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Home My WebLink AboutFORMERLY JOSEPH'S/ WYATT'S TEA - FOOD \ \ FORMERLY JOS£#H'S WYATT'ST£A \ \ ƒ \ \ \) Q q � §/ � q / � ƒ � ƒ � � \° \} \i \} }§ ` Town of Barnstable arns BOARD OF HEALTH 1+ John T.Norman Board of Health Donald A.Gaudagnoli,M.D. e,�nusr�u� � F.P.(Thomas)Lee,. Hyannis, MA 02601 Daniel Luczkow,M.D. Alt.aQ. 200 Main Street, y , Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems 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: 6 Issue Date: 01/01/2022 DBA: FIVE BAYS BISTRO OWNER: J&T FOOD SERVICE, INC. Location of Establishment: 825 MAIN STREET OSTERVILLE„ MA 02655 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IncloorSeating: 40 Outcloor5eating: 0 Total Seating: 40 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: u — For Office Use Only: Initials: i. Town of Barnstable Date Paid ( ( Amt Pd$ : .M,,ffrAB Inspectional Services �b 639. Check# Poa- ublic Health Division Thomas McKean, Director 2 JZA 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT:getV_ T zo Jm.` w cb,`Fwc-&L� isvo ADDRESS OF FOOD ESTABLISHMENT: Mw „w/p 9I C'��U(uje A4- MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 5A}415 E-MAIL ADDRESS: ku-ej2 un/�[Kx-L L o ryw - rctm TELEPHONE NUMBER OF FOOD ESTABLISHMENT: L TOTAL NUMBER OF BATHROOMS: 3 ✓ . WELL WATER:YES NO .. (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: V SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING _REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? "A IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?W TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) 1/ 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:Wpplication FormsTOODAPP 2020.doc OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES NO D.O.B OWNER PHONE # �Vx -774 �D ADDRESS_ )AAA CSC 0-5 CORPORATE OWNER:��T� 7� X a)(,�` CORPORATE ADDRESS: V &n c31". CL1; ►V 070;6 PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. � T 2. 3qME5 �u � �� / /&2, �►.�J j a �23 J2o 3 -� .aa a- SI N &E OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec. 3l'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 Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. »' BARNSTAUM, Paul J.Canniff,D.M.D. MA F.P. Thomas Lee Alternate z 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 6 Issue Date: 01/01/2021 DBA: FIVE BAYS BISTRO OWNER: J&T FOOD SERVICE, INC. Location of Establishment: 825 MAIN STREET OSTERVILLE„ MA 02655 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 40 OutdoorSeating: 0 Total Seating: 40 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q.n 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: �f Initials: Town of Barnstable 2d. ,AR„STAe�, Date Paid Amt I'd MASS. : Inspectional Services i . $ 1639. v Public Health Division Check# Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE 1A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: Q(�j { V 1 �A— MAILING ADDRESS(IF DI,FFERENT FROM ABOVE): n r E-MAIL ADDRESS: IQ TELEPHONE NUMBER OF FOOD ESTABLISHMENT: JlA 'f - SS,5,7 V� TOTAL NUMBER OF BATHROOMS: 3 WELL WATER:YES NO V.....(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:�� SEASONAL: DATES OF OPERATION:_/_/_ TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTU LER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) / r/ 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: �JJ � FULL NAME OF APPLICANT SOLE OWNER: YES NO D. 11�170 OWNER PHONE# K 710 (a-:30 ADDRESS 1 W�V\W6ye- P-A ( Z&55� CORPORATE OWNER: Z--)gTSY� CORPORATE ADDRESS: j f_n 01-05r7/ 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 n Mo s U-7-k 14 / 23 2 2. An(JOr�K3 i74F-r S GN URE OF APPL CANT 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.asy. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1 st. I Q:Application FormsTOODAPP REV3-2019.doc 0� Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. BAMSTAOM Paul J.Canniff,D.M.D. MASS 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate .Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 6 Issue Date: 12/10/2019 DBA: FIVE BAYS BISTRO OWNER: J&T FOOD SERVICE, INC. Location of Establishment: 825 MAIN STREET OSTERVILLE, MA 02655 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 40 OutdoorSeating: 0 Total Seating: 40 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: CA FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: c For Office Initials: "'E' .� Town of Barnstable Date Paid Aid$ ' ICZ— • MUM STABLE, Services �- 9eLe. t ._. Chec #k 1 '� Pr t s63q. ,• Public Health Division �. �FDMA�� Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 ' Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FWD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: ��\167 "Me Pj I ADDRESS OF FOOD ESTABLISHMENT: k2-5- M Ad 1/1 St. iE- MAILING ADDRESS(IF DIFFERENT FROM ABOVE): 5AYyvr- E-MAIL ADDRESS: }6y-"�I_ \ojAa (J, QaY i L& -uyn - TELEPHONE NUMBER OF FOOD ESTABLISHMENT: (%�)'7W - nj�6 TOTAL NUMBER OF BATHROOMS: 73 WELL WATER:YES NO ✓... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:V/ SEASONAL: DATES OF OPERATION:_/ / TO NUMBER OF SEATS: INSIDE: 4M OUTSIDE: TOTAL: 40 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? P A IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 QAApplication FormsTOODAPP 2020.doc u OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/ O D.O.B 2 V OWNER PHONE# 55� -77tp ADDRESS Z� 1l �- CORPORATE OWNER: �1 i-T— CORPORATE ADDRESS: Ez PERSON IN CHARGE OF DAILY OPERATIONS: t 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. ASOAM "A )•1' t3LA k) / 00 1,TIl'Y ojN C --nvv�-t-lY.� uzl� z ZI 2.I fl1�� T i --/ 1 H-/ - IGN URE OF APP CANT 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 I st to Dec.3I't each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC Ist. Q\Application FormsTOODAPP REV3-2019.doc *y T BOARD OF HEALTH Town of Barnstable Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. BAIMS ABLL John T.Norman F.P. Thomas Lee Alternate $ ins• 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 199 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: 18 Issue Date: 12 20 Permit No: 6 / DBA: FIVE BAYS BISTRO OWNER: J&T FOOD SERVICE, INC. Location of Establishment: 825 MAIN STREET OSTERVILLE, MA 02655 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 40 OutdoorSeating: 0 Total Seating: 40 FEES - FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: - - - - ---- --- —- MOBILE-FOOD: MOBILE-ICE CREAM: G FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: . FTNE � For Office Us ! • Initials: o� Town of Barnstable Date Paid � W Amt-Rd$ OJU ^B Inspectional Services 9GL 1639• IY,0$ (Y _ arEo ° Public Health Division Check# Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATEy A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: � 15�12 ADDRESS OF FOOD ESTABLISHMENT: (Z-- J TlilZll VC �S� MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: TELEPHONE NUMBER O FOOD ESTABL SHMENT: W) - TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO_AZ ... (.ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: (0 OUTSIDE: .—A—TOTAL: C�3 SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) V FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q:W.pplication FormsTOODAPPREV2018.doc s - s PLEASE CALL 508-862-4644 OWNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/ TO D.O.B (-7D OWNER PHONE# K -7-7� CP3Ul7 ADDRESS_ Z57 lfy�/ —Lc ` kc' CORPORATE OWNER-,A St✓ O(CIJ5 FEDERAL ID NO. : 3LO d(o l(Dz CORPORATE ADDRESS: S(4A-� PERSON IN CHARGE OF DAILY OPERATIONS: �� <S6V2 L K-3too. I 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. A19" Hnm gUn) )I / / 702 l.;►M so-)Z A it / Z3 / 2.J+ '► �ul�scan / G1 /ZOZD69 YV il SIG TURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at htti)://www.townofbarnstable.us/healthdivision/api)lications.asy. 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 1 st to Dec.315`each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. QA Applicaticn FormsTOODAPPREV2018.doc Bellaire, Dianna From: McKenzie, Marybeth Sent: Thursday, January 10, 2019 8:29 AM To: Bellaire, Dianna Subject: RE: 2019 Food Permits Pending Status List Nice job! Five Bays is all set though. From: Bellaire, Dianna Sent: Tuesday, January 08, 2019 3:56 PM To: Stanton, David; Miorandi, Donna; McKenzie, Marybeth Cc: McKean, Thomas; Bellaire, Dianna; Crocker, Sharon Subject: 2019 Food Permits Pending Status List Hi everyone; I've processed all the annual applications that have come in to our office. Here is the list of people that haven't applied or haven't given me some part of their application. Donna, I've placed all the MOBILE trucks on your list that have applied. Please review the list. If you have any questions, let me know. If you can help in any way,that would be great. I will be making follow up calls but, most haven't responded to initial phone calls. Thank you. Dianna Bellaire Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 P:508-862-4643 Fax:508-790-6304 Email:Dianna.Bellaire@town.barnstable.ma.us 1 Bellaire, Dianna ��- 'J S From: McKenzie, Marybeth Sent: Friday, December 21, 2018 1:30 PM To: Bellaire, Dianna Subject: Five Bays Just spoke with the plumber and they re-installed the mop sink so you don't have to hold the permit.Thanks. Mb 1 `pf INE rok. TOWN OF BARNSTABLE _ HEALTH.INSPECTOR's Establishment Name: Date: Page: t of 2- OFFICE HOURS r ° PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. MON.-FRI. .639• `0� HYANNIS, MA 02601 No Reference R--Red Item PLEASE PRINT CLEARLY tFo Ma+° 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT t3 Name V� S 3 fi,b Date �� Tvoe of TypLof InsRection outine Address Z � Risk ood S Re-inspection 3 �/ Level Retail Previous Inspection 17 �y) S 0- Telephone Residential-Kitchen Date: / Mobile . Pre-operation S U1U�/l °V Owner HACCP Y/N Temporary Suspect Illness ICPivi J c,/ t �6v� Caterer General Complaint A p�� Person in Charge(PIC) d -3 06V--3'c� Time Bed 8 Breakfast HACOther �k�- fb In: , Inspector s Out: Re) .r�,.¢_ - mod lZo (o S � Each violation checked re uires 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 59U.009(F) Alj2 -- d Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ / �L-9151L FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities i q EMPLOYEE HEALTH PROTECTION FROM CHEMICALS l"\ t ❑ 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 1 Lo1,C ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling - ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding _ I 1 PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control t9 Yam- d"1 V'L�tl ❑ 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 P7� r) y�x ,� wics c00d. Critical(C)violations marked must be corrected immediately. (blue&red items) l V r y Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating `v within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. Embargo Emergency Closure ❑ Voluntary Disposal Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B-One critical violation and less than 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 C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to anon-critical violations. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8non-critical violations=C. w 29.Special Requirements (590.009) y p 30.Other DATE OF RE-INSPECTION: Inspector's ig re Print: 31.Dumpster screened from public view /,z 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 ure Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N r-�,._ . }�.`- �,,.� .,_r"• 'w _.�.,eL ..-..r•.-.^r-... .-rrr ,.+`...�- +.�.. t... .i --v...... .�. -.._ n.. . --sue.. . .-S"+a .,� rA.- -° r _-. - ^ A... '�' - .._ - +'t F>.�`,�. \r Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) �'- FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 6 Cross-contamination 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 3-202.1-2 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* 8 g 3-501.16(A) Hot PHFs Maintained At or Above 140°F* ( ) P ty7-102.11 Common Name-Working Containers* 3-501.16 A Roasts Held At or Above 130°F* Require Reporting by Food Employees and Contamination from the Environment ( ) 7-201.11 Separation-Storage*Applicants* P g 20 Time as a Public Health Control 3-302.11(A) -Food Protection* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 17.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed'Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Ho[Water Monitoring* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* - 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathogens* s/f cnw tnnoor 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* ( )O J Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g �' 590 f109(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g' P a'Y 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and AutWildhority Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3=202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. * 2-301.14 When to Wash* 3-401.11 A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 590.004(C) Wild Mushrooms ( )( )( ) 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23.30) Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 13 Handwashing Facilities 3-202.18 Shellstock Identification* 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70'F to 41°F/45°F P Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Cade or 105 CMR 590.000. *HET TOWN OF BARNSTABLE, HEALTH INSPECTORS Establishment Name: � 1 S J�ry of oq, Date: Page:; Z- of ' � OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 7 63q. `0�' HYANNIS, MA 02601 MON.-FRI. No Reference• R.-Red Item,. - PLEASE PRINT CLEARLY �A 508-862-4644 lFO""A�a FOOD ESTABLISHMENT INSPECTION REPORT Name r Date Jype of Type of Inspection 9�1f `7TYOperation(s) Routine (n WINN - Address (/l/� -� r%- 6S�- Risk Food Service Re-inspection Y rr�n J'I Level Retail Previous Inspection Telephone Residential Kitchen Date: nn Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other Inspector I/ Q Out: (, f 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) ❑ how. `�v� �" 70 Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ CQ- '�"GZ b� vt6428%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 ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives 6 � � f ❑ 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 \Jw`.�'�Vt�� tx-d - ❑ 5.Receiving/Condition ❑ 17.Reheating 49- C&a, a, 10D 1L ❑ 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 I� ( I ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY t CY C� ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations c-R- W Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. Embargo Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food B=One critical violation and less than 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 6 non-critical violations=B. Seriously Critical Violation t F is scored automatically o la hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non critical. If no critical " water,sewage back-up,infestation of rodents or insects,or lack of ( )( ) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials FC-7 590.008 g violation,4 to 8non-critical violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 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* g Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-501.15 Cooling Methods for PHFs 3-302.11(A)(1) Raw Animal Foods Separated from 3-202-.12 Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties - Cooked and RTE Foods. 3-302.14 Protection from Unapproved Additives* Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45'F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * . 2. 590.003 C Responsibility of the Person-in-Charge to Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F ( ) Y P 7-102.11 C mmon Name-Working Containers 0 Require Reporting by Food Employees and Contamination from the Environment g 7-201.11 Separation-Storage* 3-501.16(A) Roasts Held At or Above 130°F Applicants* * 20 3-302.11(A) Food Protection* 7-202.11 Restriction-Presence and Use* Time as a Public Health Control 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility of A Food Employee or An 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 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 Raw Seed Sprouts Not Served 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 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 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145F 15 sec° * Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eff°eve tivzoot 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* R 590.006(B) Water Meets Standards in 310 CM 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from N$SP Listed Chemical* g g �' 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- * Ratites-165"F 15 sec* in mobile food,temporary and residential Sources g. P arY 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 practiceRequires should be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-403.113-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) 12 Prevention of Contamination from HandsRemaining * Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* (E) Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 16 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A 3-202.18 Shellstock Identification ( ) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 Tags/Records:Fish Products P * 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 1 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 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. i V/q`Qp(NE fps , TOWN OF BARNSTAB.LE _ _- _ :HEALTH INSPECTORS Establishment Of Name: 1,�� y Date: Page. . v ~u OFFICE HOURS 17/ PUBLIC HEALTH DIVISION 6:00-930A.M. BARN STABLE. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ,659. `0$ HYANNIS,MA 02601 M-8 -464FRI No Reference R-Red Item T��PRINT?Rq �prao MAC° 508-862 4644 F OD ESTABLISHMENT INSPEC1110N REPORT Name Date a ofInspection p Routine Address Risk (food Serv� nspecti n Level Previous i n� VU Telephone Residential Kitchen Date: Mobile Pre-op t Owner HACCP YIN Temporary Suspect Illness C Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other Inspecto t: . Each violation checked require an explanation on the narrat a 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 Tnhacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities s EMPLOYEE HEALTH PROTECTION FROM CHEMICALS 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 TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) 4 A ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18..Cooling � 1 ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) I F! 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP, oip(g X - -) // I* ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY - ❑ 11.Good Hygienic Practices BW ❑ 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) la1 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,th ms ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils FC-4 590.005 B=One critical violation and less than Orion-critical violations 9 ( )( ) cited in this report may result, 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 9rion-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 7.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 no critics violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violation,4 to 8 non-critical vi tion -C. 29.Special Requirements (590.009) within 10 days of receipt of this order. ` 30.Other DATE OF RE-INSPECTION: Insp ct 's na ure rint: 31.Dumpster screened from public view7,M_7� 1 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 Print: �. Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N r 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* $ Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* * 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Additives Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11 A 2 Raw Animal Foods Separated from EachIdentifying * 590.004(F) ( )O P 7-101.11 Information-Original Containers * g 3-501.16 A) Hot PHFs Maintained At or Above 140°F* 2 590.003(C) Responsibility of the Person-in-Charge to. Other 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* 3-302.1](A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*Applicant To Report To The Person In Charge* 3-304.11 Food Contact with Equipment and Utensils* 7.202.12 Conditions of Use* 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 Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 1$ Proper Cooking Temperatures for PHFs - CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.1]A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of * 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System gg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg ewe uuzoor 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-Hat Water and 3-401.l l(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 sec* Sources* ing,mobile fund,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 Requirem npracticesos]d be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165*17 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commerciall Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity y Critical and non-critical violations,which do not relate to the foodbome 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 8 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 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 3-402.11 Parasite Destruction* Temperature Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26.. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of ingredients' Supplied with Soap and hand Drying Devices 27: Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials I FC-7 .008 HACCP Plans 6-301.I2 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. i °FZr+E roN o TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date:* Page v� ti OFFICE HOURS -�- PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. • 200 MAIN STREET 3:30-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified a3q: HYANNIS,MA 02601 508-862-4644 No Reference R-Red Item PLEASE PRINT CLEARLY q'ED MP�� F_ OR ESTABLISHMENT INSPE TI N REPORT Name Date a of Type of Inspection eratio s Routine Address Risk Food Service Re-inspection L? Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness �! Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other InspectorAttz:) Out: n O Each violation checked requires n explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals Q FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) IT ❑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 y ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories Z` 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. 25.Equipment and Utensils 6=One critical violation and less than 4non-critical violations 9 (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If 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 viol 4 to 8 0 -cri' al violations 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspec n ur Pri f. 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 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* 6 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 Cooling Methods for PHFsated from 3-202.12 ' Additives* e 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 590.004(F) 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * Require Reporting by Food Employees and Contamination from the Environment 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 * 3-501.16(A) Roasts Held At or Above 130°F _ 7-201.11 Separation-Storage* Applicants* P g 20 Time as a Public Health Control 3-302.11(A) Food Protection* 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements 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 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 Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served Y P 7-206.13. Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 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 5-101.11 Drinking Water from an Approved System* gg Not Otherwise Processed to Eliminate Equipment* 590.006(A) Bottled Drinking Water* .- 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* eg cnw mnooi 4-602._11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(I)(2) Pork and Beef Roast-130°F 121 min Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-A01.11(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- Croper, l 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 W/Id 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. h*W 2-301.14 When to as * Other 590.009 violations relating to good retail practices sh 590.004(C) Wild Mushrooms* 3 401.11(A)(1)(b) All Other PHFs-145°F 15 sec 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding Requirements]d be debited under#29-Special 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* (Blue Items 23-30) g �ty 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* 16 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°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3 402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 1 Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 1 Hand Drying Provision 29. 1 Special Requirements 009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Forynback6-2doc *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. II -- a � `oF. Tow TOWN OF BARNSTABLE HEALTH INSPECTOR's Establishment Name: J Date: Page: of _ 6 OFFICE HOURS PUBLIC HEALTH DIVISION ` 8:00-9:30 A.M. enrtNsrna�e. 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 03 HYANNIS, MA 02601 M- No Reference R=Red Item PLEASE PRINT CLEARLY pTED MP'�°i 508862-4644 64 FOO ESTABLISH ENT INSP C ON REPORT Name Dat e o Type of Inspection p Routine Address Risk rood Servi Re-inspection Level Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary ess Caterer enerai p aI Person in Charge(PI Time Bed&Breakfast Other Inspector W(s) Each violation checked requires an explanation on the narrative 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 o EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by rood Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control. ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) � ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP / ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories I-lJ� \✓ - Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No ❑ Yes- Non-critical(N)violations must be corrected immediately or within 90 days as determined by the Board of Health. Overall Rating ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below b a Board of Health member or its agent 24.Food and Food Preparation (FC-3)(590.004 p g Y 9 A=Zero critical violations and no more thananon-critical violations. F=3 or more critical violations.9 or more non-critical violations, constitutes an order of the Board of Health. Failure to correct violations B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.Equipment and Utensils , (FC-4)(590.005) cited in this report may result in suspension or revocation of the food if no critical violations observed,4 to 6 non-critical violations=B. 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less.than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 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 n iota ical violati ns. If 1 critical refrigeration. within 10 days of receipt of this order. violation,4 to 8 non-critical viola'ons=C. 29.Special Requirements (590.009) Y p 30.Other DATE OF RE-INSPECTION: Ins to Signature Print: 31.Dumpster screened from public view. 69 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N �/ #Seats Observed Frozen Dessert Machines: Outside Dining Y N IC's i ture 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* $ Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties - 3-302.14 Protection from Unapproved Additives* ' Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* * Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* , Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F Applicants* Protection* * 7-201.11 Separation-Storage* 20 Time as a Public Health Control PP 3-302.11(A) Food Protection 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 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* q Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and g 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY Concentration and Hardness* 22 3-603.11 Consumer Advisory Posted for Consumption of 3-202.16 Ice Made From Potable Drinking Water* 3-401.11A(1)(2) Eggs-155°F 15 sec Animal Foods That are Raw,Undercooked or 5-101.11 DrinkingWater from an Approved System* 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* PP Y Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Egeaive 1112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR.22.0* Cuutact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hat Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* in mobile food,temporary and residential Sources g P 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165*F* 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 practices should be debited under#29-Special 17 Reheating for Hot Holding Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165*F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity ( ) y Critical and non-critical violations,which do not relate to the foodbome 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 3-501.1 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification � ) 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70"F to 41*F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 3 402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-20 .11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. 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* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. �p 114E r TOWN OF BARNSTABLE _ HEALTH INSPECTOR'S Establishment Name: Date: _ Page: of 4 OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARN STABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �p 639. `m� HYANNIS,MA 02601 soa 8' -Fasaa No Reference R Red Item PLEASE PRINT CLEARLY. - , FOOD E TABLISHMENT INSPECTION REPORT Name Date o Type of Inspection O R Address Risk ' ood Servi e-inspection '� Level vious nspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed 8 Breakfast HACCP In: Other Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen 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 Log-ry�!, ❑ 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) I 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 4 non-critical violations 26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If if no critical violations observed,4 to 6von-critical violations=B. Seriously Critical Violation=F is scored automatically if: no hot 27.Physical Facility (f C-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 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 8non-critical violations=C. 29.Special Requirements (590.009) Y P 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view A� Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N s Signature Pri Self Service Wait Service Provided Grease Trap Size Variance_ Letter Posted Y N 1 Dumpster Screen? Y N Violations related to Foodborne Illness Volatlonsr Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.),,n ,. FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS �t 3-501.14(C) PHFs Received at Temperatures,According to 1 590.003(A) Assignment of Responsibility* 6 Cross-contamination Food.or ColorAtld+twes„ Law Cooled to 41°F/45°F Within 4 Hours* 14 ...v,.. ._. _. .. 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 i 3-302 14 Protection from Unapproved Additives - Contamination from Raw Ingredients 15 Poisonous or To'Ic 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 7-101 11 Identifying Information-,Original Containers* 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or AboJe.140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* 3 -7 201'11 Separation-Storage" Applicants* * P g 3-302.11(A) Food Protection 3-302.15 Washing Fruits and Vegetables 20 Time as a Public Health Control - 590.003(F) Responsibility of A Food Employee or An ` 11� Restriction Presence and Use* 3-501.19 Time as a Public Health-Control* ; 7 202 Applicant To Reporl 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 Reservice of Food* 7-20412 Chemicals for'Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated 'g � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* -77205.11 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 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* Raw Seed Sprouts'�Not Served*` 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures 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. 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 * Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* ( ) Eggs-Immediate Service_145 F 15 sec Equipment* - Not Otherwise_•Processed to ;Eliminate .. .� 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* E�ctiw 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 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,temporaryand residential 10 Proper,Adequate Handwashing •� ,•: - Game and Wild Mushrooms Approved By 3-401.I1(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 es should violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 9 g practices should be debited under#29-Special Reheating for Hot Holding 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*_ __-_.ci:3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* * (Bhieitems`23-30)`•' 3-202.15 Package Integrity g g i 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 11 E Remaining Unsliced Portions of Beef Roasts* 3-101.11 Food Safe and Unadulterated O g_ illness interventions and risk factors listed above,can be found tn.the, 6 TagslRecords:Shellstock 590.004(E) Preventing Contamination from Employees*;.:, "fig Propej,Cooling,of'PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashin g Facilities 3 501.14(A) Cooling Cooked PHFs from.140 F to 70 F * 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 TagslRecords:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3 501 14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction - Temperature Ingredients to 41 F/45.F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance --. Within 4 Hours*" ° 26. Water,Plumbing and Waste FC-5 .006 Labeling of Ingredients* Supplied with Soap and hand Drying Devices.. :... 27. Physical Facility FC-6 .007 Approved 6-301.11 Handwashin Cleanser,Availability 2g• Poisonous or Toxic Materials FC-7 .008_7 Conformance with roved Procedures/ g HACCP Plans 6-301.12 Hand Drying Provision -`'' -' - 3` + 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S 590Formback6-2doc 'Denotes critical fterii in the federal�1999 Food..Code or 105 CMR 590'.000."'" *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000, -- - n , Gallant, Therese AY From: Miorandi, Donna Sent: Tuesday,August 4, 2020 4:21 PM To: Scali, Richard; Flynn, Margaret; Florence, Brian;Jenkins, Elizabeth; McPherson, Gloria; McKean,Thomas; McKenzie, Marybeth; Desmarais, Donald; Stanton, David;Winn, Michael; R. Pfautz(RPfautz@barnstablefire.org); Burke, Peter; David Webb (dwebb@hyannisfire.org); Sonnabend, Mathew; Gallant, Therese; 'Gallant, Therese'; Hadfield, Golda;Anthony, David; Connolly, Kathleen Subject: RE: Five Bays Bistro-outdoor expansion Hi Richard: I have reviewed the submitted documents and have no issues with their plan. Thank you. Anna_Z. cJVGioranez, A. Town of Barnstable Health Inspector Public Health Division 200 Main Street, Hyannis, MA 02601 The information contained in this electronic transmission re-mail"),including any attachment(the "Information"), may be confidential or otherwise exempt from disclosure. It is for the addressee only.This Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre-decisional in nature.As such,it is for internal use only.The Information may not be disclosed without the prior written consent of the Director of Public Health and/or the Town Attorney's Office of the Town of Barnstable. If you have received this e-mail by mistake, please notify the sender and delete it from your system. Please do not copy or forward it.Thank you for your cooperation. From: Scali, Richard Sent: Tuesday, August 4, 2020 3:25 PM To: Flynn, Margaret; Florence, Brian; Jenkins, Elizabeth; McPherson, Gloria; McKean,Thomas; McKenzie, Marybeth; Desmarais, Donald; Stanton, David; Miorandi, Donna; Winn, Michael; R. Pfautz (RPfautz(ftarnstablefire.org); Burke, Peter; David Webb (dwebbCfhyannisfire.org); Sonnabend, Mathew; Gallant,Therese; 'Gallant, Therese'; Hadfield, Golda; Anthony, David; Connolly, Kathleen Subject: Five Bays Bistro-outdoor expansion Dear all, Please find attached the last patio expansion application I have received. I did not want to have a meeting for one application so please review this application and plan for Five Bays Bistro. It is all on private property, has social distancing of tables.You only need to review tables 1 and 2; 12 -16 as these are the tables outside. If there are no objections,or if you have comments, please forward to me your response. If it is all set, I can administratively approve it. Thank you all! Richard 1 Richaid,V,,kScali, Esq. Licensing Director Town of Barnstable 200 Main St, Hyannis, MA 02601 508-862-4778 508-778-2412 fax 2 i V'U&((:�M Gallant, Therese From: Scali, Richard Sent: Friday,July 17, 2020 2:15 PM To: fivebaysjoyce@gmail.com; jamie.suprenaut97@gmail.com' Cc: Flynn, Margaret; Hadfield, Golda; Gallant,Therese; Gallant, Therese; McKean,Thomas; Florence, Brian Subject: Five Bays Bistro- outdoor patio Attachments: reopeningguidelinespressrelease.doc Dear Jamie, It has come to our attention that you have expanded your outdoor seating at Five Bays Bistro at 825 Main St. Osterville. Just as you did with Crisp,you must apply to add seats outside to be reviewed by the staff committee. I have attached the policy and application again for your convenience.Just send us the application and plan and we will get you on for review next week. Have a great weekend! Richard Scali Richard V. Scali, Esq, Licensing Director Town of Barnstable 200 Main St, Hyannis, MA 02601 508-862-4778 508-778 2412 fax 1 i Staff Review of Outside Expansion Requests 07/27/2020 Meeting to be held at 11:30 AM via ZOOM. INFORMAL AGENDA 1. The West End, 20 Scudder Ave, Hyannis — Expansion on private property, previously approved but applicant has moved outside location. 2. Cotuit Center for the Arts, 4404 Falmouth Rd., Cotuit - Expansion on private property. 3. Five Bays Bistro, 825 Main Street, Osterville — Expansion on town property (pending receipt of application materials) T:10 Staff Review Outside Dining Expansion requestsX07-27-2020 Applications Join Zoom Meeting https://zoom.us/j/94163086133 Meeting ID: 9416308 6133 1 Gallant, Therese From: Scali, Richard Sent: Tuesday,August 4, 2020 3:25 PM To: Flynn, Margaret; Florence, Brian;Jenkins, Elizabeth; McPherson, Gloria; McKean, Thomas; McKenzie, Marybeth; Desmarais, Donald; Stanton, David; Miorandi, Donna;Winn, Michael; R. Pfautz (RPfautz@barnstablefire.org); Burke, Peter; David Webb (dwebb@hyannisfire.org); Sonnabend, Mathew; Gallant, Therese; 'Gallant,Therese'; Hadfield, Golda;Anthony, David; Connolly, Kathleen Subject: Five Bays Bistro-outdoor expansion Attachments: fivebaysbistrooutdoorexp.pdf Dear all, Please find attached the last patio expansion application I have received. I did not want to have a meeting for one application so please review this application and plan for Five Bays Bistro. It is all on private property, has social distancing of tables.You only need to review tables 1 and 2; 12 -16 as these are the tables outside. If there are no objections, or if you have comments, please forward to me your response. If it is all set, I can administratively approve it. Thank you all! Richard Richard V. Scali, Esq. Licensing Director Town of Barnstable 200 Main St. Hyannis, MA 02601 508-862-4778 508-778-2412 fax 1 r APPLICATION FOR TEMPORARY OUTDOOR DINING NAME OF APP T: BUSINESS NAME: � ✓;I~t. i!'_t +_LJ f Ii4DDRESS OF BUSINESS: T)S i}if 1�tVV �I ��J l L,Y, MANAGER'S NAME(If different): BUSINESS TELEPHONE# '�,� yl CELL TELEPHONE# ( j�. �t/` EMAIL: _ i I! �I c� it r� �fV1: BRIEF DESCRIPTION INCLUDING DAYS OF WEEK,HOURS OF OPERATION,OTHER DETAILS:a MAXIMUM SEATING CAPACITY OF OUTDOOR DINING AREA,PLUS STAFF: c If you already hold a liquor license,would you like to extend alcohol service outside as well? Where is the outdoor dining area located?(check all that apply) 0 Private property I already have the right to use W'" Private property I have authorization to use with agreement ok/Public property(Town Manager License required) ADDITIONAL DOCUMENTS AND INFORMATION REQUIRED: o SKETCH OF OUTDOOR DINING LOCATION AND LAYOUT(see requirements attached) o SPECIFICATIONS OF OUTDOOR FURNITURE o PROOF OF AUTHORIZATION TO USE AREA(LEASE OR LETTER FROM OWNER/TOWN),IF APPLICABLE (write name) being the owner or manager of, L/,-, S fJ,4 (name of restaurant) located at��'S" 111VI W J I (address) ,acknowledge that they have read and , accept the responsibilities for restaurants herein, any and all mandatory state safety standards for workplaces and outdoor dining issued by the Commonwealth and will adhere to an Outdoor Dining COVID-19 Safpty Protocol Plan. i. ;w Signa ,',ire of Applicant Date THOMAS McKEAN, DIRECTOR . A Barnstable Public Health Department MAM Thomas.McKean@town.barnstable.m a.us 200 Main Street,Hyannis,MA 02601 BARNSTABLE PUBLIC HEALTH DEPARTMENT CHECKLIST The Boord of Health has authorized the Director of Pudic Health to issue variances to these requirements for temporary outdoor dining. If you believe your restaurant may need a variance from these requirements, please include this information in your application, DESCRIPTION YES NO _ R � All entrance and exit doors used by food service personnel and customers must be screened and provided with air curtains meeting National Sanitation Foundation standards. All windows or openings used for the transfer of food will have a self-closing screen on the window or have an air curtain. Food cannot be stored or kept outside.All food must be prepared inside the facility's kitchen and kept inside until served. Hose bibs with vacuum breakers must be available for washing down the dining area. Ir i Table tops must be smooth, nonporous,easily cleanable and durable, and readily maintained in a clean and sanitary condition. [NOTE: Picnic tables may be used if finished with polyurethane.] Food-service personnel must constantly police the dining area for wastepaper, garbage and other trash. Placement clips, cup holders and other such devices must be utilized to prevent blowing paper. Covered trash receptacles must be i provided in close proximity to the dining area and must be emptied as needed to ¢ prevent overflowing. Strict cleanup practices must be adhered to. Waitstaff and buspersons must clean up after each patron as in indoor dining. Outside food handlers must have easy access to handwash sinks and cleaning cloths. Facilities for preparation and disposal of sanitizing solutions must be accessible. Hair nets or other effective hair restraints, such as hats covering exposed hair, shall be worn by all outside food or drink handlers. Beards and mustaches must be neatly trimmed. ,F7 _ r Al r 4 _ a r - This Record of Training is awarded to Congratulations! You have completed ServSafe Re-Opening Guidance: COVID-19 Precautions J4fw 06k 20z0 Naticna-i Restaurant Association Issue gate 1x'rtYF` Scali, Richard From: Jamie Surprenant <jamie.surprenant97@gmail.com> Sent: Monday,August 03, 2020 2:02 PM To: Scali, Richard Cc: Flynn, Margaret; McKean,Thomas;Anthony, David Subject: Re: Five Bays App Just to clarify,tables 3 to 11 are all inside-yes Tables 1 and 2 are right in front of restaurant on on our property Tables 12 to 16 are on private property owned by Herb Pheeney of Oyster Real Estate he has granted us permission to use the space from S PM on..when his business as well as his tenants JMcLaughlin are closed. We do not have a formal lease for that space but I'm sure I could get one if necessary. I did forward an email in the original application where Mr Pheeney graciously offers for us to use that space. -Jamie On Aug 3, 2020, at 1:51 PM, Scali, Richard<Richard.Scali 0town.barnstable:ma.us>wrote: HI Jamie, Just to clarify,tables 3 to I 1 are all inside. Tables 1 and 2 are right in front of restaurant on private property or public sidewalk? Tables 12 to 16 are on private property-but is that common area? Leased to anyone else? Do you have this area in your lease? Richard Scali - -----Original Message----- From: Jamie Surprenant [mailtoJamie.strrprenant97(a2gmail.com] Sent: Monday, August 03,2020 1:29 PM To: Scali, Richard Cc: Flynn,Margaret; McKean, Thomas;.Anthony, David Subject: Re: Five Bays App Richard- Sorry again for the delay getting back to you. It is difficult to get an image of the outdoor set up in front of Oyster real estate due to the fact that we can't set up until 530 when their business is close and we get busy soon after. I was able to get this panoramic view that might give you an t v�l l L vzl_ bench 16 stairs 6ft+ <fence 6ft+ <fence #14 loft+ --r 6ft+ <fence our �� o� w s Fie 2 I OUT Z or MVf, POLY F-!1v`Jg 1 2 outdoor this 12'+apart 2 wv inside vuv 3 4 host G S i I � gA- F[�T�v bar I 8 7 11 9 10 ... �rd1f�11N - I Gallant, Therese From: Scali, Richard Sent: Thursday, August 6, 2020 11:03 AM To: Flynn, Margaret; Florence, Brian;Jenkins, Elizabeth; McPherson, Gloria; McKean,Thomas; McKenzie, Marybeth; Desmarais, Donald; Stanton, David; Miorandi, Donna;Winn, Michael; 'R. Pfautz(RPfautz@barnstablefire.org)'; Burke, Peter; 'David Webb (dwebb@hyannisfire.org)'; Sonnabend, Mathew; Gallant,Therese; 'Gallant,Therese'; Hadfield, Golda;Anthony, David; Connolly, Kathleen Subject: RE: Five Bays Bistro-outdoor expansion Seeing that I received no objections I am approving this application administratively. Richard From: Scali, Richard Sent: Tuesday, August 04, 2020 3:25 PM To: Flynn, Margaret; Florence, Brian; Jenkins, Elizabeth; McPherson, Gloria; McKean, Thomas; McKenzie, Marybeth; Desmarais, Donald; Stanton, David; Miorandi, Donna; Winn, Michael; R. Pfautz (RPfautz@barnstablefire.org); Burke, Peter; David Webb (dwebb0hyannisfire.org); Sonnabend, Mathew; Gallant, Therese; 'Gallant,Therese'; Hadfield, Golda; Anthony, David; Connolly, Kathleen Subject: Five Bays Bistro-outdoor expansion Dear all, Please find attached the last patio expansion application I have received. I did not want to have a meeting for one application so please review this application and plan for Five Bays Bistro. It is all on private property, has social distancing of tables.You only need to review tables 1 and 2; 12 -16 as these are the tables outside. If there are no objections, or if you have comments, please forward to me your response. If it is all set, I can administratively approve it. Thank you all! Richard Richard V. Scali, Esq. Licensing Director Town of Barnstable 200 Main St, Hyannis, MA 02601 508-862-4778 508-778-2412 fax 1 Wheelden, Linda From: McKean,Thomas Sent: Tuesday, February 10, 2015 4:00 PM To: Wheelden, Linda Subject: Re:GeoFlow Linda Will you please print our 4 copies of this for the Board Of Health Meeting that is currently in progress? Sent from my BlackBerry 10 smartphone on the Verizon Wireless 4G LTE network. From: George Heufelder Sent:Tuesday, February 10, 2015 2:49 PM To:Thomas.mckean@)town.barnstable.ma.us Subject: GeoFlow Tom: Per our recent conversation,you have asked whether the GeoFlow TM Pipe system removes nitrogen from wastewater. I submit the following: The GeoFlow is an alternative drainfield product which does not purport, nor does it receive credit for, removal of nitrogen from wastewater. I have attached both its Remedial Use and General Use Approvals from Massachusetts DEP. The system would have comparable nitrogen removal in our geological setting to a standard pipe-in-stone trench. I have not seen any data that indicate that this alternative drainfield product removes nitrogen in any way superior to standard drainfield materials. Regarding your question about nitrogen removing systems in general. As you know,there are a number of systems on the market. The FAST unit you referenced does have units specifically designed for nitrogen removal. In the high- strength setting of a restaurant, it is conceivable that the system could cost the $50K you referenced, however the systems are normally specified based on the strength of the waste stream. Unit costs range from about$18K on the low end to$36K on the high end. This does NOT include the tank that the treatment unit fits into.Add say$1/gallon for the tank(5,000 gallon tank=additional$5K),and you could get to$50K fairly soon. So, short story? $50K additional cost for N removal would not be out of the question, depending on the measured strength of the anticipated wastewater. r If you have any questions, please don't hesitate to call. George 1 825 Main Street Osterville; Five Bays Bistro septic plans for Board of Health Hearing 12/9/14 Staff comments: 1. Note: Food establishment permits for 40 seats, septic replacement for 50 seats proposed staff ok with 50 seats (note: estuary only, inspection showing over 50 seats in 2004 prior to estuary regulations, several septic permits no plans or capacities, 2. Test holes and perc tests not conducted. Must apply\pay for witnessed perc test, which can be done at the time of install and must be witnessed by Town. Will need revised plans once complete including the test hole\perc data. 3. Revised plans will need to include all 4 beds tied into the low vent manifold 4. Before permit can be issued system owner notification checklist to be submitted to Health. 5. Before permit can be issued deed notice to be recorded at Registry of Deeds and submitted to Health (because they are using Geoflow with remedial use per plans) Z Q:\septic\825 Main Street Osterville staff comments 2.doc Message Page 1 of 1 Stanton, David From: Stanton, David Sent: Wednesday, October 01, 2014 9:30 AM To: Michael Pimentel Cc: McKean, Thomas Subject: Five bays Bistro 825 Main Street Osterville Hi Mike, Tom wants me to run a question by you. The septic repair for the Board of Health hearing says it's a 50 seat restaurant, however all the Health Department Food permits are for 40 seats. Tom has some calculations in the file saying the can have 40 seats. There are 4 septic permits, none of them have engineered plans and also none of them have a number of seats on them. The applications for food permits have varied over the years ranging from 40, 46, 49, 50 and 77, however, Tom does not go by what someone else fills out on the applications, only by what is on the permit. Do you want to still move forward with the variance application and keep the 50 seats as proposed and risk the Board denying it or do you want to submit plans for 40 seats? Thanks, Dave 10/1/2014 Message Page 1 of 1 Crocker, Sharon / From: Crocker, Sharon Sent: Monday, November 10, 2014 1:24 PM To: 'mpimentel@jcengineeringinc.com' Subject: FW: 825 main street Thanks for getting back to me. ` Please be sure to provide us with four packages of any changes from the originally submitted BY MONDAY, NOV 24, 2014. 1OyThank you. Sharon � _ � ✓ 1t�/l1 0 ---Original Message----- From: Mike Pimentel [mailto:mpimentel@jcengineeringinc.com] Sent: Monday, November 10, 2014 12:25 PM To: Crocker, Sharon Cc: 'Rich Capen'; 'John Churchill Jr'; 'Amanda Cavanaugh' Subject: 825 main street Sharon: Please continue our project located at 825 Main Street to the next meeting agenda on December 9, 2014. Thank you. Michael Pimentel, EIT, CSE Project Manager JC Engineering, Inc. 2854 Cranberry Highway East Wareham, MA 02538 PH: 508-273-0377 Fax: 508-273-0367 11/10/2014 Town of Barnstable Barnstable °f SHE T°�y Board of Health j�"ecfty j I nAnNS'rAQLE,S. 200 Main Street, Hyannis MA 02601 MAS Q 2007 ArfD µp't A, Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi March 5, 2015 Mr. Michael Pimental JC Engineering, Inc. 2854 Cranberry,Highway East Wareham, MA 02538 RE: ' Five Bays Bistro Septic System Variances `825 Main Street Osterville A = 117-100 Dear Mr. Pimental, You are granted variances on behalf of your client, Jamie Suprenant, to construct an onsite sewage disposal system incorporating a Geo-flow Pipe Leaching System at 825 Main Street Osterville. The variances granted are as follows: 310 CMR 15. 405: To install the soil absorption system beneath 4.2 feet of soil cover, in lieu of the three feet maximum soil cover allowed. 310 CMR 15. 405: To install the soil absorption system at (zero feet away from) the property line, in lieu of the minimum ten feet separation distance required. 310 CMR 15. 405: To install the septic tank at the property line, in lieu of the minimum ten feet separation distance required. 310 CMR 15. 405: To install the grease trap septic tank against the property line, in lieu of the minimum ten feet separation distance required. 310 CMR 15. 405: To install the soil absorption system 11.1 feet away from an existing dry well, in lieu of the minimum twenty-five feet separation distance required. Q:\WPFILES\PimentalSuprenantFiveBaysBistroSepticVarFeb2Ol5.doc 310 CMR 15. 405: To install the soil absorption system 8.9 feet away from an existing dry well, in lieu of the minimum twenty-five feet separation distance required. 310 CMR 15. 405: To install the soil absorption system 1.5 feet away from an existing subsurface drain, in lieu of the minimum twenty-five feet separation distance required. 310 CMR 15. 405: To install the soil absorption system 17.2 feet away from an existing foundation wall, in lieu of the minimum twenty feet separation distance required. 310 CMR 15. 405: To install the soil absorption system 1.3 feet away from an existing leaching pit, in lieu of the minimum ten feet separation distance required. These variances are granted with the following conditions: (1) No more than 1,750 gallons per day of wastewater discharge is authorized this property. For this use, this equates to 50 seats maximum. (2) The applicant shall submit a signed one-year maintenance contract for the operation and maintenance of the GEO-flow Pipe Leaching System. (3) The applicant shall adhere with all of the Department of Environmental Protection conditions contained in the 'Certification For General Use' letter dated revised May 22, 2014. (4) The septic system incorporating GEO-flow Pipe Leaching System shall be installed in strict accordance with the revised engineered plans November 22, 2014. (5) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the revised engineered plans dated November 22, 2014. These variances are granted because the proposed plan appears to meet the maximum feasible design standards contained within the State Environmental Code, Title 5 and local Health Regulations. Sinc ly your , Wayne/Miller, M.D.; Chairman Q:\WPFILES\PimentalSuprenantFiveBaysBistroSepticVarFeb2Ol5.doc s 210 DATE. FEE: / • IARDISPABLE • 7 6 I I f6fl��n tuess.039. REC. BY S �� Town of Ba nstable �� SCHED. DATE: q Board of Health a �b , /,j 0 Main Street, Hyannis MA 02601 ��/ Office: 508-862-4644 ZOO A.Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION f)) 13 k N fl ` r J c�0 Property Address: `(I ► A Assessor's Map and Parcel Number: G Size of Lot: 21 5 y 7 r s,F. Wetlands Within 300 Ft. Yes Business Name: " l No ✓ Subdivision Name: p1 A APPLICANT'S NAME: ` Eytgir�z `°'`�i.T� Phone -�} _ 73"° 5 7 7 Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON iaa.ile S tz:��.�t NiCv�F,e: - .1�Ef0C 3, Name: L�ste.:yi ll� �e I�oKJivl��` LLG Name: S°- E n ejco c(a-)ct , To c , Address: 6Z5 Ka.zo Sj t cskzcvAe- ` ;[� O2(a 5 Address: )65y Phone: C b 3(0 7'/ °L Phone: o 6 - 21 3-6 3 7 7 "1 CL/ VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE May/nttach if more space neede rI -" NATURE OF WORK: House Addition El House Renovation ❑ Repair of Failed Septic System 0 -�r7 - C73 ,r, Checklist (to be completed by office staff person receiving variance request application) Please submit copies in 4 separate completed sets. =` _ Four(4)copies of the completed variance request form i Four(4)copies of engineered plan submitted(e.g.septic system plans) -» Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered san ian _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) _ Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) _ Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Out look\BAJ9P9B7\VARIREQ.DOC JC ENGINEERING, Inc. Civil & Environmental Engineering 2854 Cranberry Highway East Wareham, Massachusetts 02538 Ph. 508-273-0377—Fax 508-273-0367 APPENDIX A Due to the physical constraints of the property,the following local upgrade approvals and variances are requested. In accordance with 310 CMR 15.401 - 15.405, the followinglocal ocal upgrade approvals and variances are requested from 310 CMR 15.221(7) for item 1; 310 CMR 15.211 for items 2 thru 6; and 310 CMR 15.252(2)(f) for item 7: (1.) A 1.41'waiver(3.00' -4.41') for the max. cover over the proposed SAS. (2.) A 10.0'waiver(10.0' - 0.0') for the setback from the lot line to prop. SAS. (3.) A 10.0'waiver(10.0' - 0.0')for the setback from the lot line to pr. septic tank. (4.) A 10.0' waiver(10.0' - 0.0') for the setback from the lot line to pr. grease trap. (5.) A 2.4'waiver(10.0' - 7.6') for the setback from ex. drain manhole 1 to prop. SAS. (6.) A 1.2' waiver(10.0' - 8.8') for the setback from ex. drain manhole 2 to prop. SAS. (7.) An 8.8'waiver(10.0' - 1.2') for the setback from ex. leaching pit to prop. SAS. - f. >; f TA OW Tp S Mys b 6-tv VOCAL �1.f7P;a It wI-rH LOW areN K IUA' N Co�V�`Lr�N Dye 0 s si.Nl _ P j'�(ff DIB4 AW R I ' 1 f IT Existing Kitchen Floor Plan 825 Main Street, Osterville, MA 02655 t FIVE CAIIJ Klsri�v FOov- PLAIJ G _ p L I Etc, r_; H^ _ p 1 12 Cta Town :of Barnstable: Regulatory-Serv" ceS Richard v..Scab,Interim Directorz ic.. ealth D► rston P Thomas.McKean,Director 20O Mam;,Street,Hyannis„MA 02601 'Fax: '5.08490=b304- Officer 508-8624:644 Aomeowaer Certification'Form for,Alternative:'S sy teens Property Address:. 4"S tr a►r S tj ,.c-t` ►z�',:1 i; Arse sor's:' p\ParC0-- Picoper-.tyOwnersName In:accordance with Massachusetts DEP alteriiative._system.approval.letters,,the,.following cerhficatton informati required by the,.rs Owner of:record. The Owner..of.record must place an "u" in, the; applicable box next to�each.line certifying:the:information., `�es NIA. .of theTitle 5`VA technolo.'gy Approval letters: D l have been`provided,acopy' (16.page Standard•Conditions lettei and the specific technology retter) D I have been-provided.with the caner s'Manual ElM lbave been provided.with the Operation.and Maintenance 1Vlanual D (� For Systems,installed,under°a Remedial Use.Approval,I.agree to fulf It my resporisib`ilites to ptovide.:a Deed Notice as required,by.3"10 CNIR.l,5.287,(14) and the Approval. D. 0 : For Systems,installed under..aRemed. Use Approval,I agree to fulfill my responsibilities o provide written notification of the Approval.to any newOwner,,as required by 3.10 CMR 15,287(5� { D. If the design:does not provide for the use of garbage.grinders;the restriction is understood. and accepted D D` Whether or not covered,by a warrarity,I understand the'requiremerit to repair,replace;.modify or take,any other action as required'by the Department.or4he LAA,,: f the Depactirient-or the LAA.determines,the:System.-to be.failing„to protect public health and,safety and the environra n -as,defined to 3 l.0'CMIt 15.303 r . .. with all terms<and.condtions above, t / agree to;comply . Property ' wners:pr. nted;n e ZL UD3 l xaperh,0 hers- igna with Note: This form must be submitted along with the septic syst em. dis osal works: e a:"ltcation for,alt I1A ..,stems �ncludm new construction re airs\u rides with and. without Ageregate tstone) and with. conventional design criteria or credited ;design criteria: QilSepi<c1�A;h'6mWWIfCf certificatibm&C Page 1 of 1 Stanton, David From: Steve Minor[Steve.Minor@ads-pipe.com] Sent: Tuesday, December 02, 2014 3:27 PM To: Stanton, David Subject: RE: 825 Main Street, Osterville, MA Hi Dave, I spoke to Mike Pimentel with JC Engineering and he knows all 4 serial beds require venting and it was just an oversight on his part and he is making the adjustment. Mike would like to know if this will require a new set of plans as the actual design will not change and seems like a lot of work for a.small fix. I have met with Rich Capen about this project and he has been certified. Thanks, Steve Minor Advanced Drainage Systems,Inc. On-Site Specialist 207-240-5967 www.arc-chamber.com From: Stanton, David [David.Stanton@town.barnstable.ma.us] Sent: Tuesday, December 02, 2014 10:58 AM To: Steve Minor Subject: 825 Main Street, Osterville, MA Good morning Steve, I have a quick question. I was given the set of septic plans for 825 Main Street, Osterville, MA; Five Bays Bistro, designed by JC Engineering. It is a Geoflow design and the plans look pretty good given the site constraints, however it will be going before the Board of Health for a hearing next week and I would like to ensure it is all set on my end before it gets to the Board for the hearing. It has 4 serial beds (4 lines coming from the distribution box) of various lengths. Only 2 of the beds (the first& fourth lines\beds) are tied into the low vent. Should all 4 beds be tied into the low vent? The vent is required as it is deep and under pavement, and under 1000 lineal feet of Geoflow piping. The installer is going to be Capewide Enterprises out of Mashpee, MA. Do you know if they are certified by you to install the Geoflow system? It would most likely be under the name Rich Capen if you use installers names. Thanks, Dave 12/2/2014 f Message Page 1 of 1 n '4 f s ' r. Stanton, David From: Stanton, David Sent: Wednesday, December 03, 2014 11:42 AM To: McKean, Thomas Subject: 5 bays Bistro Tom, Attached please find a rough set of notes I did for the 5 bays bistro septic plan review for the Board. Feel free to change\re-word anything necessary in my rough set for the Board. Thanks, Dave 4/29/2015 r fy �e 825 Main Street Osterville; Five Bays Bistro septic plans for Board of Health Hearing 12/9/14 Staff comments: 1. Note: Food establishment permits for 40 seats, septic replacement for 50 seats proposed staff ok with 50 seats (note: estuary only, inspection showing over 50 seats in 2004 prior to estuary regulations, several septic permits no plans or capacities, Board has allowed in past like 539 River road...) 2. Test holes and perc tests not conducted. Must apply\pay for witnessed perc test, which can be done at the time of install and must be witnessed by Town. Will need revised plans once complete including the test hole\perc data. 3. Revised plans will need to include all 4 beds tied into the low vent manifold 4. Before permit can be issued system owner notification checklist to be submitted to Health. 5. Before permit can be issued deed notice to be recorded at Registry of Deeds and submitted to Health (because they are using Geoflow with remedial use per plans) Q:\septic\825 Main Street Osterville staff comments 2.doc Jamie Surprenant Manager of Osterville Re Holdings,LLC 825 Main Street Osterville,MA 02655 September 30,2014 Board of Health Town of Barnstable 200 Main Street Hyannis,MA 02601 Re: Declaration of Authorization 825 Main Street,Osterville,MA Dear Members of the Board: Let it be known that I,Jamie Sucprenant(Manager of Osterville Re Holdings,LLC),do hereby authorize JC Engineering,Inc.of East Wareham,MA 02538 to represent my interest regarding the upgrade of the sewage disposal system located at 825 Main Street, Osterville,Massachusetts in meetings both public and private. Sincerely, `Jamie Surprenant(Manager of 0s le Re Holdings,LLC) Page 1 of 1 Miorandi, Donna From: Jamie Surprenant Uamie.surprenant97@gmail.com] Sent: Wednesday, January 30, 2013 3:29 PM To: Miorandi, Donna Subject: Fwd: Five Bays Bistro- Kitchen Floor Quote ---------- Forwarded message ---------- From: Jamie Surprenant Date: Wednesday, January 30, 2013 Subject: Five Bays Bistro - Kitchen Floor Quote To: healthna,town.barnstable.ma.us Attention Donna: Attached is the quote from Line X to resurface our kitchen floors. We will be closing the 1 st week of March for 4 days to get this taken care of. Please contact me if you have any questions. -Jamie Surprenant 508-776-6300 Five Bays Bistro, Osterville www.fivebUsbistro.com 1/30/21013 Ak �{5•Rest • i }F • ;} LIB s ;508 � y 508-776-0716 Quote Line-X DATE: JANUARY 29, 2013 379 Iyannough Road Unit 8 QUOTE # 1363 508-776-0716 linexcapecod@gmail.com DUE DATE: To be determined ?` Jamie Surprenant, owner Five Bays Bistro.. Main Street, Ostery lle . - SPERSON JOB PAYMENT TERMS ,DL7E DATE 2 SALE Quote drafted by:Caylee Shramek ;Fide BaysM Bistro T,BDTBD QTY a D'E ON UNIT PRICE LINE TOTAL ? Total square footage: = approx. 460 square .feet 460 of floor- with 6 inches up the walls; to be ! sprayed week of. March 12,2013 Material being 12.00J appr0x used: XS310 Black; to .be sprayed over 4 inch square 5520.0:0 square AC plywood feet foot Electrical. Eources., wind barriers if 1 requested, and additional services provided TBD TB`D by contractc-r. SUBTOTAL ;. 5520..00 SALE§ TAX tbd _._ _... $.00 BALANCE: $552 0.0 0 Thank you for your business!" I CATEKED 15Y THE. DAYS Y I TKO lzzi MEN ME NQ 02, ffiffil R � - 1-- OSTERVILLE OSTERVILLE 825 Main Street Full Service Catering Everything from Weddings & Rehearsal Dinners To Intimate Dinner Parties in your home S ling 2011 p g' Even back yard Clam Bakes Dinner Menu `2.et Catered by the Bays make you the perfect host." "Contemporary Cuisine with Neighbor- hood g hood Appeal" "There's Five Bays Bistro in Osterville which may as well Y � Y be Soho...." -Boston Globe For Reservations call 508-420-5559 fivebays@gis.net "Simple and chic with a martini list to rival any big-city wa- Locally owned and operated by: tering hole, this is the kind of place you could bring home with you." Chef / Owner — Tim Souza —Boston Herald & G.M. / Owner —James Surprenant "Working on being the best bistro from Provincetown to Boston....,, —Zagat Restaurant Guide www..flvebaysbistro.com . seapi French Onion 7 Smo Tomato&Red Peer er Bis Pan Seared Sea Scallops Basil o dd parmesan crisp pp 4ue 9 Grilled zucchini&shrimp risotto, roasted fennel broth 28 Sole Francaise sauteed asparagus,parmesan risotto, lemon caper wine sauce 24 saw Tomato and Cumin Roasted Salmon Field Green Salad Lemon and.pinch orZo, cucumber dam'shrimp salsa 26 Roma tomato,English cucumber, red onion, crouton, Roasted Half Chicken herb balsamic vinaigrette 6 IYlhipped potato,garlic green beans, artichoke gremolata 19 Spinach Salad Glazed Duck Breast Green apple, walnut�°roasted onion, warm bacon Miso &so la ed, ve etable ed rice 26 dressing 8 so 8 Caesar Salad . Grilled Sirloin parmesan cheese, croutons, anchovies g Red pepperjam, sauteed broccolini,Bleu cheese frites 28 Grilled Filet M2�nnn o Bacon and chive mas-hed,grilled asparagus,Burgundy demi 35 �1 Kobe BeefBurger Asian Vegetable Wontons Cnpy pmsciutto, red onion relish, roasted garlic aioli on brioche, hoisin plum dipping sauce g pommes frites 19 Baby Back Ribs barbecue sauce,pommes frites 11 Crispy Fried Artichokes Sklej lemon aioli, baked Pecorino 12 Lobster Mac and Cheese 14 Sauteed BroccoAw 6 Grilled Thai Shrimp Macaroni and Cheese 7 braised bok choy, spicy peanut rauce >4 Bleu Cheese Pommes Frites 6 Fried Calamari Lobster Mashed Potatoes 11 banana cherry peppers,garlic,snraeha chili sauce 10 Grilled Chicken Risotto sundried tomato, spinach,parmesan cheese 10 Prosciutto Carpaccio Aweoez& Dry figs,pecorino,greens&balsamic reduction 14 Baked Chocolate Chip Cookie Grilled Vegetable uesadilla ala mode 6 Smoked paprika creme fraiche, masted corn salsa 12 Peach and Blueberry Cobbler Angus Beef Sliders Cardamom whipped cream 7 caramelized onions,pickle chips and pommes frites 12 Chocolate Torte Lavash Pizza Scallop, apple wood smoked bacon, caramelized onion, Espresso anglaise, drunken raspberrie 7 goat cheese >> Ginger and Orange Creme Brulee 6 Penne Bolognese meat sauce, melted mo!�Zarella 10 SOUPS French Onion garlic crouton, Swiss and pecorino gratin6e 7. Lamb Stew root vegetable, chive oil 8. SALADS Mixed Greens dried cranberry, orange segment, almond, chevre poppers, cranberry vinaigrette 9. Spinach glazed pecans, red onion, green apple, warm pancetta dressing 9. Iceberg Wedge smoked apple wood bacon, roasted tomato, crumbled bleu S. *add grilled marinated chicken 6. *add shrimp or scallop 9. APPETIZERS Asian Vegetable Wontons hoisin plum dipping sauce 9. Butternut Squash Ravioli sage brown butter, caramelized onion, parmesan cheese 12. Crispy Fried Artichokes Dijon aioli, roasted red pepper jam, baked pecorino 12. Grilled Thai Shrimp braised bok choy, spicy peanut sauce 14. Proscuitto Panini mozzarella, tomato, basil, prosciutto, caper anchovy buerre blanc 12. Fried Calamari banana cherry peppers, garlic, sdracha chili sauce 12. Lobster Mac and Cheese 16. Baby Back Ribs barbecue sauce, pommes frites 12. Grilled Chicken Risotto I sundried tomato, spinach, parmesan cheese 11. Lavash Pizza sharp provolone, roasted tomato, roasted.garlic, portabella, balsamic glaze 12. Penne Bolognese \ meat sauce, melted mozzarella 11. v Angus Beef Sliders apple wood smoked bacon, Swiss cheese, truffle frites 12. ENTREES Sole Francaise parmesan risotto, sauteed asparagus, lemon caper wine sauce 25. Pan Roasted Sea Scallops prosciutto agnolotti, sweet peas, carbonara sauce. 28. Grilled Salmon roasted vegetable strudel,blood orange reduction 27. Curry Shrimp Thai yellow curry broth, coconut rice, bok Choy, carrot, shiitake mushroom 29. Panko Crusted Chicken & Lobster Roulade vegetable risotto, peppercorn sherry cream 29. Braised Pork Osso Bucco linguica whipped potato, spaghetti squash, pork jus lie 25. Asian Braised Short Rib jasmine rice cake, miso stir-fry vegetable egg roll 25. Filet Mignon caramelized onion potato cake, broccolini, crisp leeks, wild mushroom ragu 36. Kobe Burger coiby jack cheese, chipotie bbq, onions rings, pomme frites 19. SIDES Sauteed Spinach golden raisin & roasted garlic 7. Kobe Meatball& Parmesan Focaccla 9. Macaroni and Cheese 7. White Truffle Frites 8. Lobster Mashed Potatoes 14. DESSERTS Baked Chocolate Chip Cookie a la mode 6. Bourbon Pecan Tart cinnamon ice cream 8. White Chocolate Mousse almond lace cookie, fresh fruit 8. Vanilla Bean Creme Brulee 7. EXCERPT FROM THE BOARD OF HEALTH MEETING MINUTES 12/09/14: I. Septic Variances (Cont): A. John Churchill, and Michael Pimentel, JC Engineering, representing Jamie Surprenant, Five Bay Bistro — 825 Main Street, Osterville; Map/Parcel 117-100, 0.06 acre parcel, multiple septic variances. Mike Pimentel, JC Engineering, and Rich Capen, Capewide Enterprises, were present. They are requesting multiple variances and requesting a seat count of 50. The current and the proposed septic systems are all on an easement on town parking lot property and space is limited. The current system is 1,000 gallon grease trap, 1,500 gallon septic tank and 4 leaching pits. The proposed is: 1,000 gallon grease trap, 5,500 gallon septic tank and a geo flow leaching pipe system. Mr. McKean said the staff noted that 1) the establishment is permitted for 40 seats, not 50, and 2) checklist is needed, 3) revised plans will be needed as perc tests need to be done and all four leaching beds need to be tied into low vent manifold, and 4) the owner notification needs to be recorded on the deed for the geo flow system with remedial use. There was much discussion on the seating count and the Board determined 50 seats will be used based on historical information. When asked if the seating included bar seats, Attorney Phil Boudreau said the count is 44 seats and 8 bar seats (a total of 52 seats). The system did pass the septic inspection in April 2014; however, it was showing signs of approaching failure. Michael estimated the distance to groundwater is 20 feet. The Board expressed concern that the geo system does not have de-nitrification / secondary treatment unit (STU). Mr. Pimental said adding this would be very costly and doesn't believe it necessary. Mr. Capen estimated the cost to be an additional $45-50K. For reference, Mike said the geo system is very similar to the Presby system which was just put in at the Cummaquid Golf Course. Mr. Sawayanagi asked for floor plans to review for the next meeting and to see which sink is connected directly to the grease trap. The Board is interested in hearing about different systems which would, hopefully, reduce the nitrogen. The Board asked whether a Fast system will work at this location as it would be less costly. The engineer will check into the leaching requirements, etc. The Board would be very happy if the engineer is come up with an alternative to reduce the nitrogen by 30%. Upon a motion duly made by Dr. Canniff, seconded by Mr. Sawayanagi, the Board voted to continue this to the January 13, 2015 meeting and the engineer will 1) research comparative systems and costs, and 2) provide floor plans to see which sink is attached to grease trap. (Unanimously, voted in favor.) i Page 1 of 1 Five_ �jtsfi-� Crocker, Sharon r From: Mike Pimentel [Mpimentel@jcengineeringinc.com] Sent: Tuesday, January 06, 2015 1:08 PM To: Crocker, Sharon Cc: 'Rich Capen'; acavanaugh@jcengineeringinc.com; crosa@jcengineeringinc.com Subject: 825 Main Street and Crisp Hi Sharon: As discussed today, please reschedule the 825 Main Street and Crisp restaurant projects to your February 10, 2015 meeting. We understand if we cannot meet the January 26 deadline to submit our package to your office, we will have to rest ul�e thee meeting to the M meetingq. hank you. Michael Pimentel, EIT, CSE Project Manager JC Engineering, Inc. 2854 Cranberry Highway East Wareham, MA 02538 PH: 508-273-0377 Fax: 508-273-0367 I fti-e+ J 1/6/2015 1111/P I17 - ia® Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 5 825 Main Street Property Address COOLEY, JEAN D &CHRISTOPHER TRS Owner Owner's Name information is required for every Osterville Ma 02655 4/11/2014 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection Company Name 74 Beldan Ln. rem Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com S14522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 4/11/2014 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. I t5ins•3/13 Title 5 ftForm:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 825 Main Street Property Address COOLEY, JEAN D &CHRISTOPHER TRS Owner Owner's Name information is required for every Osterville Ma 02655 4/11/2014 page. City(rown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The commercial property located at 825 Main St Osterville is served by a Title V Septic System consisting of a 1000 gallon septic tank, 1500 gallon grease trap and 4 1000 gallon precast leaching pits. All system components are located in the paved parking lot and are H2O loading with steel covers to grade. I B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M s 825 Main Street Property Address COOLEY, JEAN D&CHRISTOPHER TRS Owner Owner's Name information is required for every Osterville Ma 02655 4/11/2014 page. CityrTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 825 Main Street Property Address COOLEY, JEAN D &CHRISTOPHER TRS Owner Owner's Name information is required for every Osterville Ma 02655 4/11/2014 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ , ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 825 Main Street Property Address COOLEY, JEAN D &CHRISTOPHER TRS Owner Owner's Name information is required for every Osterville Ma 02655 4/11/2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 825 Main Street Property Address COOLEY, JEAN D&CHRISTOPHER TRS Owner Owner's Name information is required for every Osteryille Ma 02655 4/11/2014 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 825 Main Street Property Address COOLEY, JEAN D&CHRISTOPHER TRS Owner Owner's Name information is required for every Osterville Ma 02655 4/11/2014 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal fuse? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Restaurant = Design flow(based on 310 CMR 15.203): 35 gpd x 50 seats 1750 gpdGallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): 50 seats Grease trap present? ® Yes ❑ No Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: 2013=264,000 total t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 825 Main Street Property Address COOLEY, JEAN D&CHRISTOPHER TRS Owner Owner's Name information is required for every Osterville Ma 02655 4/11/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: current Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 825 Main Street Property Address COOLEY, JEAN D &CHRISTOPHER TRS Owner Owner's Name information is required for every Osterville Ma 02655 4/11/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2feet Material of construction: iron 40 PVC other(explain): ® cast ro ❑ ❑ Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joint were ok no leaks, vented through the roof Septic Tank(locate on site plan): 1.5 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: 5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Lt 7 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 825 Main Street Property Address COOLEY, JEAN D &CHRISTOPHER TRS Owner Owner's Name information is required for every Osteryille Ma 02655 4/11/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? opened covers, took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank was cleaned 3/25/2014, tank is H2O located in paved parking area with steel covers to grade. Tank was structurally sound and not leaking. Inlet and outlet tees were intact. Grease Trap(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: 1500 gallons Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: 3/25/2014Date t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 825 Main Street. Property Address COOLEY, JEAN D&CHRISTOPHER TRS Owner Owner's Name information is required for every Osterville Ma 02655 4/11/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease trap was cleaned 3/25/2014 and should be done every 3 months to prevent heavy grease buildup. Grease trap is H2O located in paved parking area with steel covers to grade. Inlet and outlet tees were intact. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GM , 825 Main Street Property Address COOLEY, JEAN D &CHRISTOPHER TRS Owner Owner's Name information is required for every Osterville Ma 02655 4/11/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert N/A Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 L I Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 825 Main Street Property Address COOLEY, JEAN D &CHRISTOPHER TRS Owner Owner's Name information is required for every Osterville Ma 02655 4/11/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 4 ❑ leaching chambers number: ❑ leachinggalleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Town of Barnstable regulations regarding Title V Septic Inspections state that the actual water level at the time of inspection shall determine pass or fail and not the observed stain lines which indicate past conditions. At the time of inspection the leach pits had 2' of standing water with signs of previous hydraulic overloading. All pits are located in paved parking area with steel covers to grade. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , ' 825 Main Street Property Address COOLEY, JEAN D &CHRISTOPHER TRS Owner Owner's Name information is required for every Osterville Ma 02655 4/11/2014 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 825 Main Street Property Address COOLEY, JEAN D&CHRISTOPHER TRS Owner Owner's Name information is required for every Osterville Ma 02655 4/11/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately �P t� [ S [ r O O .O° S t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 825 Main Street Property Address COOLEY, JEAN D &CHRISTOPHER TRS Owner Owner's Name information is required for every Osterville Ma 02655 4/11/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 35 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments y 825 Main Street Property Address COOLEY, JEAN D &CHRISTOPHER TRS Owner Owner's Name information is required for every Osterville Ma 02655 4/11/2014 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 4 No. 0 b Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes appliLation for disposal 6pstrm Cunstruttion 30er it Application for a Permit to Construct(4, Repair( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No.9257 C1,f,41A)ST o$r. Owner's Name,Address,and Tel.No. L3S1eP_VILrLS RG MaL..Dt#.JFrS'LLc- Assessor's Map/Parcel 1 f07 1100 S 4462 5=-- 05MOM L.(E Installer's Name,Address,and Tel.No., 77•-&t07 Designer's Name,Address,and Tel.No.jQ$-,;t73-0377 Q"4P&_-W1tb& :Z c eme'lAjaw- c �t:�J(_ 1 s-r M,4�Ca P&g Hwy OF. Lt4k&44A4 Type of Building: Dwelling No.of Bedrooms Lot Size ,'S °] sq.ft. Garbage Grinder( ) Other Type of Building Q 7 (J�R/"T- No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 05,0 5,0 gpd Design flow provided gpd Plan Date _cJ-�el -a 014 Number of sheets f Revision Date it -.Z a--'0 4 Title _S a 5 N A-1 A) 15 r JE&,T_ b-ST-EAU I C_C.- Size of Septic Tank J,S 00 6*_ j4-P0 0l Gam, Type of S.A.S. oZ y MOWS 1 afP Gen-rdow i 1 Description of Soil MC171 0Cu 0 -0.)b ��?G tf � �� PL AAj Nature of Repairs or Alterations(Answer when applicable) =&6- S!5z>D 5tSV17[e_. ,41Vi:L -M D Bra in �IQ Lhwj; OF:, I;L 1=(,0LR) SAC c LJE�4w rV& p1, A( L Cote fDe)Lhnw C-7 �l- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt Signed Date Application Approved by A_ r u Date Application Disapproved by Date for the following reasons Permit No. a'6/ O —G 3 b Date Issued 1 % 2 ®.,.7 . 4 0 No. Fee j ,'O m-�t�,q�. Fee THE COMMONWEALTH OFaIrAASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es .1 4pritation for Disposal 6pstem donstruttion Jermit Application for a Permit toConstruct(✓� Repair( ) Upgrade( ) Abandon( ) 05omplete System ❑Individual Components Location Address or Lot No.9257 k91A1 S_r QS'r. Owner's Name,Address,and Tel.No. 651sRViLLG 1zG M6(b1.06►SL.-<- Assessor's Map/Parcel 117 �y0 S 1 44N S7- DS 14, / Installer's Name,Address,and Tel.No.502 4477-g&-77 Designer's Name,Address,and Tel.No._$p$ C.4o1r-ZorDF_- GV-r6x?0,ISES "c. 4C 15 co e. P t �ta►¢4F1�4M Type of Building: Dwelling No.of Bedrooms Lot Size pt 1 �7+ sq.ft. Garbage Grinder( ) Other Type of Building RCS"' 3 UAANT No.of Persons Showers( ) Cafeteria( ) Other Fixtures L� v ' ',Design Flow(min.required) p gpd Design flow provided gpd Plan Date Number of sheets Revision Date !1 - I;t-ao 1 Title 5?'ojesT 05_r&AJ/C.CZ_ Size of Septic Tank 5}5 OD 644C. -070 a<49R, Type of S.A.S. Z(� �OcJS 1 a/t G� �4LDUt) Pl?4:� Description of Soil MESA! JA00) �(�� fgc_` PLAj l r Nature of Repairs or Alterations(Answer when applicable) =QS-0�,U &Aoc 10,00_Gf=(Log (5a£ 1�� I 'L �n—1=(,OCR) 15 0n c 1926 Ij ,C, A -L �k-fib Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions'of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He h. r Sign ( ► / Date Application Approved by U Date Application Disapproved by Date for the following reasons Permit No. a G / U G Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE`COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system.Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by at ga'j MA((J 5'T OS �-12`1 U,15 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. o (j r-d a dated Installer C A(Po.*->i b U r• - Designer SL, #bedrooms /�// Approved design flow gpd The issuance of this pe it shall not be construed as a guarantee that the system will function as e igned. Date ' l f j Inspector .� --------------------------------------------------------------------------------------------------------------------------------------- No. C) 3 O Fee 1 Q U— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstetri (Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at 531 r- d S'T' Y/L.4� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date Approved by v. tC r Town of Barnstable Regulatory Services Thomas F.Geiler, Director .AAWABL , Public Health Division Al 16 Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-962-4644 Fax: 508.790.6304 Date: 15 Sewage Permit# �` 1`' � ' Assessor's Map/Parcel 1 I -7 �► o 0 Installer& Designer Certification Form Designer: eectncc , Tvic Installer: Cape,.;icle. toFerfr(szS Address: 2951 Ucw)locrrY 4 !iyay Address: 153 Co,-nme.t;r*C(l Sfre,?A 4JVQ-no,n VIA 0153. Masln�e� + NJ� p1 �`I `� ;off 273 0377 On �l Gape.wiJL F_-M2fprism was issued a permit to install a (date) (installer) septic system at 9 2.5 M 01 h based on a design drawn by (address) , C En5ineecu -roc-- dated 9.36-1y (Qeu,l: II.zZ-iy) (designer) 1 certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than l 0' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) ected and the soils were found satisfactory. 1M OF i JOHN L. r CHURCHILL (I l"esigner's ' Signature) ML 41e0 ature (Affix lae g Here) P ASE RETURN TO ARNSTAS I.IC HEAL DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED U,1N11L $O'er THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE HARNSTA]!LE PURI.IC HEALTH DIVISION. THANK YOU. gAof ice formMdesignercertification form.doc Town of Barns abled Regulatory Serwees ti Richard V,.Scali,Interim Director' Pu.,bl Walth,D�vtsion lie KAM - �' Thomas McKean,;D,iree '�'Eo r+us''.• ZOo Main Street,Hyannis,MAI 01601 Fax: 5,084,90-63.04 Office: 508-8624644; Homeowner Cerhf cation Form foc.Altecnatiye;Systems Prot}'er , Addr-,essi L 5 iln a�f S c G T p - Assessor's:rMaplParcel: Property Owners Name*,, Ih:accordance with Massachusetts.DEP alternative.system.approval letters,,,the N-lowingvert. ation information 'is required by the Owner of.record. The Owner of record riust° dace an " " .m the, appTrcable"box.next to each,line-certifying the,kort�ation., `Yes: IV\A D .have beew rovided a.copy'of the'Title 5`UA technology, Approval letters. 06 page Standard Conditions letter,grid the specific technology letter) (] R. Ihave been-provided with_the Owneris°`Manual, ® L have been provided with.the Operation.and Maintenance Manual. [� 'Fot;Systems:installed.under•a.Remedial Use Approval,,I:agree to.fulfill my responsibilities to provide,a DeedNoticeas required by 310 CNiR IS.287(10) and the Approval. Q For.Systems installed under.,aRemediall:Jse,Approval,I agree to fulfill my- esponsibilities to p rovide wntten.notificatiori of the Approval to any new Owner,as required by 314 CMR 154287(5) .D If the descgn,does not,provid'e.-for-the use,of garbage grinders;the restrict on"understood, and accepted.. Q, , Whether or not covered by a-warranty,I.understand the;requ requirement`to repair,replace,modify' or take;any other action as'required:by the Department or,the LAA, if the Departirient or the LAA,determines,the:Systemao be,failing;to protect public.health arid,safety and the, env�ronrnen As, in 110 CIvIR 15.303 / ' , agree to:comply with-allterms and conditions above. Property wners p nted"n "e 7 roperty:0 / ers gna . Dat . Nate:_ This .form, must be, submitted alon , with the sent I ig s .stem. dis osal works ermit enohcation for all IAA systems includM; new construction. re `airslu rad'es with and without a i:regate (stone) and with .conventional design criteria. or credited des n_ criteria. Q"ilSepii�\IA,homeowner certification.doc r APPROVED THE COMMONWEALTH OF MASSACHUSETTS Barnstable Conservation Department BOARD OF HEALTH 4-G.6 S WN OF BARNSTABLE 'fined Date Appliration for Biripoiul Wor1w Tomitrnrtion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair (KX) an Individual Sewage Disposal System at: 825 Main Street Osterville ................•'•----....-----..................-••--...........-•-•--•-•---.....-•-•---------- ••••---••---•••••----••-t......................................................................... Location..\dd,,ss or Lot No. Joseph' s Restaurant ......................_.......................................................................... --•-------------•-••------••-•----••-------•••-----------••------.........----...--------.._....•. OK'tter Address W J .P .Macomber Jr. Installer Address UType of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ---------------------------- No. of persons----------------............ Showers ( ) Cafeteria ( ) dOther fixtures ...................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width--.--...--..... Diameter................ Depth................ W Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. x 3 Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------- ----------------------•-•--------..........---•--•--•----•-•••--- Date........................................ as Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 4 4 Test Pit No. 2................minutes per inch Depth of Test Pit.......------------- Depth to ground water....................--.. 0 Description of Soil------•-----Sand & Gravel --------------------------------------•----.............-•--•----.•--•• x -• ----••. -••... W UNature of Repairs or Alterations—Answer when applicable...-_1--.1-5-Q0...aa.1-14 ....leach...pit........................... .B.e.7,x1g...a.dd.d... o...O-...t-�..tl e...f.ime---;aept.�, ..s.Ystem--VT th rease...traA.-................................ 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 Complia ce has be sued y the bo d health. Signed -- --- '� ...... ApplicationApproved By ................i ...... ..,..., ----------------------------------------------------------------- --- Date Application Disapproved for the following reasons: ................................................................................. ................................. ' ' ............... ............................................................................ ..................................................... ........................................ Dace PermitNo. ........ ..--...�A..��---------------------- Issued ................................. . ...........' ............. Dace THE COMMONWEALTH OF MASSACHUSETTS �/ 1 BOARD OF HEALTH —S3 TOWN OF BARNSTABLE Appliratinn for Diriputiul World. Tomitrnrtiun f rrmit Application is hereby made for a Permit to Construct ( ) or Repair (KX) an Individual Sewage Disposal System at: 825 Main Street Osterville .....--•....................•--.......•......---------.......-----------.............._..._.....-• ------......-------•••--......---•••...-•--•••------------•---•---............._..---.......---•-- Location-Address or Lot No. Joseph' s.Restaurant .......................•--------------------•----------•------ •-•-•••------------•------....-••--...----.....•-----•----•--...--••-•----......................_. W J. P.Macomber Jr. O�cner ;... r.i Address .... . ----•.-- •--- -•---•-- Installer Address d Type of Building Size Lot------------------_-----.-Sq. feet U Dwelling No. of Bedrooms--------------------------------------------Expansion Attic Garbage Grinder 114 Other—Type of Building ----- --?.._= '..-.-_. No. of persons................�'.......... Showers ( ) — Cafeteria ( ) 0.1 ; `•.l, t. d Other fixtures . ..... -------------------------------------.--------------------------------- ----------------------------------------•........._..------- W Design Flow.................................t_.....:....gallons per person per day. Total daily flow............................................gallons. R: Septic Tank—Liquid capacity............gallons Length-------------- -Width----------..---- Diameter.-.--.---..----- Depth................ Disposal Trench—No. .4:............... Width.................... Total Length.................... Total.leaching area....................sq. ft. Seepage Pit No--------------------- Diameter---................. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation ri�Test Results Performed by........................................... .............................. Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit--------............ Depth to ground water........................ fZq Test Pit No. 2..................minutes per inch Depth of Test Pit.................... Depth to ground water.---................--.. fYi - 0 Description of Soil............Sand-_& Gravel ..........................................•----------------------------------.....--------------------------------•----•-•---------•...... W UNature of Repairs or Alterations—Answer when applicable..... --.15.Q_0 9a�Uon..leach--bits........................ einc -.added---to-.-a--ttl.s•-.f• ve---septic--system.-with-.•crease- trap................................................................ 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 betfn i5sued byy the bop,d f he Signed alth. ............L x � ._�.......... ........................ ... ' Application Approved By .........- C ... . ...... ........................................................... ....f.1..-. G.-..�%...3 J............. Dace Application Disapproved for the following reasons: ................................................... ........... -- ............ . .............................-....--- ......... ..................................................... .. .. ..............................................................__.. ---- • ......... .. -- ... . -- ........................................ Date PermitNo. ....-._1... .. ��... ./_...................... Issued ........--... ............. .................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ter#tttcato of C�omplinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired.�XX ) by J.P.Macomber Jr. .............. ._._.... ........_..........-_................_....... ------------------------------------.-....-..._-------------------------------..-------------- at ---..--825 Main Street .0sterville 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. .., 3_-....�... /...._........ dated -------...._.....--...._------------- .._.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE !: SYSTEM WILL FUNCTION SATISFACTORY. �� DATE.---._..__...../4.........I.... ... ...........____............... - Inspector ....._... ... a..... ................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No...�-i ��_ FEE.-�...30...00.. Raplisal nrhs Tonstrurtion rrmit J P.Macomber Jr. Permissionis hereby granted------ ------------------•-------------.....------•------•----•-•-------•-•--•-•---------•-----------•--.....-------•--:...---............... to Constg.2q (vta). or S tpair X�s t e rvil'l e Sewage Disposal System atNo................................t-•--•---- -•--•--r. -11------------••-----------------------------......--•-----------------------•-----------------------------.--------.---- Street as shown on the application for Disposal Works Construction Permit No.9�- --- Dated........................................... --•---------------------•-- ------------------•---------------•---•------•--------- DATE Board of Health � h-- . FORM 36508 HOBBS Q WARREN.INC.,PUBLISHERS 0 V E D THE COMMONWEALTH OF MASSACHUSETTS Br Off' HEALTH / /LEBOARD OWN OF BARNSTABLE iguc:u ApplirttttlDrtean for Disposal Works Tonstrnrtiun ranfit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: ................e-phs ,Resterant ••.....................•------....-•••-----............ ........._....•-•••-•--•--•-•-.......-•-•-•••-----•••-....------•----.........----..............•- Location-Address or Lot No. 825 Main St. Osterville MA ............ -----.....---,---- ----------•---• -•-.1e.._........................ .......••-•...........•-•-•-•-•---._.......------•••....-----•---•--------•---..............---••- Owner Address WE. Robin.s.o.n Se.• tic Servi..• Address Type of Building Size Lot............................Sq. feet t-� Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a4 Other—T e of Building No. of persons............................ Showers Cafeteria YP g R�s�e�ar�t--• P ( ) — ( ) dOther fixtures ------------------------------------------------------------••••---------•----•---•-•-----------••---•--••-•--•-••---••-••••-•....-••-•-••---•-•----. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ 4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................ a ---•••••••-•----••-----------•-•-•..........•••---•-••••....•-•--•------••---•..................................................................... •......... 0 Description of Soil...................s-and.................................................--------------------------------------------------- V .........--•----••-•---••------•---••--••••-••---.....----•-•••--••••••••---•-•-••-•...........•--------••••-----•-••••••-•-•--•-•••--•--•-••----•-•---._....--••-••••-•-•-•••........................... W x -••---•-•-------------------------•------------••-------•-----------•---------------•--••-•-•••--•-•-------•--••----------------•--•••--------•-----•--•---••-••-•---•••------•----•-•-•.......-•-••.... U Nature of Repairs or Alterations—Answer when applicable---k_1.)-----1.0-0-0---gal_----s-tonepaeked..................... t.----•-•---•-•••--•--•---••••......••--••-•--••-•--••--------------------•-- 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 furl r agrees not to place the system in operation until a Certificate of Compliance has beJued th and 1� ��` � Signed -- ---.......... -= ...... (�-- Dare ApplicationApproved By .... ..... . ..... .. . ---. .............. : - ............... ...........---.......------------------- Date Application Disapproved for the following reaso s' ...... •-------------- ----=---- .............................-- ................... . ......----------...------------ ............................----- ------ -------- ----.......---. --- --- -- ........................... -- --- .......... -------- � ... ... Date Permit No. Issued ---------- - ----- .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Applirttfion for Uiopooal lgorkii Tontrnrtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: .....Josephs_:_Resterant .......... .... - .......-------- - ..................-- Location-Address or Lot No. 825 Main St. Osterville MA Owner Address a W.E. Rnson Septic Service ...................................................---.....---------------•-...............• ... ......--•-••--•.......................••-•.........................--•------..................•--- Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................ _Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building 3 No. of persons............................ Showers Cafeteria 0.1 YP g I:�-�t.er.altt--- P ( ) — ( ) a' Other fixtures .............................................. ----------------------------------------------------- •-------- -••------------.-..---------- WDesign Flow..........................................•..gallons per person per day. Total daily flow.:__.._......_..............................gallons. WSeptic Tank—Liquid capacity............gallons Length,,,............. Width................Diameter---------------- Depth................ Disposal Trench—No..................... Width.................... Total Length.................../Total leaching area....................sq. ft. Seepage Pit No------------------_ Diameter.................... Depth below inlet...............:.... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY.......................................................................... Date......................----------------- W Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-___--_--__-_-_-•-_ --. Grq Test Pit No. 2.............t-minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 ----•-•--•••••--••••••-•••---••--•------------•-----------•......................................•--......................................................... ODescription of Soil...................&2_,.qd---------........---.................-----------•------------------------------------.....---------...----•--•-----•--•-•---------------• x U ..................................------•--...---.....--•••-•-••------------------•-•..........•-••------....•-----•----------•••-----•-•------••......-•--------------------------••............._•••--- W V Nature of Repairs or Alterations—Answer when applicable----(_1.)._...100.0_...t, ..l.. _._atonepa_ckPd..................... heavy-duty- leachpit ..................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with they provisions'of TITLE 5 of the State Environmental Code-1`he undersigned furt r agrees not to place the system in operation until a Certificate of Compliance has.b uedyhe Signed `.. - ... -- -- . -a--l--t-h---.------- --------------------------------------- � - Date APPlicationApproved BY - -- -- 1 ..�...l.. .. ............ ............ ......_--- --- -..-'---- -----.........- ---_..`....-- -. - ..9� Date Application Disapproved.far the following reaso s" ------------------------------------------.............................................---------- ---------------------------------- _ •- - _ .- . . .-. >� ----------------- / ------- Permit No. ----- Issued /- �r Date Date LL THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cnertiftrtt#e of Graptianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (X ) by....W E ----Robinson-.-.Sept-ic Service -. Installer --------------------------- ----------- } at -82.5----Main---St----Osterville M4---------- ----- ------- ----- ----------------------------------------------- has been installed in accordance with the provisions of TITLE f Thet E&ironmenta.1 Code as des.»f e i ivJ /� the application for Disposal Works Construction Permit No. .. / ...''`. ............ dated ------- ._ ,� .... ....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUEd A,QUARANT6E THAT TF E SYSTEM WILL FUNCTION S,ATIJACTORY. DATE.................... �..---- 1........................................ Inspector --...................1AS ....--------------------------.....------.---......----------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH G��.e TOWN OF BARNSTABLE No................. FEE.$.0 0.0...... �io��r,��l orko �ono#ruan rrnti� Permission is hereby granted.-----W-.E..._Rob z scaxa_._SeP _ Sethi.ce......................'............................... to Construct ( ) or Repair (X ) an Individual Sewage Disposal System n at No. 8? -'" ?_? tsr .} ...?�?� ------------------------- v' street �n--)-f-e �as shown on the application for Disp sal Works Construction t No. .._... vd_._.�►1 _ :. -'/.-;-- ..... ' ---- - •o••v DATE y.. .�..................• Board of h ORM 36508 HOBBS&WARREN.INC..PUBLISHERS ------ Fuji.......... 15.00... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................._T.own...-----.--.O F........BarMta.ble....................................................... Ap iratinn for DWpog al Worko Tongtrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal System at: 825-•-Main Street.L..0sterville,...MA....0265�....... .................................................................................................. -•-----•-•--- Location-Address or Lot No. Kate & Company�John & Beth Bonnhardt 82 5 Main..Street, 0sterville. MA- _02655 ...----•--•--...-- ..... .... .......... Owner Address 4 A & B_Cesspool.Service_,_--Inc. 128 Bishops-Terrace,__Hyannisx MA 02601 ... Installer Address Type of Building Size Lot............................Sq. feet J Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) � Other—T e of Building No. of persons............................ Showers — Cafeteria �4 Other fixtures -------------------------------•-••••-•........ Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid*capacity............gallons Length................ Width................ Diameter____--_---____ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area....._............sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �Z4 Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................ Rr ---•----------------------------------------•-•-----------------•---------------•----------•--•---..........------•----•......---....................-•--••-- Descriptionof Soil......Sand........................................................................................................................................................ ------------------------•-----------------------------------------------•--------------•-------•--•-----•---------------.....-•---------.------------------------...................................... U Nature of Repairs or Alterations—Answer when applicable...installatio.n...of...a.-1,DQD-:_g O.Lan•..geptic..tank wi-th..the..necessary...n.onnecti.nna..................................................................................------------.;'.-......-----•-----••---•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal stem in accordance with the provisions of TITLE 5 of the State Sani ode— The undersig d fur ees not to e the system in operation until a Certificate of Complianc a rssu y the b 1 th Sign /.-•-•••..... •-•--- ---- •-- •----•........... ........... .............. Date ApplicationApproved By...................................................................... ......................... ---•-•....4/01/85.............. Date Application Disapproved for the following reasons:........0..................................................................................................... ......................................................-.........................................................................................--••-----------••-•-----•-•--•••••-------•--••......--••- Date 1 •.l55. 8 ° � ---•--. Issued_--•--•---------4• •01 8 Permit No--------------5.-.._.._...._........_..----•---- ....................... Date -11111111111111111111.11111.111.1111111.111111111111.11111//.11..1.11...................../................. 1�0►1.1M�1.14N.1..�� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................T own.........0F.......Barnstable (9rdif irFatr of Toutph atta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (x ) bY-•-••--A... ........12B..Biahaps..Terra.ce.,...Hyannis.,-.-MA.....Q2601......................... Installer at.....-825.11aa.n..Street..... ohn..&..Beth_.B.annhard-t_____________ has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.._Q5.-__._. vy................ dated-.--------44/al/85__--................. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........................................•-•-•--.....-•-•.......------••..------ Inspector.................................................................................... f� .. lk_:,:.._8.5:.-._„ ��/ FES......$....15..OD... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... ....P awn...........O F........ a rnstable-------------------------------------------------------- Appliration for Disposal Works Tontxnrtion rrntit Application:14 hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: A....02655....... .................................................................................................. Location-Address or Lot No. Y;ate... --u�mga �t�I,�irL.&_.Reth..Ronnbaacdt............ v�-1��,-. -A--•-�l?Ca ....._ Owner Address a ...�...-Ce.. 4.91..Y.4xyiQea...Inc.L............................... 1? isho as. '�arrace,....H.yanais, `�-.---026at.... P Installer Address UType of Building Size Lot............................Sq. feet ,., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria p`I Other fixtures -------------------------------- ... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I...........:....minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-•-••-•-•-•----------------••--••--•••------•-•-----•••---•.......----...........---.......---••--•......................................................... ODescription of Soil...... Bdid..........................................................................................................--..... ...................................... V .-------------------•---•-----•--------•-•--••••-----•---•---••--••-•----------------•--•--......--••...•----------------•--•----•••-•---•---•-----------•••••-----••--••••----•----•-.....--------•--••. W VNature of Repairs or Alterations—Answer when applicable_.Jznstal.l&tio2n---F3f...a---j,r004--g U-on--,Repti-e---tank w1th..t,.he-_neces y co=e�_-tlons.----------••--•----------•------------------------------------------------------------------------------------•-----------•---. Agreement: The undersigned.agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned f er a re s not to ace the system in operation until a Certificate of Compliance has>Dnss e8�y the-board Signed. !!LL/ ---- .•----- - �� r Date ApplicationApproved By................................................................................................... --•----• .............. Date Application Disapproved for the following reasons----------------------------------------------------------------•------------------------._...--••--•-----•---•-. ------••----------••---------••-•--........--•••-------•----...--••••-••••-------•...................••----...................•----•------•-----...-•-------•-----------•--•--•-----------•••......--••- 170 4/. Date Permit No.---...---85-....................................... Issued..............4401/85---------------------•-- Date G THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..::' "own..........O F......�arnstable............... .................................... CIrr#ifiratr of Tontpliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (X ) by...... .......a28..Ri%haps..Te_rr=e,.Jky_a ants,..YL....02601-----------------•--------- Installer at.---. .----0265.-5----. Rate..A..ro../,LQhn..&..Rp-th..Pannbami has been installed in accordance with the provisions of TITLE�j Aof The State Sanitary Code as described in the application for Disposal Works Construction Permit No._55."............................... dated---..---- /.0-4/.01/55..................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... r P'NE COMMONWEALTH OF:' tICASSACHUSETTS BOARD OF HEALTH � cr ..................rain..............of.............. �.x�x� b�.a....... No85-............•--- <. FEE.........$ U.00 Disposal Works Tontuation ami# Permission is hereby granted..A.&l..Cees off,. .f3 v � .'' �ri�-x........................................................................ to Construct ( ) or.Repair (X ) an Individual Sewage Disposal System at No..- =S--Main-_Street....star..ille,--MA----.Q2..�5..----------IO�te--B�--Cs�_.�:?Qbn._&.__P�th..�_onnk�.xd�-----.-- Street ,S f✓�� as shown on the application for Disposal Works Construction Permit No8.5-.............. a ed 41 g5........................ .........--•.............•--•------•-------•---- -------- G,/ r Boar of Health i 7 DATE----------------------------------------------------------•------------........ FORM 1255 A. M. SULKIN, INC.. BOSTON & 0- 3 ... Yzim ...$....5...49....._ THE C MONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...... .T.own...............O F......Barnst,..bj.e...........-------------------------..................... App iratiou for Dhip aal ?forks Touts rurtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at: ...Lilly-Pulitzer,---=.e68-Main.St....�stery �a,e. . ...._026j - Location-Address or Lot No. Holbrook Davis _Seapgit__Rd,__,__Oste y ],��,„MA__,,..0.26 ..........,„__ Owner Address A & B Cesspool Service 128--Bishops__Terrace,,_„Hynnis,,__MA,,,,0260�,... - --•--------------•--------•-•-•-•------- ............................. Installer Address d Type of Building Size LotSq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria P4 Other fixtures ------------------•-----•--•--•• . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. I' W Septic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.--_----_-..------ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. _ Other Distribution box Dosing tank z ( ) g ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. i----------------minutes per inch Depth of Test Pit.-_---.------_---. Depth to ground water........................ Gt, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ P4 --•-•------------------•-••-------------•--------------••-------•-----------•------•--------------.........-----•--------••-••-•........................... 0 Description of Soil......BAni........................................................................................................................................................ x ----------------- --•... -------- - ----- UNature of Repairs or Alterations—Answer when applicable----Zx_�sta,llat pl?..af---a,_-6.-X-4-pr.p ,cazt...1eaQh. ...pit..--(.Qverfl-au .---to..rapla.ce.--a---cave.-ia-............................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T `�T y g g p y 5 of the State Sanitary Code— The undersigned further reel not to lace the system in operation until a Certificate of Compliance has en issued by the bo d f 1 th. Signed- - •-•--- •--•-- 4 =•---------•-------...a..... /2 a 81 ApplicationApproved By.................................................................................................. 3� ................. Date Application Disapproved for the following reasons------------------------------------------------------------------------------------------------------•-------- ....-•--•••-•-••--------------•-•-----..............---•---..........•--.......---------------•----•--...---------•---------•------------------------------...---------------------------------------•-- Date pp ! Permit No.......81- l ......................... Issued_........3�23/81 ------...--- Date N 8 ----�32 . F>�s..... .. .00...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................Town...............OF....... aarnstable.... Appliratilan for Dinpuiai Workii Tonstrnrtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: ••.Lilly Pulitzer 868 Main St. Osterville,_MA 02655 ........................ •----••---•-•--•..................••-•......-•--------•-.... ... ..... - Location-Address or Lot No. Holbrook Davis Seapu3t Rd, � .Osterville, MA _026 •. ......................__........................................................................ A B Cesspool 5"e O ner Address a .................................................ry ce.--.......------...------.......----••--•- 128 Bishops__Terrac......H�.?u►is�.MA....02601... Installer Address dType of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 'k Other—T e of Building No. of persons............................ Showers — Cafeteria Q, Other fixtures ---------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth.............. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter...-.-_-._-.._--.-_. Depth below inlet.................... Total leaching area..................sq. ft. Zt Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water----------- ............ (% Test Pit No. 2................minutes per inch Depth of Test Pit-_-__._..._________- Depth to ground water..--___.....__--.._-_--- ---------------------------------------------------------------------•---.........-•-•-•------...............-----...........--•------•••......•--•-...---_.. D Description of Soil....... . ............. x V .----------------•--------------------------------------------•-•--•-------•--•-------•-•-•---•----------...-----------•-•--•-------•----•.............................................................. W ---------------------------------------- - ---- -----------------------------------------------_-----------------------------------------------------------------------•----------•............. UNature of Repairs or Alterations—Answer when applicable---installation---of__ 1...5.X..6..pre-Cast.-leach. pit (overflow) to.XVplam. axe-lz�............. ................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with = the provisions of!'t T: of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en issued by the bo d f 1 lth. Signed ------ tc ...............�L-r. ..... /23/6.1..... _.... Application Approved B 3/2J181 Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------- •----------------•.......-•----------•--••------•--•-----------------------------------•••-••---•----------••-•------------------------•-----•----------------------•--- ............................... / 3/ Date PermitNo......................................................... Issued................2.........81 Date G THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `town Barnstable .....................I................OF.................................................................................... Trrtif iratr of Tompliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (X) by......A &__B Cesspool Service, 128 Bishops Terrace, .Hyannis-, MA...... 2601..................................... Ins alley at........:Lilly Pulitzer ofOsterville, -868 nSt._ OsterviileI_MA 0265 - H.A. Davis a , _ ---. has been installed in accordance with the provisions of TI 5 of The State Sanitary C.de s described in the application for Disposal Works Construction Permit No .... _... '�._..__.. dated-_3Z23�8............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. $ /23/81 DATI?........................................................ Inspector . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 81- / 3'.L Town......_OF..Barnstable .............................. $5.00 No.----. ..... FEE----•................... Disposal Morks T11nntrnr#ion rrnti# Permission is hereby granted.A & B Cesspool Service, 128 Bishops Terrace, Hyannis to Cons%g 6aYem ri rStR�pabs�,MilIendiv ualagge DLllly Sv Pulitzer of S+sterville, - H.R. Davis atNo-------------------------------------•-•---------•--•----•------•---------------•-•.......----------------------------•------------------------------•-----•-----------------•-----........------ Street 3 23/81 as shown on the application for Disposal Works Construction rmit o 81- _._._.._._ Dated.........f----.1------------------------ f .------••------------•..............- 3/23/81 Board of Ith DATE ---------------- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS No.... ------ FEs ..0...�.�......... !' L THE COMMONWEALTH OF MASSACHUSETTS 8 - "'° BOAR® OF HEALTH TOWN OF BARNSTABLE Appliraf .an for lgtipmal Works Tomitrurtion jJrrutit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: .....J o s eDh s---R e s t e r a n t -------------------•------•---•--------------------------•---------------•--------.--•------------ Location-Address or Lot No. 825 Main' St. Osterville MA - - ......................... ..........--..................................................................................... Owner Address a W.E. Robinson S -----------------•--- -------------•----e- ti-c------Sery i-c--e ------------------------.........•......-----------------.....------------....------•-•••---- Installer Address Type of Building Size Lot................:.........:.Sq. feet .- Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) �a Other—Type T e of Building No. of persons............................ Showers yP g Re-s�e�an-t--- P ( ) — Cafeteria-( ) dOther fixtures ---------------------------------------------------------------------------------------------------------•--. . W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. WSeptic Tank—Liquid capacity............gallons Length---------------- Width................ Diameter................ Depth._---_-.._-_---. x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No-_------------------ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date---------------------------------------- Test Pit No. 1___-_-__-_-____minutes per inch Depth of Test Pit____________________ Depth to ground water----_--_________-----__. GL, Test Pit No. 2----.---__-_--_minutes per inch Depth of.Test Pit______________----- Depth to ground water.___-____-__--_--..._--- P ----------------------------------------------------------------------------------------------------------------------------------------------•------•----- ODescription of Soil----------_-------&a-nd-------------------------------------------------------------------------------------------------------------------------------------- U ----------------•----- ----------------------------------------------------•---------------•--•------------------------------------------------------------------------------------------------------ W . V Nature of Repairs or Alterations—Answer when applicable-._k_l.)-----1.0-0.0...�ga1._----s_t_onepa eked..................... -----h e a yy._du t y--l g a c hp i t------------------- ----------------•------------------------------------------- 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 furt r agrees not to place the system in operation until a Certificate of Compliance has be Jued�the and o ealth. i A—�! Signed ----- -------_--_ - ----------- ------- - --- -- ---------------- ..........--- i ---...-------- . re Application Approved By ------ . ._ . ...... Dare Application Disapproved for,the following reaso s. ---------------- ----------------------------- - ------------ - ------- - - -- - --- ------- ----- --- ------ Date ......_. Permit No. -- ----- . v Issued ( - --- --------- --- -- ---- . Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cfextif r ate of (gomylianve THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (x ) by....s .=.E.,....Robinson- Septic Service - -------------------------------------------------------------------------------------- ------ -J .................................................... Installer at 8 2 5 Main - t O s t e ry i_l l e---� ------------------------------------------------------------------------ has been installed in accordance with the provisions of TITLE - f The a-e Emvironmental Code as/ escri,e 1 the application for Disposal Works Construction Permit No. Q PP P T ==•:;:: dated l -�.--1._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S`=A.GUARAINTEE TH T THE SYSTEM WILL FUNCTION TIS7ACTORY.nAT� � Tncncrtnr ' -�/ r THE MOST ADVANCED NAME IN DRAINAGE SYSTEMS November 25,2014 Michael Pimentel,EIT, CSE JC Engineering, Inc. 2854 Cranberry Highway East Wareham, MA 02538 RE: GEO-flow Leaching Pipe design conformance certification for the Restaurant located at 825 Main Street in Osterville,Massachusetts. Dear Mike, I am writing in reference to the approved GEO-flow Leaching Pipe design plan for the Restaurant in Osterville. I have reviewed the design plans for and approve of the GEO-flow Leaching Pipe calculation and design layout. Please feel free to contact me if you have any concerns or questions in regards to this design plan at 207-240- 5967. 1-6- /v yin Steve Minor Advanced Drainage Systems, Inc. Onsite Specialist ADVANCED DRAINAGE SYSTEMS,INC.,4640 TRUEMAN BLVD., HILLIARD,OH 43026 PHONE:800/733-7473 E-mail:info@ads-pipe.com Web site:www.ads-pipe.com TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. 'c; ,,,hip , SEPTIC TANK CAPACITY /,�O, , lS7a �-L LEACHING FACILITY:(type) , (size) C� NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 17 `iL Aj 0 /w /it 5r TOWN OP BARNSTABLE � II LOCATION ._ . ._ SEWAGE VILLAGE O 5 j ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. � ' �ab �r� 0 �•+ 7 ? ��7 b' , SEPTIC TANK CAPACITY .Z /6 6 6 LEACHING FACILITY:(type)-7*/0 o 6 S (s ) NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No I i /e 'TOWN OF BARNSTABLE 05ie1' � , I LOCATION ... SEWAGE 0 VILLAGE Q / ASSESSOR'S MAP & LOT I � INSTALLER'S NAME & PHONE NO. Gy ��6 ,ram 6 O SEPTIC TANK CAPACITY 6 6 S LEACHING FACILITY:(type) /0 o b S (size) j NO. OF BEDROOMS PRIVATE WELL O PUBLIC wXk-tER I° BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �eb L,a Wtl I all Id or- /l �TOWN O BARNSTABLE LOCATION SEWAGE# 2-o tJ-o 3o `VILLAGE� Yr _c ASSESSOR'S MAP&PARCEL 0 INSTALLER'S NAME&PHONE NO. L.,a e C t^ by7J SEPTIC TANK CAPACITYC/000 &c l 4—,-X Q (o yu I ,cy-An +C4,-i�. LEACHING FACILITY:(type) � en-F/oW l;�/� (size) X 5 �d•a NO.OF BEDROOMS G.] A-cdv/P,er Sea' ,30 Somas ��n� OWNER O.S4eylly i & HO ld i'vn c L L PERMIT DATE:> a ' Lo COMPLIANCE DATE: orh Separation Distance Between the: do r�ec (p+d Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Q/p, ✓)Ve Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) ✓l/ / Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY L-LC. Ar 'Deck, A-4=A6*' A 7=61n6 A-9=6®° 57,5 00 o 7 0 t TO'..N 0 BAa STAB LE LOCATION �.�, A4 r4 1,41 :5 SEWAGE # VILLAGE [j STe-A V 1/-z ASSESSOR'S MAP & LOT 117. )66 INSTALLER'S NAME & PHONE NO.j //0,4 C 0/0�eQA fi Sflr/ SEPTIC TANK CAPACITY 100o , �X TrC, /aD LEACHING FACILITY:(type) f (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER' BUILDER OR OWNER DATE PERMIT ISSUED: a '� ►.� �/?j DATE COMPLIANCE ISSUED: - 1 - C? VARIANCE GRANTED: Yes No r 1 417 o a i i TOWN OF 8.' R. STABLE LOCATION `J SEWAGE # VILLAGE 6 s 1 ASSESSOR'S MAP & LOT ' INSTALLER'S NAME 6t PHONE NO. SEPTIC TANK. CAPACITY LEACHING FACILITY:(type) 3"`C/v-/6 (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER J.Ss Z�N S DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No. `�-- -= /Ap e TOWN OF BARNSTABLE LOCATION g s`5 ^� � I SEWAGE # VILLAGE 6,5 1 ASSESSOR'S MAP & LOT en INSTALLER'S NAME & PHONE NO. K0i,,-A--56 CO -7 7:7 SEPTIC TANK CAPACITY f,!�A / S'T� •mac" �` ' L- LEACHING FACILITY:(type) (size) G C NO. OF BEDROOMS �r PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER -�66 p /,1. K&S 1 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �Aj i F o i .0 r' O T j`f 'TOWN OF BARNSTABLE LOCATION ._. . _ SEWAGE # �'"Ll (✓ J VILLAGE 1 ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. GA) '' l�d� ��/�d 0 i I SEPTIC TANK CAPACITY LEACHING FACILITY:(type)�/r b i o�+ S (size) 1 NO. OF BEDROOMS PRIVATE WELL O PUBLIC�W�X_TER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: _ VARIANCE GRANTED: Yes No V � M r _ r TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE Q `g j ASSESSOR'S MAP & LOT INSTALLER'S NAME 6t PHONE NO. CCJ► `16 �-s a ��'�� SEPTIC TANK CAPACITY LEACHING FACILITY:(type)A gel ; (size) NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER - BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes 611 No i No..( ._. Fss $.........30.00 ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appilration for Diipnstti Works Tomitrnr#inn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 82� Main Street Cotuit ... . ..._.__... _................. . ----------•--•---------------•-- --•-•.._......••-----•-...•---•----•---------•-•----••..........-----•----.........._.._.......... Boden Location-Address or Lot No. W J.P.Macomber Jr. Owner Address Installer Address Type of Builc n Size Lot............................Sq. feet U gg1X� �-, Dwellin —No. of Bedrooms.__.........3------_--------------------Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type e of Building ---------------•------------ o.N of Persons............................ Showers Cafeteria a ( ) — ( ) dOther fixtures --------------•----------------------------------------•---------------------------------------------.........-----_..... - --_... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter-_-_____--__-- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------_-----------_ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) , Percolation Test Results Performed by------------------------------•-------•----------•------------••------•--- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ----•--•-••----------------------------------•------•---•--•-•-----..•---------------------------- -----------------------•-----------------------------••-- 0 Description of Soil------•----------------------------------------------•---------------•--------------------------------------------...--------------..--...------•--......_.........----- x Sand U - W UNa--r--of{- RepairsTiAlterations—Answer when applicable...................................................................................:...... _e1000 gallon tank & 1-1000 gallon leaching pit............................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE S of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia e has ee issu by the oard f health. g 6 1 0 Si ned .- r � to Application Approved By .. .... .... ... . ... . ... ..o -------------- &------- ---9Q Application Disapproved for the following real .. ---------- ------................................................................................... ----------- Permit No. �. . Issued .....- f.... .- --.....---'---- '-----Date � — --...- No.V_ FEs . 30.00 THE COMMONWEALTH OF MASSACHUSETTS • -- BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tonarwtinn f amit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: 825 Main Street Cotuit Boden - Location-Address or Lot No. Owner Address W J.P.Macomber Jr. a ........... - ------..... ... Installer Address Q Type of Building Size Lot............................Sq. feet DwellingxNo. of Bedrooms............3.............................Expansion Attic ( ) Garbage Grinder ( ) PL4Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ......................•----. . Q W Design"Flow..........................................gallons per person.per day:Total.daily flow............................................gallons. WSepticiTa"nk. Liquid capacity....__..gallons Length................ Width...._........... Diameter...........__.__ De`pfli"`..._......_.. x Disposal.Trench No...................... Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Piv NO........ _. ._ Diameter.... �............ Depth below inlet.................... Total leaching area..................sq. ft. Z - Other�Distribution lboxy(, ,) Dosing tank ( ) a Percolation'Test yResults � Dosing tank Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •------------------------------- ................................................................................................... 0 Description of Soil...........---------------------------------------•••-......••••••-••••-••---•---------------------•-•-•--.....------..._:::.......................................... W -----•--------------------------------------------------------------------------------------------------------------------------------•----------------•-•--...----•---•--......:_.t--..t----1.-•-----••-•-- U Nature of Repairs or Alterations—Answer when applicable.............................................•..._..........._......._..._......_._._..._...__. 1-1000 gallon tank & 1-1000 gallon leaching pi-t. ..-•------------- 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 Complian a has been'ssu by the board f health. 6/l/ Signed .-.. W. ....... -----'---------------------- --- ..------------ Application A B roved .-- .... p........, ..Q--.. Application.Disapp'roved for the following,reaso ------------------=------------------------------------------------------------- ..................................... ` .. ................................................................-----........_a ----........................................................----.........---------- 1 ........................................� te Permit No. ` .. ---------------- Issued ....---�1.�/�. ............................... e THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate of (gorrtyliartc.e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired. XX ) by---J.._P.Macomber Jr. ..............................Installer '- .....-...- '---...-....................................................-............-------...--...--...-.............-- at .....825 Main Street Cotuit .........................................................----------------------------- --- --------....................................................--------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as d cribed 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.....!..!.[-�n---------------------_--_--_--- - ......................... Inspector -- --- �-, �''"`�>.....--....----------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.....:.........•. FEE.$._.�J,.•Q�J-,-- Dispnstt1 Workii Tonotrnrtivit "prrntit Permission is hereby granted.......J.P.Macomber ` r.-------------•---.........._..............................-•-........................._.. ................ ... to Constru2c�(M€titl �PCreet )COtuiitldual Sewage Disposal System atNo..-----•-••.............•--...---...--e.........------•----• .................................................. --------- Street as shown on the application for Disposal Works Construction per it No.!�� Uated�_�__lQ.. ._�_. 'e, n._ .._.. Bo DATE........ d of Health -•---�-------•---------- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS * GENERAL NOTES NOTE. SIEVE ANALYSIS REQUIRED ON T M - TOP OF FLOOR SYSTEM SAND ASTM 3 I ,. C3 IN SITU, BEFORE INSTALLATION OF PIPING. CONTRACTOR T PROVIDE O RO DE ENGINEER ELEV.= 43.7'f' FINISH GRADE OVER D-BOX= 39.0�± RAISED CONNECT/OlV(NOT TO SCALE) 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION WITH BILL F I -I I' LL O LADING CERTIFYING THAT THE SAND MEETS ASTM C 33. PROVIDE H-20 CONCRETE RISER WITH TOP VIEW SIDE VIEW END VIEW METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE EXISTING ROOF VENT SHALL BE USED AS THE"HIGH" SECURE CAST IRON FRAME&COVER TO F.G. PROVIDE H-20 RISER w/SECURE LEVEE moo" ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. I' III I 'PV / OVER TANK COVERS AS SHOWN TYP. OF 5 a cPP _ VENT FOR SYSTEM VENTING. DIFFERENTIAL VENTING ( ) CAST IRON FRAME& COVER TO F.G. FINISH GRADE OVER LEACHING FIELD= '37.5 39.4 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD r r I BETWEEN "HIGH"&"LOW"VENT SHALL BE 10'MIN. °g0" 5"DIA. OUTLET(S) SLOPE @2% MIN. OVER SYSTEM OF HEALTH AND THE DESIGN ENGINEER. INSPECTION PORT w/ 3. 4 SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL 4'PVC PIPE OFFSET ADAPTER " i gp" OFFSETADAPTER "LOW" � • ACCESS BOX WITH COVER S CO E LOW PVC VENT PIPE r ENV/ROSEPncPIP C E I E WITH r r r E BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. DO NOT INSERT PVC PIPE MORE ENVlROSEPT/C PIPE T F.G.G. OVER GREASE TRAP EL 39.4 -40.0 F.G. OVER TANK EL.= 39"0 - 39.7 O EE NOTE#22 f r!/ANa"/NTOOFFSETADAPTER ( ) CHARCOAL FILTER 9 MIN. 4. TO PREVENT BREAKOUT,THE PROPOSED FINISH GRADE SHALL NOT BE LESS THAN n PROPOSED 9"MIN. „, 36 MAX. ELEVATION =34.20 FORA DISTANCE OF 15 AROUND THE PERIMETER OF THE SAS. x 9 MIN. PROPOSED n ° 36 .MAX.. _ I 4 SCHEDULE 40 PVC MIN.SLOPE 1/o BREAKOUT ELEVATION - UNLESS A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. 4"SCH.40 PVC 4"SCH.40 PVC 36 MAX- PROP.4^ \ 34.20 t -SCH.40 PVC COMPACT 90%MIN.SPD a AND THE TOP OF THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. I -3» » 3» TO D-Box L=3't PROVIDE WATERTIGHT 35.70r- "SYSTEM SAND ASTM C-33 1.5 MIN. (H-20) 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. -:..-a-- 6 2 DROP MIN. n l 9 „ 3^ n JOINTS P. 4.2 MAX. 7 ,� (TYP.)3 DROP MAX. o min g" -3- » 9n 3 / 4 PVC IN FROM „ 3520r RAISED CONNECTION SEE NOTE 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. _ SEPTIC TANK 4 PVC OUT TO (see detail above) 3 '* - 9 s�oPE ^1^k m 7. LOCAL BOARD OF HEALTH TO BE NOTIFIED PRIOR TO BACK FILLING WHEN 24" , „------- ----- n ^ 1 » LEACHING FACILITY - _ 36.25 34 o n y ::.. 48 3s 10 O ^ 0 - :. _ :. :,- :. - 3 �, SYST M IS NEARLY MP -- •- -•. ..: . . .::. . . - ECOMPLETE AND READY FOR INSPECTION. SYSTEM, LIQUID MIN .-- :- ..: : -- ---: :_, - -- - - --.--- -•- 6 O S S EM IS NOT TO r 12 6 _ .5O LIQUID --_ •,:_:-- o o. :_,.• ._,..•. , - ; ;=- - � �--:,--:. BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL.FROM BOARD OF HEALTH. I 36 LEVEL SUPPORT 35 75 - - - '�- INLET OUTLET TEE - ,' 8 ELEVATIONS BASED ON APPROXIMATE U.S.G.S. DATUM. ELEVATION OF 39.60' STRAP P » LEVEL 35:17 Mw. 35.00 �" - - TEE j 12 MAX: 12"GEO-FLOW SEPTIC PIPE(LAID FLAT) >:_ ::'= _.,::12" ESTABLISHED ON A NAIL SET IN UTILITY POLE#64/1A i.e.BENCHMARK#1 AND (3,500 GALS.) (2,000 GALS.) :: = :.-: o o ) OUTLET n -- � `- � .. 6 CRUSHED STONE = . 4 PVC TEE C S � :. - - --:� '•.:.=._:.: -:-.- -, -.:::._.-• ._ -- ... :_;.: ,:"-•.--•-:; . •:'-;"-. - ELEVATION OF 39.00'ESTABLISHED ON A NAIL SET IN UTILITY POLE#64/1ASS i.e. 36.00 in from t. _ ( 9 ) TEE - :; o o PLACED DIRECTLY •-. �.ALL TEES SHALL BE C 34.78 - -- - `- OVER MECHANICALLY ( in from bld ---:"=. --- . •._. -... .- .. . . ....-•- • ... .: . :. . ..:.... ... .. . :.... w. .... - -- - � '- --- � �•--..........,:- � . :. :_.. --_:• K#2)AS SHOWN ON PLAN. UNDERNEATH CENTER OF RISERS 36.00 ( g) GAS BAFFLE » 6 BENCHMARK 12 DIA.ZABEL FILTER .. COMPACTED BASE - =- -- ----------- - _.... - ,. . ._ --. -.„:. .._ . _,. .- -. . . _.. 34.20� _ 1.0' 1.01 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION *CONTRACTOR TO VERIFY EXIST ING INLET TEE MODEL#A100-12x36-VC 5 12„ BOTTOM OF FIELD TO BE LEVEL, EL. 33.70 12„ THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE ELEVATION PRIOR TO ANY WORK& (GAS BAFFLE ON BOT. OUTLET DISTRIBUTION BOX1. 1VARIES 1.5' 1.5' 1.5' - - - AT 1 888 DIG SAFE AND ANY OTHER APPLI ABLE AGEN IE P 16" TO BE IN TALLED ON A LEVEL STABLE C C S RE ORT ANY CRUSHED STONE... NOTIFY ENGINEER IF DIFFERENT. (TYP) (TYP) r u r n r n OVER MECHANICALLY , n r rr , n BASE. FIRST TWO FEET OF OUTLET DISCREPANCIES TO THE DESIGN ENGINEER. LENGTH 16 -6 WIDTH <-7 -6 DEPTH 9-7 VARIES 31.5' LENGTH 9-0 WIDTH 5'-4" DEPTH 6-3 COMPACTED BASE PIPES TO BE LAID LEVEL. 5 MIN• 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE STRUCTURES SHALL BE MADE WATERTIGHT. - TYPICAL GEO FLOW FIELD PROFILE -TYPICAL GEO FLOW FIELD END VIEW PROPOSED 1 ,000 GALLON PROPOSED 5,500 GALLON - CROSS SECTION VIEW = 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH H-20 GREASE TRAP 2-COMPARTMENT{H-20 SEPTIC TANK GROUND WATER ELEV.= � 27.70� DETERMINATION FROM APPROPRIATE AUTHORITY. k H-20 DIT IUTION O DETAIL G O-FLOW FIELD DETAILS NOT TO SCALE NOT TO SCALE NOT TO SCALE NOT TO SCALE 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS 1 I s r.r ,�• i} ` . - :.: LOCATED UNDER PAVEMENT,DRIVES OR TRAVELED WAYS IN WHICH CASE EXISTING EASEMENT. t� _, "- *' •� ;' t TEST PIT DATA THEY SHALL WITHSTAND H-20 LOADING. #825' SEE L.C.DOC.#7340 , (/ � ( ) ` ,j (ASSUMED)S U 1 V e G®) 13. IF NEEDED,DOUBLE WASHED CRUS:IED S r ONE SHALL BE FREE OF ALL DIRT, DUST&FINES. EXISTING 50-SEAT ,. RESTAURANT v1. .., E I � ,. . . .. - . PERC NO. TO B DETERMINED _ WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM SUBSOIL AND FFE -43.7± i .� . .. O BE bETERMINED . . . 3 _... ., INSPECTOR. I UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF ;•,.- y..< LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN 'EVALUATOR. Michael Pimentel EIT CSE L x, w O ,: �: l' 2.= . • s�, ! COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN . ' - Oct. 1999 • � F. G y: � '-' C.S.E.APPROVAL DATE. '9 A� ACCORDANCE WITH 310 CMR 15:255!3). 7 MAP 11 .�. '9 ,, F.. ..�. ;:,:.- • .::' .,., TO BE DETERMINED '9 :_.. r.,, DATE. � r e / •. ,,:, ;:, :•, 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN O *ems i • • �. ? PARCEL 101 k ,: i> -- „a • «, TEST PIT#. 1 SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. u.. .. y '�. .: . + ' - * € ... f ELEV TOP= 38.00' 16. PROPOSED PROJECT IS LOCATED WITHIN: I F� ZONE 2 :: ASSESSORS MAP 117 LOT 100 „ � ELEV WATER= (assumed) w �; �' OWNER F I - O O RECORD. OSTERVILLE RE HOLDINGS LLC I co �: � , �. �, :,.- « .•� - 2,mrn.hnch assumed Gy PERC RATE- < (assumed) , 7 #o i I � ` p, '9� I, •. . • '• ' ADDRESS: 825 MAIN STREET j J • „ ` A • * DEPTH OF PERC= 36 -54 OSTERVILLE, MA 02655 CV i / Q MAP 117 ♦ �� • , TEXTURAL CLASS: 1 A I 2 17. _ FEMA FLOOD X PARCEL 100 1 LOCUS \ AS SHOWN ON COMMUNITY PANEL# 25001CO544J s U r 2 547_S.F. .� _. . O 4 + n 18. DEED REFERENCES. L.C.C.#203608 (LOCUS); L.C.DOC.#7340 EASEMENT o ► 1'i�p to ) (EASEMENT) 38.00 , *� 5�` .• +; �; rr • i I Fill 19. PLAN REFERENCES: L.C. PLAN 12546-F; PLAN BOOK 117,PAGE 23 iYi.. n - 20. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL.CONDITION. p �. „ �, ♦ . ,: �' e Loamy Sand 21. THIS PLAN IS TO BE USED ONLY FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT EXISTING 50-SEAT .� •, �,r �c;:. ,s , + r . - �\ ;'. � , ,. ��• _ , a: ,�•; _ ,: 36 ...,._ ASSUME ANY LIABILITY FOR USES OF THIS PLAN,OTHER THAN ITS INTENDED PURPOSE. CONVENTIONAL SAS DESIGN „ "LOW" RESTAURANT'Al \ PROP. 4 PVC LOW VENT PIPE O ►. ' 1'l , �► ±' +! + : - ( FFE 43.7± SEE NOTE 1 BELOW +� : ,,. �4:: •�.�' . �r *:..,It .'� =-_ � , ( ) ,,, • ,..v ,. ; .H ; ..: 22. A 4 PERFORA �ED SCH.40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A - �: trs. . )I. 54 33.50 n EXISTING NEIGHBOR'S � ' +�`F - '�. *r,,.,�-,• �;;a +*� ,,:<<: •'.!" � DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3-OF FINISH GRADE. A � ,•;. ,I I , .. }, ; .:� ,.: „M '+�: . err -�;r ..- �' SEPTIC TANK TORE1V1A11'v \ :7� h'�:`� ,. *�& rt,z{,. ,�i. +� � , ( ) I \� 8f1 ` *;, . a:.. REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. All r u dr r . w . • rr , w 23. -1N ACCORDANCE WITH 1 I _ C 3 0 CMR 15.401 15.413 THE FOLLOWING LOCAL UPGRADE x DIMENSIONS PLAN PROPOSED GREASE GALLON ♦e\ I / MAP 1 17 `" + ' . ''"„ APPROVALS AND VARIANCES ARE REQUESTED FROM 310 CMR 15.221 FOR ITEM 1 310 H 20 GREASE TRAP � I:. "`"] • AND 310 CMR 15.252(2)(f) FOR ITEM 9: �) ' SCALE: 1"=20' �• }� p\'2'\ PARCEL 99 „ -_..__.. C Medium Sand CMR 15.211 FOR ITEMS 2 thru 8; I,I CONVENTIONAL SAS DESIGN REQUIREMENTS EXISTING •1,000 GALLOfJ GREASE r`1 2.5Y 6/6 (1.)A 1.2 WAIVER(3.0 -4.2)FOR THE MAX. COVER OVER THE PROPOSED SAS. �o , 2. A 10.0 WAIVER 16.0 -0.0 FOR THE SETBACK FROM THE LOT LINE TO PROP. SAS. T BE REMOVED �° / . . \o�,o° O ( )I TRAP O _ � As required per Standard Conditions for Alternative Soil Absorption Systems A � 1 28 �O� {3.)A 10.0'WAIVER 10.0'-0.0' FOR THE SETBACK FROM THE LOT LINE TO PR. SEPTIC TANK. / 1 ( ti ' .with General Use Certification and/or Approved for Remedial Use � � �- LOCUS PLAN 4 A 1 b.0 WAIVER 10.0 -0.0 FOR THE SETBACK FROM THE LOT LINE TO PR. GREASE TRAP. } EXISTING 1500 GALLON SEPTIC O\ g�` ( -) ( ) c I r , Revised: September 26,2014 Fo�` �� TANK O BE REMOVED (5.)A 13.9 WAIVER(25.0 - 11.1 )FOR THE SETBACK FROM EX. DRY WELL 1 TO PROP.SAS. qV \ / SCALE: 1"= 1000' A CO1 C'i0 - d a (6.)A 16.1'WAIVER(25.0'-8.9')FOR THE SETBACK FROM EX. DRY WELL 2 TO PROP. SAS. 1.)FOOTPRINT OF CONVENTIONAL SAS CONSISTING OF A 32 x 74 ��, FiZj� /�' �1 (7.)AN 8.5 WAIVER(10.0'-1.5')FOR THE SETBACK FROM EX.SUBSURFACE DRAIN TO PROP.SAS. O T o _ T R ILLUSTRATION PURPOSES ONLY;NOT TO 8. A 2.8 WAIVER 20. 17. FOR T FIELD(JUST FOR LLU V 0 2 O HE SETBACK FROM EX. L T LEACHING F � J''� : �+ CELLAR O PROP. SAS. I 120 03 28.00 , - DESIGN N DATA _�7 G SYSTEM CAPACITY- 1 752 GPD BASED ON ASSUMED 9. AN$.7 WAIVER 10.0 1.3 FOR THE SETBACK FROM EX:SAS LEACHING PIT TO PR. AS. SYS C , G S BUILT). LEACHING ( , _ --�► �L ( ) ( ) EXISTING NEIGHBOR'S S 0 r PERC RATE OF<2 MPI . - No Mottlin Standing or Weeping Observed_tt ) LEACHING PIT(TO RI�,�IA;N) � o�O o\�� TYPE OF ESTABLISHMENT = RESTAURANT 9, 9 p 9 LEGEND D = 50 (per owner NUMBER OF SEATS ti \ A TEST PIT DATA o �' = x 50.0 EXISTING SPOT GRADES 01 DESIGN FLOW 35 GPD PER SEAT s 8 BIT. CONCR. I - r S �\ Benchmark#1 ASSUMED) 15 EXISTING CONTOURS pL Nail in U.P.#64/1A TOTAL DESIGN FLOW = 1,750 GPD T PERC NO. TO BE DETERMINED PARKING LOT ` \ , _ 50 PROPOSED SPOT GRAD LP S ES '� � � Elev. -39.60 0 ' y GREASE TRAP SIZING: INSPECTOR: TO BE DETERMINED Approx. U.S.G.S. 50 PROPOSED CONTOURS _ 1000 _ • ,. .. USE PROPOSED GALLON H 20 GREASE TRAP TANK - , - :. 1 EVALUATOR. Michael Pimentel, EIT, CSE _ _ � W W EXISTING WATER SERVICE - - 15 GPD PER SEAT- 15 x 50-750 GPD REQUIRED . ( ) .. ro .Oct. 1999 C.S.E.APPROVAL DATE. • ro O A� USE 1 000 GAL.TANK PROVIDED . EXISTING OVERHEAD UTILITIES EXISTING CACHING PIT �O BE REMOV , _.:. � � \ ,5 PROP. 5 500 GALLON r / 2-COMPARTMENT \ DATE: TO BE DETERMINED �-PLAC�13�,.:, CLEAN COA ..E SAND (TYP ?F 4) `., >, _� -.- �✓ � . .: . , .: ,' �` » � --� TEST PIT LOCATION p`L D1 \ H-20 SEPTIC TANK SEPTIC TANK SIZING: TEST PIT#: '` 2 O : : . .. USE PROPOSED 5 500 GALLON 2-COMPART. H-20 SEPTIC TANK ,�`5 -39 ELEV TOP= 37.70 \ O 0 PROPOSED 1,000 GALLON H-20 GREASE TRAP 00 'l Cr PROP. 5-OUTLET H-20 a. O COMPARTMENT 1: O DISTRIBUTION BOX LEV W = <27.70 (assumed) \ 5 , DESIGN FLOW x 200%= 1,750 x 2= 3,500 GAUDAY(REQUIRED) CITY = GAUDA (PROVIDED) PERC RAT = OPOSED 5,500 GAL. 2-COMP. H-20 SEPTIC TANK . -. DE AP 117 3 N CAPACITY ( )DESIGN 3,500 Y P D E � 0 PR C A D PARCEL 179 : p _ COMPARTMENT 2: DEPTH OF PERC= n 00% = 0x1 = 0PVC PIPE EDGE O PROP. � PROPOSED 4 SOLID SCHEDULE 4 jj 1,75 1,750 AY(REQUIRED) DESIGN FLOW x 1 GAUD UI , SAND ED DESIGN CAPACITY - 2 000 GAUDAY PROVIDED TEXTURAL CLASS: 1 D - - ❑ PROPOSED 5-OUTLET H 20 DISTRIBUTION BOX o IT. CONCR. LEACHING FACILITY SIZ NG: " 3PROPOSED 12 0 GEO-FLOW SEPTIC PIPE PARKING LOT PLAN NOTES. 0 37.70 ,�? Rcp �1• INSTALL 20 ROWS OF 12 0 GEO-FLOW PIPES (880 total Lf.) - 1 _ _ Changed SAS to Geo-Flow m m p, 11 22 14 MCP JLC g System, moved tanks, etc. 5 Fi ll • �\ 1. MAGNETIC MARKING TAPE SHALL BE PLACED ALONG •• _ _ REV. DATE BY APP'D. DESCRIPTION \ ) REQUIRED GEO FLOW SYSTEM PER GEO FLOW DESIGN MANUAL. THE TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. _ - 12" 36.70' _ (ASSUMED PERC RATE=2 mpi) _ _ Loam Sand . PROPOSED SEPTIC SYSTEM UPGRADE 2. CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE TABLE 1. MIN. L.F. 875 (50 PER 100 GPD FLOW, PERC 1 to 9 mpi) g Y -I ® _ ' 10Yr 5/6 . PORT wJ H-20 ' PROP. 20 ROWS OF 12"!ZS ) i.e.(1,750 GPD/100 GPD x 50'=875 L.F. •_:� PREPARED FOR. PROP. INSPECTIONPO - C ( , ) � , ^n Z LOCATION OF THE PROPOSED LEACHING FACILITY TO - - o = n ,P F 4 37x9 \ GEO-FLOW SEPTIC LEACHING TABLE II: MIN. PIPE SPACING - 1.50 0 10/o PERC 1 to 10 m r 34.7 �' COVER TO F.G. (TYP O ^. , P 0 F . 3( ) O ENSURE CONSISTENCY WITH THE ASSUMED TEST PIT 6 s I M i. o A _ _ � C PEWIDE ENTERPRISES Sligo PIPES(880 TOTAL L.F.) DATA SHOWN'ON THIS PLAN. REPORT TO ENGINEER AND TABLE III. MIN. SAND BED AREA=81 s.f. per 100 GPD FLOW- 1,418 s.f. JO L. S � 37x5 3 1 p c� _ CH 1 N 0 _ U H.L R. CONNECTION H RAISED CO LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT i.e. 1 750 GPD/100 GPD x 81 s.f. 1 418 s.f.PROPOSEDC _ WITH 4"CONNECTION PIPE (TYP) 94' \ / \ o WITH TEST PIT DATA: ` T LOCATED AT PROVIDED "GEO-FLOW'SYSTEM: ss �� PROPOSED 40 MIL. GEOMEMBRANE LINER; �� % ❑ 3.) ENTIRE PROPERTY IS LOCATED WITHIN THE PIPING L.F. =20 ROWS F VARIEDLENGTHS = 0' r v'' > 7 ' min. " •� s 2 MAIN I ' - o ss (� o d) s 5 ( ) a 8 5 N STREET TOP EL.=34.20' / p,Os ESTUARINE WATERSHEDS AND NOT LOCATED WITHIN A \ ' ♦ 12 N PIPE SPACING= 1.50' roV'd ; 1.50' min. r 'd CB (p ) ( eQ ) - OSTERVILLE M A 02 � BOT. EL.-30.20 �7x Q DEP APPROVED ZONE 2. , 655 1 (NON-LEACHING) SAND BED AREA=31.5'x 46.0'= 1,456 s.f. (prov'd) > 1,�418 s.f. (min.) ` \ (TYP FOR BOTH ENDS OF SAS) \\ x 1 0 \ \ \ ♦\` '�/l\ 4.) CONTRACTOR SHALL OBTAIN ACCESS APPROVAL C Medium Sand FROM ALL LAND OWNERS AFFECTED BY THE 2.5Y 6/6 SCALE: 1 INCH = 10 FT. DATE: SEPTEMBER 30,2014 I -- ♦ / NOTE: . \� DRY WELL 1 � _�� ' CONSTRUCTION OF THE SEWAGE DISPOSAL SYSTEM. . GEO-FLOW SYSTEM DESIGN IS BASED ON"APPROVAIL FOR ttl � 0 s 10 20 40 FEET (LEACHING) �\ DRY WELL 2 3 ' REMEDIAL USE"FOR THE GEO-FLOW PIPE LEACHING SYSTEM; SN of rags , ED_GE OF PAVEMENT O\ (LEACHING) _ 5.) GEO-FLOW DESIGNER CERTIFICATE NUMBER: 282. .�� ' - __- - REVISED ISSUANCE DATE: 9-26-14 BY THE COMMONWEALTH OF .w PREPARED BY: .-• __ I JOHN L. U.P. -- -- _ I MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL CHURCHILL J ca JC ENGINEERING INC. H/ _ , w -_ AFFAIR DEPARTMENT FENVIRONMENTALT GV ,. S D ENT O PROTECTION; / o/H/w __-___ --_.. _ Benchmark#2 • NO. 2854 CRANBERRY HIGHWAY {( �/H/w ----__ p/ ----__..�_ II . . - TRANSMITTAL NUMBER: W088685. H/w t _ _ Nail m U.P.#64/1ASS 120" 27.70' Poi R r �o EAST WAREHAM, MA 02538 t�/H/w o/H/w Elev. =39.00' STANDARD CONDITIONS FOR ALTERNATIVE SOIL ABSORPTION r SITE PLAN Approx. U.S.G.S. No Mottling, Standing o Weeping Observed 508.273.0377 SYSTEMS WITH GENERAL USE CERTIFICATION AND/OR APPROVED SCALE: 1"=10' FOR REMEDIAL USE; REVISED: SEPTEMBER 26,2014 _, Drawn By: MCP Designed By:MCP. Checked By:JLC JOB No.2847 I I I I I, I I I I I I I ; ' I I