Loading...
HomeMy WebLinkAboutCHART ROOM AT CR - FOOD CHART ROOM AT CR 330A WEST BAY RD. 11 b- 013 OSTERVILLE, MA. 02655 i BOARD OF HEALTH Town of Barnstable John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BA ABLE ��' F.P.(Thomas)Lee MAS& Daniel Luczkow, M.D. Alt. 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 30513, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 300 Issue Date: 01/01/2022 DBA: CHART ROOM AT CROSBY'S OWNER: CRAC INC. Location of Establishment: 330 WEST BAY ROAD OSTERVILLE MA 02655 Type of Business Permit: FOOD SERVICE Annual: Seasonal: YES IndoorSeating: 36 OutdoorSeating: 13 Total Seating: 49 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE- FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: 13 outside dining and 36 inside total of 49. The seating number will-not change due to weather. There will only be 49 seats available which includes inside and outside dining. � For Office Use Oglys Initials: Town of Barnstable . Date Paid Amt Pd sM— snxxsrnei� Inspectional Services i63q. Public. Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 a APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 12 2- 71 NEW OWNERSHIP RENEWAL ✓ NAME OF FOOD ESTABLISHMENT: C hKf — aoam 144 ADDRESS OF FOOD ESTABLISHMENT: 3✓y A A 15 (lYlC✓ell//T, 04 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): Pe N(I Y- Z V� T— E-MAIL ADDRESS: Z,y �. �.� /* COM 1-115 f. 1W 7 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ?�) 66L- F1 S 61-1 TOTAL NUMBER OF BATHROOMS: t,, _ WELL WATER:YES NO.:°� (ANNUAL WATER ANALYSIS'REQUH2ED) ANNUAL: SEASQNAL �><✓', �DATES`OFAPERATION: / /%/�Z:TQ /ZU /Z;Z 'A - p NUMBER OF`SEATS:'INSIDE: OUTSIDE: 2 TOTAL: Y x. SEATING:MUST"OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? 1p S IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? I-P TYPE OF ESTABLISHMENT.-- (PLEASE CHECK ALL THAT APPLY BELOW) 'FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST t r COTTAGE FOOD INDUSTRY(formerly residential kitchen) ^ FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED)...'..._.._......_ CATERING.:.(CATERING NOTICE REQUIRED.BEFORREVENT(SEE PAGE#2) ° *** SEASONAL' MOBILE & NEW FOOD'ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc 6A 4CC OWNER INFORMATION: FULL NAME OF APPLICANT �✓ ®� SOLE OWNER: E /NO OWNER PHONE # ADDRESS p ' 2 9 f a Ill In//�l�! �n , �� a? T 7�v CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food-Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date' Allergen Awareness Expiration Date. f __ V 2. V14 04101 12- /G 2 L- 2 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-8624644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to'do so will result in the suspension or revocation of your Frozen Dessert- Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.ast). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.31't each calendar year. IT IS YOUR RESPONSIBILITY.TO RETURN ;THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-2019.doc i w Town of Barnstable ble BOARD OF HEALTH �+ John T.Norman Board of Health Donald A.Gaudagnoli,M.D. tBA Rx3reo Paul J.Canniff,D.M.D. �$ a 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate Deg Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 300 Issue Date: 01/01/2021 DBA: CHART ROOM AT CROSBY'S OWNER: CRAC INC. Location of Establishment: 330A WEST BAY ROAD OSTERVILLE, MA 02655 Type of.Business Permit: FOOD SERVICE Annual: Seasonal: YES IndoorSeating: 36 OutdoorSeating: 13 Total Seating: 49 FEES — FOODSERVICEESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: -------- - --- ----- - MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: 13 outside dining and 36 inside total of 49. The seating number will not change due to weather. There will only be 49 seats available which includes inside and outside dining. • � OPINE i Town of Barnstable For Office Use Only: Initials:� t Date Paid 3 I0 u Amt Pd$01J� MRWFAHLE,r Inspectional ServicesMAM, liqRL � v� 16,39. �m Check# �Fo�rs Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 3 NEW OWNERSHIP RENEWAL - NAME OF FOOD ESTABLISHMENT: C/*a- ADDRESS OF FOOD ESTABLISHMENT: 70;j �'✓�� v/A���!//i /"'7 MAILING ADDRESS(IF DIFFERENT FROM ABOVE): Pd A0 2 V OZG E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (7 L) 601 - 4 TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO (ANNUAL WATER ANALYSIS REQfUIRED) ANNUAL: SEASONAL: (/ DATES OF OPERATION: 7 / 11 TO 12_/ 2Z/ Z1 NUMBER OF SEATS: INSIDE: OUTSIDE: f L- TOTAL: y SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. �i� Q IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? w � C IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? ! TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) VF/�OOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ...(MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT 0,441 SOLE OWNER: YES/NO OWNER/PHONE# 0 2,77 - Ski a ?� ADDRESS ?—I E-NV15#00 k� Mj M&I�`�`//,t CORPORATEOWNER: IZ14G l �n41 CORPORATE ADDRESS: 356 �7� PERSON IN CHARGE OF DAILY OPERATIONS: Vw soeww / VIP, '1�felelep List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div.will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 2.1�1Amas � z (l IZi tZi SIGNATURE APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cookirg,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January I st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FonnsWOODAPP REV3-2019.doc pp1NE Tp� TOWN OF BARNSTABLE HEALTH INSPECTOR,s Establishment Name: Date: Page: of 'OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BABNSTABLE. ' 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 9 MASS. $ MON.-FRI. ago HYANNIS,MA 02601 508-8624644 No Reference R-Red Item PLEASE PRINT CLEARLY 'FDA""� FOOD ESTABLISHMENT INSPE TION REPORT - Name J�� Vl�S S, Date /4 Tvoe of Type of Inspection 1 Routine C ►� ^'� �� T Address �- �' ji f¢ Risk Food ServL' Re-inspection-30aLevel Retail Previous Inspection Telephone Residential Kitchen D � // ' L Mobile Pre-operatic J Owner HACCP Y/N Temporary Susp ness / Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP _I -? / In: Other J. J li - ! / ' Inspector Out: Each violation checked re uires an explanation on the narrative page(s)and a citation of specific provision(s)violated. U�) Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) i �i gA FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands "l yx El 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities ` -' ' 3 � LeU EMPLOYEE HEALTH PROTECTION FROM CHEMICALS J ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives -1V ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals ! -�C 2-- 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 12) ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control 4 /?t"`� �1 l✓2�f / J . � ✓ ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items Total Number of Critical Violations ( Critical(C)violations marked must be corrected immediately. (blue&red items) �� v Corrective Action Required: ❑ No El Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils . (FC-4)(590.005) cited in this report may result in suspension or revocation of the food 6=One critical violation and less than 4non-critical violations - 9 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of.food establishment operations. If if no critical violations observed,4 to 6npn-critical violations-B. 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)(590.007) aggrieved by this order,you have a right to a hearing. Your request must be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 violation,4 to 8npn-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signat e_,Zf. Print: FE 31.Dumps r screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: / Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* * * _ 3-501.15 Cooling Methods for PHFs 590.003(B) Demonstration of Knowledge 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives Cooked and RTE Foods.* 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 590.004(F) 7-101.11 Identifying Information-Original Containers* 7-]02.11 Common Name-Working Containers* 590.003(C) Responsibility of the Person-in-Charge[0 Other* 3-501.16(A) Hot PHFs Maintained At or Above 140'F 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 7-201.11 Se azation-Storage* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Re uirements 590.003(G) Reporting by Person in Charge * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and AdulteReserrated for of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Waming Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y * P 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products 4-501.112 Mechanical Warewashing-Hot Water Monitoring 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* - Concentration and Hardness* 3-401.11A(1)(2) Eggs-155'F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of Eggs F 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145' 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-40 1.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165'F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12' Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C). Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements.practices be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140`F* (Blue Items 23-30) 3-202.15 Package Integrity* ( ) Y Critical and non-critical violations,which do not relate to the Foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification* ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement -� 24. Food and Food Protection FC-3 .004 * 3-501.14(B) Cooling PHFs Made from Ambient 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 1 6-301.12 Hand Drying Provision 129. 1 Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* 1 S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. of, roN TOWN OF BARNSTABLE -HEALTH INSPECTOR'S . Establishment Name: (./� Y f.Date: 1YZ Page:�_of , OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNS-TABLE. 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. MON.-FRI. �p +039• �0 HYANNIS, MA 02601 508-862-4644 No Reference R.-Red Item PLEASE PR NT CLEARL _ 1� 'Ara"""'' FOOD ESTABLISHMENT INSP CTION REPORT Name Dateq T e o T Inspection outine ✓) Address (` } t Risk 47-ail e e-inspectonVv Level Previous Inspection litti Telephone Residential Kitchen Date: Mobile Pre-operation d Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) _ Time Bed&Breakfast HACCP [ t r/� In:-3- cam, Other t• Inspector �ff�� Out • Y I GlJ - - Each violation checked r quires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ / Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ S r�i I/t LJ04&'N �u b Action as determined by the Board of Health. Allergen Awareness 590.009(G) J FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands �� ❑ 1.PIC Assigned/Knowledgeable/Duties LJ- s�Handwash Facilities 1 EMPLOYEE HEALTH PROTECTION FROM CHEMICALS "` k�� J (s+• ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives �n ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals dd�� FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) L ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ✓ rl �I-Ckallll ❑ 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 t� PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health ControlG J . ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) �� y� f 9 Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP 10.Proper Adequate Handwashing CONSUMER ADVISORY b6�7 1 / ` �� t-� - ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories to l S Q u Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations t ,.)nCritical(C)violations marked must be corrected immediately. (blue&red items) "6 CIVI Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction.Based on an inspection today,the items ❑ Embargo Emergency Closure ❑ Voluntary Disposal Other: checked indicate violations of•105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than o 6 non-critical violations 9 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations: If 1 critical refrigeration. 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspecto' SI nature Print: 31.Dump r screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N A 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- Assi nment of Responsibility* 6 Cross-contamination Law Cooled to 41°F/45°F Within 4 Hours* ( ) - g14 Food or Color Additives 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202,.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives*- _ 19_. _ PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties - - 3-302.14 Protection from'Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F)- EMPLOYEE HEALTH - - 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identi in Information-Ori Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* g g * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment * 3-501.16(A) . Roasts Held At or Above 130°F 7-201.11 Separation-Storage* Applicants* 3-302.11(A) Food Protection* 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 3-304.11 Food Contact with Equipment and Utensils * ( ) q 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11. Sanitizers,Criteria-Chemicals*, _ REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food. 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and - - - - - * 4-50].]I I Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations 3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures Raw Seed Sprouts Not Served*7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and MIIIC Products*" 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re -Served* 3-202.13 Shell Eggs* _ Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-10L11 _ Drinking Water from an Approved System* gg Equipment * Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eff-"°e inrzooi 4-602.11 _____ Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed * Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Chemical Ratites-165°F 15 see* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms-Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 77 Reheating for Hot Holding Requirements.practices 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* 3-403.11 C CommerciallyProcessed RTE Food-140°F* (Blue Items 23-30) 3-201.11 Package Integrity ( ) Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification* ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41'F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Forrnback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. oF� r TOWN OF BARNSTABLE HEATH INSPECTOR'S Establishment Name: kjau ,tcA7N__ ��1�D� (�S Date: Page;-7- of ',Z '4 OFFICE HOURS PUBLIC HEALTH DIVISION a 00-=9 30A.M. BARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item - PLEASE PRINT CLEARLY. p a 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name �- iS Dat Ty e ne of T f inspection O n s outine Address. l Risk -food Service - ection i S CY Level Retart Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation 4 ` Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint - Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: �3ap 4�. d ,cam Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. v �` Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ l `yl 0 Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties Vt ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food an Water from Approved Source ❑ 16.Cooking Temperatures01 -' ❑ 5.R iving/Condition C] 17.Reheating - 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 C f ❑8.Separation/Segregation_/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) _rC4619 S `A 1. ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations m t Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Susp nsion ! C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure El Voluntary Disposal Other: . checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations 9 re ardless of the number of critical,results in an F. B=One critical violation and less than Orion-critical violations 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation t F is scored automatically la hot C=2 critical violations and less than 9rion-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 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 8rion-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's ignatu Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' ore Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N 4 + .-r._.+.�.. -may -_w +,.�y a. -•, v.,.� •^...r• +_�.._..�+.�...�-..__. ..--•---.- .•- -. �.��•.. - .. .>>__ - _ °a- _ Jr• .- �_ - �-r. -y � -� - ., - -� ,_ - r z �, ,+°. r :1-., + �- i a ... 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.) '-~ ti FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003 A Assi nment of Responsibility* 8 Cross-contamination Law Cooled to 41°F/45°F Within 4 Hours* ( ) g14 Food or Color Additives 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202:12-- Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* *• 19 PHF Hot and.Cold Holding 2-103.11 Person-in-Charge Duties - 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to _ Other* 3-501.16A) Hot PHFs Maintained At or Above 140°F . (7-10211 Common Name-Working Containers* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage*g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An _ _ 3-302.15 _Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 590.003(G). Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q ._ - - - Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR _ 3-306.14(A)(B)Returned Food and Reate for of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 1590.003(E) Removal of Exclusions and Restrictions g � ) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g - Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B) Com liance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( P 4-501.141 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations * 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served P 7-206.13 Tracking Powders,Pest Control and 3-201.13" Fluid Milk and Milk Products* -' 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. L16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5401.11 Drinking Water from an Approved System* gg - Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E//c i-11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source _ 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 - Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- - * - Ratites-165°F 15 sec* in mobile food,temporary 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 practices should be debited under#29-Special Requirements. 5 Receiving/Condition - 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES " * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercially Processed RTE Food-140°F* (Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction* Temperature Ingredients to 41°F/45'F 25. Equipment and Utensils FC-4 .005 * 5-205.11 Accessibility,Operation and Maintenance 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. F IKE► TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: Page:�_of OFFICE HOURS � PUBLIC HEALTH DIVISION e:oo-ssoA.M. BARNSrABLE. • 200 MAIN STREET s:3o-a:so P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �4p639. �62 4644 �� HYANNIS,MA 02601 MON.-FRi. No Reference R-Red Item PLEASE PRINT CLEARLY 508 'En A' FOOD ESTABLISHMENT INSPECTION REPORT Name ��- � t� Date ,f Type of Type of Inspection �l Routine Address V 6 /� Risk Food Se ' Re-inspection v Level etail Previous Inspection lei Telephone Residential Kitchen D Mobile re-o eratio Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint i Person in Charge(PIC) `1 Time Bed&Breakfast HACCP In:1 b �lb fr1�'1 Other Inspector ��p Out o, �D Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) anti-Choking 590.009(E) ❑ C� ��� Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ � rl V�-t'k Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures I ( , S _ `y ❑5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling w ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) a t Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ® Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. Embargo Emergency Closure El Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 6=One critical violation and less than 4npn-critical violations re 9 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to anon-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 29.Special Requirements (590.009) within 10 days of receipt of this order. violation,4 to 8npn-critical violations=C. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45'F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 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 590.004(F) 7-101.11 Identifying Information-Original Containers* * Require Reporting by Food Employees and Contamination from the Environment 2 Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * 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 Re uirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* ( ) q Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reated or of Food 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 1590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 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* Pe 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 713-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* EJfecnve 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)-in cater- Ratites-165°F 15 sec* Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. Other 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* practices should violations relating to good retail be debited under#29-Special 9 3-201.17 Game Animals* 11 Good Hygienic Practices 1 T Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-001.11 Eating,-Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C * (Blue Items 23-30) 3-202.11 Package Integrity ( ). Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140'F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45'F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41'F/45'F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 1 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *IMF TOWN•. TOWN OF BARNSTABLE. , HEALTH INSPECTOR,s Establishment Name: MAte: Page: // of OFFICE HOURS -7r-- °� PUBLIC HEALTH DIVISION 8:00-9`:30A.M. y 3:30-4:30 P.M. EARNSTABLE. • 200 MAIN STREET - Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified A 1639•p�0� HYANNIS,MA 02601 M-1 62-FRI. O Reference R.-Red Item PLEASE PRINT CLEARLY lFo MAC 108-8 FOOD EST LISHME NT INSPTIN REPORT PA 0 Name Date f _TJW6YTnS68c9 In S Routine Address Risk ood Sere` Re-inspection Level Previous Inspection Telephone Residential Kitchen Za :Mobile operati Owner HACCP Y/N Temporary Iness e� Caterer General Complaint Person in Charge(PIC) PT Time Bed&Breakfast of eCP Inspeclop tor 4i Wd Z41jM1"ft;" Each violation checked requires an explanation on the narra a ge(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding 09 O PROTECTION FROM CONTAMINATION ❑20.Time Asa Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP j,?q2jao❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No Y s Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items F] Embargo Emergency Closure ❑ Voluntary Disposal Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a eight to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non- ritical violations. If 1 critical refrigeration. 29.Special Requirements ' ation,4 to 8non-critical vio l(590.009) within 10 days of receipt of this order. ion 30.Other DATE OF RE-INSPECTION: IL pe tor' Signature co Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N P C's Signature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions ,+M Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives* 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* g3-501.16(A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* * 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.00411 Requirements 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* ( ) Variance Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and AdulteReserrated for of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP S90.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.1 i t Manual Wazewashin Hot Water 7.206.12 Roden[Bait Stations 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and * 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11 A Clean Utensils and Food Contact Surfaces of * Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* ( ) Eggs-Immediate Service l45°F 15 sec Not Otherwise Processed to Eliminate Equipment* ( )( ) Pathogens* 590.006(A) Bottled Drinking Water* 3-401.11 A 2 Comminuted Fish,Meals&Game g * a ec&e uuzooi 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and StuffingContaining Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g ry 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources 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 2-301.11 Clean Condition-Hands and Arms the appropriate sections above if related to Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.1l(B) Microwave-165°F 2 Minute.Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items non-critical 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g' Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 [33-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 0.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements502.11 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. d t lw ER CAT, OFCv: P:.L 'GIs CtkUFlE HA E i , DAVID JARVIS - has success iu€lly co rap. eteil a .p sesl all requ �edl courseivork d" r each s tdk dabta,m certincaltidau in y - Adult/ChildNfant CPR and AED 04 21-2020 10,1681. 1587492292 "04 21 2022 a. S Cornpletaon at pit Taate Date pir V Lr Ir • . iµ. V.xr,.w�':y. _.wu,.a.,a,.,,>,« wA..,,x -.>w•w`. .,un: .w, .-.,es:.w� xxr. n.Av.+.e�'+aa.�:V..^wxt r«e .n er ,.�Wn.u...r,MM»v y ,r y « y , , oFi rok TOWN OF BARNSTABLE HEALTH INSPECTOR�s Establishment Name: CViM 1 R46�1 Date: I� Page: I( of , OFFICE HOURS BARNSTABLE.,` PUBLIC 0 MAIN STREET 3:30-4:30A.M. 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified M639:a m� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY rEp MP'� 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name ChOlrl- Pzom Date a Sao/{q Mae ofiQn s T ns ec ion me - r f n Address f 7 dnn / A rU-` Risk ood Sery Re-i ion / - CI AS �'r Ws I Level a Previous Inspection •1 r Telephone Residential Kitchen Date: - le (v, Cd dA Mobile Pre-operation wl / Owner HACCP Y/N Temporary Suspect Illness P f 6 l �Ad4,/ `r /E ' Caterer General Complaint �r Person in Charge(PIC) Time Bed&Breakfast HACCP �( ford Bd,- An (i um In: Other Weed Inspector Out: - 0 `fL I�m Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ r'1_ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ �/ cor It d -M61 lew {a Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ a C C FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands 1�wy� of nq ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities I 'v l EMPLOYEE HEALTH PROTECTION FROM CHEMICALS aA Jtf Gtjq gd� tq ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives NO ►v Q hi ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals J f i r h FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking TemperaturesQ� ❑ 5.Receiving/Condition ❑ 17.Reheating if ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling Lf I 1 I I L{�Q ❑ 7.Conformance with Approved Procedures/HACCP Plans El19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time Asa Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories 5 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ® ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled . ❑.Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. B=One critical violation and less than 4mon-critical violations re 9 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7590.008 be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. _ )( ) violation,4 to 8mon-critical viola V violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. Print:Inspector's Signature 30.Other DATE OF RE-INSPECTION: J 1 V 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Sign a Print: vVCic Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y.. N J �. / Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 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 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 2 590.003(C) Responsibili 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection**' 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* * Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR- 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition 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 Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Eggs Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eb i9e 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* aces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17, Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g, g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial) Processed RTE Food-140°F* (Blue Items 23.30) 3-201.11 Package Integrity ( ) Y Critical and non=critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* [_I 3: Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 TagsiRecords:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser;Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. &"f"oFp1E ro OF BARNSTABLE HEALTH INSPECTORS Establishment Name ) ate: Page: of q010 OFFICE HOURS ALTH DIVISION 8.00-9:30 A.M. \*WN N STREET 3mob, :3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified BARN5rABLE. • ZOO MAI 'gyp ,619.pad HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRIN LEA LY �Fn MPS508-862-4644 D ESTABLISHMENT INSP TI N REPORT Name Date a of Tvpe of Inspection g Routine Address Risk (Food Se Re-inspection Level arl. Previous Inspection Telephone Residential Kitchen Mobile Pre-operatf Owner HACCP Y/N Temporary t-t Hess IQ irT Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other Inspectorzaa 117. Each violation checked requires an explanation on the narrative fage(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS i ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling !- ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY (_`fI ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories r Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ,❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo Emergency Closure ❑ Voluntary Disposal Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and lessytha 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7 590.008) be in writing and submitted to the Board of Health at the above addressviolations observed,7 to 8 ritical olations. If 1 critical refrigeration. )( on,4 to 8HoH-criticaltion 29.Special Requirements (590.009) within 10 days of receipt of this order. ctor' ur ri 30.Other DATE OF RE-INSPECTION: _ 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N Print: PIC's Signat #Seats Observed frozen Dessert Machines: Outside Dining Y N �. /�Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) +D-em, ssignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives _ Law Cooled to 41°F/45 F Within 4 Hours* ° 590.003(B) nstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from�Unapproved Additives - Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to. Other* . 7-101.11 Identifying Information-Original Containers* 3-501.16 Hot PHFs Maintained At or Above 140°F* 2 ) 7-102.11 Common Name-Working Containers* (A Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Storage* - Applicants* 3-302.11(A) - Food Protection* 7-201.11 Separation g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* * Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* . . 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and 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 g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashing-Hot Water 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 Eggs Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef five 11112001 4-602.1.1 _ Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source - _ _ 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3 401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165'F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°17 Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products 5-203.11 Numbeis and Capacities* 5-20411 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004 Labeling of Ingredients* Supplied with Soap and hand Drying Devices (J) 9 9 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. rt47 'I oF�r.r. TOWN OF BARNSTABLE . HEALTH INSPECTOR'S Establishment Name: I :AM Page: of OFFICE HOURS : BAR E.o: PUBLIC 200 MAIN STREET 3:30-4:30A.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 3:30-4:30 P.M. MON.-FRI. �p ie79,n o HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY rFD MAC FOOD ESTABLISHMENT INS C 10 REPORT - Name Date yue of Tyne of Inspection Operation(s) Routine Address Risk Food Service Re-inspectionn1aLevel Retail Previous Inspection - Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector Out: Each violation checked requires a planation 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) ❑ 01 Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ . 11 Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17..Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo Emergency Closure ❑ Voluntary Disposal El Other. checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than non-critical violations g if no critical violations observed,4 too 6 von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If C=2 critical violations and less than 9 non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 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 within 10 days of receipt of this order. violation,4 to 8 non ritical violations=C. 29.Special.Requirements (590.009) y p , 30.Other DATE OF RE-INSPECTION: InspecQ'- Sl Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed 'Frozen Dessert Machines: Outside Dining Y N PIC,SPrint: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N n(�, /�A Q;t S y Dumpster Screen? Y N (y r-'i.�,a-„ - .. _ - _ar �.• - - -- .,:4._. .- ._ _ .. - ?.i�"7�^-. .:k.-.... +.. - .-r-r -- --- - Try, L ..}...r-•,.^-^},r�c,,,.�.'y.....-� ..v�r--� - '_ - - - - - .c„ Violations related to Foodborne Illness " Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) [Demonstration gnment of Responsibility* 8 Cross-contamination 1q Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 - Person-in-Charge Duties - Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Applicants* 3-302.11(A). Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-20111 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions g ( ) Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 - Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. LiL Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Clean Eggs Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef ctwe 11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 70 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail * 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 3-201.17 Game Animals 9 g Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* * 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11 B Microwave-165°F 2 Minute S[andin Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.11 PHF's Received at Proper Temperatures ( ) g 3-301.12 PreventingContamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* g 3 403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F * Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004' 3 402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 * 5-205.11 Accessibility,Operation and Maintenance 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. INS Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BARNsrAOU& Paul J.Canniff,D.M.D. MAM 1619. 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate D" r'' Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L.Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 300 Issue Date: 01/01/2020 DBA: CHART ROOM AT CROSBY'S OWNER: DAVID JARVIS Location of Establishment: 330A WEST BAY ROAD OSTERVILLE, MA 02655 Type of Business Permit: FOOD SERVICE Annual: Seasonal: YES IndoorSeating: 36 OutdoorSeating: 13 Total Seating: 49 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: GQ� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: 13 outside dining and 36 inside total of 49. The seating number will not change due to weather. There will only be 49 seats available which includes inside and outside dining. .fi 1 a r' �FIKE r ForOffice Initials: JIL5 ti Town of Barnstable Date Paid •. inaxsraetE, Inspectional Services t, 1639. �0� Check# ' �fo �a Public Health Division Thomas McKean, Director - 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 r� APPLICATION FOR PERMIT TO OPERATE A/FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL V NAME OF FOOD ESTABLISHMENT: 64'4&g ��✓''I � 7/7�r� ADDRESS OF FOOD ESTABLISHMENT: 33,ah 40 Ad MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: 1!(/12 Y IW� /GI) TELEPHONE NUMBER OF FOOD ESTABLISHMENT: U �G- TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: '� DATES OF OPERATION:1l 7 44 TO /2 / 3Q/ 21-9 NUMBER OF SEATS: INSIDE: OUTSIDE: /L- TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? qo IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? qio TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q\Application FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: E /NO OWNER PHONE # Jt/ 7W S—a7- ADDRESS Lyl I✓if �� �AIV��"y`�®i O�i�I�® Q CORPORATE OWNER: CORPORATE ADDRESS: ?X PERSON IN CHARGE OF DAILY OPERATIONS: 7UP V 1�to,V1 �✓� List (2) Certified Food Protection Managers AND at least (1) Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. ��' � 12/ /Z / 2/ 1. 7k ;gym2, / /0 / zZ 2. kwm / l 2/ rl vtv� 4 �id/2L 2, 2� SIGNATURE OF ffPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asi). OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January Ist to Dec.31`each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q\Application FormsTOODAPP REV3-2019.doc s:,�a .g � •.. <, t,� @ ., t.w.+',,�J,� +��...ti.;:y :';t:rt�� a,-� :.:}:.aY•e `'� ,�*l�' .01 •.t*.�. ��$. : '> m•a�, �`e `�A, M .,TM'*" °Z,,: '4�. :� � .���sa+u�',.Y. •fir,a -.+:,,n c'k efi� � �,'�'��,� �'6g•. �A. 'R ro.. w;- 4,-tip �e e.`.�.'l(a 4.�" � # °" ,7P`�rt'a.{"�. '�V. :� �. '4�"•`� _ ..,r ..-�� l- `"N" N'•,a �. +. t'• ,: ° 4 Fyy$ �>'•� P. _ v %. :'vu fee. ;i, '�»a.` � �: � v 4a�. � �" D� _ ,�,r-. � - <'�,. �':; -�?•• ~�u- �r "�»n �4 ';d:pta r r EID.TIFICATEOF COMPLETION 0 X THIS CERTIFIES THAT Yt h DAVID JARVIS i SO'- has successfully completed and passed all required coursework and �f .. exams to obtain certification in r Adult/Child/Infant CPR , > � pit - - 2• � - �. 05/21/ 020 . � ID # CCPR 18 127777 ' • III � � '•�°� - "` Completion Date Expiration Date. > new l i f e CPS. lona eene Certified Instructor :. f M� 1 , Tv ��II .ar'+5'. 'a{ =-•rz •a., .<d;""a',4'. w .'mr +:":- erf a ,.1,F4,i :.t `*� :'�� w`ef� + tpyT• A. ', Fvr,'h-wr a i " " • ..r'''rt,.•,. �h'. c::'_+.f •'.:..a „' :..Ai,, x R:�y,.. k .'�4. � n,k•. �'.;t,, ��F. 'M1 ,:� �,„1�,� ::sf', `46{�vY�•.. .�. ..'a ,fie..»-. .,� kl ss��.. 5+�'r.a. '. .... e.:°4 a• .. - ��,e�;-� _ �y: rm.- ... 6., .. -�°� L•. < `, � «,, •��_... '�>," _. ', .� : ;rs';r,� �. '� .� `:� r ,�., �. :{� ,fir'- R +', ' * .. Of ., ^•-;, -.. .ro• .'?�? ?�u�.�M .. .� ..,,.: r ,,`�:, ^u•, `s. •;'".' `" "�'^ a ""�'; +9a'�ap �;.A�"� .ry?3- E ..e�� '.'S3t7§� r, y , Allied Barge Reale' Pinot Nair 2018 i 142633 Puglia 12 750 $136.00 Allied Borgo Reale' Ch e 5 2017 142523 Tuscany 12 750 $144.00 ISRAEL .. Allied Oabon' ,Careen Red 2018 142223 - Upper Galilee 12 750 $152.00 Allied Dalton' Cabernet Sauvignon 2017 142203 Upper Galilee 12 750 $228.00 Allied Dalton' Knaan Cabernet Seuvgnon 2017 143963 Upper Galilee 12 750 $156.00 Allied Gmot Cabernet Sauvignon 2014 1411993 Shaman 12- 750 $320.00 Allied Jerusalem Vintage 3400 Cabernet Sauvignon _ 2016 142943 Judean Hills 12 750 $176.00 CHILE -- Allied Lanzur Cabernet Sauvignon 142713 Lantus Valley 12 750 1 $82.00 Allied Lanzur Meriat 143113 Lontae Valley 12 750 $8200 Allied Lamur Reserve Final Nolr 2017 r 143133 Maipo Valley 12 750 $104.00 `Mevushel '. r MMD Ramos Pirrto Duas Oulntas 2015 220343 Douro 12 750 $132.00 Deutsch Qulnte do Vale Mesa Meandro 2017 932193 Douro 6 750 $120.00 SOUTH AFRICA Tedato Estate Ernie Els Big Easy Red 2016 920613 Stellenbosch 8 750 $84.00 Tedato Estate Ennis El. Cabernet Seuvgnon 2015 920M Stellenbosch 6 750 $116.00 Tedato Estate Ernie Els Proprietor's Blend 2015 920613 Stellenbosch 6 750 $168.00 MMD Fleur du Cap Pinotage 2016 210143 Stellenbosch 12 750 $120.00 MMD Fleur du CapCabernet 2016 2101. Stellenbosch 12 750 $120.00 MMD Meeriust Rubicon Cabemei/MedoUCeb Franc) 2015 210503 Stellenbosch 12 750 $300.00 MMD Meerlust Rod 2014 210543 Stellenbosch 12 750 $158.00 Terlatc Estate Rust an Vrede Medot 2018 920533 Stellenbosch 6 760 $96.00 Tedeta Estate Rust an Vrede Cabernet Sauvignon 2016 920523 Stellenbosch 8 750 $140.00 Tedato Estate Rust an Vrede Estate Red 2014 920513 Stellenbosch 6 750 $240.00 Gonzalez Byass Beronia Riols Cdoma 2016 736883 Rioja 12 750 1 $136.00 Gonzalez Byess Beronis ,Riole Grand Reserve 2009 73M Rioja 12 750 $300.00 Gonzalez Byess Seronia Rioja Reserve 2014 736873 Rioja 12 750 $184.00 Pernod Campo Viejo Tempranillo 2016 551613 Rioja 12 750 $128.00 Pernod Campo Vmjo Gamacho 2017 551633 Rioja 12 750 $128.00 Pernod Campo Viejo Reserve 2013 551623 Rioja 12 750 $168.00 Frewenet Handed Collection Morianda Priorat 2016 421975-16 Spain 6 750 $192.00 Freixenet Hereded Collection - Veze Mole Crianza 2013 421922-13 Spain 6 750 $80.00 MMD Marques de Munieta Dalmau Rioja Resents 2014 210843.14 Rioja 6 750 $400.00 MMD Marques de Murrieta I Rioja Reserve 2015 210823 Rioja 12 750 $240.00 MMD Marques de Murtiete Castillo Ygay Rioja Gran Reserve 2009 210S33-09 Rioja 6 750 1 $520.00 Park Street Imports Ramon Bilbao Cdanze 2015 941603 Rioja 12 750 $144.00 Park Street Imports Ramon Bilbao Reserve Limbed Edition 2015 941623 Rioja 12 750 $184.00 Park Street Imports Ramon Bilbao Reserve 2011 941613 Rioja 12 750 $224.00 Fre&enet Rene Barbier Barbier Red NV 425621 Spain 6 1.5 $64.00 Freaenet Rene Barbier )%rbier Red NV 425M Spain 12 750 $64.00 Freixenet Rene Barbier Berbier Red NV 425620 Spain 4 3L $60.00 Hand Picked Vinestml Rioja Joven 2017 418343 Rioja 12 750 $96.00 NEW ZEALAND REDS Pernod Brencod Vineyards Piinot Nair 2017 121 Marlborough R12 750 $136.00 Old Bridge Callers Gml=ke Pint Nair 2018 575713-18 Marlborough Sustainable 750 $320.00 Old Bridge Cellaro Innocent Bystander Final,Nair 2017 578803 Cereal Otega 750 $224.00 T.NtoPremierLoveblock Pinot Noir 2018 683423 Central Otago Certified Sustainable 750 $280.00 Accolade Mud House Pinot Noir 2018 392333 Central Otago 750 $160.00 Deutsch The Crossings Finot Noir 2017 87513 Ataere Vagey Sustainable 750 $180.00 URUGUAY Terlato Premier Shim¢W4o Mei Pure Dusk Junme!Gino NV 662844 Japan 12 30D $11200 Torsto Premier Shim¢u-No Mai jPure Dusk Junme,Daiginjo NV 662834 Japan 12 300 $136.(10 PORTS :. .-..-=.,t. , Potugbl MMD Ramos Pinto Wood Aged Ruby 220253 Douro 6 750 $74.00 MMD Ramos Pinto I Tawny 220273 Douro 1 6 750 $74.00 MMD Ramos Pinta White 220263 Douro 1 6 750 $74.00 MMD Ramos Pinto Collectar 220283 Douro 6 750 $82.00 MMD Ramos Pinto Lagrima 220623 Douro 8 750 $78.00 MMD Ramos Pinto Late Bottled Vintage 2012 220293 Douro 8 750 $108.00 MMD Ramos Pinto 10 Year Tawny'Quints de Ervamoira' 220303 Douro 6 750 $160.00 MMD Ramos Pinto 20 Year Tawny'Quinta do BomRstiro 220313 Douro 6 750 $300.00 MMD Ramos Pinto 30 Year Tawny 220453 Douro 6 750 $480.00 Evaton Sandeman 10 Year Old Tawny 87753 Douro 6 750 $154.00 Evaton Sandeman 20 Year Old Tawny 87713 Douro 6 750 $272.00 Evaton Sandeman 30 Year Old Tawny 87763 Douro 8 750 5460.00 Evaton - Sandeman 40 Year Old Tawny 87723 Douro 8 750 $750.00 Evaton Sandeman Apetiv Reserve Port 87823 Daum 12 750 $176.00 E-on Sandeman Founders Reserve Ruby 87663 Douro 12 750 $178.00 Evaton Sandeman Late Bottled Vintage 2011 87703 Daum 6 750 $154.00 Evaton Sandeman Quints do Sewo 87833 Douro 6 750 $212.00 Evaton Sandeman Ruby 87673 Douro 12 750 $142.00 Evaton Sandeman Tawny 87683 r -Daum 12 750 $142.00 Evaton Sandeman Vintage Port 2016 87813 Douro 6 750 $520.00 SHERRIES - PO in Gonzalez Byess Harvey's Bristol Cream NV 540402 Jerez,Spain Sustainable 12 750 $140.00 Gonzalez Byess Gonzalez Byass Amontillado Vina AS NV 736733 Jerez,Spain 6 750 $128.00 Gonzalez Byass Gonzalez Byars Clarom Alfonso NV 736753 Jerez,Spain 6 750 $128.00 Gonzalez Byers Gonzalez Byess Palo Cortado Anode 1987 736483 Jerez,Spain 6 750 $600.00 Gonzalez Byess Gonzalez Byess Palo Cortado Lmrtor NV 736743 Jerez,Spain 6 750 $128.00 Gonzalez Byass Gonzalez Byass Pedro Xlmer-Nectar NV 736763 Jerez,Spain 6 750 $128.00 Gonzalez Byass Gonzalez Byass Vermouth Le Cope Blenco NV 736473 Jerez,Spain 6 750 $108.00 Gonzalez Byass Gonzalez Byess Vemauth La Cope Rojo NV 736463 Jerez,Spain 8 1 750 $108.00 Evaton Sandeman A-da Cream 87613 Jerez,Spain 6 750 $80.00 Evaton Sandeman Character Sherry 87623 Jerez,Spain 6 750 $80.00 Evaton Sandman Don Fine She" 87603 Jerez,Spain 6 750 $80.00 Evaton Sandeman Fine Rich Madeira 87643 Madeira,Portugal 12 750 $172.00 Evaton Sandeman Raimvatar Madeira 87653 Madeira,Portugal 12 750 $172.00 Gonzalez Byass To Pepe Fino NV 511143 Jerez,Spain 12 750 $178.00 Gonzalez Byass Tio Pepe Fino NV 511144 Jerez,Spain 12 375 $11200 Gonzalez Byass To Pe Fino an Rama 2019 511154 1 Jerez,Spain 12 375 $128.00 GRAPPA Banville CesoniAp.rtfivo 1814 344523 Italy 6 750 $104.00 Benville Cason! -Amaro Heritage 344503 baly 6 750 8120.00 Benville Casdni - Amara del Citlista 344513 holy 6 750 $168.00 Teriato Estate Gale Greppo'DarmagP 66954 Piedmont 6 375 $300.00 Terieta Premier Nonino Qulntessentia Amam 68503 Friuli 6 750 $232.00 Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. D.ATdNSTAIS4� John T. Norman M.An F.P. Thomas Lee Alternate 200 Main Street, Hyannis, MA 02601 r a 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, 30SB, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 300 Issue Date: 03/01/2019 DBA: CHART ROOM AT CROSBY'S OWNER: DAVID JARVIS Location of Establishment: 330 WEST BAY ROAD OSTERVILLE, MA 02655 Type of Business Permit: FOOD SERVICE Annual: Seasonal: YES IndoorSeating: 13 OutdoorSeating: 36 Total Seating: 49 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2,019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: ---------- - - -- - ------ - MOBILE- FOOD: MOBILE- ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: ! j PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: 13 outside dining and 36 inside total of 49. The seating number will not change due to weather. There will only be 49 seats available which includes inside and outside dining. i �_0* T 4 For Office Use Only: Initials: o� Town of Barnstable �Amt Pd$Q Date Paid � 13MN TABLE, : Inspectional Services MAM. a cneclz AjFo�tA�A Public Health Division j Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL 1V NAME OF FOOD ESTABLISHMENT: (. kW- 40K e ADDRESS OF FOOD ESTABLISHMENT: 330df ��sf /� lC >���� ®24 Fr- MAILING ADDRESS(IF DIFFERENT FROM ABOVE): PO 2m E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: a]y) - a TOTAL NUMBER OF BATHROOMS: WELL WATER:YES NO P<.. (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: l��A TO NUMBER OF SEATS: INSIDE: 37 OUTSIDE: 1 Z TOTAL: L� / SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** E APPROVED BY THE HEALTH DIV.AND LICENSING A OUTSIDE DINING MUST B AND MEET OUTSIDE DINING i REQUIREMENTS. IS IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? 'kS ' 9 IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? � � $ TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) r CATERING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE 02) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV FOR JNSPECTION PRIOR TO PERMIT BEING ISSUED Q:1Applicatim FomisWOODAPPRL'V2018.doc is 'y 4 O' PLEASE CALL 508-862-4644 OWNER INFORMATION: /� FULL NAME OF APPLICANT �J Jd V l`�J e -3firul''S �r SOLE OWNER: YE /NO OWNER PHONE# (OV ADDRESSid+�I � �� _ i►�l�� "oL OU CORPORATE OWNER: fZA G � FEDERAL ID NO. : CORPORATE ADDRESS: ���/vl PERSON IN CHARGE OF DAILY OPERATIONS: ry List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date lif 2. k-eutool 121 /2 kw � V �/ 2,01-1 SIGNATURE O,,y4PLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile tucks must be inspected by the Health Div. prior to openingi l Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http•//www townofbarnstable.us/healtlidivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January Ist to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC I st. Q:\Application FormsTOODAPPREV2018.doc 1 r THIS LICENSE SHALL BE DISPLAYED ON THE PREMISES IN A CONSPICUOUS POSITION WHERE IT CAN BE READ LICENSE No. 03310-RS-0070 S ALCOHOLIC BEVERAGES 3 THE LICENSING AUTHORITY OF T10e TOWN OF BARNSTABLE, MASSACHUSETTS HEREBY GRANTS A MMON VICTUALER se to Expose, Keep for Sale, and to Sell All Kinds of Alcoholic Beverages y To Be Consumed On the Premises 0: CRAC Inc, d/b/a Chart Room at Crosby's Thomas J Gordon Jr.,Manager on the following described premises 330 West Bay Road, Osterville,MA First floor of 3 story wood frame building.One front Entrance/Exit.Two side Entrances/exits, 1500 sq.ft.open area,bar seating,400 sq. ft.storage area,.190 sq.ft.walk in refrigerator and dry storage shed in Northwest side;420+/-sq..ft.patio/deck/outdoor area.49 total seats with 2 scenarios as follows:Scenario 1:Bar seats-12,table seats 24,and 13 outdoor:seats with 14 standees and 15 employees. Scenario 2:Bar Seats- 12;table seats 32 and outdoor seats-5 with 5 standees and 15 employees. This license is granted and accepted upon the express condition that the licensee shall, in all respects, conform to all the provisions of the Liquor Control Act,Chapter 138 of the General Laws,as amended,and any rules or regulations made thereunder by the licensing authorities. This license expires January 15,2018 ,unless earlier suspended,cancelled or revoked. ............................... IN TESTIMONY WHEREOF, the undersigned have hereunto affixed their official signatures this 9th day of May 2017 ........................ ....................................... The Hours during which Alcoholic RESTRICTIONS-See Below Beverages may be sold are: • v WEEKDAYS: 11 AM TO 11:00 PM .J• ..--...... SUNDAYS: 11:00AM TO 11:00 PM 11 AM TO 11PM ..............••... ..yr . -- .........�........... m NOT VALID unless issued in conjunction ....••••......... ••• •-•••- with a Food Service Permit. LICENSING AUTHORITY PAID: $3,050.00 RESTRICTIONS Hours of operation April 1-October 15 are 11 AM to I IPM. Oct 15-January 15 are 8 AM to 11 PM Thursday-Saturday. Oct 15-January 15 are 8 AM to 5 PM Sunday . ~'•t11511NGSHEO •".Sr f Il4andlocallon lobe v¢Ijpedl -�I — F,uJufdn eulgn.Equlpmml 1md SnppOu Boodsetvice Design I �• RCi±AVING AREA , i ":'i!i w`�i;:..M"• e" / 4a .°r JaWuu�.,,yyu.1.MvK���•'.w�'wI�LnY, b,r w'uw1`.,lur'•L,Ar,NrlS.ilw `��\, -f•ynnwWu ill,r•4 IV "�:1 r _ — L1.1eI /',it eke �s,ie•• t' Chart Rohm 1701 AG¢M¢A I .t,fb4• �/ ✓ " q \ at Crosby 1 Yacht Club Mfg1AlnAq�/IIOeAGf 72 Crosby Or �������� OsFarvllle,MA 02655 llu -- ---f----_— . WWW • ,�• 1 I I-, ' r SERVICE '04 I I T4+ --- •• I I {Or/ X11— �NSI,< l•a� / li `_ r' ,• +. ,•,,Ns• a,11'IROVIa dt.a�NITTRo a ( hNIMy"1 iim_w`E.e`. In41n aN'Q C�te 'E' QNaTAFFe4 9e1NeeUSMrr BAR^ fl. •� � > fi , r �stw C •!_ �/ ® 4 ` �' !. r=�r0/ - ��'- ♦ Food 9erAce PllmInE ul ment Floor Plan + ' EMSTING EXISTING RESTROOM , RESTROOM , YY •� ti �:: °..Izn , FS-1 Ut4Ak4 - ,_�.. _ ����yppe yy fit■■ • `'rE%ISfING SHE{7 .;^ � A■/��•�D���6 MW - (six.and 1*11on to be VR,Vled, qa•y n,�,-.r lw.,..w..�.r rnnda,Mc.0o11n,Equlpm.0 and Suppil.a 11OO1111e[Vi0e Deal n O� I M X-11-1 I—.., r Y•a la.lall ____� ` 1 •_... _ t tin' rY1,@E•r.YYr �� .# •.11•r1Y•aP.of•n•Yr �aaa3 t ,N!a W,',r..w.l.r.u.,•rn.v I , ` RECEIVING AREA --- _ A Chat Room 4 ItY : ,e.,E' '?0 Ttl,GI I tli`9R�Y 1 — ,amtwewY[A I at Crosby ------------ Yacht Club > _ _ 72 Crosby Or • MW,IAMCAUINIOEAGE OftrVlpe,MA 02655 AREA WMYtoIxaN nWnm� 11 W cif-aft \� `t, - - �(r• f�"•t\,b,^a' ^� !^d { .jo; ,... r ,..o.,�.. ♦ 0a►YWOVRVA&.UWU eo .,/ V , d l l• ,�� �'� I]Ar�ROVHR Al NO7E0 Y Y , N.{ A►IWUVROI0.Elr1 T /..J �'11�• tb. `��L k:�bTil{�-� �i� 4r.`� q e.V.0 SIP tl 121-1 41b gc� .Wa f•"s ir'.:N�}`y� . BARME E =--_ HOO { { I Food Service 9 I I I i \. i{ Preliminary' p a ® ",•,,-- --,;,- ��' ;I + u Equipment Floor Plan kle EXISTING _ __—• EXISTING 67RO r i Q , REM , , � ,, RE9TROOM { • �l r e41i17 l - McKenzie, Marybeth From: ` Dave Jarvis <fuzzydcj@comcast.net> Sent: Thursday, March 29, 2018 6:48 AM To: McKenzie, Marybeth Subject: Chart Romm At Crosbys Hi Marybeth So the restaurant is designed with 12 bar stools, 12 seats outside and 25 inside for a total of 49. After we learned that it wasn't 61 seats that the license read, we submitted an inside and outside plan,which was approved. However we realized that the inside dinning was just right and if it rains the outside is not used. Thank you David Jarvis Sent from my Wad 1 •' CFI E ram, Town of Barnstable 0 � o " Regulatory Services r 4 r r • BARNSTABLE, • 9� MASS. `e� Thomas F. Geiler,Director 39. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Richard B. Egan August 18, 2003 Crosby Yacht Yard 72 Crosby Circle Osterville, MA 02655 NOTICE OF VIOLATIONS OF 310. CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE According to Water Pollution Control records, the septic system on the property owned by you located at 330 West Bay Road (Keepers/Crosby Yacht Yard), Osterville, has been, pumped twelve (12) times in the last ten months. The following violation of 310 CMR 15.00, the State Environmental Code, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage and 105 CMR 410.00 State Sanitary Code II - Minimum Standards of Fitness for Human Habitation: 105 CMR 410.303: Septic system is in hydraulic failure. Septic system has been pumped a total of twelve (12) times in the past ten months. As outlined in 310 CMR 15.000, Department of Environmental Protection's Title V, a septic tank or cesspool that is pumped more than four(4) times in one year is said to be in failure. 1) You are directed to keep the on-site sewage disposal system pumped as many times as necessary(daily if need be) to keep it from overflowing onto the ground. 2) You are further directed to contact and hire a professional engineer to design a septic system which meets local and state regulation requirements within fourteen (14) days of receipt of this letter in order to repair this system or connect to town sewer. 3) The newly installed septic system shall be completed on or before October 20, 2003. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10)days after the date the order is served. Non-compliance could result in a fine of up to $500.00. Each day's failure to comply with an order.shall constitute a separate violation. PER ORDER F THE BOARD OF HEALTH Thomas A. McKean Director of Public Health A� KEEPER'S RESTAURANT FLOOR PLAN 49 SEATS I ALMN REFRIDGERATOR E%IT Fl SERVERIPREP AREA 0 m 0 KITCHEN n O O O O p O Fl O ❑ EXIT DECK = ~ v REST ROOM REST ROOM KEEPER'S KITCHEN 3'S' i+f MF N shelving I mle va � snadwkh prep raAVrefidga freezer� ioe m freever ------------- �• fryor ,--- storage mop rinse chemical - storage O O O O O O stovelgrig storage �'at"'ng QO O O O O O cnosByYART CROSBY YACHT YARD, INC. 72 CROSBY CIRCLE OSTERVILLE (CAPE COD) MASSACHUSETTS 02655-2087 j 508/428-6900 FAX 508/428-0323 March 10,2003 Site Plan Review Zoning Board of Appeals Town Of Barnstable Hyannis, MA 02601 To Members of Site Plan Review and Zoning Board of Appeals: This letter is in support of Keeper's Restaurant and it's application for a special permit; and to affirm our agreement with Keeper's Restaurant pursuant to parking accommodations. Our agreement with Tim Buchanan,owner of Keeper's Restaurant, is that his business is able to use at least thirty three (33)parking spaces adjacent to, and in front of it's establishment. This arrangement has worked without complications for more than twenty years that a restaurant has been operational at this location. Keeper's has been in business for two years. During this time we have never had any problems or disputes over parking. Keeper's has conducted its business in a very professional manner and has been an asset to our marina environment and community. We look forward to having Keeper's at our boat yard in the future and trust your review of its special permit application will be positive. Please do not hesitate to contact me if I may be of any further assistance. Sijere Gg Vnt G CUSTOM BUILDERS: TUGS - STRIPER - HAWK - CANYON 30 -WIANNO SENIOR ID ESTABLISHED 1850 MEMBER APPLICATION FOR SITE PLAN REVA . LOCATION P'l� an Businessame: ,-;;; �„F,�� Assessor's Map # l kl� Parcel# ter 3 ite PI Property Address: 3 3Q Rya�. OWNER OF PROPERTY PLIC T p n .� N e: w.t l A"A N Name: �������.����� ,',�lu���nv:..� aG � Address: G.. _ Address: z ,- T2✓�u: (�F eMl Telephone: S yb-��_4k Telephone So£ `�u 3 6`� `I z `1 �P'A Fax _. Fax ARCHITECT/DEVELOPER/CONTRACTOR/ENGNSER® AGENT/ATTORNEY Name: Name: Iu��e= Address : Address: - Telephone -` Telephone: _ -- Fax ciF RNSTABLE Fax BUILD IDIV. STORAGE TANKS(HAZ MAT/FUEL OR WASTE OIL) ZONING DISTRICT CLASSIFICATION District irw _ A Overlay(s) 8 P Existing Proposed C)jAg& Lot Area Sq. Ft. 1 Ac. - Number lNumber hLL ✓ Fire District _ AA 0,A Size b Q�2 Size uy Cann Setbacks (ft.) Above Ground�_ Above Groun uv��6ke Front 5v Side 5o; Rear S + Underground •j— . Underground Contents c a Contents �t& Number of Buildings _ Existing Proposed Po Demolition v U,I'ILITMS TOTAL FLOOR AREA BY USE Private Size � O al Existing (sq.ft.) Proposed (sq.ft.) Sewer- ❑Public ❑ g Water- [ Public ❑Private Basement r-v ck^! m� Electric- FYI Aerial ❑Underground Residential Gas - FX�Natural ❑ Propane Restauranta- Grease Trap - ❑X Size i ,cr)U gal Retail1(specify) Sewage Daily Flow * gpd OfficeMedical OPARKING SPACESCURB CUTS CommercRequired Existing Wholesalp i�o cProvided ,33 Proposed Nc�12. Institutio ' w ,I^AOn-Site To Close Industrial ��� e U,,4 wce Off-Site v__ Totals All Other Uses On Site ,moo I^��� 3 ti� Handicapped_ f Gross Floor Area *GP or WP areas restrict wastewater discharge to 330 gallons per acre per day into on-site system. Q:SiteP1an:SPRPG3-02/20/2002 Old King's Highway Regional Historic District File# Approved? ❑ Yes 0 No Hyannis Main Street Waterfront Historic District File# Approved? ❑ Yes E No Listed in National and/or State Register of Historic Places? ❑ Yes 0 No Previous Site Plan Review File# Approved? ❑ Yes ®No Previous Zoning Board of Appeals File# Approved? ❑ Yes ®No Is the site located in a Flood Area(Section 3-5.1) 0 Yes ❑No In Area of Critical Environmental Concern? �Yes No Yes ❑ Is the Project within 100' of Wetland Resource Area? ❑ Yes ❑ No No Site sketch—infonnal presentation Site Plan prepared, wet stamped and signed by a Registered PE and/or PLS. 0 Yes ❑No parking and Traffic Circulation Plan Yes ❑No Landscape Plait and Lighting Plan ❑x Yes ❑ No Drainage Plan with calculations and Utility Plan Yes ❑No Building Plans, (all floor plans, elevations and cross sections) Yes ❑ No Note that all si nape must be approved by Code Enforcement Officer at the Building Department Lot area in sq. ft. &7,555.• L sq, ft Total Building(s)footprint �29, 5 3 / sq. ft. Maximum Lot Coverage as % of Lot 3 z.5 ' % GROUND WATER PROTECTION OVERLAY DISTRICT REQUIREMENTS: DISTRICT: Lot Coverage (%) Required Proposed P o :in A I- tie:' o Proposed �j Site Clearing (/o) Required p � - PRINCIPAL BUILDING ACCESSORY BUILDING(S) 0 Yes ❑No Number of floors ;a Height: ft. Number of floors i Height: ft. FLOOR AREA: FLOOR AREA: Basement sq. ft. Second I, } 3 sq. ft. Basement sq. ft. Second sq. ft. First ; 47 sq. ft. Attic sq. ft. First 4U0 sq. ft. Attic sq. ft Other (Specify) 5-ro2�3 `(S I- sq. ft. Please provide a brief narrative description of your proposed project: 1 r I assert that I have completed(or caused to be completed)this page and the Site Plan Review Application and that,to the best of my knowledge,the information submitted here is true. .1 �1care Date a Print Name of Applicant Q:SitePIan:SPRPG4 02/20/2002 REVIEW LOCATION Business Name: Buck!3port, Inc. d.b.a. Keeper's Subdivision Plan Assessor's Map # 116 Parcel# 013 ANR Plan Property Address: 72 Crosby Circle Site Plan X Barnstable, MA 02665 OWNER OF PROPERTY APPLICANT Name: Richard B. and Audrey Egan Name: Timothy Buchanan Address: 8 Sagamore Road Address: 215 Bridge Street West Yarmouth, MA 02673 Osterville, MA 02665 Telephone: (508) 771-3671 Telephone (50,8) 420-2905 Fax Fax ARCHITECT/DEVELOPER/CONTRACTOR/ENGINEER AGENT/ATTORNEY Name: Name: Michael J. Princi s Address: Address: 300 Barnstable Road. Hyannis, MA-. 02601 Telephone: Telephone (508) 775-3665 Fax Fax (508) 775-1244 STORAGE TANKS(Mz MAT/FUEL OR WASTE OIL) ZONING DISTRICT CLASSIFICATION District MB-A Overlay(s) Existing Proposed No Change Lot Area Sq. Ft. Ac. Number Number No Change Fire District Size Size No Change Setbacks (ft.) Above Ground Above Ground No Change Front 50 + Side 50 + Rear. 50 + Underground Underground No Change Contents Contents No Change Number of Buildings Existing 3 Proposed .No Change t Demolition 0 UTILITIES TOTAL FLOOR AREA BY USE Sewer- ❑Public ❑Private Size gal Existing(sq.ft.) Proposed(sq.a.) Water- ❑XPublic ❑ Private Basement 0 No Chancfe Electric - ❑ Aerial ❑ Underground Residential 0 No Chancre Gas - F Natural ❑ Propane Restaurant 3,998 No change Grease Trap - ❑ Size gal Retail 0 No Change Sewage Daily Flow * gpd Office 0 No Chance Medical Office 0 No Change PARK-ING SPACES CURB CUTS Commercial (specify) 0 No Change Required Existing Wholesale (specify) 0_ No Change Provided 31 Proposed NoNo Change Institutional (specify) 0 No change On-Site To Close Industrial (specify) 0 No change Off-Site Totals All Other Uses On Site 0 No Changa Handicapped Gross Floor Area 0 No Change *GP or WP areas restrict wastewater discharge to 330 gallons per acre per day into on-site system. Q:SiteP1an:SPRPG3—02/20/2002 i 0 SENDER:Complete items 1,2,3,and 4. Add your address in the"RETURN ,.fin reverse. r'(CONSULT POSTMASTER FOR FEES) gi.The following service is requested(check one). XU Show to whom and date delivered.................... _¢ ❑ Show to whom,date,and address of delivery.. —¢ 2.❑ RESTRICTED DELIVERY —0 (The restricted delivery fee is charged in addition to the return receipt fee.) TOTAL S 3.ARTICLE ADDRESSED TO: m Mr. Richard B. Egan, Pres. Crosby Yacht Yard, Inc. z 72 Crosby Circle OSTERVILLE MA.02 55 = 4. TYPE OF SERVICE: ARTICLE NUMBER n ❑REGISTERED ❑INSURED v xnFIED ❑coo P517 442 111 1 ❑EXPRESS MAIL p (�!e'-we dhWn signature of addressee or agent) i I have received the arWe described abgve. a SIGNATURE ❑ Addressee Authorized agent C S. - 6� DA F DELIVERY 'r/ POSTMARK M rn 0 Z 6.ADDRESSEE'S AD ESS /9� Only rf requested) C n M r 7. UNABLE TO DELIVER BECAUSE: 7a.EMPLOYEE'S m INITIALS v i= UNITED STATES POSTAL SERVICE. OFFICIAL BUSINESS- / .w L y PENAL Yf FOR:PRIV SENDER INSTRU ,CTION J1 1 USE To�N O[]STdAC Print-your name,address,and ZIP Code to the MIT w of a3oo Complete Rom i,%S,and 4 on the r €i3e.S - -� � L =-tik, Attach to front of article N space perms ` otherwise affix to back of erticie. • Endorse Mole"Return Recelpt Requested" .<h adjacent to number. RETURN TO $" BOARD OF HEALTH - TOWN OF BARNSTABLE (Name of Sender) P. 0. BOX 534 (Street or P.O. Box) HYANNIS MA 02601 0534 I (City,State,and ZIP Code) P517 442 111 RECEIPT K)R CiRTIFIED MAIL ` NO MURANCE COVERAGE PROVIDED— NOT FOR INTERNATIONAL MAIL (See Reverse) Sent to Mr.Richard B. Egan, Pres. S(DmscYacht Yard, Inc. P.O.,State and ZIP Code Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to whom and Date Delivered Return Receipt Showing to whom, r„ Date,and Address of Delivery ao o� TOTAL Postage and Fees $ 1.55 d Postmark or Date c mailed 6/6/84 00 Mc , F 0 O Cn a. a MICK POSTAGE SFAa1PS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CE.11P1F111t MR FEL AND CHARGES FOR ANY SELECTED OPiIORAL SERVICES.(tee f rm 1 r 1.If you went this receipt postmarked,stick the gummed stub on the left portion of the address side Of tltc,ai t!60l V%WRO the receipt attashod and present the article at a post office servicewindowor hand It to your rural carrier.(no extra charge) 2.lf-you do not want this receipt postmarked,stick the gummed stub on the left portion of the address ado of the arSiole,date,detach and retain the receipt,and mail the article. 3.If you want a return receipt,write the certified-mail number and your name and address on a •return receipt card,Form 3811,and attach It to the front of the article by means ofthe gummed ends, if space permits,Other4vi,e,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED ad)o nt to tho number. t G.If you want delivery restricted to the addressee,or to an authorized agent of the addressee, endorse RESTRICTED DELIVERY on the front of the article. - 6.inter fees for the services requested In the appropriate spaces on the front of this receipt 1 return raceipt is requested,check the applicable blocks in Item 1 of Form 3811. 9.Save this receipt and present it if you make inquiry. rt ,� ,.+5.�� fgga + •# .� ".� r x. •a'ry i ; as' . f t=i �.r � � °- r - iv � z*�$r7i � - '� `"�.�ae Y� i^ � f'r' xa � e � rt ,�4r ��.. + trl�•', t,. �� R v r stir a' •rlo � ;y �'�� �.tiy 3",�, , ,•� y;Lr; t s. r �et�^�K •+.`+ ii f ajA*�� y.- r � - � < fy� ,�,• �C �` :. rr, 1 r ao� a e,k '?J..rn '- td•y;:�.x'4 v u ,.'St , 'W. .e ,: >� 'f'•.` ,. •+ a ` .� r -• '� 2., n"r r ,, ,''r - t y '`' °`� �J ,st + ;' a. `'aw r r r.^ ..,. t i+ .� Y ..+� •. n �,yt y���� "v ,N" �,rTM{L aµ4. '. ,.e' ti N p- � ''•t 2�� •� 3, r. r � �`�r• ,. �y ti, `-r s t�y}, �{ 3 w .f n a a�r f%"«.� r< !< 41 2 �. �i 4 r '�, f 1 t - �, t• r, ,� .. 3 a,r J ? 4 � ;i�' t w � `!a r,,,_'',, { r � `'� Y�`'�'' � �'- •Yr=7(f � rti• .d +r, 1 w �ti '. ,S{ r ` 7 {_,•L 1 fp «'t s �Cr. r M S }# �q�r " .fir r e t•s.r .•. '.•A.Sx rt• a a,t t a:,• r:¢"`}�'� * 4 - •-3. ' �„b t l��,'.� s '•�� r a ;'` a _ < ,�+' { > f,.. r .. r`. !-. `,r Yr; � k r s t# ,{�..' • x":'� Y•cf ^a'} > f• Jt•F ♦ 4r::1r ` �.,.t ��:.�. s t ; ,�' _ h�� Ant r i S a s - '� r'z� ,w^. d `�.-.. � t r' •M1. fc.I's t 1 :$• f Ar.. r., �rw �r � rr w y S �a.•-. r,C: r c '�...r" •*�' x: b f^ P ti ; :_.., • ,'R a #' t It ,Aw rt r � c -� a `- r ;. •+ .�. fi r-v rY,t *�..{p. ► d ,f wQp//��'„ ,fir y t +, 'fir f � <•�y�$ i :y�� r a 1 fs�r r a r.a is`•rZa r e June 6,'. .1Si•FA �t ;r t n.r ..•'t4 �',. �a '� f _ '�" ?a n w. .i.f#re ,5„a t C ti 4 Yl 4 .; It "d..• �'t f ., ra ,'S ,;; c "� f X .Yr+a, ++ ', '' 4 a c r E i14 .+ ,1D41t +�f "' "' ;'�� f -= •, i - • t r f+s, t t• t r nttn` 1.•�� r y' r+ ::r 1 `'aF e. ,t .* t ., t .ray. r'f} .S,. T ` '� `a ;ri 4` •'.! ', at o "B d - 4 Al tA a "Al 1%. ^ a a'} � - '. � t '" + fa,�{ >. � 4 a l i; 2•.t r1":i! i,. s �'`a` `+1 l � F ,M c F �.3i{� .'twf 2 K j. r •'�' " N �"E V C�•r L ✓ ��^$� 4 ,z�t '.kf, ... r � '?!1�'.k:°r e.., µ +r�r ,. r,.w -s. •� M_ .i * +y.. i ^a•f r� +�"fl ����• .. .i•` Mr.Richard $:r, Egan;, President {' .y �,y ,sl fs r r ,' Crosby 'Yacht:Yard, -Ic e L L ! a*7.2"CrrVo8i llf�er,r f r V. Ma 0265 am' -��•,r'� 1rr QSt 10 �x ,. Si '?�`• C w ,3�t-3 .� ti'kL•. �.,.., 4 #! }~+' rr - '� k'?�t � r ;' 7r � �. :,. . NOTICE TO rtIPGRADE. ON SITE 'SEWAGE DISPOS'A� :SYSTEM,TO CONFORM TO''31© t w : E f CMR 415.E30, 'TITLE 5"# OF THE STATE"SNVIRONMBNTAL CODE.fl S1 7 � r. Tli `oneite sewage.dispbsa:l system at•�e Black Gull Restaurant, r must be',upgraded to''mee a eq irements �of ]05 CMR,15:00, `-, ,t all-of the u �#�r x Title r5 ' State. gnvirona�nt�l',Code;+ Minfmum �equ �ements•for�the t r $utisit=face D spo'sal aof;,Safi it`arq rySewage and,the ;Toxn bf Barnstable ' ' "�r Health Regulations r prier to^1Scensin*g' .for the r.• r r;fp �� r ;r' `► r rr c �F ri r - r +r,„ .+ ,r "c �." 1 ..F k � ~e�n �$v° t rl�_ � 4 •* 4 �"•'...r � e-. � , • +� a, �.,{ yK :fir S}<'s �'". .. `�• -i i t,4 f ';i'z- - r. Due tto Lhe topography'and proximity to�the,h'arboz the're� is:.a strong �,`'� �`,"• ' ` , . A• z t. ., . ' f pcssibilityrthat thee bottoni,your leaching p% s are close or'in ' � , F vatP.Y � +Xv j E`' ^F '': �' r rd^ L �w.• `` 'r AD '` 3 ar`,, x tt K•• ! ;�«`. -r�� ti j!}., n : a t ,3 tp{ i '� • `sw` h`PE$ ORDER OF ,//'��tt���,,n� ' TT _ rBV .VI^��1 HEALTR' ?!F •, 1a_ S'R 4" t., `� y,.„ �. 'N w -1 •'t..., T ,+ r ., 'Y •kr.:. N i r+} ! }y, -• •r f f y eF • i� Fa •.+ k s.a.^+ i '• F i er t "�NF*r n? ��g 1 �, 7 - j '�.�«�*.S�'�:,,.e 5�'^,t..r�, ''.'•J � ,s� + % +,r, e � Z� s' �:IV a d v::;J Ras. .4 ''i[a,. + c ,,t r - ckr. zt ,� 'r . .r:: ".t t s. `- r fi 5a M• k „: •• l ; !F a •r t ytS I - 1 r v. i , •,"7rtai �� ,r -, Ro:ert L""� hi'lds,.- Chai^rszan , „`..•{ _ l , ,.� ' • , . ,":,� • •t wr,> t ,w, '�. i r Y ;' �'.- •^y r` � 1 tir -'Mrq,�r•} �q.y, w` t.¢ ;,c� 1 �4, l_% ,. ,• * r`l' ; !: tc x � " •�� :t ,7 c�x a•. - {� R ,.... •� x,C{ a.<r, r� �R .*. d"• rr«, r�� • a •a e E Baugh :-�4' r, ut ,�;• s *_r :t " t , r +'� �,.,°r x a^r t0.r:,4 '{ , " +`rw `"`�t ,¢,.4t ,•,ry „4 '�.' �. •P „., �..•,a j + i n '.l r r S 4 .�.•, n � ;', trr s.. r d � :`t': i• (,�'•" ,- : r r .,�.s{ � � ' �4.r ,r^rr u•4,' i�: :;i�• �{. p yt ryr?t _ .u itA r• r ge'_M' 'D•'S', '; r r n }rJY' t ' a r G ..tt •L r . X t `+1•.rJ ,,, br• wn. i r .,t? s rai t # l• s BOARD WF,HEALiL3.. i r• ,t f ,�`a 4 •..t r. ri r, w .t it j n '+ t,1•t '-rrr r � r! :A.-: r4 � ��, .,�.. „ a }F + ` , c 'TOW y OF BARNSTABLE M i i zt f r"Y r ,. �.r ar a+:� '` r % r Tr * �' a � �.q, i,,ta S6 Y' � '•{s r s ar .i, 4' ,,.s. �aa�,'�.'r ' i ,++.. •r rar.r '* .,a , + �r :r� r a.j ✓. t �� •s. i �• a`+' <.Y ► i 1 a t• a .� .�Y r^*;,� « Nam,'. - y t �:ee ^ ,., W i{o►�m111�.' L a �f 9 s �"4 ��-f` s t .c n <� a '++y! 1 S az?a - it �1, r t r' Jr Y ^+ ♦ r r� k r'rdt,,v 1+; + rT.;r f Y Z •r,.� r a 4 ,', A i Sr t Mr ? .,?",v z K y, • .. 'a i � �,x - ara ty , u ,YA•.rr" } , _ .,_i i�. i, a u •h {,. •{•i�i � :"4 y.�,. � r.s✓�ry l r•?w. � �r E- ; .� �{'' r r _ ,cr r s•., * �° z a y,MR: a s x."a - T`''1 ,. g."q'r 3:♦ w>w; a ? � tr:�'w v�r��, T � �� Fia. y ♦�, rrF n ,� ` r, ,.� r r „� tr `' r _ � + ,�aR, �.R�"t a� ',�� � `' tr. � ", Yt a � �` t=a .. tr r•.�� _ � �� � !' `.�r�r ! F' ti t`r• d�° t, �" ^ o `.+. r - l'a >=,s,. <L P y, 'u'' ••" F--. .1. a 4.it a,*�: f ' •• 3..:7.r'C , ., r -,,,` 6-'•< � 3 +, ra r «'a ` i r ,s', r i '�q 5, rr" r .. t w., { J•' rt • eL, 6 r - ♦ �+� r ^'< ;y-r }� `« q.• J 4 S '., L ,;.. .r.,.�l, c>g, ,d -i-• 1 ( r �.,7 ' tt id t'� " A «t s.+ *t .Y tt{ L'4` va^L .'Sµ f J; c 'f. a +•, ,tyy7l•f [.,r4 -f. 1,,; rY� L ✓ x 4 i i_. a t +,i ,` 3 r . r •! 1° '.'rt +r 4 t��, r i �- )� 4 f s7 v L r r ;k;flt y''6 4 R ! - r 9 +/ ,F i r,r• r •t, , •-}, '+� .y : +, !! r;t `++ !r ?S s f s , ai 'i a` r i .;�. � 4-,;�sr ,�'*,k , t l� {'r.¢ � fr � tt',"�'.=��`7,,' OP `�al'•,S'.r�.� :t`kr ''{'S a •�s , �' a .i ,e. a.. r N . �:.,,a t Y I' t.. r# r � ti A r s �ti 9'+ J}u.+:, x. k` 3'x� >! t ♦ ` � s .i c Y ., „� s �' „ +�d,r�r' +� rt� *1. 5 rr-i' v y �" f�` .� f ti. .- r.t.',�." .f , ' l '1 a -' � •�'• 1 . 4 r •ri 4s 3 r. F f h 1 w r x 'r .r, 'r w r s• ,.i} y. r, * r. �.,,i t +�it o xta.-r �. • i.�} ` ,•� " esr . Y a t_ , + ' r a, ..�'. w �H•t � a, gpy� +: .. r � ''t -t�'+, ae .f ti�'��- t s - ti •. w� - ,r •u. l•. 1. , - 9` "+" FitF,'4" +F, �t S * 1k:�".z pa ;"i'/'+ 'r y wt 4_ s.. fit•• w o +. V. s. *`'o .t` x k K r`i c s .,• ,# s .<'•�tt i 14 ' < Af r ;� au :. � µ,; . hr e r. '•* v r } r a 't }; c,rt ., y q f a I�.' _�' . - s:', L � lYc,"• � r fiat a.�• •r,r^�,^ g � , y �. r a. + � F� � " {''r' �` �'r a t 4 t, r Fr=t' �'•, s � � .t t r` s;, ,A,•t " 'r a -. 1* T.• � 7 r'r7 } •'�", '?e.r� 4a,..��tu • r � ', y, '��` w'C r��_ .� a. fit', k. t sa4'a ":a ✓+ - .i � ,, r " h y, xYa a.. 4 d".,, . ..-yx * '3 ,r a$ �.� a?i t• �it t vt 3 Y + • x:. i, + .+ ,"'.t� r r�s M,•;°A�. F^ a r, r� :`t�1 „•••'�� -y 7' '�E-_ ; t ~ y I� R n � , c i� • e�"w .r, r' ,f#,� ��', ry�`. T - 5. K :r�' x •a'e� �, 1 .r .a"- i ., ., g.wy�±�. af^S 0 a CROSBY YACHT YARD, INC. 72 CROSBY CIRCLE OSTERVI LLE ( CAPE COD ) MASSACHUSETTS 02655 617/428-6958 May 25, 1984 Town of Barnstable Board of Health 367 Main Street Hyannis , MA 02601 Attn: John Jacoby Dear Mr. Jacoby, As per our telephone discussion, enclosed is a sketch indicating the location of the cover for the septic tanks. As indicated, the covers for the grease pit and leaching pit are at grade level. I trust this is the information you requested and thank you for your cooperation. Si ely, Richard B. Egan President RBE/jk Enclosure BUILDERS OF THE VVJIANNO SENIOR - BUILDERS OF TUGS - BUILDERS OF THE HAWK 29 ESTABLISHED 1850 z LRILLA J i •� �. SST MOSSY YACH ��P�S �� � � �� ,.� 72 CROSBY CIRCLE z ( o COD CAPE `�i OSTERVILLE ( ) � 195 P88752897 MASSACHUSETTS 02655-2087 3 7 5 Os 04 . Z20 SEP Q$ 03 8247 OSTERVILLE,MA 112655 7�99 3220 �008 _92�3 1751 Town of Barnstable Regulatory Services 200 Mian Street Hyannis, MA 02601 tii� •�' "�..5_�:� ,. - :�t�!}l.t.!�-:�51}.!!'fl.fl.F!I}lil�3.11��.lt!11}AF';.?.�lii�tt31�!}lFlf!?� I a S _ _ . . �. .�,. -.�...., � �.� r .� Y � `\ - - - I� � � % -.__ i � �q t � l} � ,� � r- ' � � u . 4 � � I i � � �' t 1 t I �`� �.4. •u..x.l.�; y ., cliu D J6 161CH CROSBY YACHT YARD, INC. 72 CROSBY CIRCLE *, OSTERVILLE (CAPE COD) MASSACHUSETTS 02655-2087 508/428-6900 FAX 508/428-0323 September 8, 2603 ' Town of Barnstable Regulatory Services 200 Mian Street Hyannis, MA 02601 Attention: Thomas McKean Dear Mr. McKean: In reference to your letter of August 18, 2003 regarding the excessive pumping of our septic system. We contacted A&B Canco to clarify the actual activity. Enclosed is a copy of the letter from Canco with the explanation of the number of pump-outs. I trust that this clears this situ a on, but if there are any concerns,please let me know. incerely, r'r c and B. Egan President RBE/klb Enc. CUSTOM BUILDERS: TUGS - STRIPER - HAWK - CANYON 30 - WIANNO SENIOR . ESTABLISHED 1850 MEMBER 09/05/2003 17:05 5087789628 AB CANCO PAGE 01/01 350 MAIN STREET TEL: (508)775-2800 WEST YARMOUTH MA 02673 (800)698-3993 FAX'(508)778-9628 Septic Service Mechanical Services Pumping& . � Beating&Plumbing Installation Fire Spriniders Since 1930 September 5, 2003 Crosby Yachts 72 Crosby Circle Osterville, MA 02655 Dear Richard, I checked the m i pu p ng services for your complex for the last year performed by A & B Canco. Most all the pumping needs were for the waste water pump out station located by the docks. During the winter months pumping of individual boats in dry dock work areas were performed numerous times. We pump the office system and the boat shop system each year on our recommendation. The Town of Barnstable Waste Water Treatment Plant disposal permits to not provide a listing for tight tank or a written description. So all disposal slips will state septic tank as the source of pumping. A & B Canco drivers have been instructed to hand note on disposal slips that the boat tanks were pumped on all future services. Sorry for the inconvenience. Sincerely, q20&� Richard K. Cannon RKC:akb �X�t PEW. LICENSING DIVISION NOTICE OFHEARINGkFOR APPLICATION FORA+NEW SEASONAL °ALL ALCOHOL COMMON UICTUALLER LICENSE;ANDNON Clwft t`WEtot NTERTAINMENTUCENSES ce w aln accordanith Chapter 136tantl Chapter 740 of the Genetalf� Laws an application has been filed for a<new Seasonal All<plcohol e� Common Victualler License and Non:LiveSEntertainment UcgnsesTMforza CRAC Inc dlb/atiChart rt?oom at Crosby s!e pMsrJ Gordpn'Jr fA lmanager 330�WestBay�Rtl�Osterville'i` ��'f i«�',�x`i"'v�;t„ � °v;� KPescnphon;of Premise Frst goor ofG3 story,wapd frametibuddmg + One front EntPance/Exd Two sitle Entrances/exits,'<1500 sq it enQO er + 1 atorjland3tlry»storagegs edtmNorfhwe'sti�sdett420 +/ sgg7ft jl patio/deck/dutdoor7area 49titotal seats with 2 sc@nanos as fpliows k ,j SGenano 1 Bar seats 12-table seats=24 and 13voutdaorrseats wdh"fk !14 standees and615§emplayee�`3Scehano t2�BarSeats 1r table c seats y�32 and outdoor$seats 5 wdh 5 standees and S employees j All approvedby the Bwlding Commissioner fl"H ursrof alcohol sales al l AM Y2 90 AM Daily Y °; 2+ , Nan Live Entertainment+to include+2telewsmns shours of3enter tainment 1r1 Od am 72 30 pm`dady rilcrF �xik ,Y ' t 3�k; i�Saidrheanng wdl be+field on Monday flMarchT6$201710t 9.30 a m ° qr+as sconP!ollowmg as,prachcal In the Town Hall'Bwlding 2nd_?Floor Hearing Room^367 pAam Street Hyannis .f y.r�i g etc Tw Martin;E'Noxie Chairperson"+, : ''+ c � a oss 4 { 1 +z tit F Gene-Burmar t k R p4�^riX F s iu � ; "g at•, rztko t4 Ai,Ron Seinpnni F. . David Nunlielmer 3 2" €Bamsfabfe 6icen'sing'Authorfty T�a The Bamstatile Patnot +t � ' + t40 * Jf rxx> .February 10'-2017°sF?...�t,b`s�tr,..:.;;,,kt��'a �:,ir.3Y`.�s#G.�rks,�'�•:.v:.r,�;; f Page 1 of 2 °s Credit Services-Receipt Lookup Printed on:04/11/2017 15*24.11 Receipt Transaction Identifier:[2612,01/17/2017,5,7373] Receipt Image Account Details %ref nnmbec Account N,mibex Type Ex Date Signature Entry x xxxxx xxxx 1009 xxxxxxxxxxxx 1009 A% 04/20 Y EEY CP Settlement Release Date :01/18/201'] More saving, Miscellaneous Details Sales Posting Date:01/17/2017 o More doing." EMAIL ME ABOUT YOUR SHOPPING EXPERIENCE CONOR.KENNEDY@HOMEDEPOT.COM 2612 00005 73733 01/17/17 10:02 AM CASHIER SHEILA 604743134222 LAMINATE <A> OUTLAST+ AUBUR SCRAPE OAK 10MM 16.12 37@44.97 1663.89 - SUBTOTAL 1,663.89 SALES TAX 103.99 TOTAL $I,767.88 XXXX.X,X.XXX,XX1004 AMEX, 1,767.88 AUTH CODE 265243/6053363 TA 2612 0IIIIII7 I3 IIIIIIIIIIII2017 6545 RETURN POLICY DEFINITIONS POLICY ID DAYS POLICY EXPIRES ON A 1 90 04/17/2017 THE HOME DEPOT RESERVES THE RIGHT TO LIMIT / DENY RETURNS. PLEASE SEE THE RETURN POLICY SIGN IN STORES FOR DETAILS. BUY ONLINE PICK-UP IN STORE AVAILABLE NOW ON HOMEDEPOT.COM. CONVENIENT, EASY AND MOST ORDERS __READY IN LESS THAN 2 HOURS! ENTER FOR A CHANCE TO WIN A $5,000 HOME DEPOT GIFT CARD! Tell us about your store visit! Complete our short survey and enter for a chance to win at: www.homedepot.com/survey PARTICIPE EN UNA OPORTUNIDAD DE GANAR UNA TARJETA DE REGALO DE THD DE $5,000! Comparta Su Opinion! Complete 1a breve encuesta sobre so visita a la tienda y tenga 1a oportunidad de ganar en: www.homedepot.com/survey , User ID: H89 150367 147760 Password: 17067 147755 Entries must be completed within 14 days of purchase. Entrants must be 18 or Older to enter. See complete rules on website. No purchase necessary. https:Hwebapps.homedepot.com/RLUWebApp/ 4/11/2017 Pergo Outlast+ Auburn Scraped Oak 10 mm Thick x 6-1/8 in. Wide x 47-1/4 in. Length L... Page I of 3 Horne / Flooring / LaoiinateFloonng J Laminate Wood Flooring Nl,,dd I LF060843 1-9emot#206740133 Sore SKU#1001676071 Pergo Outlast+ Auburn Scraped Oak 10 mm Thick x 6-1/8 in. Wide x 47-1/4 in. Length Laminate Flooring (116.12 sq. ft. / case) *V(491 Write a Revliw QUeST101"S&.A­,W­: (76) Authentic wood look and texture in seven colors Beautiful dark tone complements any home decor Stylish,durable flooding is built 10 last Covers 16.12 sq.ft. $2.79 /sq.ft. $44.97/,;,,,e Choose Your Options Pack Size Case . ............... ............ Save to List Quantity + Pick Up In Store Today We'll Ship It to You Add to Cart Add to Cart Free store pickup at Hyannis Free Shipping EEin stock Expect it April 19-April 21 End Cap 3,Bay 001 Check Nearby Stores See Shipping Options We're unable to ship this item to: Or buy now with AK.GU.HI,FIR,VI schedule delivery as soon as tornmow Product Overview ............... ...... Pergo Outlast-Auburn Scraped Oak's warn red-brown color with golden urdertones is exquisitely Info&Guides brought to life with an old English character hand-scrape.The premium detail of cracks and knots Installation GLU& add a beautiful juxtaposition of traditional and rustic to a sophisticated design with handsome color play.This durable laminate floor offers SurfaceDefense wear protection and the revolutionary Instructions 1 Assembly SpillProlect24 technology exclusively from Pergo that defends against household spills for Lip to 24 Use and Cate. hours.so you can rest assured that your newly installed floors will stay clear-and sleek.Pergo Outlast+insanely durable,always beautiful. Warranty California residents:see Proposition 65 information P Y­MINced Adobe A,,m1b.t&Reeder 1.view PDF doeamerns. Do%vii:i)adaLee copy from the Adobe Web site. Pergo Outlasts Auburn Scraped Oak Laminate Flooring 10 mm thickness 1 2 nnrn attached Underlayinent x 6-1/8 it.width x 47-1,14 in.length planks 16.12 sq.ft.per case.Case quantity:8+Case weight:29.55 lbs. Auburn Scraped Oak Featured in a Medium Color with a Hand Scraped Texture and Covered With Surface Defense Protection Planks have a pressed edge Attached 2 inni underlayment that reduces Sound and increases ease of installation http://www.homedepot.com/p/Pergo-Outlast-Auburn-Scraped-Oak-10-mm-Thick-x-6-1-8-... 4/11/2017 Pergo Outlast+ Auburn Scraped Oak 10 mm Thick x 6-1/8 in. Wide x 47-1/4 in. Length L... Page 2 of 3 Radiant heating may be used Can be installed over smooth,flat and dry surfaces:concrete,ceramic tile,vinyl,and wood Approved for residential and light commercial use Lifetime limited residential and a 10-year limited light commercial warranty Don't forget your coordinating trim and moldings to complete the installation All online orders for this item ship via ground:small parcel will arrive in multiple boxes It is recommended you purchase a minimum of 10%overage to account for arts Please see infonnation and guides section for downloadable PDFs of the warranty,use and care instructions,assembly instructions and install essentials guide (IIC)Impact Insulation Class 55 per ASTM E492 and E989 STC-Sound Transmission Class 50 per ASTM E90 and E413 -Actual item color may vary from device screen representation.We recommend that you order a sample and view it in the room where your flooring will be installed $0,89 per sq.ft.basic installation of laminate SKUs$1.50/sq.ft.and over when purchased with eligible Underlayment:(min.purchase of 250 sq.ft.)-Valid 2/25/201 6—4/20/201 6 u ,h a � p a p•„ � a 4 6 � S y r u r Specifications Dimensions .... ....._.... Product Length(in.) 47.24 Product Width(in.) 6,14 Product Thickness(mm) 10 Square Feet per Box(sq ft) 16.12 _..-.. Details ......... ......... _ _ http://www.homedepot.com/p/Pergo-Outlast-Auburn-Scraped-Oak-lO-mm-Thick-x-6-1-8-... 4/11/2017 Pergo Outlast+ Auburn Scraped Oak 10 mm Thick x 6-1/8 in. Wide x 47-1/4 in. Length L... Page 3 of 3 AC Rating AC4:Commercial Medium Traffic Flooring Product Type Laminate Wood Plank _._ ._.......__ ._...._..... Board Form Plank Gloss Medium Gloss Color Family Red � Indoor/Outdoor ...�._.. Indoor Radiant/Underfloor Warming Color/Finish Auburn Scraped Oak Laminate Flooring Features Approved,Underlayment attached,Water resistant Commercial/Residential Commercial/Residential Material Laminate _. ., .._�...._.�. �. ......._........... .. Edge Type Pressed Returnable 90-Day ._..-- .................. ......... ..... ......... ........................ ......... Finish Type Authentic Textured ......... .......... ...... .... ......... _. ............. ........... Warranty/Certifications ......... Lifetime limited residential,10-year Manufacturer Warranty limited light commercial warranty against wear,staining and fading I-lota can ite improve our product information?Provide feedback. http://www.homedepot.com/p/Pergo-Outlast-Auburn-Scraped-Oak-10-mm-Thick-x-6-1-8-... 4/11/2017 I Quote ® ® 10/05/2-016 Guiding The Food Service Industry Since 1920 229 Marginal Street,Chelsea MA 02150 (617)884-3900•www.harbourfood.com Certi ie e D ' tChmS Ba6m E Project: From: Chart Room-Osterville Equipment Harbour Food Service Equipment Harold Kalick PO Box 6009 229 Marginal St. Chelsea, MA 02150-0006 6178843900 (617)884-3900 (Contact) 6178841935 (Fax) hkalick@harbourfood.com Item Qty Description Sell Sell Total 1 lea CONVECTION OVEN $3,250.00 $3,250.00 Vulcan Model No. DISVULVC44GD Convection Oven,gas,double-deck,standard depth I 1 ea (2) 120v/60/1-ph, (2) 1/2 HP, 16.0 amps total, (2) 6'cords with plugs, NEMA 5-15P,standard 1.1 2 ea GAS CONNECTOR HOSE KIT $170.00 $340.00 T&S Brass Model No. HG-4D-48K Safe-T-Link Gas Connector Kit, 3/4"connection,48"L,stainless steel . .." 7. braid with extruded coating, (1) quick disconnect, (1) street "EL", ball f' valve, restraining cable adjustable for 3'to 5' - 2 1 ea UPRIGHT BROLIER $7,650.00 $7,650.00 Blodgett Oven Model No. B32G-171 USED Model#B32G-171 Warming Oven Cabinet Base 2.1 1 ea GAS CONNECTOR HOSE KIT $170.00 $170.00 T&S Brass Model No, HG-4D-48K Safe-T-Link Gas Connector Kit, 3/4"connection,48"L, stainless steel Our "EL", braid with extruded coating, (1)quick disconnect, (1)streetball valve, restraining cable adjustable for 3'to 5' 3 1 ea RANGE,48",8 OPEN BURNERS $5,070.00 $5,070.00 Southbend Model No.4481DC Ultimate Restaurant Range,gas,48", (8) non-clog burners,standard grates, standing pilot, (1) standard oven with battery spark ignition, (1) cabinet base, includes(1) rack, 22-1/2"flue riser with shelf, stainless steel front,sides,shelf&6" adjustable legs, 309,000 BTU,CSA, NSF Initial: Chart Room-Osterville Equipment Page 1 of 8 Harbour Food Service Equipment 1010512016 Item Qty Description Sell Sell Total 1 ea Note: 10%up charge for Int'I orders shipping outside of North America, beginning January 2016 . 1 ea Standard one year limited warranty(range) - 1 ea NOTE: 22.5" high flue riser,with heavy duty shelf,standard 1 ea Specify Gas Type " 1 ea Casters,.2 locking&2 standard, in lieu of legs $195.00 $195.00 ITEM TOTAL: $5,265.00 3.1 1 ea GAS CONNECTOR HOSE KIT $170.00 $170.00 T&S Brass Model No. HG-4D-48K Safe-T-Link Gas Connector Kit, 3/4" connection,48"L, stainless steel r� braid with extruded coating, (1) quick disconnect, (1) street"EL", ball valve, restraining cable adjustable for 3'to 5' 4 1 ea STOCK POT RANGE,GAS $635.00 $635.00 Imperial Model No. ISPA-18 � ' Stock Pot Range,gas, 18", (1) 3 ring burner,cast iron grate,open front cabinet, manual'controls,full width drip pan, stainless steel front& sides, 6 legs,adjustable feet,90,000 BTU,cETLus, ETL, NSF 1 ea Limited one year parts and labor warranty,standard 1 ea Gas type to be specified 4.1 1 ea GAS CONNECTOR HOSE KIT $170.00 $170.00 T&S Brass Model No. HG-4D-48K u„ Safe-T-Link Gas Connector Kit, 3/4" connection,48"L, stainless steel braid with extruded coating, (1) quick disconnect, (1)street"EL", ball valve, restraining cable adjustable for 3'to 5' 5 1 ea HD RANGE,24"THERMOSTATIC GRIDDLE $1,975.00 $1,975.00 - Jade Range Model No.JTRH-24GT USED Heavy Duty Range,gas, 24",griddle, 1"thick polished steel plate, i thermostatic controls, cabinet base, stainless steel grease trough, splashguards, 6" plate shelf,front, sides, stub back& bottom, 6" adjustable legs, 60,000 BTU, CSAus, NS'F 5.1 1 ea GAS CONNECTOR HOSE KIT $170.00 $170.00 T&S Brass Model No. HG-4D-48K Safe-T-Link Gas Connector Kit, 3/4" connection,48"L,stainless steel "'y '• braid with extruded coating, (1) quick disconnect, (1)street"EL", bald valve, restraining cable adjustable for 3'to 5' 6 1 ea EXHAUST HOOD Harbour Food Service Equipment Price To Be Determined 1 ea FIRE SUPPRESSION Price To Be Determined 7 SPARE NO. 8 SPARE NO. 9 1 ea SANDWICH UNIT Initial: Chart Room-Osterville Equipment Page 2 of 8 = i �4 Harbour Food Service Equipment 1010512016 Item Qty Description Sell Sell Total Existing 10 1 ea PIZZA PREP UNIT Existing 11 1 ea DOUBLE OVER SHELF $2,595.00 $2,595.00 Harbour Food Service Equipment 11'-8" 16ga 304 Stainless Steel Double Over Shelf Table Mounted 12 2 ea HEAT LAMP $195.00 $390.00 Nemco Model No. 6150-60 Bar Heater, 60"x 6-3/4"x 2-3/4", infrared heating element, on/off a` toggle switch, indicator light, aluminum shell, 120v/60/1-ph,1400 watts, 11.7 amps,cETLus, NSF 13 1 ea WORK TABLE,WITH PREP SINK $1,575.00 $1,575.00 Harbour Food Service Equipment 30"x 42" 16ga. 304 Stainless Steel Work Table with Prep Sink 1 ea T&S Brass B-3972 Waste Valve, lever handle, 3-1/2"sink opening, 2" $57.50 $57.50 ' drain outlet(replaces B-3923, B-3927) ITEM TOTAL: $1,632.50 13.1 1 ea WALL/SPLASH MOUNT FAUCET $155.00 $155.00 T&S Brass Model No. B-0231-CC Sink Mixing Faucet, 12" swing nozzle, wall mounted, 8" centers on sink faucet with 1/2" IPS CC male inlets, lever handles 14 1 ea HAND SINK Existing 15 1 ea PLATE CABINET $1,875.00 $1,875.00 Harbour Food Service Equipment 18"x 96" 16ga. 304 Stainless Steel Plate Cabinet 16 1 ea REFRIGERATOR,REACH-IN Existing 17 1 ea BEVERAGE COUNTER $3,150.00 $3,150.00 Harbour Food Service Equipment 30"x 8'-4" 16 ga. 304 Stainless steel Beverage counter. Price to include 12"x 10"x 10"Sink 17.1 1 ea DECK MOUNT FAUCET $150.00 $150.00 T&S Brass Model No. B-0325 { Mixing Faucet, deck mount,swivel gooseneck, 13-1/4"H-deck to top of gooseneck, 9-1/8"tip of nozzle to deck, lever handles, 6" swivel 114 gooseneck,4" center.with 1/2" IPS eccentric flanged female inlets , 18 1 ea COFFEE BREWER By Others 19 1 ea POS STATION By Others 20 SPARE NO. Initial: Chart Room-Osterville Equipment Page 3 of 8 Harbour Food Service Equipment 1010512S16 Item Qty Description Sell Sell Total 21 SPARE NO. 22 SPARE NO. 23 1 ea DISHTABLE,SOILED $2,315.00 $2,315.00 Harbour Food Service Equipment Dishtable, Soiled, straight design, right-to-left, 8" splash w/prerinse sink, stainless steel legs, with stainless steel crossrail, 72" long, 16/304 stainless steel. Price to include 12" Landing Shelf 23.1 1 ea PRE-RINSE FAUCET ASSEMBLY $340.00 $340.00 T&S Brass Model No. B-0133-B Easylnstall Pre-Rinse Unit, wall mount. base faucet with spring check o,l cart. & lever handles, 2" diameter flanges with 1/2" NPT female eccentric flanged inlets, 35-1/2"H, 15"overhang,8-1/4" clearance, 18" riser,'B-0107 spray valve, B-0044-H flex stainless steel hose, 6"wall bracket 24 1 ea DISH MACHINE By Others 25 1 ea CORNER SINK,(3)THREE COMPARTMENT $1,695.00 $1,695.00 BK Resources Model No. BKCS-3-24-14-24T Corner Sink,three compartment, 75"W x 29-1/2"D, 18/304 stainless 'Y steel construction, 24"x 24"x 14" deep compartments, 24" drainboards on left& right, 9"H backspl.ash, (2)sets of 8" O.C.faucet holes, 1-1/2" rolled edges on front&sides, includes drain baskets, galvanized steel legs with cross'bracing, adjustable high impact corrosion resistant feet, NSF 3 ea T&S Brass B-3972 Waste Valve, lever handle, 3-1/2"sink opening, 2" $57.50 $172.50 drain outlet(replaces B-3923, B-3927) 1 kt BKL-SSH-1424 Sink Legs& Bracing Kit, includes: (4) 1-5/8" O.D. legs& $95.00 $95.00 (2) crossbraces, (4) end rail support sockets(Model# BKBS-1), (4) adjustable high-impact corrosion-resistant feet(Model# BK-SSPAF), 18/304 stainless steel construction (for NSF approved compartment sinks with sink bowls measuring 24"front-to-back x 14"deep) 1 ea HARBOUR Modify Right Drainboard to connect to Dish Machine $562.50 $562.50 ITEM TOTAL: $2,525.00 25.1 1 ea PRE-RINSE FAUCET ASSEMBLY $340.00 $340.00 T&S Brass Model No. B-0133-B Easylnstall Pre-Rinse Unit, wall mount. base faucet with spring check cart. & lever handles, 2" diameter flanges with 1/2" NPT female eccentric flanged inlets, 35-1/2"H, 15"overhang, 8-1/4"clearance, 18" riser, B-0107 spray valve, B-0044-H flex stainless steel hose, 6" wall bracket 1 ea B-0156 Add-on Faucet,for Pre-Rinse Units, 12" nozzle, includes 3" $95.00 $95.00 nipple ITEM TOTAL: $435.00 25.2 1 ea WALL/SPLASH MOUNT FAUCET $155.00 $155.00 Initial: Chart Room-Osterville Equipment Page 4 of 8 i 1 � Harbour Food Service Equipment 1010512016 Item MY Description Sell Sell Total T&S Brass Model No. B-0231-CC Sink Mixing Faucet, 12" swing nozzle,wall mounted,8" centers on sink ' faucet with 1/2" IPS CC male inlets, lever handles 26 1 ea HAND SINK Existing 27 SPARE NO. 28 SPARE NO. MD 20 ft MODULAR BAR SYSTEM $140.00 $2,800.00 _ Glastender Model No. MD Packed 1 ft Modular Bar Die, 16 gauge galvanized steel structure with 300 series stainless steel bartender side finishing, GFI outlets built into bar die !` wall based on customer preferences(wiring not provided), LED lights built into bar die wall above underbar equipment (wiring not provided), built in chaseways for plumbing, electrical, soda, & beer lines (priced per foot) 29 1 ea GLASS RACK $655.00 $655.00 Glastender Model No. DBGR-18 Underbar Glass Rack Storage Unit, drainboard top, 18"W x 24"D,open . front base, holds(2) 16"dia. glass racks, 7"H backsplash,adjustable intermediate shelf&fixed bottom shelf, drain pan with removable ' perforated insert& 1/2" drain, stainless steel construction,stainless steel legs&adjustable bullet feet, ETL 30 2 ea ICE BIN $1,250.00 $2,500.00 Glastender Model No. IBA-24-CP10 Underbar Ice Bin;with 10-circuit cold plate, 24"W x 19"D, 67 lbs. ice capacity, 7"H backsplash, 10-1/2" deep bin liner,ABS plastic breaker strip around ice bin liner, includes sliding stainless steel bin cover, stainless steel construction, stainless steel legs with adjustable stainless steel bullet feet, ETL 2 ea 1 year parts&labor warranty 2 ea SSR-24 Single Speeq il, 24"W, open step-and-rail design, ABS sound- $95.00 $190.00 � eadenin covers,R rsnap-on liquor' Z n label cover, fief aSxe=1 V4 06 t,ioO installed, stainless steel construction, L xed 1ei•1614 . 31 2 ea WASTE CABINET $630.00 $1,260.00 ;insa,4lasA84 MAM0SWB-12 dI uoli•etS edAi awll a;ea Underbar Wet Waste Sink Unit, 12"W x 24"D,9-1/4"wide x 11-1/2" front-to-back x 6" deep bowl, 7"H backsplash, deck mount gooseneck faucet (low lead compliant), lift-out plastic perforated sink strainer, uolloesuejj1se1. stainless steel construction, stainless steel legs&adjustable bullet feet, ETL 9 .. y0 IoO 32 2 ea BOTTLE DISPLAY $540.25 $1,080.50 J01 Bogy xed salaaS e1,WIN 0099 oJd 1090100 dH Initial: Chart Room-Osterville Equipment Page 5 of 8 Harbour Food Service Equipment 10/0 12016 ` Item Qty Description Sell Sell Total Glastender Model No. LDA-12S Underbar Liquor Bottle Display Unit,freestanding, 12"W x 24"D(aligns with 19" deep units with single speed rail), (4) steps, extra-wide rear step, includes clear lift-off liquor-identification cover, stainless steel construction, stainless steel legs &adjustable bullet feet, ETL 2 ea 1 year parts&labor warranty 32 1 ea HAND SINK $795.00 $795.00 Glastender Model No. DHSB-12 Underbar Hand Sink Unit,free standing, 12"W x 24"D,9-1/4"wide x 11- 1/2"front-to-back x 6" deep bowl, 7"H backsplash,deck mount faucet (low lead compliant),soap dispenser, hinged front door conceals towel dispenser, stainless steel construction, stainless steel legs & adjustable bullet feet, ETL 1 ea 1 year parts&labor warranty 33 1 ea GLASS RACK $725.00 $725.00 4 Glastender Model No. DBGR-24 Underbar Glass Rack Storage Unit,drainboard top, 24"W x 24"D,open front base, holds(2)20"x 20" glass racks,7"H backsplash, adjustable z intermediate shelf&fixed bottom shelf, drain pan with removable perforated insert & 1/2" drain, stainless steel construction, stainless steel legs& adjustable bullet feet, ETL 34 1 ea DISHWASHER,UNDERCOUNTER $6,350.00 $6,350.00 Hobart Model No. LXER-2 ;- LXe Advansys Dishwasher, undercounter, 23-15/16"W x 26-13/16"D x 32-1/2"H, high temperature sanitizing, Energy Recovery,30,24, 13 Racks/Hour, Fresh Water Rinse, .62 gal/rack,Automated Delime Cycle, Clogged Wash Arm Alert, 3 selectable cycles- light, normal, heavy(Pot & Pan cycle on heavy cycle),Advanced Service Diagnostics, 120/208- 240(3W)/60/1, Detergent, Rinse Aid & Delimer Pump, ENERGY STAR® 1 ea Standard warranty- 1-Year parts, labor&travel time during normal working hours 35 1 ea STORAGE CABINET $590.00 $590.00 Glastender Model No. DBCB-12-LD Underbar Drainboard,open front cabinet base, 12"W x 24"D,drain pan t with removable perforated insert, 7"H_backsplash, adjustable bottom & intermediate shelf, stainless steel construction, adjustable stainless steel bullet feet, ETL 1 ea 1 year parts& labor warranty 36 2 ea BACK BAR COOLER $3,795.00 $7,590.00 Beverage Air Model No. BB72GY-1-B-27 _ A Refrigerated Back Bar Storage Cabinet,three section,72" W,36" H, .r_E I 19.4 cu.ft.,(3)glass doors, snap-in door gasket, (6) epoxy coated steel shelves, (3) 1/2 barrel kegs, fluorescent interior lighting with manual on/off switch, black exterior finish, 2" stainless steel top, stainless steel floor, galvanized interior, right-mounted self-contained refrigeration, 1/4 hp, UL,cUL, UL EPH, NSF, MADE IN USA 2 ea 3 years parts& labor warranty(excludes maintenance items) t 2 ea Self-contained refrigeration standard 2 ea Additional 2 yr compressor warranty, standard Initial: Chart Room-Osterville Equipment Page 6 of 8 r - is Harbour Food Service Equipment 1010512016 8600 NQ4 4 a cages Description �^fQF Sell Sell Total 2 ea 115v/60/1-ph,5.0 amps,standard 2 ea Compressor located on right Oct 04 201611.42A5.4 ea VKAF I Otr.K LUULLK ,525.00 R Beverage Air Model No. BM23-B Draft Beer Cooler, portable, 24"W, 7,8 cu.ft., door type, self-closing Las "' action door with locks, self-contained refrigeration, one-keg capacity, 3" insulated tower with single faucet, black exterior, stainless steel top, galvanized interior,stainless steel floor, 1/5 hp,4" casters, UL,cUL, UL Date Time EPRYMF, MADE IN USA Station ID Duration Pages Result 1 ea 3 years parts& labor warranty(excludes maintenance items) 1 ea Self eentained Fe#figerat+en standaM Digital Fax Oct 4 11.J?AMAd0'6tft?yr compressor vj%ffggjy Bard 0:57 1 OK 1 ea 115v/60/1-ph,4.0 amps,8'cord, NEMA 5-15P,standard NSA 1 ea 406-055A 3 Tap 3"OD Beer Faucet $365.00 $365.00 1 ea 402-188A 2-way manifold $65.00 $65.00 ITEM TOTAL: $1,955.00 NOTES 1 ea $3,950.00 $3,950.00 Harbour Food Service Equipment Non-Union, Delivery, and Set-In-Place of all Foodservice Equipment in this Contract by Harbour Food Service, ready for Plumbing, Electrical and Mechanical Connections by others. * Please Note Delivery Set in Place Price Based on_Days at Site. Charges will be added if Site is not ready at time of Delivery. Price is, also based on Our Delivery Hours Monday Thru Friday 9am to 4:00pm. If outside of our delivery hours additional Charges will be applied. * If Union Installation is to be used, Harbour Food Service will provide pricing as per spec and site verification. NOTES 1 ea GENERAL NOTES: Harbour Food Service Equipment A. Unless otherwise noted, all merchandise shall be covered by the individual Manufacturer's standard warranty.This quotation does not include any special licenses, permits,or fees that may be required. Owner is responsible for obtaining any and all approvals and permits from the Health Department, Building Department, Fire Marshall, etc. All equipment is supplied with standard components and is ready for the plumbing and electrical connections by other contractors. B. Prices are in effect for orders placed and approved within 30 days from date of quotation. Delivery is during normal business hours- Monday through Friday from 8AM to 5PM by non-union personnel to first floor sites with reasonable access. For purchases of less than the total package, itemized costs are subject to review and change. C.All quotations,terms and financial arrangements are subject to approval of the credit department at Harbour Food Service Equipment. Terms are indicated below.A Uniform Commercial Code form will also be presented for your signature at time of receipt of Initial: Chart Room-Osterville Equipment Page 7 of 8 Harbour Food Service Equipment 1010512016 ' Item Qty Description Sell Sell Total acknowledgement, which will provide Harbour Food Service Equipment a security interest in the products listed above until paid in full. D. Certain fabricated items may not be placed in production until the site is ready for field measurements. No merchandise is to be returned without written permission from Harbour Food Service Equipment. When permitted, the return is subject to prevailing factory re-stocking charges and all freight and related costs to and from the job site. All custom made items are non-returnable. If the job site is not ready at the time of initial scheduled delivery, re-delivery and/or storage charges will apply. Thank you for the opportunity of quoting you on this project.We look forward to receiving your valued order. TERMS: 50%DEPOSIT 40%DUE 10 DAYS BEFORE ESTIMATED DELIVERY DATE BALANCE NET DUE 15 DAYS AFTER EQUIPMENT DELIVERY. Merchandise $65,953.00 Freight $1,750.00 Tax 6.25% $3,875.19 Total $71,578.19 Acceptance: Date:. Printed Name: Project Grand Total:$71,578.19 Initial: Chart Room-Osterville Equipment Page 8 of 8 •g hart _R- oom P1,900F A at CROSBY'S Dinner Menu 330A 1W5I M7 AD he Osterville, MA 774-602-8156 1 � www.?????????????????.com A snack bar was built in 1954 as a single story building for the purpose of opening a combination snack bar and marine store selling supplies, gifts and nautical clothing. It became known as "Crosby's"and was a very popular eating and social place to chat. Open from TOO cam to 8:00 pm it was managed by "Sonny" Crosby, Malcom Crosby's mother and staffed by the Crosby family for many years. Through the years past names for the eating establishment have included "Black Gull" "The Harborside", "Keepers"and "The Islander". . In 1992 the building was remodeled, adding a second and third story to accommodate the new Osterville Anglers Club thereby making the whole first floor a restaurant serving a much broader menu. Our restaurant has been continually serving boaters and local residents on a yearlong basis since 1954. The new restaurant has been completely remodeled and is now called "The Chart Room at Crosby's". We look forward to serving you. APPETIZERS - 0FEBF Oysters on the Half Shell Little Necks on the Half Shell 3 each 2.50 each Shrimp Cocktail Clams Casino Chilled jumbo Shrimp Local Cherrystones, Broiled with Garlic Butter, Served with our House Made Cocktail Sauce Seasoned Breadcrumbs and Bacon 3.50 each 12 Stuffed Quahog Mussels From Cape Waters, A Local Cape Cod Recipe Steamed with White Wine, Garlic and Herbs 6 14 Maine Crab Cake Steamers Served over Greens Steamed Local Soft Shell Clams Topped with Lemon Aioli Served with Drawn Butter and Broth 14 Market Price SOUPS - �® 0 Chart Room Chowder Lobster Bisque Our Own Classic Cape Cod Fresh Lobster Meat in a Quahog Chowder Recipe Rich Creamy Lobster Broth cup 6 bowl 8 cup 8 bowl 10 SALADS - a[][ 0[][ j7M Dressings: Egg &Anchovy, Balsamic, Honey Mustard, Caesar Blue Cheese, Italian Garden Salad Caesar Salad Iceberg &Romaine Lettuce, Cucumbers, Romaine Lettuce, Croutons, Onions, Cherry Tomatoes, Shaved Parmigiano-Reggiano Cheese, zaith your Choice of Dressing Tossed in Caesar Dressing 8 9 Spinach Salad Additions Baby Spinach, Marinated Mushrooms, Grilled Steak Tips 9 Candied Walnuts, Bacon, Onion, Egg, Grilled Chicken 6 Tossed in Honey Mustard Dressing Grilled Shrimp 12 9 Grilled Salmon 12 Avocado Salad Seared Scallops 14 Mixed Greens, Avocado, Grape Tomato, Lobster Salad 18 Cucumber, Carrots, Goat Cheese, Tossed in Balsamic Dressing 9 7% State Tax Consuming razu or undercooked meats may increase your risk of foodborne illness, especially;if you have certain medical conditions. ENTREES - [:1R9[EDEBDMR Served with Baked Potato or Rice, Vegetable and Rolls & Butter Baked Stuffed Lobster Baked Lobster Mac & Cheese Stuffed with Fresh Lobster Meat Fresh Lobster Meat and Penne Pasta and our Seasoned Breadcrumbs, in a Three Cheese Sauce with a Served with Drawn Butter and Lemon Garlic Parmesan Crumb Topping 39 28 Schrod Salmon Fresh Local Cod Broiled with our Seasoned Grilled and Topped with Lemon Basil Vinaigrette Breadcrumbs and Lemon Butter 25 26 Steak Tips Swordfish Marinated in our Bourbon Marinade, Broiled Swordfish with our Seasoned Breadcrumbs Grilled to your Choice Temperature and Anchovy Butter or Blackened with Lemon Butter 22 27 Filet Mignon Scallops Grilled to your Choice Temperature Baked in a Casserole with Butter, Sherry Wine with a Cabernet Demi-Glace and our Seasoned Breadcrumbs 30 27 SANDWICHES _ Fc3l[][ M❑• ���❑ Served with Potato Chips, Potato Salad or Cole Slaw Lobster Salad Reuben Fresh Lobster Meat lightly seasoned and Grilled Corned Beef, Sauerkraut, tossed with Mayonnaise and Celery Swiss Cheese and 1000 Island Dressing Served on Fresh Portuguese Bread on Grilled Marble Rye or Stuffed in a Tomato 11 28 02- Cheeseburger Chicken Salad Grilled 10 oz Beef Burger with American, Oven Roasted Chicken lightly seasoned and tossed with Swiss or Cheddar Cheese on a Toasted Roll Mayonnaise and Celery 12 Served on Fresh Portuguese Bread add bacon 13 or Stuffed in a Tomato 10 Grilled. Cheese & Tomato Hot Dog on your Choice of White, Wheat, Marble Rye or Portuguese Bread Grilled and Served on a Toasted Roll 6 7 Consuming razu or undercooked meats may increase your risk of foodborne illness, especially if you have certain medical conditions. WINE SELECTION White Wines ............................................Glass .....Bottle Red Wines..................................................Glass .....Bottle 1 Chardonnay,Robert Oakley,Australia.......................9............30 24 Cabernet Sauvignon,Geyser Peak, 2 Chardonnay,La Crema,Monterey......................... 11 ...........38 Alexander Valley....................................................... 9 ...........30 3 Chardonnay,Mer Soleil "Unoaked",Santa Lucia................... 40 25 Cabernet Sauvignon,Beringer "Knights Valley", 4 Chardonnay,Jordan,Russian River........................15............ 55 Napa........................................................................ 15 ........... 55 5 Chardonnay,Chalk Hill Estate,Sonoran................................ 65 26 Cabernet Sauvignon,Tordan,Alexander Valley ...................... 75 6 Chardonnay,Far Niente,Napa................................................ 90 27 Shiraz,Greg Norman,Australia.............................. 8 ........... 28 7 Sauvignon Blanc,Domaine Paul Buisse,France ...8 ........... 28 28 Pinot Noir, Belle Ambiance, California .................. 8 ........... 28 8 Sauvignon Blanc,KoNo,Nezv Zealand ....................9 ........... 30 29 Pinot Noir,Steele"Shooting Star", 9 Sauvignon Blanc,Charles Krug,St.Helena ......... 11 ...........38 Lake County.............................................................11 ........... 38 10 Sauvignon Blanc,Cloudy Bay,Nezo Zealand.......................... 45 30 Pinot Noir, Adelsheim,Oregon................................................ 45 11 Sauvignon Blanc,Cakebread, Nan ............55 31 Pinot Noir,Merry Edwards,Russian River ...........................90 :12 Riesling,Saint M Loosen/CSM, Germany..............9 ...........30 O 32 Zinfandel,Dry Creek, Sonoma ...............................11 ...........38 413 Poully Fuisse,Louis Latour, France........................................40 33 Mountain Cuvee,Chappellet Napa ......................................55 14 .Pinot Grigio,Kris,Italy..............................................9 ...........30 34 Malbec,Skeleton,Argentina..................................... 8 ........... 28 15 Pinot Grigio,Santa Margherita,Italy ....................................40 35 Red Blend,Castelo do Sulco,Portugal.................... 8 ........... 28 16 Chenin Blanc/Viognier,Terra d'Oro, 36 "Super Tuscan",Santa Cristina,Italy...................... 8 ........... 28 Clarksbz.irg..................................................................9 ...........30 37 Beaujolais Villages,Georges Dubeuf,France........ 9 ...........30 17 Sancerre,Paul Cherrier,France..............................12 ...........40 38 Merlot,Decoy,Napa................................................ 12 ........... 40 18 Chablis,Simonnet-Febvre,France...........................................40 39 Montepulciano,Cantina Zaccagnini,Italy...........10 ........... 35 19 Vinho Verde,Aveleda,Portz.igal............................... 7........... 25 40 Chateauneuf du Pape,Chateau Mont-Redon,France.......... 75 20 Macon Village,Domaine Les Chenevieres, France.......................................................................11............30 Champagne/Sparkling 21 St. Veran,Joseph Drouhin, France..........................................30 41 Brut,Domaine Chandon, California........................................ 25 42 Brut Rose,Roederer Estate,Anderson Valley.........................40 Blush 43 Brut,Pol Roger, France.............................................................. 75 22 Rose,Mulderbosch,South Africa..............................8 ........... 28 44 Prosecco,Zonin,Italy......................................187 ml 7 23 Rose,Cotes De Provence,Whispering Angel, 45 Sparkling Rose,Belaire, France...................375 ml 25 France.......................................................................12 ...........40 46 Champagne Split.............................................187 ml 7 House Wines By The Glass Chardonnay,Cabernet,Merlot,Pinot Grigio.........? BOTTLED BEER DESSERT- S DomesticPie of the Day....................................................................... +y.. ? Budweiser,Bud Light,Michelob Ultra,Miller Lite, Key Lime Pie................................................................................ ? Coors Light, Narragansett 16 oz Can, Chocolate Cake.......................................................................7.. ? Angry Orchard Cider ........................................................... 4.25 Shipyard"Island Time"Session IPA,Sam Summer Ale, Blue Moon,Sierra Nevada.Pale Ale,Pigs Ear Brown Ale, Harpoon IPA,Sam Adams Lager,Summer Shandy, Naukabout Lighthouse Ale.................................................. 5.00 Cape Cod Blonde 16 oz Can,Allagash Belgian White..... 6.00 Imported Heineken,Harp,Stella Artois,Corona,Corona Light...... 5.00 i% State Tax Guinness 14.9 oz Can ............................................................ 6.00 PLEASE INFORM YOUR SERVER IF A PERSON IN YOUR PARTY.HAS A FOOD ALLERGY 1 Non-Alcoholic St. Pauli Girl............................................................................ 5.00 Saratoga Sparkling Water..................................................... 2.50 Fiji Artesian Water................................................................. 3.00 Appetizers Entrees Served with Baked Potato or Rice, Vegetable and Rolls&Batter Oysters on the Half Shell Little Necks on the Half Shell 3 en 2.50 ea Baked Stuffed Lobster-Stuffed with Fresh Lobster Meat and our Seasoned Breadcrumbs, 39 Served with Drawn Butter and Lemon Shrimp Cocktail-Chilled Jumbo Shrimp,Served with our House Made Cocktail Sauce 3.50 ea Stuffed Quahog-From Cape Waters,A Local Cape Cod Recipe 6 Sehrod-Fresh Local Cod Broiled with our Seasoned Breadcrumbs and Lennon Butter 26 Maine Crab Cake-Served over Greens,Topped with Lemon Aioli 14 Swordfish-Broiled Swordfish with our Seasoned Breadcrumbs and Anchovy Butter 27 or Blackened with Lemon Butter Clams Casino-Local Cherrystones,Broiled with Garlic Butter,Seasoned Breadcrumbs,and Bacon 12 Scallops-Baked in a Casserole with Batter,Sherry Wine and our Seasoned Breadcrumbs 27 Mussels-Steamed with White Wine,Garlic,and Herbs 14 Salmon-Grilled and Topped with Lennon Basil Vinaigrette 25 Steamers-Steamed Local Soft Shell Clams Served with Drawn Butter and Broth MKT Baked Lobster Mac &Cheese-Fresh Lobster Meat and Penne Pasta in a Tizree Cheese 28 Sauce with a Garlic Parmesan Crumb Topping Soups Steak Tips-Marinated in our Bourbon Marinade,Grilled to your Choice Temperature 22 Chart Room Chowder-Our Own Classic Cape Cod Quahog Chowder Recipe cup 6 bowl 8 Filet Mignon-Grilled to your Choice Temperature with a Cabernet Derni-Glace 30 Lobster Bisque-Fresh Lobster Meat in a Rich,Creamy Lobster Broth cup 8 bowl 10 Sandwiches Salads Served with Potato Chips,Potato Salad or Cole Slaw Dressings:Egg&Anchovy,Balsamic,Honey Mustard,Caesar,Blue Cheese,Italian Lobster Salad-Fresh Lobster Meat lightly seasoned and tossed with Mayonnaise and Celery 28 Garden Salad-Iceberg&Romaine Lettuce,Cucumbers,Onions,Cherry Tomatoes, 8 Served on Fresh Portuguese Bread or Staffed in a Tomato with your Choice of Dressing Chicken Salad-Oven Roasted Chicken lightly seasoned and tossed with Mayonnaise and Celery 10 Caesar Salad-Romaine Lettuce,Croutons,Shaved Parmigiano-Reggiano Cheese, 9 Served on Fresh Portuguese Bread or Shiffed in a Tomato Tossed in Caesar Dressing Reuben-Grilled Corned Beef,Sauerkraut,Swiss Cheese and 1000 Island Dressing 11 Spinach Salad-Baby Spinach,Marinated Mushrooms,Candied Walnuts,Bacon,Onion,Egg, 9 on Grilled Marble Rye Tossed in Honey Mustard Dressing Cheeseburger-Grilled 10 oz Beef Burger with American,Swiss or Cheddar Cheese 12 Avocado Salad-Mixed Greens,Avocado,Grape Tomato,Cucumber,Carrots,Goat Cheese, 9 on a Toasted Roll add bacon 13 Tossed in Balsamic Dressing Additions-Grilled Steak Tips 9 Grilled Chicken 6 Grilled Cheese &Tomato-on your Choice of White,Wheat,Marble Rye or Portuguese Bread 6 Grilled Shrimp 12 Grilled Salmon 12 Seared Scallops 14 Lobster Salad 18 Hot Dog-Grilled and Served on a Toasted Roll 7 7% State Tax BEFORE PLACING YOUR ORDER, Consuming raze or undercooked meats may increase your risk of foodborne illness, PLEASE INFORM YOUR SERVER IF A PERSON d especially if you have certain medical conditions. IN YOUR PARTY HAS A FOOD ALLERGY In 1954 a single story building was built for the purpose of opening a combination snack bar and marine store selling supplies, gifts and nautical clothing. It became known as "Crosby's" and was a very popular eating and social place to chat. Open from 7.00 am to 8:00 pm it was managed by "Sonny" Crosby, Malcolm Crosby's mother and staffed by the ROOM Crosby family for many years. Through the years past names t �l\®S�Y�for the eating establishment have included "Black Gull", a S "The Harborside"; "Keepers" and "The Islander". In 1992 the building was remodeled, adding a second and third story to accommodate the new Osterville Anglers Club thereby making the whole first floor a restaurant serving a much broader menu. The new restaurant has been completely remodeled and is now called "The Chart Room at Crosby's". We look forward to serving you. 330A West Bay Road, Osterville, MA 774-602-8156 www.chartroomcrosbys.com j � D(!STING SHED tsire and location to be veri0edl i I - food—&,Dwip.Equipment and Seppliea C Foodsecvice Design +745 .e.en.m..ne.uar ' RECEIVING AREA it F4 I �{'.'_____ e i i �.�•+e wedgy=alfe.b t IR,e t IE B s R I Chart Room STORAGE AREA I i ----------- --J Crosby \�X/16e Yacht Club n�y 4 3 _ _ �® MECNAIUGLS/STORAGE -i 72 Crosby Ork' Ostervllle,MA 02655 AVn I I i I UT SERVICE --- i I � ; 'o 1 1 \I APPROVED AS SUBMITTED �C {� w ❑A"R VED AR RRr D -— — `-; ❑❑ND APPROVEDI UDMR F RNO T r a 3 .n ty,. " BAR i . 1i1N h'�6A Imm10 a� Riga � __ ♦ Food Service El ED itrr y I Preliminary Equipment Floor Plan . EXI"No �:- _ _.— EASTPIG RESTROOM . RESTROOM . I _ i I FS-1 a� 'IIOA _ I I EXISTMG SHED �.11'�/11111' Islze and bcallon to be vedriedl 1 . n-,.•r.. -.•, roodsmdu EWgN Equ*wl mid Suvdl,% Poodservice Design �' I I ss n•.pa, .. .. _ '.e ..s•.n.v.r•oe�...n RECEMNG AREA "-~ - Chart Room ---- ,..e:ae {�qe i I F ,3ssp.=I;LG!JI I CS\ �J `� / ia , _,I - STORAGEA I 1 at - " _ .. _ Crosby Yacht Club Crosby //J�\ � MEeNAwcusrnoTAGe APIA Osteer AA rville, A 02 02655 .4 r LL ❑�rRsoveo u auermeo a Ovraovso u Noreo NOT AP►IIOVEO/RE6YBMR - may= # , I } ' Ef •mod 7 BAR t 4. 9-1 xO f ..mow I :;VOV" ,(3 I 8 f 1f ,� wuv t I'! mrva• C olq �� D Food Servibe i 0 it -`c li Preliminary _ I Equipment Floor Plan - it Iw_ I I EXISTING t RESTRESTROOM OM T RESTROOM � I 1 •.-wT - � FS 1 FI 1'be Law Office of . DAVID V. LAWLEI, PC 540 Main Street, Suite 8 Hyannis, MA 02601' Telephone: (508)778-0303 acsimile. =(308)778=4600--= -- --- Email Address _ 062 Main Streeterville,MA 026 1 Dlawler.atty@verizon.net Telephone:(508)428.0542 January 17,20.17 Paul Roma,Building Commissioner Town of Barnstable 200 Main Street Hyannis,MA 02.601 Re:The Chart Room at Crosby's Dear Building Commissioner Roma: The attached :site plan review is accompanied by a'certified plan by Peter Sullivan dated June 26, 1992. It is important to.notetthat the premises have not changed with respect to the parking layout as contained in the attached report nor have the parking or septic requirements By way of history,in the spring of 2016 the applicant had placed a°substantial nonrefundable deposit with the landlord based upon the most recent All Alcohol License issued by the Town,this license attached allowed for 6 seat restaurant with the service of alcohol until IAM In the process of filing.it was discovered'that there was a'Special Permit issued on the roe and that the attached license in violation of the Special _ P p ,rh' Permit. As such,I am in the process of filing a request to amend the Special Permit with the ZoningBoard of A g ppea s, Site Plan Review bein' the first ste p ' Please note,that the Zoning Board of Appeals waived any site`plan requirement ack`'in 2010,all the applicant to rely upon the existing documents and the plan which is the one I':have attached herewith, indicating.a minimum of 114 parking spaces f .or the premises,three HP spaces surrounding the restaurant. A 49 seat restaurant was approved by Special Permit,the parking requirements of..one space for every 3,seats and one space for every 2 employees have not changed. : Paul Rom ;Building Commissioner January 1:7 2617 Page 2 a roved b the Zomn Board ' The applicant isrequesting to keep the presen#4 seat restaurant as previously PP Y g` of Appeals and the septic capacity as confirmed in the attached letter by'Thomas McKean,entitled "Further Clarification"dated May The Applicant is see a different confi guration of seat�i with two separate floor plans always allowing fax a maximum of 49 seats See attached fpor plans;one entitled" "Sunny the other"Rainy".. The,Sunny plan provides for 13 outdoor seats with'<36 indoor. seats, The ratan plan provides far S outdoor seats with 44 udoor eats In each plan the Indoor seating includes 12 seats at the;bar If:approved the applicant would move the; seatsan or out de end<n on the weather Also,please note that there are=na other changes that would require S1te Review The Applicant a<s seeking to expand the hpurs of operation until l2 3 AM and days of operation for a Seasonai License from April lst fp<January 15 with the.varied outside seating as;addressed'alove. Should you have;any questions or concerns,;please.do riot hesitate to contact ine. I tharik.you for your cpurtesies in th%is regard; Very trul our , Dav<d a . er r { APPLICATION FOR SITE PLAN REVIEW SP# -_ Date: LOCATION Business Name:Co Qe-t- i26bcr► at C x o Sh`i 5 Subdivision Plan Assessor's Map# I I(,:, Parcel# O t .3 ANR Plan Property Address: 3 b t Site Plan ---- OWNER OF PROPERTY Name: Jckr f c Name: C_04AC/ " Address: os6C4re Address: ( cal L iz5 - - Telephone: ;pSr- S--6 3 a 3 Telephone: - Fax Fax: ARCHITECT/DEVELOPER/CONTRACTOR/ENGINEER AGENVATTORNEY Name: 2nc.neer� Name�Akt.':- V. UAWLt2 Address: Address: !V-to A-iL,.., S S�e S- Telephone: Telephone: 7 If— 6_::�b 3 Fax: Fax: STORAGE TANKS(HAZ MAT/FUEL OR WASTE OIL) ZONING DISTRICT CLASSIFICATION Existing—/�C) ,Proposed l�fv we District m j1 ) rq Overlay(s) Number 1 KNumber Lot Area Sq.Ft. Ac.. Size Size Fire District. C ory)rn Above.Ground Afo Ckk Above Ground w6zy Underground Underground Setbacks ft. Contents Contents Front: Side: Rear: Number of Buildings Existing _Proposed f, o q��,m J U=IES DemolitionE- Sewer ❑ Public ❑ Private Size gal Water ❑ Public ❑ Private TOTAL FLOOR AREA BY USE Electric ❑ Aerial ❑ Underground Existing Proposed Gas ❑ -Natural ❑ Propane (sq. ft. s .:t. Grease Trap JE1 Size gal Basement Sewage Daily Flow * gPd Residential *GP or WP areas restrict wastewater discharge to 330 gallons per Restaurant 5 /,(U Q c� acre per day into on-site system. Retail Office PARKING SPACES CURB CUTS Medical Office Required � Existing KaC a Commercial(specify) Provided I1 Proposed Wholesale(specify) On-Site To Close Institutional(specify) Off-Site Totals Industrial(specify) Handicapped 7:�:(k CU O-W I) All Other Uses On Site Estimated Project Cost: Fee: Gross Floor Area $ /D CZ). bD $ SMORM-P1.DOC-06/18/2004 4� Old King's Highway Regional Historic District File# Approved? ❑Yes N No Hyannis Main Street Waterfront Historic District File# Approved?❑Yes ®No Listed in National and/or State Register of Historic Places? ❑Yes ©No Previous Site Plan Review File# Approved? ❑Yes ❑No Previous Zoning Board of Appeals File Approved? ❑Yes ❑No Is the site located in a Flood Area(Section 3-5.1) ❑X Yes ❑No In Area of Critical Environmental Concern? ®Yes ❑No Is the Project within 100' of Wetland Resource Area? ®Yes ❑No :Yes= __❑::No Site Plan prepared,wet stamped and signed by a Registered PE and/or PLS. Yes ❑No Parking and Traffic Circulation Plan ©Yes ❑No ----- L-andsca a-Plan-and-L-Lighting Plan--- - --- P g g.. ---.,____ _____ _.... _..__..Yes-_ ._..__E?9-No-- Drainage Plan with calculations and Utility Plan ❑Yes ©No Building Plans,(all floor plans,elevations and cross sections) ❑Yes [3 No Note that all signage must be approved by Code Enforcement Officer at the Building Department Lot area in sq. ft. sq.ft Total Building(s)footprint sq.ft. Maximum Lot Coverage as%of Lot % GROUND WATER PROTECTION OVERLAY DISTRICT REQUIREMENTS: OVERLAY DISTRICT(S): Lot Coverage (%) Required Proposed Site Clearing (%) Required Proposed PRINCIPAL BUILDING ACCESSORY BUILDING(S) ❑Yes ®No Number of floors Height: 56o ft. Number of floors Height: ft. r FLOOR AREA: FAR: FLOOR AREA: FAR: Basement sq.ft. Basement sq.ft. First sq.ft. First sq.ft. Second sq. ft. Second sq. ft. Attic sq.ft. Attic sq.ft Other(Specify) sq. ft. Other(Specify) sq.ft. Please provide a brief narrative desc 'ption of your proposed project: I assert that I have c eted or caused 2tion ompleted)this page and the Site Plan Review Application and that,to the bes my kno edge,the ' o submitted here is true. Date P ' ted e of plicant - SP-FORM-PIDOC-.06/18/2004 r Town of Barnstable Regulatory.Services Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 --- ---- ce:- - _v :__-:.- __. -------- --._ -- - -=Fax-508=790-6304-.. Mr. Richard Boy Zoning Board of Appeals RE: Keeper's Restaurant, 72 Crosby Circle, Osterville/Further Clarification Dear Mr. Boy, I am responding to your inquiry earlier this morning in regards to the septic system capacity,at 72 Crosby Circle. The existing septic system has a design capacity of 1840 gallons. During site plan review,we were informed that only thirteen persons maximum frequent the Anglers Club (13 persons X 10 gpd= 130 gallons),with an average of only eight persons per day. This leaves 1710 design gallons for the food service facility(Keepers). Thus,there is capacity within the food service establishment for the number of seats requested 1710 gallons divided by 35 gpd=49 seats. Hypothetically, if the entire facility were to be used for food service (food preparation), the existing septic system has.the capacity for 52 seats. Sincerely yours, a Thomas A. McKean, RS, CHO THIS LICENSE SHALL BE.DISPLAYED ON THE PREMISES IN A CONSPICUOUS POSITION WHERE IT CAN BE READ LICENSE No. 7°°0248 S ALCOHOLIC BEVERAGES THE LICENSING AUTHORITY OF _ The TOWN OF BARNSTABLE, MASSACHUSETTS — -- —- -------- _HEREBY-GRANTS - - _-- COMMON__VI_CTUALER__-------_.__-. -- License to Expose, Keep for Sale, and to Sell All Kinds of Alcoholic Beverages To-.-Be Drunk.:On the.Premises To: 4 Our Fathers, LLLC; d/b/a Islander(The) -­_-' ..--••.............................................................•----•-----............ ......................-- . Joseph. Dunn, II,Manager' on the following described premises 33D WeA13.7iay Road,Osterville;MA FIRST FLOOR OF 3 STORY WOOD FRAME BUILDING. ONE FRONT ENTRANCE/EXIT;—2 SIDE ENTRANCES/EXITS. 1,500 SQ.FT. OPEN AREA CONTAINING DINING AREA SEATING 54;BAR SEATING 7&400 SQ.FT.STORAGE AREA. 100 SQ,FT.WALK IN REFRIGERATOR&DRY STORAGE AREA IN NORTHWEST SIDE. This license is granted_ .and accepted upon the express condition that the licensee shall,in all respects,conform tor allthe provisions-of the,Liquor Control Act, that 138-of the General Laws,as amended,,.-a-dd any rules or regulations made thereunder by the'licensing authorities. This license expires fanuary 15,2012 ,unless earlier suspended,-cancelled or revoked. IN TESTIMONY WHEREOF,the undersigned have hereunto affixedtheir official signatures this `-. 1 "day of April;2011 The Hours during which Alcoholic RESTRICTIONS-See Below Beverages may be sold are: ,9 ,p . d WEEKDAYS: 8 A.M.TO 1 A.M. `'....�..:.:.. ........ . .....•-•--... SUNDAYS: 12 MIDNIGHT TO 1 A.M. --•..................................•-•----••---..........---•----• 12 NOON TO 12 MIDNIGHT ................. ... . ........................•............. NOT VALID unless issued in conjunction ................................................I*"*........ ......-•---•...........................................••-. - - with a Food Service Permit. LICENSING AUTHORITY PAID: $3,050.00 RESTRICTIONS vy� Town of Barnstable Regulatory Services NA" ,� Thomas F. Geiler,Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 20, 2003 Mr. Richard Boy Zoning Board of Appeals RE: Keeper's Restaurant, 72 Crosby Circle, Osterville/Further Clarification Dear Mr. Boy, I am responding to your inquiry earlier this morning in regards to the septic system capacity at 72 Crosby Circle. The existing septic system has a design capacity of 1840 gallons. During site plan review, we were informed that only thirteen persons maximum frequent the Anglers Club (13 persons X 10 gpd= 130 gallons), with an average of only eight persons per day. This leaves 1710 design gallons for the food service facility(Keepers). Thus, there is capacity within the food service establishment for the number of seats requested 1710 gallons divided by 35 gpd=49 seats. Hypothetically, if the entire facility were to be used for food service (food preparation), the existing septic system has.the capacity for 52 seats. Sincerely yours, Thomas A. McKean, RS, CHO Revised Daily Flow Calculation Keeper's 49 seats X 35 G.P.D. O.A.C.— 13 people X 10 G.P.D. 1,845 total daily flow X 150% 2,767.50 t � L 13 No....../. Fss........Lo.a.......... rh C,—,—=t!o ctinnDeprtmenTHE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 7 ------.... -a.k:._....................O .................................. AVVIiratiun for Disposal Works Tonstrurttun Wrmi# Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: `�UC-1! Ei L4 LL Q;jrA,0 -A.VJ-r Y..... Location ddress o Lo No. .•, td ...C g�.``C. c � _. .----..� ...�.Y.... .----- ..�L Owner Address W Installer Address S d Type of Building Size Lot.._....°. ...............Sq. 0-4 U Dwelling—No. of Bedrooms............................ .-------------- Expa on Attic ( ) Garbage Grinder ( ) PL4 Other—Type of Building �sl�'�_� !*!v No. of persone s51 A`TS _ Showers ( ) — Cafeteria ( ) p{ C,(-ug oPEr� Q Other fixtures -------........................................................ •-••-•••--•-------..-.._...---•-•---r-........................................... W Design Flow..........1 9........................gallons per person per day. Total daily flow........I_............_............._gallons. WSeptic Tank—Liquid'capacity.. gallons Length....1?._..._.. Width----1®_----- Diameter._.---.... Depth x Disposal Trench—No. .................... Width..._6........... Total Length..... 0........ Total leaching area..%� .... .._.sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (K Dosin tank ( ) &e-6,06 E l¢atp loco C-OkLA-n i-LS Percolation Test Results Performed by___ Arks. .. .4YEJq.C..................... Date_.A2°,_2.°-!.)..I............... Test Pit No.3-.L A...._..minutes per inch Depth of Test Pit-----`Q.......... Depth to ground water--_A_►3___--___--. ;T4 Test Pit No. 2--LZ........minutes per inch Depth of Test Pit.....`Q_.......... Depth to ground water_ a ............................ W Description of Soil--(� 2 LoAvLI- ... ..35 C4-Z-j•a----.�5 1�v--------------------------------------------•----•-•------------.. x W ••••------•-•---------------•---••-•----------•-•-•...--------------•---•----------------•-•------------•------------------....•------•---------•----------•-------....................--•---•---....... UNature of Repairs or Alterations—Answer when applicable._.............................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by jbgboard of health. Signed --:... -------`------- .. ..... "".`........--- Vi- --I Application Approved By ------------ C� V .. .1u ----� �.---- 1...0--------9_� Date Application Disapproved for the following reasons- ----- -- --- ---- -- .........--------------- .....-- . . -- -- -- --- . ....---...---------------- ------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------- ------ ----- -- ---------------- ---------------......................... Permit No. --------74�--- ---/--&---------------------------- Issued ....--.........-.....-.... Pate Date No................_....... Fins............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t Vet 1l,d OF............'l�i :W,55.._�e.. ?f...�. Appliration for Disposal Works Tonstrurfion Frrutit Application is hereby made for a Permit to Construct (A•) or Repair ( ) an Individual Sewage Disposal System at IS L,Ar - C- y L t Y'C r :o r AN ,^O c �l t �►� D....\kI Er -t ' ....Ito .....( L. .�f a�z .... ........ -•--••-• -•--•--• • --•••--•-•................•--•. ,L+ocationj d9d-ress_ o�- L�,o/tyNo ,F g.� 4.-r�"_'_i_'�_.. f�'o 8r�..---•' t.�••""">�. 'An.�,q� .-- •-- 0 ""...C..,.y� 1 ! P.. i,•.w? .._.. _ --------• .. ...........s............................ Owner Address W Installer Address Ac =5 Q Type of Building Size Lot....... ... Sq. r v Dwelling—No. of Bedrooms_.........................I........ .Expa ion Attic ( ) Garbage Grinder ( ) Other—Type e of Building c: ttr o. of ersonsl�r ` d'` .s Showers Cafeteria a YP g -••-•-----•-- •••.. P ( ) — ( ) Otherfix ures -•-•-•... ------------------------•-----•--------------•- ................................... Design Flow.......................... ...............gallons per person per day. Total daily flow.---_.l.r`��..........................gallons. � Septic Tank—Liquid capacity..K gallons Length....�!.......W Width 8.... Diameter..:-g.... Degth.-.��_:q. Disposal Trench—No..................... G Width.....e: ....._..__ Total Len th.....::............ Total leaching area ._.._. _ s t. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (`.4) Dosin tank ( ) U 2 q4�s a: t ZAP t ooc) f'a.at t-0 2,4.S Percolation Test Results Performed by... A,A;.� ."'_....J5 +jt�,...1' —................... Date_- "_)_� '9... ,........... Test Pit No.3...�-........minutes per inch Depth of Test Pit......Q.......... Depth to ground water..---.6----_--------- Test Pit No. 2..A?�.......minutes per inch Depth of Test Pit..._' ......,... Depth to ground water.NOT-.t=..?...... ........................... - ------------------------------ -- Description of Soil U-2 t v;rt r...°=U wot-L_ -'`--' t a ` ....1 W •-•-•-•----••---•-•••-----•-••--••--•-•----••--•........-•••--•----•-•---•----••---••• ,....----••-----•---••-••-•--•---•••--..........••. -•-•---•--------.............................................. --------------------------------------------------------------------------------------------------------•---------------------....---------------------------------------------•--••----•------••-...... U Nature of Repairs or Alterations—Answer when applicable.--._........................................................................................... ----------------------------•--------------------------•---•------•-•--••--••---•--.................I.....•-----••-•••-•-•---•-•--------•--•-•-•-----•--•-•••-•-........._......................•.....-- . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ------------------------------------------ -- --------------------------------- -- ----------- ........................................ , Dare ApplicationApproved By ------------------------------------------------------------ .........................................................--..............------ ----------------�-e----------- ---- Application Disapproved for the following reasons: .-..... ........................................................ ...................................... .. ................. ........-- -- -- - -- -- -- - ---- -- -------.............................................---....---..........................-- -----------...............----. Dace PermitNo. ----------- -------------------------- Issued ...........................................-----..-..---_-------- Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............'..... ....................... .--- C6.er#ifirate of C�nmpiiance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( X,, ) or Repaired ( ) by ----_-_ � � �� � �------------------------------------------------------------------------------------------------------------------------------------------------------------------- _ Insraller at . - '2 G' \ ` `= ! !�? r - S X. ---�C-f�A-D- ....��- ..................................................... 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 -----...--.................------............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. -�---� DATE......................... /--j0'?-®'----...................------.......................................... Inspector ......-............... a----------------.......................................... r THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH !ro OF.. rc,r t.� �. . � L .......................... No........................ FEE........................ Disposal Vorks Tono#rnrjtion Vvrrmit Permissionis hereby granted.................................................................................I............................................................ to Construct (K) orA.epair ( ) an Individual Sewage Disposal System �/ at No Lfk.cr_ �,-L_. 4-. l)V at(4) 4 ! -�°.a v�"_� r>t!� ` .Q.................................t k 1 f i`i?.\JtLtt Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... •.......................•------- f �----------------------------------=--•------••-•-•---.----- r� Board of Health ✓.i+ DATE.. I_-- ------• .......I...••--•-------.....••-• FORM 1255 HOBBS & WARREN. INC., PUBLISHERS TOWN QF BARNSTABLE LOCATION - SEWAGE # VILLAGE Osn, �� ASSESSOR'S MAP & LOT - / INSTALLER'S NAME & PHONE NO. GO R--O .l�y w��v, '���a'��q0 SEPTIC TANK CAPACITY 3.1000 GP«ul LEACHING FACILITY:(type) G aM e fs (size) ' NO. OF BEDROOMS ///4 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ��CeR�I lc � lcr� C(A - Cr,2jll DATE PERMIT ISSUED: /� i�C/' -,qdZ DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �� e C. log ' GAILI 9-,f D I�ox qy IY cpO �i= 33Q TOWN F BARNSTABLE e LOCATION G SEWAGE # 1oZ'/6 VILLAGE CO57cn �t ASSESSOR'S MAP & LOT INSTALLER'S NAME 6 PHONE NO. Go RUo��r.".j -L(a -�6 y o SEPTIC TANK CAPACITY 31 00o GArtivh LEACHING FACILITY:(type) G A e is (size) I tf NO. OF BEDROOMS N�f PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER s7eN-J (e „` ` c ,.,1 eS � v _ � '7 DATE PERMIT ISSUED: /d a9 DATE COMPLIANCE ISSUED: - VARIANCE GRANTED: Yes No 4 l N oo N ��?Aikkj�4 6 cc�� r f t It � 109 ' GA 10 _THh-a'- 1 =y' •� 2 Fes: I 1ez: ,2 i_ ROSE: ,-., .' Ai=.`-HT Rri P _ 1=y :a, c� OSTERVILLE ANGLERS" CLUB 5' 13GARu OF u1RLCIORS P.O. Box 395, Osterville, h1n 0265.5 Cad Ricdell Ro(lr,r cKMwill January 10 , 1992 Ka, hfruphy Rkhar,( F.pin $Iephcvr Runw'll W i I I i a m N y e Robol Sampson Baxter and Nye , Inc . l;,u! Ma-11skcv; Jr. 812 Main s t r e e t Ostervi11e , MA. 02655 Dear Bill , As discussed , we are 'proposing to add a second floor to the Black cJ«11 . The restaurant will remain unchanged with the thirty--two seats , The second floor will be used by the Osterville Anglers C1 ub. We anticipate having a maximum of fifty people , six days total ,, in the course of the season. The balance of the time we expect 'ono more than fifteen- people , If you have any questions , please call me . Since I , 12ichavd B , Eg RBE/nk mw Ln ' .� F ru a Oj ru Postage $ C3 CoMfled Fee 2 , 3o V °' I A1�G Z Retum Rerpt Fee f !5 , Here QPdoreem.M Required) a (EndolBertleMRegryg; USpS 0 Total Postage a Fees $ ,4 Z per- Sent To 1� Cl ►D� D �'q -/girosbv &b � or PD Box No. d p - M1 City,Stets,ZIP+4 S /(![ D Z SS II Certified Mail Provides: E o A mailing receipt o A unique identifier for your mailpiece n A signature upon delivery o A record of delivery Rept by the Postal Service for two years Important Reminders: n Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. o Certified Mail is not available for any class of international mail._ o NO INSURANCE COVERAGE IS PROVIDED with Certified'Mail. For valuables,please consider Insured or Registered Mail.' o For an additional fee,a Return may Receipt p y be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on,your Certified Mail receipt is required. j n For an additional fee, delivery may be restricted'to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Deliver}/'. o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. WPORTANT:Save this receipt and present it when making uiry. 800,January 2001 (Reverse) 1025954-01-2425 C17 ETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. nature it6;u 4 if Restricted Delivery is desired; ,. Agent ■ Print your name and address on the reverse X Addressee so that we can return the card to you. B. Rec ed by(Printed Name) C,n to of Delivery ■ Attach this card to the back of the mailpiece, l]Oi 'LJ or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No t 3. Service Type ;Certified Mail ❑ Express Mail M14 d Z&SS ❑Registered Return Receipt for Merchandise �� vrt" ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number PH, 194Q . QQQ4 9Q42 2Q65 (transfer from service labeq [.V PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1540 i UNITED STATES POSTAL SERVICE' �'. First>Class,!Vlail Postage&Fees Paid c LISPS t 3 A Y Permit No.G10'k ' c-u-� I • Sender: Please pr t your name, address,and'ZIP+4 in thls'box' 3� I I Public Health Division Town of Barnstable I 200 Main St Hyannis,Massachusetts 02601 i i III i;;iii;;,li;.:::i:iiiiIlii:i;:i;i:i IVIDTOWN OF BARNSTABLE LOCATIO 0 / a WAGE #_ VILLAGE��,���,�� ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY J,o00 LEACHING FACILITY:(type) (size)_`''( NO. OF BEDROOM S�PRIVATE WELL OR PUBLIC WATER ------------- BUILDER OR OWNERE C,.�6c DATE PERMIT ISSUED:_ �Q a4-9a DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No CrT 961 31 �01 _ ��,� (,�cz TOWN OF BARNSTABLE16 -0 LOCATION ��vsh �2C1 SEWAGE # 7a _A/ VILLAGE 0.57e`n, t ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 3iaao GPJlv�l LEACHING FACILITY:(type) l�F��le�S (size) NO. OF BEDROOMS /YA PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER STeR-:l�c �h �� c u - DATE PERMIT ISSUED: m -C;L DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes —No_p C.aou WA log / CA �� � y Cjb,P,d { t t j Gredsa_ X�® 1�5 i • � I ti f� { { K i � d G� # alaoesp s�t�e/ t.► �' _..w-----e a-n, _e��.z__..._e.,�-��..-__...�. .:mow.,___ �►; ;L,.`3.=._ `A��.«"'.,`r t� _;.,� �...���...s�..,w..--•-�=`- - __ OF BARNSTAB`BLES 3�0 LOCATION SEWAGE # VILLAGE p �.2v�� '� ASSESSOR'S MAP & LOT I N 0 2-V INSTALLER'S NAME & PHONE NO. 'G o 2 0 e���. �s— qa8-s%�o SEPTIC TANK CAPACITY � eOo GA- LEACHING FACILITY:(type) (size) 3 NO. OF BEDROOMS /SY4 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNERc�,g2� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: I 17-9 a— VARIANCE GRANTED: Yes No y ��� � � . ., �`� � _ -� �� � - ,. ��', ,a�' S��'G °�� 33���i I. S®� ��� �t �n � �� e c, 1�l ar�/(` �-�Z� �� ObWN OF BARNSTABLE 33o f LOCATION SEWAGE # 9,5R 1Z VILLAGE w�fc�k'v�`� ASSESSOR'S MAP & LOT / INSTALLER'S NAME Ct PHONE NO. T—, SEPTIC TANK CAPACITY 3,C)po Ge,c��•i LEACHING FACILITY:(type) �9 <<P4S (size) �L( NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER Cu c � DATE PERMIT ISSUED: /D -C�4"902. DATE COMPLIANCE ISSUED: /Oln VARIANCE GRANTED: Yes No � ' 31 - ® ?vMf Town of Barnstab* �� ` Regulatory Services M Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 20, 2003 Mr. Richard Boy Zoning Board of Appeals RE: Keeper's Restaurant, 72 Crosby Circle, Osterville/Further Clarification Dear Mr. Boy, I am responding to your inquiry earlier this morning in regards to the septic system capacity at 72 Crosby Circle. The existing septic system has a design capacity of 1840 gallons. During site plan review, we were informed that only thirteen persons maximum frequent the Anglers Club (13 persons X 10 gpd= 130 gallons), with an average of only eight persons per day. This leaves 1710 design gallons for the food service facility(Keepers). Thus,there is capacity within the food service establishment for the number of seats requested 1710 gallons divided by 35 gpd=49 seats. Hypothetically, if the entire facility were to be used for food service (food preparation), the existing septic system has the capacity for 52 seats. Sincerely yours, Thomas A. McKean, RS, CHO �JOLTA SA IS(A W!:j cc CA- C)CUS MAP CO 01 f! e A P Z,Aj G is AP 14.q reATF 12-0 14. 33-11 Ole, -----------r I4 C-f2A IZ-n. 16.4 FA eq Fume LO 7;............444 k 13 I>%Q_'T S Pq J2,6 A. /1.0 %n)C2/Oc))z c 4-log(L c v C-Or A M O V. b-, 10.0 LocAna>T_ .4 F ..................................3 L wArep_ I 0 lie t loez.i 4y 10- A54 Ap 4 141.r . ........ /01*Af/ly r ftft VAJ r_-D &1/461 Al (AJO Fb;JAJ 709 rl C --.6,_"I L P.4- 7 1 4!A/45 ET2� .............................lie 4.9 I ------------ Ia 10, z 6 PA 7->0 e I... ...........0 —?-L C— I 22 L AvLL U�4 DE 0.(s�e-CKJ 7 A uI -4AJ ASS UMG 5"4Cy- OAZ .3z -3 1 C> *V-t C�<?_-Z�l co M 4-,Teu L-7 t O I V2 6L (f J> - -------_-- ;!4f'A&J C-tC)25 /O s C) r7.qL Poe. DAY.0 '51yr ;r soft(F-qrS ­----(/),/00d C L 6�7_e'q�S�Z T4 PQMJ9 CA(,q M eL'___e L/s 8- /O 4!A 4--' IGZJ LES 5 )(4+G�7 W 4 LL OE'A 44 2.1 8 7- 7 P. -"(>A r10/%I /2,4 Tp- _H JAJ OJZ E&T OF AT-e�jb EE E_13 IE UA W 10 (4 Seetk .40.e Dr-PEA S72A Q, -1 i im rat .0 . . . . . .4*& SIA a 4r oil it-MD 0 :300d '6�( Box OnlTo M I N v- %I, INV 4.to' MP 4.80 Se?T\c- 7 om+ 4-MAW ge F1 4E L v N S. n dTCUL KIM At cover- &-44;Q(zX_Ft-ti514 -Uno F7%tA%_,+4 AJ16 �S C A LCFZ,�) -r,7zr--V iz P-79 44-.......... �'Wy��= t>�C U-Se FC>IR KIEE_rIL -rium, ^r_jc)� pqR lrl^L- L_,OkrjI:>MCOkpE C>"L--,r 4.4Lf I2!Ndq 4!:-3 _3Ta 11\11 LLG-�R wsl !STC>Q s 2�_ 14- 4' SCA 19(3 1\>o F1 C:U M Q V\N qrue.L 2.91 Ea C-T, V 419 7T_.7_ LUXE: MA?UMP C"pMjaU _r _BS C,-flzAv 5 s.F-n c- 7A w K ATE?-P�Zco�-�A ATs, c.r- AQ' G-f'6k_y PETER.-VILUVAII -t�_7-1 HE M FIS 71Y4 a fAj 11 p S AR.G.L gjEq\SIe Fj:j AND M\JST A L-rt--Q-JQ A-r=- aT ILL(B) BE M1015TUPLE FMCOF AQO 10 PSIZATE I W I C,-. IL If(6) QMF 011 (A ALA P-Pi 0 Q Akio c P LA 7 k-NS nASIZID 'O K� 1\�,GdT4 FUMpS SHA LL: E3�5 i Fp sO w M4 Am A(_AV_t4\ Fovic-giz-o SY A!�-,EFARLATE' C-12r-ULT F\jNp 'FaWGR, 1?00?NMPS 7a eE IKSTNUJ�z- lb3 e-M%C:r CcQFbr2_HAP=- WIM4 MA&.�uFA(CT-Qp_c-e;- R E v SP15�1 F( A 0-6--S�4 4 Lf,�� S cAFABLS (5rr- PA-S!�wC,411-40 F u • ' °� 35. S-4 5 S 3 do Nye e�sS .. ► � Lai . M C;hILI t� T�h-3! •-cam , i�` �'i C"r 24 CA7C f•}• a z cg G� MAR 1 0 2003 TOWN OF BAFeNS7ABLE BUILDING DIV. Oi a SULLNAM old 29733 •- �ski L��� PARTIAL LA pSCAPE/UTILITIES Ora - ;E ATTACHED FOR PARKING-"LAN ; .w I" YXC H-r ---/AOP I 20 _-T S45 4 do i �RvQ. 45 \� vie z` e,l?A C k)S Imo'-UCTIG U G C�sS v1 �%I J ' cf;A,T_14 �Uhz i L ITEM C�u V11. r 24 e. co ►08°� ILI 3 �►.1 it �'� �i� � • �}�'� Z' to 9) PEM a StIUNAN y - c MO. 29733AL � �? r }A PARTIAL LANDSCAPE/IJT�jLIT1ES C. r oM v a SEE ATTACHED FOR PARKING PLAN B /�kZ= �� i t V i c._ RUR►J 0 F ?F=r��e-0 - QC-,P\U FJ60K Z mod. PayC"p-' 2�'o \c)K.3�L_. L_A-,t-Jp 5 u