated ....................... .. I THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... .........: "'_...... a.... -"° ..........✓ Inspecto —,---,... ...... .-------..-------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH p TOWN OF BARNSTABLE ° 0p FEE........................ Owposal Vorhv Tonotrudion "omit Permission is hereby granted_... l ,•. ................................................. f to Construct ( ) or Repair (" an Individual Sewage Disposal System � J at No f: _... -------•--Qc �-) --------------- .S.7P. ... f Street as shown on the application for Disposal Vl'otr]s Construction Permit No._ __ __ Dated_____________________________..-.__._._.... .................................. � _---- h�oar of Health DATE-----•-------g -- � "T� FORM 36508 HOBBS&WARREN-INC..PUBLISHERS �JNo.........2:.l.. Fps... ....... THE COMMONWEALTH OF MASSACHUSETTS 0 BOARD O HEALTrH <tf ....OF.............. .., ' [,................... .................. Aphrtttiurc furiuuttl urk (� #rrtiuttPruiit Application is hereb made for a Permit to Construct or an Individual age D'pp y ( ) p ( ) Sewage Disposal System at: ..........--1.....�=�`----.....-.... ------------------------- .-lion•Addres ^ or Lot No. t� --------------------------------- ----------------= Address Installer Address d Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms--------/v-a'� .......................Expansion Attic (NC) Garbage Grinder (/U©j aOther—Type of Building __L:J0.� �.{�Mlo. of persons______ _ __________________ Showers (,-0) — Cafeteria (,v o) a d Other fixtures ..------.�...CS.��Ces----------------------------•-•--••---...-----...._..._.............-•-•----._.........---.._..----------=----- W Design Flow.......... 6...........................gallons per person per day. Total daily flow.................I.,1___.Q............---gallons, WSeptic Tank L Liquid capacitv.t-090.gallons Length________________ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width........ �..A ,4tal Length.................... Total leaching area....................sq.-ft. Seepage Pit No....I--------------- Diameter...l0PO....... Depth below inlet-----............... Total leaching area- .-.--_--___--scl. ft. z Other Distribution box ( ) Dosing tank ( ) - -/1 - j t� - // 7 J— aPercolation Test Results Performed bY-------- -------•---........-•--------------------•-------------------... Date--------------------------------------- ,� Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water..-.__--______._.._.---- rX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..................... R+ �---�---�-t ODescription of Soil------�fC`.—------------------------------------------------------------------------------------------------------------------------------------------------ -- x U --------------------------------- ...................................................................................------ ---------------------------------------------------------------------- ------------------W U Nature of Repairs or Alterations—Answer when applicable...--------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en i ued by the boar f health. AA 11 Si .n ... �v--------- Application A roved B F' ( - x- - -------------------- `=��r Date------' PP Y -L r�_sf1 �� .>.... `-- 7l- /.......................................•----........._._.............---Date......•. Application Disapproved for the following reasons_____________________ ___._ -----------------------•-••--•--------------------------------------......-------------------------------•-•--•--•-•-------------------------------...---------•--------------------------------------- Date PermitNo......................................................... Issued..................... .................................. Date No.........-��o .......... Fimu.... ..................... • THE COMMONWEALTH OF MASSACHUSETTS BOARD 0, HEAL R-1 I 'W-ru ----OF. ............... Apphration -for. 43hipatial Workii T_ varurtion Vanift _ 'O"Application is hereby made for a Permit to Construct (7orRepair an Individual Sewage Disposal System at: l. ......... ...........�Sw.................................................... ................................................................................................. oc.alio.n ddress% or Lot No. - ----------------- ... .. ------ ........................... .................................................................................................. A -�- P. Address . ... .................. ............................................ ............................................................................................. Installer Address U Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms---------/i-------a ----------------------------Expansion Attic ('_)Q) Garbage Grinder (410 Other—Type of Building (- jr,,'01-- ---0--(Vo. of persons...... .................. Showers (,,,0) — Cafeteria (.,0) C Other fixtures ..... n....��_C2------------------------------------------------------------------------------------------------------------------ Design Flow.......... t>S............................gallons per person per day. Total daily flow-----------------LS'_n...............gallons. 9 Septic Tank-L Liquid capacitvl( _gallons Length................ Width..___........_.. Diameter_-----..-_._--- Depth---------------- Disposal Trench—No. .................... Width........._._..._ Total Length_-_.-_-_---_-___-_-- Total leaching area-------------- -----sq. ft. Seepage Pit No....I---------------- Diameter..0-0.Q...... Depth be inlet.................... Total leaching area------------------sq. f t. Other Distribution box ( ) Dosing tank ( ) -6A- V /� - // - 7 J_ Percolation Test Results Performed by.......................................................................... Date---------------------------------------- a Test Pit No. 1________________minutes per inch Depth of Test Pit-.--_.-.--__-.____-- Depth to -round water-..-_--.--.--.----.---.. (� Test Pit No. 2................minutes per inch Depth of Test Pit._-___-.---.____-_-- Depth to ground water--._..--___-___---__.... ------ ------------------------------------------------------------------------------------------------*-------------------------------------------------- OI N Ilk j Description of Soil---- ---------------------------------------------------------------------------------------------------------------------------------- ---------------------------- U --------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------- W ----------------__..........------------------------------------------------------------------------------------------ ----------------------------------------------------------------------- U Z Nature of Repairs or Alterations—Answer when applicable_--------------------------------------------------------------------------------------------- --------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bFen il; ued by the boar 07f health. Sind-_ ....................... Date Application Approved By-.-., --------------------- .... h......7_(------- Date Application Disapproved for the following reasons:................................................................................................................ ........................._-------------------------................................................................................................................................................ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OLFHEALT'J 4 . . . ....... ..... ...... ......... . ... ................... ....................... Tntifirate of Tomphaurr THIS A TO C IFY, That the Individual Sewage Disposal System constructedorRepaired by.. .... ........ .... ..C&-e............. ................................................... ... .......................................... -----------------Installer a ---- ... t .....................................0& has been installed in ac ordance with the provisions of 7r of The State Sanitary Code as described in the application for Disposal Works Construction Permit () ( dated'__5 ............. Az��__._.a..() ---------------ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. F,ac or( DATE..................................................... .......................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS 76 BOARD Of HEALTH ........ .... ....... OF.......1�0.t....�.ZIal.;�... ...................... No......................... FEE--- ............. Binpoiial orkq ClIonstrurtion Vrrmit Permission is hereby granted_-_Pa"'_/-------------------- -- ....................................................... .................... to Con ru7) or .pair an.Individua) Sew e tspos Sy tem .................... 4,16 a .. ............. Street ... _7 as shown on the application for Disposal Works Construction Per No. . ..... . ..... Dated...5 cam......... ---------- ............................. Board of Health DATE................................................................................ FORM 1255 HOE38S & WARREN. INC.. PUBLISHERS �-�.� � �-,�.r�E � out��� � • , 1kQ � 0 Al 1 .5 TEEG SyF p TO j �, 6, V cw- ff COiI/C. BL J FdUNp UNOE,2 CONS T (� 7 N � THE COMMONWEALTH oFwAssAoHuSsrra B�-O--"� RD � " � OF--. �� -.------ Appliratiou -for Bhipwial Works Towia4urtow* - Pkrr »tvt Application is hereby made for u Permit to Repair ( od�� `a Sewa ge Disposal System at: - -.................................. ----_........................ �-��- �'-'-_---.---..-------------------------.------_-' . � [ ~~ or Lot m` -__---- -------------' ----_--------- --'-------.---------.----------'---------------_ I i Aaa�." --_-_. _.-'--_-,---_-__��--__--____- -_-__----_-'--___----_---._.—_.-_-__. Installer AddressTvneuf8uBdin � � o e�uJ' � s ~ Size Lot.....�����..U��^...Sq. fee Dwelling--No. c6 Bedrooms-------------------------------------------- Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons--��................ Showers ( ) -- Cafeteria ( ) ^� Other fixtures ...................................................................................................................... .............................. Design Flow............................................ per person per day. Total daily flow............................................gallons. Septic Tzok--Liquid Length................ lYidhb .............. Diameter----- -...... Depth_-.--- Trench—No ..................... Width-------------------- Total Length-------------------- Total area--------------------sq. 6. Seepage Pit No-109!>-_ Diaoetor------.. Depth below inlet-------------------- Totalleaching area------------------ h. Other D�t�6o600box ( ) Dosing tank ( ) '- Percolation Test Results Performed by---................................................................ Date----------------------------.--- ' Tes Pit No l................minutes per inch Depth of Test P6'---'--- Depth to -round water...------� Tca Pb No per inch Dcn16 of Test Pit.................... Depth to ground water------------------------ ---------------------------------------------------------------------------------------------------- -'_-_--_-----.-__-- 0 Description of Soil-----_.-__----.__'_'---''_-'_----'----'-----.--.----------.-.--- --------------------------------------- --- ---Q�- ----------...... 100 /' , , � ' ' , Agreement:_ The undersigned agrees to install the aforedemribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State 5 not mplace the system in operation. until. . Certificate .. Compliance. has b n is ed by the boag oLhealth. , ' �l^�-- -' ..]�.�.� �~.. Date � Application Approved Dy'-. -- ��/..���-�� -��`~- _ u"� � Application Disapproved for the following reasons:................................................................................................................ � --`------'-`-`---'--'--------------------`-----------'`--------'-'------`----- Date Permit 4 Date ........................................—___-__-__--__--________ __--_--___ ____ ^ ___ NO...J 413-----•. � F>�s.�... ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE LTH .......-....0F........ . ... . .. .. ..... ...!::! . .............................. Apphration -for 15iiiVosa1 Works Tauuitrurtiuu Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (--)--ai''Individual Sewage Disposal System at ? UJ el V A Y Location-Ad ess or Lot No. .............. C10�� i ........................................ W Owner t Address f --- --------------------•----•--• ------•--•----------•-------•-•--•----•--------••-----•-----•--•- •--------------•- Installer Address UType of Building off. (;S Size Lot..... C"t .....Sq. feet Dwelling—No. of Bedrooms.............._........._-------------------Expansion Attic ( ) Garbage Grinder ( ) Pa-, Other—Type of Building ____________________________ No. of persons.......<__________________ Showers ( ) — Cafeteria ( ) 0.4 Other fixtures d W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. W Septic Tank—Liquid capacity►-a ov_.gallons Length................ Width................ Diameter................ Depth-__-_____-_----- ,., x Disposal Trench—No. .................... Width..................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No... ________ Diameter____________________ Depth below inlet.................... Total leaching area------------------sq. it. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by------ -----------------------------------------------------••----_---•- Date____----------------------------------- Test Pit No. I................minutes per inch Depth of "Pest Pit.................... Depth to ground water......__-_-_-...__---.-. rs, Test Pit No. 2......._........minutes per inch N Depth of Test Pit.................... Depth to ground water__-__-_-.-_-_________-.. Ix --=--------•----------------•---•-•-------______------------------•---------- ............................................................................... ODescription of Soil---------------5------- ------------------------------------------------------------------------------------------------------------------------------------------------- x ------ - -------------------- ------------------------------------------------------------------------------------------------------------------- --- ----- - -- ------------ U Nature of Repgi s r Alterations—A sw r when applicable.--�__.1 �( _______________________ , �--_-.-____-_- .. ----------------------- ------/I- .. . ', . ----- - -----00�...../ ---------------/------I.................. ............................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to'place the system in operation until a Certificate of Compliance has bn is ued by the b dpj health. gne ----- •------ ------ n"----- ----G�V D- ..... � ae Application Approved By........ .. Date Application Disapproved for the following reasons:_-.._--••--•-_----•_____________________________________________________________________________________________ ----•--•-•--•-------_._.•_-•-•---•-•----------------•------•-•------•-----••-•-------•••-•-••-•--------------------•------••----•------------------•-----------•-------_...._........---------------•-•- Date Permit No. Issued e -- t ,(J Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O EALTH k." Cnrrtifiratr of f�umpiiaurr €:<. THIS IS TO C�`''" IFY, That t e Incfivid Sewage Disposal System constructed ( ) or Repaired by - - --•--------------------- ................. ta ` l t I ler YIf has been installed in accorc i nce with the provisions of _ ti 1e XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No__,1......... _ ______________ dated'..4—)_ ......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE----l j _, lu' ----------------------------------------------- Inspector---------- ------------------------ A / - THE COMMONWEALTH OF MASSACHUSETTS BOARD Of HEAL No ...�) ---•----------- FEE --•---......... _. iriVniiat Norkii on trurtion rmit Permission is hereby granted_. ----- -tt+--?d- � .._... to Construct ) or Repair ( an Indivi a S wa, `'Dispo al Syste at No.'- �-�' c ----f--------- /'�'"� --- O . Street " as shown on the application for Disposal Works Construction Permit No._ Y-7_______ Dated..... _-1+�.'-1,J`r_____iL s oC _._.. - ---•------•-- -------------- Boa of Health DATE.......... ------------------------------------------ ---------------•- 'FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS / 141 t` � . w { I �. f� LOC&TIOKa : 5EW8,C4E PERMkT Mo. IWSTI�LLER-S W&NAE NDDRE�S�S (IT bUILDER ,5 Q &MF- ar->C)*RF-,DS DtN-,TE PER"VT 15SUF-D -.--Z-' D )VT E COKAPLI &IIaCE ISSUED ; TOWN OF BARNSTABLE LOCATION � � � 1,:�,4` A SEWAGE # VILLAGE �S 1 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY r LEACHING FACILITY: (type) (size) NO.OF BEDROOMS � BUILDER OR OWNER /,/*- � PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: . Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on.site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet le cility) Feet Furnished III \0% I � r l,, voo I de.�!' v �. • TWN OF RARNSTABLE �ef�10�• LOCATION ., SEWAGE # } VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /40 dlav 71 A %Cs /' LEACHING FACIL=: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER` � dJ PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and,.Le Ching Facility(If an wetlands exist within 300 fee 1 cility) Feet Furnished ,�' `! pl - 0 o 0 '/ 4 0 t . ® \ p Vv .57 dam`- CT l TOWN OF BARNSTABLE LOCATION �"J SEWAGE # VILLAGE �S ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ® LEACHING FACILITY: (type) �' ��� �, (size) NO.OF BEDROOMS BUILDER OR OWNERS PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet le cility) fM '� Feet Furnished b v I o A N 3 l000v r 41 TOWN OF BARNSTABLE LOCATION 1 QQ)eS4 SEWAGE # Zoo(-1 1 3 VILLAGE O s+e,,y,/k_- ASSESSOR'S MAP & LOT /!l L016 INSTALLER'S NAME&PHONE NO. P SEPTIC TANK CAPACITY t o (a ,LEACHING FACILITY: (type) 3 (size) / X 3 CC X 2 NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: S l Z'a/ COMPLIANCE DATE: 3— l f G Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist _ on site or within 200 feet of leaching facility) L-"/J Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) 4U6 dV 1�1_ Feet Furnished by (o0 C� e � IL — G 4g f �3 . — 72— c TOWN OF BARNSTABLE j LOCATION S SEWAGE # VILLAGE P yV 0 V lE ASSESSOR'S MAP & LOTH/ INSTALLER'S NAME & PHONE NO. 000.ff� SEPTIC TANK CAPACITY O LEACHING FACILITY:(type) �, � (size) NO. OF BEDROOMS -_-- PRIVATE WELL OR PUBLIC WATER c---"'"— BUILDER OR OWNER dc) I A ,DATE PERMIT ISSUED: -- U -ter DATE COMPLIANCE ISSUED: _ VARIANCE GRANTED: Yes No �V .LOCATION_: _ _ _ _ _ _5EWAC,E PERMIT MO. IAISTQLL°ER°5 U&ME ADDRESS I— — —f r)dl L-UT jEe BUILDER 5 tel % VAF- P, ADDRESS piQTE PERNAVT ISSUED — Q D ATE COMPLI A I`ACE ISSUED /S �. 0 TOWN OF BARNSTABLE �aTHET�� OFFICE OF I HAflalTdBL BOARD OF HEALTH 1 MA!& 0 °0 1639• �e� 367 MAIN STREET MAY k, HYANNIS, MASS.02601 May 21, 1991 Walter Greenblott 6 Naragansett Street East Falmouth, MA 02536 Dear Mr. Greenblott: You are granted a conditional variance from the Board of Health "Re_v_ised Supplement to Minimum Sanitation Standards for Food Service Establishments" Regulation 10 that requires a minimum of a 1,000 gallon grease interceptor at all food establishments. This variance will allow you to operate a food service establishment at 15 West Bay Road, Osterville, with the following conditions: (1) No cooking or steaming of food will be allowed. Pre-prepared ice cream may be scooped onsite. (2) Only disposable single service paper, plastic, and other disposable dishes and utensils are authorized. (3) You must install an under-sink grease interceptor under the triple compartment sink approved by the town plumbing inspector. (4) This grease Interceptor shall be cleaned monthly (instructions enclosed). (5) You must install a water flow restrictor device at the triple compartment sink approved by the plumbing Inspector. (6) All other regulations contained in 105 CMR 590.000: State Sanitary Code, Chapter X - minimum Sanitation Standards for Food Establishment and of Town of Barnstable Board of Health sanitation regulations shall be strictly adhered to. (7) This conditional variance expires June 1, 1992. (8) This variance is not transferable, and will be voided if the establishment has a change in use, change of ownership, or leased to a party other than an applicant. Mr. Walter Oreernblott Re: 15 West Bay Road, Osterville vMay 21, 1991 s. Your request for a variance from the Board of Health "Revised Supplement to Minimum Sanitation Standards for Food Service Establishments Regulation Il Toilet Facilities" to install bench seats although the bathrooms are not accessible to the patrons is not granted. The Board is of the opinion that seated patrons should have access to the toilet facilities without traveling through food preparation areas. In addition, it is suggested that you seek advice and review of your proposal from the Building Commissioner prior to any activity to locate and/or operate such a business at this location to determine: 1. That such a use is not an intensification of the present use; and 2. That off-street parking requirements have been met on-site, or secured off-site and with the approval of the Zoning Board of Appeals. Sincerely yours, OAA)Uk n_. �,L _ ...�._ Ann Jane I Eshbaugh, Chairma Susan O. Rask oseph . Snow, M.D. BOARD OF HEALTH TOWN OF BARNS'TAI LE TM/bcs i cc: Jack Cotton Joseph DaLuz j Robert Schernig Enclosure ` For office use only TOWN OF BARNSTABLE Received by Tii>i v ' ' • OFFICE OF Date '�✓ } ,AJ,T ; BOARD OF HEALTH 'ooe, 1659, {6' 387 MAIN STREET mmy / g� 'FO MAY k� HYANNIS.MASS.02601. •. . 11/ VARIANCE REQUEST FORM uests must be submitted fifteen (15) days prior All variance req to the scheduled Board of Health Meeting. . TEL.# NAME OF, APPLICANT F"i.�"oJ ma ADDRESS OF APPLICANT (o NOff0. 0.n5e S+. E f�, NAME OF, OWNER OF PROPERTY �'ac,K Co�S0 n DATE APPROVED SUBDIVISION NAME / , � CO LOT. SIRE ASSESSORS .MAP & PARCEL NUMBER. �`1 LOCATION OF .REQUEST 15 '��e`3 �a Qk- 05� \)ikle, • VARIANCE FROM REGULATION (List Regulation) REASON FOR VARIANCE (May attach letter if more space is needed) See t�Ccu�a.c.Q. L OM PLAN POUR COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. VARIANCE APPROVED NOT APPROVED REASON FOR DISAPROVAL Ann Jane Eshbaugh, Chairman Susan G. Ras Joseph C. Snow, M.D. BOARD OF HEALTH TOWN OF BARNSTABLE a i Walter A. Greenblott 6 Narragansett Street, Falmouth, MA 02536 April 23, 1991 Town of Barnstable Board of Health 397 Main Street Hyannis, Ma. 02601 Gentlemen: We would like to install an in line grease trap so that we may operate an Ice Cream Store at this location. We do not manufacture Ice Cream nor will ever manufacture Ice Cream at this location. All of our Ice Cream storage containers are disposable and will be disposed of in the on site dumpster . Therefore, the amount of butterfat that will drain into the sewer line is slight and an inline grease trap below the sink should catch all residual butterfat before reaching the septic system. Our water usage is approximately 450 gallons per day. We will have on site : two bathrooms (employees only) , one hand washing sink and. one dip well in the front work area, one triple bowl and one mop sink in the back work area . Sincerely, "t46u- ut," Walter Greenblott _ i - LOCATION : 5EWil,C�E PERMIT UO. kL VILLAGE dFL - - IWSTNLLF-R•5 WWF_ ADDRESS i BUILDER 5 Q &VAF- ADDR SS DI�,TE PER" T ISSUED D A-TE COMPLI &&ICE ISSUED: 1-2 /2 ZAS ,r i I L' � Q i I i i QQ THE roar TOWN OF BARNSTABLE OFFICE OF i PARISTAALEBOARD OF HEALTH 29. MA!�. °o t639. �� 391 MAIN STREET am k' HYANNIS, MASS. 02601 REVISED SUPPLEMENT TO MINIMUM SANITATION STANDARDS FOR FOOD SERVICE ESTABLISHMENTS Adopted February 21 , 1975 The following regulations are promulgated- by the Town of Barnstable Board of Health, in accordance with the provisions of Chapter 111, section 31 , as amended, of the Massachusetts General Laws, and are being adopted to supplement, clarify and augment the provisions of Article X, Minimum Sanitation Standards for Food Service Establishments , of the State Sanitary Code. Applicants shall refer to the State Sanitary Code for basic requirements. REGULATION 3 - FOOD PROTECTION 3.1 All food served buffet style shall be enclosed in such a manner to prevent contamination from patrons. ------------ REGULATION 10 - PLUMBING Grease traps must be provided at restaurants, nursing Dperday ols, hospitals, bakeries , or similar establishments as detehe Board of Health. The capacity of the grease trap shallated by the kitchen flow rate of 15 gallons per seat, or chaybut in no case shall be less than 1000 gallons. This es- tablishments connecting to Town sewer, or. establishmensite ewage systems. REGULATION 11 - TOILET FACILITIES All food service establishments shall provide adequate, conveniently located toilet facilities for its' employees. Each food service establishment with a seating or standing capacity of over fifty ( 50) patrons shall provide toilet facilities -for employees that are separate from the toilet facilities provided for patrons. Separate facilities must be provided for male and female employees and male and female patrons. Each food service establishment shall be provided with adequate, conveniently located hand washing facilities for its' employees equipped with hold and cold or tempered running water, hand cleansing soap or detergent from a dispensing unit, and sanitary towels or other hand-drying devices. Common towels are prohibited. This hand- washing facility shall be located in the food preparation area. The hand wash sinks in the restrooms for patrons, or employees, can- not be considered as the hand wash f acility ' for employees, but are required for all toilet facilities. . i _ 2 'REVISED SUPPLEMENT TO MINIMUM SANITATION STANDARDS FOR FOOD SERVICE ESTABLISHMENTS (cont'd. ) REGULATION 14 - VERMIN CONTROL Outdoor cafe-type restaurants will not be permitted in the Town of Barnstable. REGULATION 22 - MOBILE FOOD SERVICE Push-cart type food service venders will not be permitted in the Town of Barnstable. Mobile food units shall operate from a commissary, or other fixed food service establishment that is constructed and operated in compliance with Article X, of the State Sanitary Code, and Town of Barnstable Health Regulations. Mobile food units serving foods not packaged for individual servings and/or involving the use of utensils shall provide a potable water system under pressure. The system shall be of sufficient capacity to furnish enough hot and cold water for food preparation, utensil cleaning and sanitizing, and handwashing. A double compartment sink must be provided for washing and sanitizing utensils. A separate hand wash sink must also be provided. Mobile units garaged outside of the Town of Barnstable must furnish written certification from their local Board of Health verifying that they operate from a licensed food service establishment. REGULATION 23 - VENDING MACHINES Any establishment with vending machines dispensing food or drink must be licensed by the Board of Health. PENALTIES Any person who shall fail to comply with an order issued pursurant to the provisions of these regulations upon conviction is sub- ject to the same fines prescribed in Regulation 39.2 , of Article X, of the State Sanitary Code. INVALIDATION If any section, paragraph, sentence, clause, or phrase of these rules and regulations should be decided invalid for any reason whatsoever, such decision shall not affect the remaining portions of these regulations, which shall remain in full force and effect; and to this end the provisions of these .regulations are hereby declared severable. This regulation is to take effect on the date of publication of this notice. TOWN OF BARNSTABLE BOARD OF HEALTH ,a.,.,- �Q..Q_ Es,_ L6-ua - A n J e Esh a� hai a ftbert . Childs A. We Mandelstam, M. D. 7/19/78 ' ' . 105 CMR: DEPARTMENT OF PUBLIC HEALTH I ' 590.017: Plumbing (A) General. Plumbing shall be sized, installed, and maintained according to law. There shall be no cross-connection between the potable water supply and any other system. (B) Non-Potable Water System. A non-potable water system is permitted for air conditioning, equipment cooling, and fire protection, and shall be installed according to law. Non-potable water shall not directly or indirectly contact food or equipment or utensils-that contact food.-!The piping of any non-potable water system shall be durably identified so that it is readily distinguishable from piping that carries potable water. (C) Backflow. The potable water system shall be installed to preclude the possibility of backflow. Devices shall be installed to protect against backflow and backsiphonage at all fixtures and equipment where an air gap at least twice the diameter of the water system inlet is not provided between the water supply inlet and the fixture's flood level rim. No hose shall be attached to a faucet that is not equipped with a backflow prevention device. (D) Grease Traps. Grease traps, if used, shall be located to be easily accessible for cleaning. (E) Garbage Grinders. Garbage grinders, if used, shall be installed and maintained according to law. (F) Drains. Except for properly trapped open sinks, there shall be no direct connection between the sewerage system and any drains originating from equipment in which food, portable equipment, or utensils are placed. 590.018: Toilet Facilities (A) Toilet Installation. Toilet facilities shall be installed according to Aft applicable law, shall be at least one and not less than the number required by } y law, shall be conveniently located, and shall be accessible to employees at all times. (B) Toilet Design. Toilets and urinals shall be designed to be easily cleanable. (C) Toilet Rooms. Toilet rooms shall be completely enclosed and shall have tight-fitting, self-closing solid doors, except for screened louvers that may be necessary for ventilation systems. Doors to toilet roams shall not open directly into areas in which food is handled, stored or prepared unless the toilet rooms are equipped with automatic exhaust fans. Toilet rooms shall be adequately ventilated. (D) Toilet Facility Maintenance. Toilet facilities, including toilet fixtures and any related vestibules, shall be kept clean and in good repair. A supply of toilet tissue shall be provided at each toilet at all times. Easily cleanable receptacles shall be provided for waste materials. Toilet rooms used by women shall have at least one covered waste receptacle. The establishment shall post in a conspicuous place in the toilet room used by employees a sign reading as follows: "Employees must wash hands before returning to work, by order of the Dept. of Public Health." (E) Patrons' Toilets. if required by law, toilet and lavatory facilities shall be provided for patrons and shall meet the requirements of 305 CMR 590.018. In establishments built or extensively renovated after the effective date of these regulations, patrons toilets shall be located so that they are accessible without traveling through food preparation areas. 590 019• H g acilities (A) Handwashing Facility Installation. Handwashing facilities shall be installed according to applicable law, shall be at least one.and not less than the number required by law, and shall be conveniently located in each food 12/31/86 105 CMR - 4243 °F THE r, Town of Barnstable, Massachusetts Department of Planning and Development yB" M E� MASS. ' Office of The Planning Board ASS. o� i639• �0 ATfO MA'S A 367 Main Street,Hyannis,Massachusetts 02601 (508) 775-1120 ext. 190 May 14 , 1991 To : Thomas McKean , Director Heath Department From : Robert P . Schernig , Director Subject : Board of Health , Variance Request by Applicant Walter Geenblott for 15 West Bay Road , Osterville , MA, Proposed Ice Cream Store . The department has reviewed the information supplied by the applicant in his request to the Board of Heath for a Variance to establish an Ice Cream Store within the premises located at 15 West Bay Road . Staff also viewed the site on May 14 , 1991 . A This site is Commercially Zoned 6- District permitting the retail sales of products such as ice cream. However , questions do exist as to the use changes and conformance with the Town of Barnstable Zoning Ordinance . Specifically : the use of the premises with an assumed seating capacity of 6 persons ( based upon 2 benches with 3 persons/bench ) and an assumed two ( 2 ) employees would require at minimum three ( 3 ) parking spaces ( Section 4-2 "Off-Street Parking Regulations" ) ; and if parking is required or if the proposed retail use constitutes an intensification of the use , Site Plan Review may be required ( Section 4-7 "Site Plan Review Provisions" ) . The applicant should be instructed to seek advice and review ( Building Commissioner ) of the proposal prior to any activity to locate and/or operate such a business at this locus to determine : 1 . that such use is not an intensification of the present use ; and 2 . that off -street 9 r parking requirements have been met `on- site , or secured off -site and with the approval of the Zoning Board of Appeals . cc : Zoning Board of Appeals Building Commissioner .. 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Office Space= 350 sf 28 90- locus , At I-east 72 Hours Prior to Any Excavation ForThis Total ass gpd Rost B Prciect The ContractorShall Make The Required ;• ;� �.,�. Noi ification to Dig Safe(1-888-344-7233) Septic Tank -------- . Re use septic tank •' ;a: , ' , k 3. Th Contractor is Required to Secure Appropriate Sized @ 200%of design now for retail= 933 gallons Pe mits From Town Agencies For Construction ' Septic tank required: 1000 gallons v°% `' :'t•: �� De fined byThis Plan. - ._ .. 4 Grease Trap Ali:.; N • ' Road Install Risers as Required to Within 12of °s .a "shed Grade. Si use grease trap " Flf� Sized @ 8.8 gpd per seat= 189.2�gpd -we 's 5.All Structures 8u�ied Four Feet or More or 8.6 gpd/seat=15 gpd/seat X 21 aad/seaItlfa,tfood) LOCUSPLAN Subject' 35 gpd/seat(re�taurant) Scale: 1:12 000 3 to 'lehicular Traffic tobe H-20 Loading. Grease Trap Required: 1000 gpd Assessors Map 141 . . 6.•Se 4ic System tobe Installedin Accordance With Parcel---- 31 ' CMR 15.00 Latest Revision And The Town of Leach Field Bc astable Board of Health Regulations Required Area=GPD/0.74 630 sf Field Size=13'Width x Length ; _....... ti- T. All. Piping to be Sch.40 PVC. Length= 34.0 If L �= Use 13'x 34'field with 3(three)500 gallon leaching drywells Area Provided= 630 sf All Components To Be H-20 Jq / I I EXISTING NFw IL;ACH FIELD r\- `;;: �.r• F G.._yfl' F.G. 40' 1000 E# 37.$ \ \ ✓ UREASE 1000 GAL. 38.b SEP�IC'TANk \ - GREASE'TRAP, } SErT it,+ ti L Jo", ;i DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM c `s, a o o Q \ Not +toScale PIT 'TD Z I I Finish Gr 7 ,c E �yX fx Fllteir Compocteti Fill 4 PrjoPOSED �� I 1 1 �f-�� Fabrile Ile-Ile Psa "Stone -- - Leaching I « `LiL Chamber 3/4 N `2b S o Doubit Wosfiod Y Th.l 1 4-10 1 1 J I r 13'-0" yq CROSS SECTION OF CHAMBER NOT To SCALE. c i � I f P � i T N.- 1 E L•'-t 2 0 1 1 a O..y O TpPSO1L-/LOAM O TOPSOIL/LOAM 13RN. COARSE SAND E BRN.COARSE SAND ^� t 1 h p. rrTE3 ,S •..\; ,, IoYFt 3 1 0R Y s/3 PULLI11AN 23 •� BI OYR BRt . COR. SAND r Bi Y1=L�FSRN COR, SAND j C� NO. ! "`07" f I`aO.2...r32 { 10YR ,S/G CdiflL E� t 4 0" 3Q. F3RN.YE . r-OR. SAND ,� L32 CIO YRyG/G DR SAND i a t fT t \I l.0 ('S LT.YEL. COR. SANq ��__ \ X C IOYRL6/CAR SAND 1?A G IOYR (n/�/ ii u pERGOLA-TION TEST I 4 - -- CLASS 1 MAT>=REAL DEPTH- 56 PROPOSED SEPTIC SYSTEM F �i , 31� LESS 'THAN a MIN/I►ICN NO \N4TEt2 ENCAUtVT1=D AT r PATE : yil3igq 15 WEST BAY ROAD i No. .. P-9390 wI-r Mss!t)M RAN41 Roa, o.'N, OSTERVILLE9 MA ` KAU,: 1" = 20' BY SULLIVAN ENGINEERING OSTERVILLE, MA DATE: FEBRUARY 22, 2001 Direct;ans to Site: From Hyannis take Craigville Beach Road to the lights at South Main Street; Turn left 1 onto S a"th Main Street and follow over bridge into Osterville(Main Street-aka So. County Road); Turn left ont,West Bay Road; Building is on the left#15. j —.....w.+...w«,.+.w...w.+.-.,•....,...+w. ++.,••..... ,•..,.•.. w+.n..n,.—.....—r,.• •, ,: .•,.w,.+r'r`ww�ww.*b:/rra4,u:i.ialarx+AfT2Nl.�tmNwq:+N.a'+Yw:►n.manwvw.awn++Kr.MY�k�MAiAF"�*'•nnaw..v-+••wn....r.s+/,wr.w!k+w+.nP a,;a� w.,.-.w r.w«w...nw.....• ��.