Loading...
HomeMy WebLinkAbout3095 MAIN ST./RTE 6A(BARN.) - Health 3095 MAIN STREET, BARNSTABLE A=279-038.001 CROCKER TAVERN Ir '., a :• - - � u , ... • „ Y - r o n . a -41 r Massachusetts Department of Conservation and Recreation dC Massa�huseres Office of Water Resources CID Well Completion Report 06-AUG-09 14:54:53 WELL LOCATION 263361 GPS North: 410 42.215' GPS West: -700 18.538' Address: 3055, Main Street Property Owner/Client: c/o Clifford Well Drilling Subdivision Name:St. Mary's Episcopal Church Mailing Address: P.O. Box 430 City/Town: Barnstable City/Town, State:South Yarmouth MA Assessors Map: Assessors Lot #: Permit Number:W2009-015 Board of Health permit obtained: Y Date Issued: 07/30/2009 ti Work Performed Proposed use Drilling Method Overburden Drilling Method Bedrock New Well Irrigation Auger CASING From (ft) To (ft) Type Thickness Diameter 2.00 -90.00 PVC Schedule 40 4.00 SCREEN From (ft) To (ft) Type Slot Size Diameter -90.00 -94.00 Stainless Steel Well .015 4.00 Point WELL SEAL / FILTER PACK / ABANDONMENT MATERIAL From (ft) To (ft) Material Description Purpose i WELL TEST DATA (ALL SECTIONS MANDATORY FOR PRODUCTION WELLS) Date Method Yield Time Pumped Pumping Level Time to Recovper Roovery (GPM) (hrs & min) (Ft. BGS) cEHr;s & Mine (Ft. BGS) y If I 07/30/2009 Constant Rate Pump 15.0000 1:30 .0000 + 0:01 2 �w C STATIC WATER LEVEL (ALL WELLS) PERMANENT PUMP (IF AVAILABLE) r Date Depth Below Ground - C Pump Description: . Measured Surface (ft) Tyop: In pay De *.p'N 07/30/2009 +2 Nominal Pump Capacity: Ho'lsepowe� M WELL DRILLER'S STATEMENT ADDITIONAL WELL INFORMATION Driller: Thomas E Desmond III Developed: Yes Fracture Enhancement:No Supervisor: Thomas Desmond III Rig #: 100 Disinfected:Yes Well Seal Type:None Firm: Desmond Well Drilling Inc. Total Well Depth: 94.000 Depth to Bedrock: Registration #: 764 Date Complete:07/20/2009 Comments: OVERBURDEN From To Description Color Comment Water Loss/Add Drill Drill (ft) (ft) Zone of Fluid Stem Drop Rate 00 30.00 Fine to Coarse Sand Brcwn Yes N/A 30.00 70.00 Silty Sand Brown & clay Yes N/A 70.00 100.00 Fine to Coarse Sand Brown' . Yes_ N/A BEDROCK From To Code Comment Water Drill Extra Drill Rust Loss/ # of (ft) (ft) Zone Stem Large Rate Stain Add of Frac Drop per ft 1/1 Fy Massachusetts Department of Conservation and Recreation dcr Massacfiusens Office of Water Resources Well Completion Report 06-AUG-09 15:04:51 WELL LOCATION 263364 GPS North: 410 41.917' GPS West: -700 21.184' Address: 59, Locust Way Property Owner/Client: c/o Clifford Well Drilling Subdivision Name: Mailing Address: P.O. Box 430 City/Town: Barnstable City/Town, State:South Yarmouth MA Assessors Map: Assessors Lot #: Permit Number:W2009-011 Board of Health permit obtained: Y Date Issued: 07/25/2009 Work Performed Proposed use Drilling Method Overburden Drilling Method Bedrock New Well Domestic Auger CASING From (ft) To (ft) Type Thickness Diameter 1.00 -80.00 PVC Schedule 40 4.00 SCREEN From (ft) To (ft) Type Slot Size Diameter -80.00 -84.00 Stainless Steel Well .010 4.00 Point WELL SEAL / FILTER..PACK / ABANDONMENT MATERIAL From (ft) To (ft) Material Description i ..Purpose WELL TEST DATA (ALL SECTIONS MANDATORY FOR PRODUCTION WELLS) Date Method Yield Time Pumped Pumping Level Time to Recover Recovery (GPM) (hrs & min) (Ft. BGS) (Hrs & Min) (Ft. BGS) 07/28/2009 Constant Rate Pump 10.0000 1:30 78.0000 0:01 4 STATIC WATER LEVEL (ALL WELLS) PERMANENT PUMP (IF AVAILABLE) Date Depth Below Ground pump Description: Measured" Surface (ft) Type: Intake Depth: 07/28/2009 4 Nominal Pump Capacity: Horsepower: WELL DRILLER'S STATEMENT ADDITIONAL WELL INFORMATION Driller: Thomas E Desmond III Developed: Yes Fracture Enhancement:No Supervisor: Thomas Desmond III Rig #: 100 Disinfected: Yes Well Seal Type:None Firm: Desmond Well Drilling Inc. Total Well Depth: 84.000 Depth to Bedrock: Registration #: 764 Date Complete:07/28/2009 Comments: OVERBURDEN From To Description Color Comment Water Loss/Add Drill Drill (ft) (ft) Zone of Fluid Stem Drop Rate .00 30.00 Cobbles Light Gray Yes N/A 30.00 50-00 Silty Sand Brown Yes N/A_ 50.00 65.00 Cobbles Light Gray- Yes N/A 65.00 84.00 Fine to Coarse Sand Brown Yes N/A BEDROCK From To Code Comment Water Drill Extra Drill Rust Loss/=Frac (ft) (ft) Zone Stem Large Rate Stain Add of PERMIT NO TOWN OF BARNSTABLE JANUARY 1, 2000 448 BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 395A and Chapter 111,Section 5 of the General Laws,a permit is hereby granted to: JEFF CARLSON AND SUSAN FARIA D/B/A: CROCKER TAVERN Whose place of business is: 3095 MAIN STREET , BARNSTABLE, MA 02630 Type of business and any restrictions: BED AND BREAKFAST ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE RESTRICTIONS IF ANY: SEATING: ANNUAL: YES SEASONAL: TEMPORARY: FEES BOARD OF HEALTH RETAIL FOOD STORE: Susan G. Rask,R.S.,Chairperson FOOD SERVICE ESTABLISHMENT: RESIDENTIAL KITCHEN FOR RETAIL SALE: Ralph A. Murphy, M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAST: $45.00 Sumner Kaufman, M.S.P.H. MOBILE FOOD UNIT: Permit expires: TOBACCO SALES: December 31, 2000 � FROZEN DESSERT: Thomas A. McKean, RS, CHO MILK'CATERER: Director of Public Health NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE .1 FEES RETAIL FOOD STORE: FOOD SERVICE ESTABLISHMENT RESIDENTIAL KITCHEN FOR RETAIL SALE RESIDENTIAL KITCHEN FOR BED+BREAKFAST $45.00 SEATING: ' MOBILE FOOD UNIT: ANNUAL: YES TOBACCO SALES: SEASONAL: CATERER: _ TEMPORARY: FROZEN DESSERT: MILK: Vie' � TWf� C1I= BA RNA , a „ 2 'i '80l_?" RD.OF HEALThI � PERMIT TO°OPERATEA FOOb EST3LIS'MENT PERMIT NO: 448 JANUARY 1, 1999 ` g: ; . Ike In accordanc wi h regulations promulga#eta=under authority of Chapter 94, Section 395A and,Chapter ' Sections 6� ffthe General Laws, a permit is lgry hereby granted to: a JEFF CARLSON AND SUSAN OARIA � W" In -firp D/B/A: CROCKER TAVERN lo 67=7577, 1777 w Whose place of business Is ��30g5 MAIN STREET, BARNSTABLE,'M �02�j630 Type of business and crest scions: BED AND BREAKFAST ESTABLISHMENT YP any 01 7To operate a food establish n In�A TOWN O�F bARNST'AB e k" Permit expires: December 31.,`19,990 "�� $ act of 0 BOARD OF HEALTH Susan G. Rask, R.S., Chairperson Ralph A. Murphy, M.D. RESTRICTIONS IF ANY: Sumner aufman, M.S.P.H. Thomas A. McKean, RS, CHO Director of Public Health �r �FIMETO Town of Barnstable Department of Health, Safety, and Environmental Services BAMSTA'� ��� Public Health Division �EGNllO''�6. P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health SEATING ANNUAL _ SEASONAL ASSESSORS MAP AND PARCEL NO. "L I`l �� O u 1 DATE X LIz3 J C,.e APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT FULL NAME OF APPLICANT NAME OF FOOD ESTABLISHMENT C\ Y ca v t 1r a d I I y e AI ADDRESS OF FOOD ESTABLISHMENTuc1 TELEPHONE NUMBER TYPE_OF ESTABLISHMENT: FOOD SERVICE RETAIL FOOD X BED AND BREAKFAST CONT.BR. RES.KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DESSERT CATERING SOLE OWNER: >C YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS S T\ -,\. S V �, �^ OLbJu HOME TELEPHONE# �bL-S S b L ' foodest/db/q FEES RETAIL FOOD STORE: FOOD SERVICE ESTABLISHMENT RESIDENTIAL KITCHEN FOR RETAIL SALE SEATING: RESIDENTIAL KITCHEN FOR BED+BREAKFAST $45.00 MOBILE FOOD UNIT: ANNUAL: YES TOBACCO SALES: SEASONAL: CATERER: TEMPORARY: FROZEN DESSERT: MILK: -,TOWI '9,Fg ARN TaBLE- � BOAftQ F.HEALTHY PERMIT, TE;.A FOOD ESuTABLISHMENT PERMIT NO: 448 bar -7 JANUARY 1, 1998 In accordance k with°reguiat, tevpromulgated under a6thdiltyi of Chapter 94, Section 395A an&Chapter 11 t ect an rho the General Laws,`a permit is hereby grae>Itecl to: JEFF CARLSON AND Sl1SAN 0-ARIA { D/B/A: CROCKER TAVERN Whose place of business Is- -36-9,6 MAIN S:T BIPRNSTABLE,MA .02630 Type of business and anykrestr ctions: BE' ' [iIC PiKFAS�T�E TABLLSHMENT To operate a food establishment'`© f OB` RNSTABLI , Permit expires: December 31998A � f BOARD OF HEALTH Susan G. Rask, R.S., Chairperson Ralph A. Murphy, M.D. RESTRICTIONS IF ANY: Sumner Kaufman, M.S.P Thomas A. McKean, IRS,CHO Director of Public.Health � . ,Y Al Town of Barnstable • Department of Health, Safety, and Environmental Services BA Mee Public Health Division i6g9• � 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 d Thomas A.McKean,RS,CHO FAX: 508-790-6304 / Director of Public Health SEATING ANNUAL _ SEASONAL ASSESSORS MAP AND PARCEL NO.)'L'1`l -'bed$ DATE \1 91 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT FULL NAME OF APPLICANT -::S C\ i c 7 C, c,v 11 3 S 1-1.5 11 'Y" NAME OF FOOD ESTABLISHMENT (_-i o,AA e v _7� 4.vc., dJv e �h� 4 3�- ADDRESS OF FOOD ESTABLISHMENT y y `-� ��' ` TELEPHONE NUMBER S �' �- - S`�J TYPE OF ESTABLISHMENT: FOOD SERVICE RETAIL FOOD 'Y_ BED AND BREAKFAST CONT.BR. )<-RES.KITCHEN MOBILE FOOD - TOBACCO SALES FROZEN DESSERT CATERING _ SOLE OWNER:_�<YES NO IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNATURE OF APPLI T RESTRICTIONS: HOME ADDRESS S HOME TELEPHONE# foodest/db/q FEES RETAIL FOOD STORE: FOOD SERVICE ESTABLISHMENT RESIDENTIAL KITCHEN FOR RETAIL SALE SEATING: RESIDENTIAL KITCHEN FOR BED+BREAKFAST $45.00 MOBILE FOOD UNIT: ANNUAL: YES •• TOBACCO SALES: SEASONAL: CATERER: TEMPORARY: FROZEN DESSERT: MILK: TOWN® BARNS TABLE � B ^ _ Fa PERMIT¢T 0 f I A' E A Of3D a_ 'AB I�Sy HMENT PERMIT NO: 448 r' 7JANUARY 1, 1997 In accordance Wlf�gulations promulgated under auth ��/ ofChapter 94' ' Al Section 395A an ,ha ter 111, Siectror�5 oche General a permit is a hereby granted to: Ni JEfF CARLSON AND SUS ►N EARIA 37a,VIS1w rix D/B!A CROCKER'TAVERN Whose place of busines is: 095 MAIN F BLE, 6,3 �'1` ,^:aka,��,.',f M� T of..business and any res& o s: B t ES A WENT y a kr? "�ee•P� �i�c$� :�'�'..��;k' "�;.•'�' ..y,� w-y To:oerate a food:establish t:in TOWN O TABL - :� `4M 7: �!.`4`"wst,'r;.a.{. ...P rArs ,•� 4„ ,+.c<-. �.�r e, .ay` '..r ,,i,.,.;-,.�-i.- -,"1lir' d+, - � ....:#••'�., ',r - w r�.'.74:':4:... v"..,�. s e _J'..y"• tom' Penm�t ex Tres:_•r,,,:-December ,^,Y'. .. r�"k'd fl• i.. ,yz :�•' .a r -x, C»»Mw, "'.ar.,.Lw.x.+ �, ,+.;+ J» ^� _�... +rx"± .. ..,»•a..v,M«.:.. J,.r..:::.:.. �•q ;or _•v a . .K.,ff ,�. r . t" ;' .,'r,. BOARD OF.H T■,u� s .. _ x ,r...T- ,�,.v Y"rt, �,j:.,_ y.,�,,: ;.a y,{.• tea„, -'�`.... •Y..-y:,-'+� "' ,,...�."` -S6iaiiG,kask,R S ,.Chairperson, s��I �-.3 ^:.. n,,... '+C- U. �w, .fix .+:._:J.;,. r.. ..t 'i „�;i.:� .Fs. �:�sr• h: Yif eat. n a* Y` w�.. S - .."-' y.[.' {:.�•.. t' 4ri f"" , ,µ.rwx. j'] {.. �,� �• a :,��� ...., s ;.3:� �� F..� �% .:. R Grad. R. *: _ .Brian S. y .� ,... ':..5 ,:,., ., � �- y a'.,> rt.�• .' .'�..'^.:. a,i. .S',. Y 7C ,x,.�Rr 6.x»y w„ arx. .- .:'ki:`,�', syn<� .•s+.,�:� -7., •,�,...,:.,xti ,;s� .,�, vY -x� ,a «x.j.,,✓.a;,r. a..y,. .�F ",,.may s.�'. h. ay. ..#._ q^Ji« :`-4.R-.-w. ..r.s•._q�. 5..,'L.^.* �i�s^-5 ."7`.a•� - «:.��Y'.. ` oi,`� at. a ::r.4 e5 r ar "RESTRICTIONS IF ANY Sys FP ,_„ ,. ., ,. a W .,.� Ralph A.Murphy;M.D..',"', .e• ",I - '"rR,s N?". Y^i'a,' "•y _,.,y,.:•;., .•`•r�..e�....r+ ,..r:' ''-`Mr-- "a. ...:Q �t .+71:�Y.'•,qh '-.,�'^°y' :�t t.� 'tY u.?b .�'•�.: S<'+'' �. r,�s #. '+ ;C.:�'e. ,- T .:i�. ." +„. �s.a_3r s, •+:�. -�`• ..,�.Ys,:.:3- ,`s.. -ri,:�t "�., �r•. �w.k`,.�'" a"�.. "ram-4t�,7- gip". _�?-' g C sty k a Y ��' rndcs- ..,t. g ..0 h. �z ems-.. _ ""' ��a. h, •.ml! i�%�'t..a !r.,+ `�,+f„-1 "" *f�`F` - '•��'`� 4�`T�:. -,� :u.� �' -�'�. '•r. 3;v.%'-'S,h i.�. i .C :+ '!.::.� n:: „s �kr"? yt,. :,,.wt -' a. `a=�-••f .r+x. ,p y;r`i-a -.vrF`..7 -r. :.•ii+". .r+".wS*. '!r^`'-,..•`8 ..*.,' "•s;.eq:. xk „ &...a'•w'1.�, us;L J?., •ei- +z,.�:eM'a'�v dka .4 l�':�- `•' ,,, s. �+r:� '•%_:"t ... sr ,r n. .. .r» #r•4*:.:- >�-` 'a _`., - ir. •.'k."nP..asr: 'tea `_ ! -,x.:: r;,, ;R�.«r.. .. �,,..:m.4�.4::. .r`:-.r.n- .-.,:-.e.vw s.s..,. i? k.,9•�} ..� ,� "c'l`. -.+.'a�.* T•.'° A ti 'e". .•a•• a!; M S 4, rr ak++•.. "t'°' .�.. a«m,� -•.-.F� h-: -.S.c.+..-. :.. 4 { -.e •�, i y.;rr'.r'..i_°" .,,+ a.�{e_.6.-i:�."i`. ti3_Pyr .. ....:.Lrr-:h.:..: wz' «. r• r a .:rq „1*a rt.,.• y^a`..t '4 „ {. _ .,;y4 :J`" �. 'a-a, yr •+� •a.,.. s�„x-D;-. -l3" -. '�.;x 4*t`e. �". 44 G.:Q .�yThomasrA; McKean .RCHO77 z ,.: _ s r. .a .. y� ..-..«„.,w:: ! "•'r^-.:- +.-•o,- -+, «».r,- ,^", z„.y,,'"•i••.�"":m_x .�;f�:yi ; ..':x"...,,'.,v. .--; '�' .«:-,t.•.... 3. ^`:.fi 2°j.TT�,�,,:,,o•»t ::,a ,,,.{, rrr "r}-„ a:`-�. tx;,_ ,:•iw*".'ss }s sw'= :"i?'.`. ��,,' '' - "G�' .�4.. �<'�'•�� -.�- ,:"`i2Sr��"�:..:.4�-+•. .:'.•fi......- k -._.::.,.ryr- �, +^A._ 3�=�+'.-;z;�x' +. _�".. .a.... z.�. :?!z�`r,T k .'. _v ':1. •�':• `I ,,..,a T�Sr •�. .R '�,^fr+•d:fix+` ?'�E ?.2 -+�1S t %4":_ z q .3.,ka ..,la,P .: re,'vris ,.rro.ia-`....rvy ;'; .`7'. E.:;, X ram. a_nr{ t_ �, �._ _ f .w wr _. , °Directorof`Public.Health . 'ti a�,.:. 7w„.. `C..<a."Q'" .: '7 7 �;Y.. F". ra�' r-- w; v w:.. ..• .4,.i{a ti.7 -.Y rs.. -"max' zt• - - `i. :...ta.-4a >«,. �v. d,:.5t x.-....,:.sw,.,...r#.."SE e3 ;his.., wr.fit..- i± ''.`3 -.r' Z, _ i. ...,.,.•+.•+.w'.:: ^� k .. a,rE.`�` .r+.•.... 2•t. ,:r_. �' _ .-Y+r +a :.'=� �'�!..s, '7y, � „ t. o .x�;,•''; �' = �y. -v�. �:.o,.w �vt.•3,.k Wk. ..,. *:w,- , -. . :.,•• ..: ,..o. _ -.e:.:��> ;,.__t ', ..�.'� "+: P' .r _..'t,...:. lea K«..•_ .L... �y`sF"5 s y_:. ;4.a {' ..r.F.rf �t '•�F :K-s S '-�- S,s_ .n'w .iN.A. ..+a, •L" y.., ..:,A.��yha :'r'. .,4mr_,K ...,?c``�t.,t�.. ;.T;�$.e'-1,i,Y.�' .?.n w ?w>-. r. ••I.w:, t' w ..ps« �F: w.:r# r".x^'N �S a ... �- ..... ...,.,��,...� ... ,:>. `s?'.a"`` .x.. ,. _ ter.' "r.y .• { �Cfi'r"<ss.. ,,ro �"'' + :' >x:w.•F: .F ,,r„� &,... -a .:r, :-w �.. ea,- :... --N,:. ""'�'s t. ��x' „rr�ea,+w _r ..•,a+ .;a 'i� ,—rs'1 .�,z: - ".t=, -,.• ,, ,++?• •..,:1.- ^'�.�... ,a ,+ ,� ... •.-..=.lea �^:.:F. ,.,�.,-.+r .�; .: .,:°•t .; :': �.h :.W;�... Y, s. m�,�. � .E---, ,a•: -ti,,. ,.�;�: L,f+r�,�„ fi. ,.;..'"ew..; >.,,�„�w: r.ry,«+.,�``"i.�,A...+M..E..a.�Yn�^si w,��,?r+.�-vr "^y+.�L,•aa..e•-�...Y,€ett„'`` rE�r f 3 �.'w.- <YX�-,,.. ...,�., �"-"c`^aft ie t5-.�,.:y.�•w.. ,a.�, q .._.-.. ... ., T,z., - Pam. •A,.,. .'6�"-' "�`�P.. .`.•� .- .. .*•7. .`�s •r....r+.,- ,v ->sn.. ,a _ � _ ..�. ,, > �-�.� �_�.c,-tt �;*- .^{.;. ,+-.•.«e—b �•"'-e r-- �r'. ;d•. .bat_ dK..- . .$.. 3a.,�.♦ ,..� AS- ...s�.. .... i < .. ,...-e^; *+tti.°-`::" T'S. yaca „t,!", t ., '3• f-:r..n.:-$ ..t a .,?K 1.� �§.'�aq,,.. •a t�S. 4+�v K:.;' +a.;�'S �,.. sT...:.,a1:.io,.�`�Y..k.ra,:�,�2r1�°..:r.-aic.� a�:T?. j.,C..'�1.,..,...�ri.'R.......-.,,rr..v�u?".,.:.3`,:.�.a::..•c.«..�....Ar»:.::.3,+aa���n�'r� " .>��s'.-�Yf,.s.. '^snd ���, .iw..::.a 4,"kh .. .. .... ,.aLh��r,. 'T":�i.i �...: ;w,.:.'.,. -e. t.'#.u- �<X;`. •r... _. ,ra TOWN OF BARPISTABLE 4� fy[dC)7Vl BOARD OF HEALTH ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION Date Owner Wit► Tenant Address �sC7 . 5 � h >�_ Address Compliance Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities / 6. Heating Facilities 7. Lighting and Electrical Facilities f 8. Ventilation 9. Installation and Maintenance of Facilities 10. _Curtailment of Service 11. Space and Use r` 12. Exits 13. Installation and Maintenance of Structural Elements ` 14. Insects and Rodents f 15. . Garbage and Rubbish Storage and Disposal . 16. Sewage Disposal U 17. Temporary Housing PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Person(s) Interviewed _ ` Inspector If Public Building such as Store or Hotel/Motel specify here HOBBS&WARREN,INC. , �tMEt�,ti Town of Barnstable • Board of Health BAMSenet.e. v� MASS. g 367.Main Street,Hyannis MA 02601 1639. �0 'j CERTIFICATION OF ATTENDANCE Safe Food Handling Training Name: 4,,,•» 4 please print t Name of Food Establishment: N v tNx t rr ` G y r jToday's Date: i jE t i This certificate of attendance expires two years after the date of attendance. Verfication FEES RETAIL FOOD STORE: FOOD SERVICE ESTABLISHMENT: RESIDENTIAL KITCHEN FOR RETAIL SALE: SEATING: RESIDENTIAL KITCHEN FOR BED+BREAKFAST: $40.00 MOBILE FOOD UNIT: ANNUAL: YES TEMPORARY FOOD ESTABLISHMENT: SEASONAL: CATERER: TEMPORARY: FROZEN DESSERT: MILK: TOWN OF BARNSTABLE BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT PERMIT NO: 448 JANUARY 1, 1996 In accordance with regulations promulgated under authority of Chapter 94, Section 395A and Chapter 111, Section 5 of the General Laws, a permit is hereby granted to: JEFF CARLSON AND SUSAN FARIA D/B/A: CROCKER TAVERN Whose place of business is: 3095 MAIN STREET , BARNSTABLE, MA 02630 Type of business and any restrictions: BED AND BREAKFAST ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE Permit expires: December 31, 1996 BOARD OF HEALTH Susan G. Rask, R.S.,Chairperson Brian R. Grady, R.S. RESTRICTIONS IF ANY: Ralph A. Murphy, M.D. Thomas A. McKean, R.S., CHO Director of Public Health 1+'/r' -«- �.: r- .- ,. -.: ;:. -''.tr .,rc''.: ..,e. :-.....r,:a:r � � ,cf «.,...+> -n.,ir".;,,..vt,••t.,.-:5Y '�he��vvk,� M L .. TOWN OF BARNSTABLE i? ,�,.�u - BOARD OF HEALTH ��JJ ARTICLE I1:MINIMUM STANDARDS FOR HUMAN HABITATION � 1 Date I � '! Owner Tenant ' Address 6 r (D Address Compliance Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply i 5. Hot Water Facilities 6. Heating Facilities 'u 7. Lighting and Electrical Facilities it I !It.' 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service / N f 11. Space and Use / I' ✓ III I` 12. Exits f j! 13. Installation and Maintenance of Structural Elements / �y 14. Insects and Rodents I 15. Garbage and Rubbish Storage and Disposal / 16. Sewage Disposal i 17. Temporary Housing I PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition ! Person(s) Interviewed i a^'�"t'` Inspector If Public Building such as Store or Hotel/Motel specify here HOBBS$WARREN,INC. r > :r Town of Barnstable B�Rx�ree� � Department of Health, Safety, and Environmental Services Mom. Public Health Division s639. 0. 367 Main Street, Hyannis MA 02601 Office: 509-790-6265 11omas A McKean FAX: 508-775-3344 Director of Public Health SEATING ANNUAL X. SEASONAL ASSESSORS MAP AND PARCEL NO. DATE \7i- >-Z- 19 S APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT FULL NAME OF APPLICANT NAME OF FOOD ESTABLISHMENT �- ��e v ► + h O O ADDRESS OF FOOD ESTABLISHMENT Vl 'A 5A TELEPHONE NUMBER TYPE OF ESTABLISHMENT: FOOD SERVICE RETAIL FOOD X BED AND BREAKFAST )C' CONT.BR. RES.KITCHEN MOBILE FOOD SOLE OWNER: >C YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK i, SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRE5 ®y'S HOME TELEPHONE# 36t S G1 I I I I NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS 25 5 00 T0!,JTN of BARN"2TABLE Board of Health of PERMIT TO OPERATE A FOOD ESTABLISHMENT Permit No. 25 7A%,TUAR`I X.,_19 9 In accordance with Regulations promulgated under authority of Chapter 94,Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: :1 FF CARLSON AtvD SUSA'N, FAR IA D/B/A CROCKER TAVERN Whose place of business is 3095 �JATN1 STREET. BARNST.ABLE Type of business and any restrictions BED AND BREAKFAST To operate a food establishment in TfltivN OF BARNSTABLE (City or Town) Permit Expires DECE'l BER 31, 19 95 Copy Board This Copy To Be Retained By Local of Board of Health Health FORM 738 Rev.1986 AGENT � t v TOWN OF BARNSTABLE - '4 BOARD OF HEALTH ` f a.Ar� P ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION G J Date - . I .I. - Owner 4C(e9—, Tenant Address h din. u Address Compliance Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities 3. Bathroom Facilities i 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities / 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits -- 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing ,Ij PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Person(s) Interviewed q0., Inspector _ - J If Public Building such as Store or Hotel/Motel specify here HOBBS&WARREN.INC. i