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HomeMy WebLinkAboutCUMMAQUID GOLF CLUB - FOOD CUMMAQUID GOLF CLUB 35 Marstons Lane, Barnstable 3 Got 4 rtr Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli, M.D. BAKNSMBLE. F.P.(Thomas)Lee,. MA&S, Daniel Luczkow,M.D. Alt. 1639. 200 Main Street, Hyannis, MA 02601 erg°"' a Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 30513, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 274 Issue Date: 01/01/2022 DBA: CUMMAQUID GOLF CLUB OWNER: CUMMAQUID GOLF CLUB Location of Establishment: 35 MARSTONS LANE CUMMAQUID„ MA 02637 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: I IndoorSeating: 172 OutdoorSeating: 28 Total Seating: 200 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE- ICE CREAM: 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: For Office Use On Initials: Town of Barnstable Date Paid ► �` L&MM$3�7— r s w sA NSTA$,,E, . Inspectional Services y MASS. �''OtFDp„p,V�`0 Public Health Division Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE l�" - I NEW OWNERS P RENEWAL NAME OFF D "or)l 00 ESTABLISHMENT: C� ADDRESS OF FOOD ESTABLISHMENT: 37 vvlln e VYY►!�l'� C� D 3� MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO ✓ ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL:_ SEASONAL: DATES OF OPERATION: I / •�/0/71TO NUMBER OF SEATS: INSIDE:!`e� OUTSIDE: "0` 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? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? /V J TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q\Application FormsTOODAPP 2020.doc I OWNER INFORMATION- FULL j d FULL NAME OF APPLICANT 14 LL.l 1 �3'1G� SOLE OWNER: YE NO OWNER PHONE# ADDRESS Cl� '�e_ CORPORATE OWNER: CORPORATE ADDRESS: f 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 SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://ivww.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. 3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATIONS)AND REQUIRED FEES BY DEC 1st. Q\Application FormsTOODAPP REV3-2019.doc °F.NE►°,r TOWN OF BARNSTABLE" HEALTH INSPECTOR-s Establishment Name: i Date: J"'/ age: . of q OFFICE'HOURS P °* 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 Mb3v; `e� HYANNIS, MA 02601 MON.-FRi. No Reference R-Red Item PLEASE PRINT CLEARLY -862-4 prFO MP�p FOOD ESTABLISHMENT INSPECTION REPORT sos Name / ° Date / Type of Type of Inspection Operation(s) Routine Address Risk Food Service Re-inspection Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person i arge(PIC) Time Bed&Breakfast HACCP In: Other ^ Inspect o 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) ❑ 01 Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ 1 �- �� 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•ColorAdditives9� e ❑ 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 HSR El 10.Proper Adequate Handwashing CONSUMER ADVISORY Lion ❑ 1.1.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) Iq I ! J Corrective Action Required: ❑ No ❑,Yes Non-critical(N)violations must be corrected immediately or Overall Rating J 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, a 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 B=One critical violation and less than Orion-critical violations 9 ( )( ) 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 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must C=2 critical violations and less than i non-critical. If no critical ' water,sewage back-up,infestation of rodents or insects,or lack of ( )( ) be in writing and submitted to the Board of Health at-the above address violations observed,7 to 8rion-critical violations. If 1 critical refrigeration. . 28.Poisonous or Toxic Materials FC-7 590.008 9 n, r 'cal violations=C. 29.Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: I pector' S a 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' n ure Print: . Self Service Wait Service Provided Grease Trap Size, Variance Letter Posted; Y N ,p� � • Dumpster Screen? Y N Yvlr .. t. .. .d_. Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) [Demonstration nment of Responsibility* 6 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 2 EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* _ Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* Storage* - ' Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 590.004(11)3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use * 3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions Variance Requirements 590.003(G) Reporting by Person in Charge - Contamination from the Consumer * 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reared 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* * 3-801.11(D) Raw or Partially Cooked Animal Food and ( ) P 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Roden[Bait Stations , 3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical 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 Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* Sg Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef-d-1i1/2001 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 Meals-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* g g � 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to ° 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 1 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165°F 15 sec* 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial) Processed RTE Food-140°F* Blue Items 23-30) 3-202.15 Package Integrity ( ) Y Critical and non-critical violations,which do not relate to the foodborne * 12 Prevention of Contamination from Hands 3-403.11 Remainin Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 3-101.11 Food Safe and Unadulterated (E) g 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F hem Good Retail Practices FC 1590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14{B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(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* 30. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. °p THE rot, TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: Date: 7 � Page: of ti 'OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30A.M. BARNSTABLE. ` 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified �A .659.n�0� HYANNIS,MA 02601 MON.-FRI. No Reference R-Red Item PLEASE PRINT CLEARLY rF0 MPy 508-862-4644 FOOD ESTABLISHMENT INSPECTION REPORT Name C' ,, C Date Tvae of I s ection Operation(s) Routine Address Risk 4 oo a e-inspection Level efair Previous Inspection �� C� 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 Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. m 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) ❑ F. Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands C u� ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities ^� (��� EMPLOYEE HEALTH PROTECTION FROM CHEMICALS �'r� -1 ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives \ ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals a FOOD FROM APPROVED SOURCE TIME1TEMPERATURE CONTROLS(Potentially Hazardous Foods) (u 1 ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures '� T ❑ 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 1718.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 1-4 Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations _ei l i Critical(C)violations marked must be corrected immediately. (blue&red items) `� ( 1 Corrective Action Required: ❑ No El Yes Non-critical(N)violations must be corrected immediately or Overall Rating within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction: Based on an inspection today, a ftems ❑ go ❑ Emergency Closure ❑ Voluntary Disposal Other: Embargo 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 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 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 29.Special.Requirements (590.009) within 10 days of receipt of this order. violation,4 to itical violations=C. 30.Other DATE OF RE-INSPECTION: Inspect ign ur nn 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N Z �\ #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Signatur Print: Self Service Wait Service Provided Grease Trap Size .Variance Letter.Poste_d Y N �I r Dumpster Screen? Y N `i 6 1 1 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.) r FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202'.12- . Additives* 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous dr Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 2 590.003(C) Responsibility of the Person-in-Charge to Other* 7-102.11 Common Name-Working Containers* 3-501.16(A) Hot PHFs Maintained At or Above 140°F* Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 590.003(F) Responsibility of A Food Employee or An 7-202.11 Restriction-Presence and Use* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated ( ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Wazewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Wazewashing-Hot Water 1 Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served" 3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16, Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11 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 Equipment 5-101.11 Drinking Water from an Approved System* * gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 1112001 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 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 Cough[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* (A Stuffing Containing Fish,Meat,Poultry or 590.009 Violations Section in cater- Sources* -(D) ons o on 590.009(A)-(D) Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 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* * (Blue Items 23-30) 3-202.15 Package Integrity* g g 3-403.11(C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the 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* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-202.18 Shellstock Identification* 13 Handwashing Facilities 3-501.14(A). Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 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- . Poisonous or Toxic Materials FC-7 .008 2 HACCP Plans 6-301.12 28 Hand Drying Provision 1= . Special Requirements .00 3-502.11 Specialized Processing Methods* 9. Other 3-502.12 Reduced-Oxygen Packaging Criteria* _ 8-103.12 Conformance with Approved Procedures* S:590Formback&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. 1 Cu& I ate: , Pa e: of Ft r TOWN OF BARNSTABLE HEAL H INSPECTOR'S Establishment Name: t/ g `o Oki FFICE HOURS v O 0-9:30A.M. BAR-NSrAB�E.� PUBLIC HEALTH DIVISION Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified 200 MAIN STREET 3:M - .- P.M. MO8 -FRI. LEA E PRINT CLEA LY 7 MA 9. HYANNIS,MA 02601 �A .a3v.a. sos-asz-as4a No Reference R-Red Item rFOMP+ FOOD ESTABLISHM T INS E TI N PORT -TIA1,4014-1 VP Name f Date a of s ction - a a io Routi Address Food Servi e-Inspecti n �- / Previo s c' r Date: Telephone Residential Kitchen ry[�� Mobile Pre-op idh Owner HACCP YIN Temporary SuspectIF I re s Caterer General Complaint Person in Charge(PIC Time Bed&Breakfast HACCP 1_> Other yt Inspector ttt l �( Each violation checked requires an explanati n on the narrativ 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 o / ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities §q - EMPLOYEE HEALTH PROTECTION FROM CHEMICALS �� ro ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives C ❑ 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 ` r✓ ❑ 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) Ir 9 ❑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 XC� Critical(C)violations marked must be corrected immediately. (blue&red items) Non-critical(N)violations must be corrected immediately or Corrective Action Required: ❑ No Yes ❑ within 90 days as determined b the Board of Health. Overall Rating y Y ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the Ile s 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 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations. If no critical violations observed, 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 9 or more non-critical violations=F. 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=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 4 non- water,sewage back-up,infestation of rodents or insects,or lack of lions observed,7 to 8 non-c�icaolat 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 dalatal. If no critical =C. refrigeration. 29.Special Requirements (590.009) p ys of receipt of this order. 30.Other DATE OF RE- SPECTION' I sp tor' Signature int: IN 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 FIB' ,Si re Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Q �V7 Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) ,(Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* - 3-501.15 Cooling Methods for PHFs 2-103.11 Person-in-Charge Duties Cooked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* 19 PHF Hot and Cold Holding Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) 590.003(C) Responsibility of the Person-in-Charge to 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 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* Storage* - Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation g 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** _ 590.004(11)3-501.19Time 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 7-203.11 Toxic Containers-Prohibitions* Variance Requirements 590.003(G) Reporting by Person in Charge Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Rered or of Food*Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE`POPULATIONS(HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a 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'l'emperatures* TIME/TEMPERATURE CONTROLS 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 1 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 g 4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* * Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3 401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effe c"°e uinooi 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 r f ces of qui 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 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- Proper,Adequate Handwashing Ratites-165°F 15 sec* Sources* 10 ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* - 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g, g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23.30) 1 p Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the Foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1g 3-202.18 Shellstock Identification* 13 Handwashing Facilities Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 3-501.14(A) Cooling Cooked PHFs from 140°F to 70°F 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Item Good Retail Practices FC 590.000 Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 1.008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* S:590Fomtback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 560.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. TOWN OF BARNSTABLE BOARD OF HEALTH Food Handling Establishments ri '�7- Time, ................... Name ........................... .............. ........... Address*,,,,,,. .................................. Owner .................................................................................. No. of Food Handlers Compliance Points/Item yes NO Remarks or Recomr;iendaiia 2 Floors 2 Walls and Ceilings 2 Doors and Windows 2 Lighting 2 Ventilation 2` Toilet Facilities 6 Water Supply 6 Lavatory Facilities N, 2 Construction of Utensils & Equipment 4 Cleaning of Equipment L T. d\C� 11�... _. �w� % `,Cleaning of Utensils 6 Bactericidal Treatment of Utensils -1(3Y I/V 7 4 Storage and Handling of Utensils 6 Disposal of Wastes 6 Refrigeration 6 Wholesomeness of Food zc i,t 6 Wholesomeness of Milk Products VI J IL 4 Wholesomeness of Shellfish 6 Storage,of Food and Drink �) �� ' 6 Display and Serving of Food and Drink 4 Rodent Control 6 Cleanliness of Employees 6 Miscellaneous' co) ................................................................. ............................................................. (Persorts,interviewed) (Inspector) TOWN OF BARNSTABLE BOARD OF HEALTH Date Food Handling Establishments A R Time .................. ............... (N P.M. 0 Name .. .v.. .@.\. U. CoL. ....... 1—ORdress ...LA.............C.0.(� A.�.v.(.................. Owner .................................................................................. No. of Food Handlers ........... .................................................. Compliance Points/Item YES NO Remarks or Recommendations 2 Floors 2 Walls and Ceilings 2 Doors and Windows 2 Lighting 2 Ventilation 2 Toilet Facilities 6 Water Supply 0 6 Lavatory Facilities 2 Construction of Utensils & Equipment 4 Cleaning of Equipment l� 4 Cleaning of Utensils 6 Bactericidal Treatment of Utensils 4 Storage and Handling of Utensils 6 Disposal of Wastes 6 Refrigeration - 6 Wholesomeness of Food 6 Wholesomeness of Milk Products 4 Wholesomeness of Shellfish >\ 6 Storage of Food and Drink ,i 6 Display and Serving of Food and Drink 4 Rodent Control 6 Cleanliness of Employees 6 Mis G� ........... ... s-t�ervi ..................... ................... .. ......... ............... Person ewed) (inspector) 3 `„1„t a,t d_! dt„1 .J Town of Barnstable Date Type 6 Time Inspection Form for Food Handling Establishments gr To ,n,of BARNSTABLE Name. ' Address dr Licensee Owner Item Regulation Item Yes .No s �, Remarks 1 14 Floors—Construction,clean,good repair 3 2 15 Walls&Ceilings—Good repair,cleaning methods 3 . 3 14 Doors&Windows—Screened,self-closing 2 H i 4 16 Lighting—Adequate,fixtures shielded 2 5 17 Ventilation—Adequate,systems maintained 3 6 8 Water source—Safe,hot& cold under pressure 6* 7 11 Toilet Facilities—Self-closing door, clean,good repair,waste cans 3 8 12 Lavatories—Hot&cold water,signs, t r soap,drying devise 3 9 6 Construction of utensils&equipment 2 10 7 Cleaning of equipment 4 11 7 Cleaning of utensils 4 +� 12 7 Bactericidal treatment of utensils 6* 4or 13 7 Storage&handling of utensils 4 40 ,e. 14 13 Disposal of waste—Covered,adequate,vermin proof 5* 15 3 Refrigeration—Temp.off floor,food covered 5* 15a 3 Thermometers present 2 16 2 Wholesomeness of food 6* 17 2 Wholesomeness of milk products 5* 18 2 Wholesomeness of shellfish 5* 19 3 Storage of food&drink 5* 20 3 Display/serving of food&drink 5* 21 14 Vermin control 4* 22 5 Cleanliness of employees 4* 23 3 Storage of toxic chemicals 4 r at 24 Miscellaneous 5 0/ c Total out of possible 100 Critical Items require immediate attention— "" Reasons for compliance on reverse tow Received by Inspector _ Health Department Regulations Require Conspicuous Posting of the most Recent Inspection Report AREAS OF CONTROL FOR FOODBORNE ILLNESS Reason numbers refer to item numbers. #16 Wholesomeness of Food:To control foodborne illness and food spoilage,which may result from improperly processed or handled food,the food service establishment must be concerned with the sources of food which are to be used. The safety and wholesomeness of food is a basic requirement for the protection of the consumer's health. Accordingly,the provisions listed under Compliance are intended to insure that food in general,as well as certain food which may be potentially hazardous, is obtained from sources which have been approved or are considered satisfactory by the health authority. #15 Refrigeration: Wholesome food, if mishandled, can become contaminated from a number of sources. Food protection measures are designed to eliminate the contamination of food from any source within the establishment, and to prevent the growth of disease-producing organisms,and the production of bacterial toxins,in the event that pathogens are present in the food.Proper food-protection measures should include(1)strict observation of personal hygiene by all food-service employees;(2)keeping potentially hazardous food refrigerated or heated at all times to temperatures which preclude the growth of any pathogenic organisms which may be present; (3) application of good sanitation practices in the storage,preparation,display,and service of food; (4)adequate cooking of certain food of animal origin to assure destruction of pathogenic organisms which may be present;(5)thorough washing of fruits and vegetables; and (6) the provision of adequate equipment and facilities for the proper conduct of operations. In addition, food must be protected against accidental contamination with any toxic substance. All food, while being stored, prepared, displayed, served, or sold in food-service establishments, or transported between such establishments,shall be protected against contamir ation from dust,flies,rodents,and other vermin; unclean utensils and work surfaces;unnecessary handling;coughs and sneezes;flooding,drainage,and overhead leakage;and any other source.Conveniently located refrigeration facilities,he t food storage and display facilities, and effective insulated facilities, shall be provided as needed to assure the maintenance of all food at required temperatures during storage,preparation,display,and service.Each cold-storage facility used for the storage of perishable food in non-frozen state shall be provided with an indicating thermometer accurate to—2°F.,located in the warmest part of the facility in which food is stored,and of such type and so situated that the thermometer can be easily and readily observed for reading. b. Temperatures:All perishable food shall be stored at such temperatures as will protect against spoilage.All potentially hazardous food shall,except when being prepared and served,and when being displayed for service,be kept at 45°F. or below, or 150°F. or above. Frozen food shall be kept as such temperatures as to remain frozen, except when being thawed for preparation or use.Potentially hazardous frozen food shall be thawed at refrigerator temperatures of 45°F.or below;or under cool,potable running water(70°F.or below);or quick-thawed as part of the cooking process; or by any other method satisfactory to the health authority. #22 Cleanliness of Employees: Disease transmitted through food frequently originates from an infected food handler. A wide range of communicable diseases and infections may be transmitted by food handlers to other employees and customers through contaminated food and careless food-handling practices.Boils and sore throats are sources of organisms which cause staphylococcal food intoxication, the most frequently reported type of foodborne disease in the United States.It is the responsibility of both management and employees to see that no person who is affected with any disease in a communicable form works in any area of a food-service establishment where there is likelihood of disease transmission.Clean personnel with clean habits are essential to sanitary food preparation and service.Clean hands,clean clothing,and hygienic practices reduce the likelihood of contaminat- ing food, drink, and food-contact surfaces of equipment, utensils, or.single-service articles. Hand-washing is necessary not only before starting work and after visiting the toilet,but also at any other times when the hands have become soiled or contaminated.It must be recognized that hands often become soiled in the performances of routine duties in and about the establishment. The use of tobacco while preparing food or serving food may contaminate the fingers and hands with saliva, and may promote spitting, thereby permitting transmission of disease organisms present in the saliva to food or food-contact surfaces. #12 Bactericidal Treatment of Utensils:Regular,effective cleaning and sanitizing of equipment,utensils,and work surfaces minimizes the chances for contaminating food during preparation,storage,and serving,and for the transmission of disease organisms to customers and employees.Effective cleaning will remove soil and prevent the accumulation of food residues which may decompose or support the rapid development of food-poisoning organisms or toxins.Application of effective sanitizing procedures destroys those disease organisms which may be present on equipment and utensils after cleaning, and thus prevents the transfer of such organisms to customers or employees,either directly through tableware,such as glasses,cups,and flatware,or indirectly through the food. Improper storage of equipment and utensils,subsequent to cleaning and sanitizing,exposes them to contamination and can,nulify_the benefits of these operations. Accordingly, storage and.handling of cleaned or sanitized equipment and utensils,and single-service articles,must be such as to adequately protect these items from splash, dust, and other contaminating material. #21 Vermin Control: Insects and rodents are capable of transmitting a number of diseases to man through contamination of food and food contact surfaces. Accordingly, their presence in a food-service establishment creates a potential health hazard which can be guarded against only by effective control of such vermin. Since vermin require food, water, and shelter, control measures should be designed to deprive them of these require- ments. #23 Storage of Toxic Chemicals:Only those poisonous and toxic materials required to maintain the establish- ment in a sanitary condition,and for sanitization of equipment and utensils,shall be present in any area used in connection with food-service establishments.All containers of poisonous and toxic materials shall be prominently and distinctively marked or labeled for easy identification as to contents. When not in use, poisonous and toxic materials shall be stored in cabinets which are used for no other purpose, or in a place which is outside the food-storage, food preparation, and cleaned equipment and utensil storage rooms. Bactericides and cleaning compound shall not be stored in the same cabinet or area of the room with insecticides, rodenticides, or other poisonous materials. Poisonous materials shall not be used in anyway as to contaminate food, equipment, or utensils, not to constitute other hazards to employees or customers. Tow n of Barnstable Date P' �` "„�`i's Type Time Inspection Form for Food Handling Establishments Town of BARNSTABLE Name A.x . Address Licensee Owner Item Regulation Item Yes No Remarks 1 14 Floors—Construction,clean,good repair 3 2 15 Walls& Ceilings—Good repair,cleaning methods 3 3 14 Doors&Windows—Screened,self-closing 2 4 16 Lighting—Adequate,fixtures shielded 2 5 17 Ventilation—Adequate,systems maintained 3 6 8 Water source—Safe,hot&cold under pressure 6* 7 11 Toilet Facilities—Self-closing door, clean,good repair,waste cans 3 8 12 Lavatories—Hot&cold water,signs, soap,drying devise 3 ,•� 9 6 Construction of utensils&equipment 2 .¢l � �•_ _. 10 7 Cleaning of equipment 4 ref ems` 11 7 Cleaning of utensils 4 =- ' 12 7 Bactericidal treatment of utensils 6* 13 :7 Storage&handling of utensils 4 424" ,,.,. a 14' 13 Disposal of waste—Covered,adequate,vermin proof 5* -�• - ` 15 3 Refrigeration—Temp.off floor,food covered 5* 15a 3 Thermometers present 2 16 2 Wholesomeness of food 6* 17 2 Wholesomeness of milk products 5* 18 2 Wholesomeness of shellfish 5* 19 3 Storage of food&drink 5* 20 3 Display/serving of food&drink 5* 21 14 Vermin control 4* 22 5 Cleanliness of employees 4* 23 .3 Storage of toxic chemicals 4 24 Miscellaneous 5_ Tot . Z ut of possible 100 C tical Ite require immediate attention— Re a ons for compliance on reverse v. Received by— Inspector Health Department Regulations Require Conspicuous Posting of the most Recent Inspection Report r' r AREAS OF CONTROL FOR FOODBORNE ILLNESS Reason numbers refer to item numbers. #16 Wholesomeness of Food:To control foodborne illness and food spoilage,which may result from improperly processed or handled food,the food service establishment must be concerned with the sources of food which are to be used. The safety and wholesomeness of food is a basic requirement for the protection of the consumer's health. Accordingly,the provisions listed under Compliance are intended to insure that food in general,as well as certain food which may be potentially hazardous, is obtained from sources which have been approved or are considered satisfactory by the health authority.. #15 Refrigeration: Wholesome food, if mishandled, can become contaminated from a number of sources. Food protection measures are designed to eliminate the contamination of food from any source within the establishment, and to prevent the growth of disease-producing organisms,and the production of bacterial toxins,in the event that pathogens are present in the food.Proper food-protection measures should include(1)strict observation of personal hygiene by all food-service employees;(2)keeping potentially hazardous food refrigerated or heated at all times to temperatures which preclude the growth of any pathogenic organisms which may be present; (3) application of good sanitation practices in the storage,preparation,display,and service of food; (4)adequate cooking of certain food of animal origin to assure destruction of pathogenic organisms which may be present;(5)thorough washing of fruits and vegetables; and (6) the provision of adequate equipment and facilities for the proper conduct of operations. In addition, food must be protected against accidental contamination with any toxic substance. All 'food, while being stored, prepared, displayed, served, or sold in food-service establishments, or transported between such establishments,shall be protected against contamir ation from dust,flies,rodents,and other vermin; unclean utensils and work surfaces;unnecessary handling; coughs and sneezes;flooding,drainage,and overhead leakage;and any other source.Conveniently located refrigeration facilities,he t food storage and display facilities, and effective insulated facilities, shall be provided as needed to assure the maintenance of all food at required temperatures during storage,preparation,display,and service. Each cold-storage facility used for the storage of perishable food in non-frozen state shall be provided with an indicating thermometer accurate to—2°F.,located in the warmest part of the facility in which food is stored,and of such type and so situated that the thermometer can be easily and readily observed for reading. b. Temperatures:All perishable food shall be stored at such temperatures as will protect against spoilage.All potentially hazardous food shall,except when being prepared and served,and when being displayed for service,be kept at 45°F. or below, or 150°F. or above. Frozen food shall be kept as such temperatures as to remain frozen, except when being thawed for preparation or use.Potentially hazardous frozen food shall be thawed at refrigerator temperatures of 45°F.or below; or under cool,potable running water(70°F.or below);or quick-thawed as part of the cooking process; or by any other method satisfactory to the health authority. #22 Cleanliness of Employees: Disease transmitted through food frequently originates from an infected food handler.A wide range of communicable diseases and infections may be transmitted by food handlers to other employees and customers through contaminated food and careless food-handling practices.Boils and sore throats are sources of organisms which cause staphylococcal food intoxication, the most frequently reported type of foodborne disease in the United States.It is the responsibility of both management and employees to see that no person who is affected with any disease in a communicable form works in any area of a food-service establishment where there is likelihood of disease transmission.Clean personnel with clean habits are essential to sanitary food preparation and service.Clean hands,clean clothing,and hygienic practices reduce the likelihood of contaminat- ing food, drink, and food-contact surfaces of equipment, utensils, or single-service articles. Hand-washing is necessary not only before starting work and after visiting the toilet,but also at any other times when the hands have become soiled or contaminated.It must be recognized that hands often become soiled in the performances of routine duties in and about the establishment. The use of tobacco while preparing food or serving food may contaminate the fingers and hands with saliva, and may promote spitting, thereby permitting transmission of disease organisms present in the saliva to food or food-contact surfaces. #12 Bactericidal Treatment of Utensils:Regular,effective cleaning and sanitizing of equipment,utensils,and work surfaces minimizes the chances for contaminating food during preparation,storage,and serving,and for the transmission ofdisease organisms to customers and employees.Effective'cleaning will remove soil-and prevent the accumulation of food residues which may decompose or support the rapid development of food-poisoning organisms or toxins.Application of effective sanitizing procedures destroys those disease organisms which may be present on equipment and utensils after cleaning, and thus prevents the transfer of such organisms to customers or employees,either directly through tableware,such as glasses,cups,and flatware,or indirectly through the food. Improper storage of equipment and utensils,subsequent to cleaning and sanitizing,exposes them to contamination and can nulify the benefits of these operations. Accordingly, storage and handling of cleaned or sanitized equipment and utensils,and single-service articles,must be such as to adequately protect these items from splash, dust, and other contaminating material. #21 Vermin Control: Insects and rodents are capable of transmitting a number of diseases to man through contamination of food and food contact surfaces. Accordingly, their presence in a food-service establishment creates a potential health hazard which can be guarded against only by effective control of such vermin. Since vermin require food, water, and shelter, control measures should be designed to deprive them'of these require- ments. #23 Storage of Toxic Chemicals:Only those poisonous and toxic materials required to maintain the establish- ment in a sanitary condition,and for sanitization of equipment and utensils,shall be present in any area used in connection with food-service establishments.All containers of poisonous and toxic materials shall be prominently and distinctively marked or labeled for easy identification as to contents. When not in use, poisonous and toxic materials shall.be stored in cabinets which are used for no other purpose, or in a place which is outside the food-storage, food preparation, and cleaned equipment and utensil storage rooms. Bactericides and cleaning compound shall not be stored in the same cabinet or area of the room with insecticides, rodenticides, or other poisonous materials. Poisonous materials shall not be used in anyway as to contaminate food, equipment, or utensils, not to constitute other hazards to employees or customers. BOARD OF HEALTH - TOWN OF BARNSTABLE 367 Main Street - Hyannis, MA. 02601 PURPOSE Food . Service -Establish ` ' te ' �I r Regular .. 29as Inspection Report `� Follow-up ,/� 2 Complainte a.. �s `'' G - & : c7 O Investigation ..... 4 Based on an inspection this day,the items circled below Identify the violations in operations or facilities which must be corrected by Other .......... 51 the next routine inspection or such shorter period of time as may be specified in writing by the regulatory authority. Failure to com- My with any time limits for corrections specified in this notice may result in cessation of your Food Service.operations. OWNER N , ESTABLISHMENT NAME ADDRESS ZI5 ° CODE ��\•�%���ry N C.���� �"-�r���1.��} �I �1. ,;, cal � vFj EST. ESTAB.NO. 3 SANIT.CODE :;: YR. MO. DAY :`::•.`.:#TRAVEL'TIME ':% ': INSPEC.TIME STATEJOD ')'. INSP.PROCESS .D.(1-7) #'8-10 ., 11-16 19 0-22 #'"23 24 5-27 v WT. COL. I 0.' WT. COL. FOOD SEWAGE ::•: # Source;sound condition,no spoilage 8` 30 Sewage and waste water disposal Original container;properly labeled31 PLUMBING FOOD PROTECTION >; installed,maintained E ;3 58 Potentially hazardous food meets temperature requirements "">' Cross-connection,back siphonage,backflow ?: 59 : `: during storage,preparation,display,service,transportation .:;.:,: 32 ?K4'' Facilities to maintain product temperature # ; 33 TOILET& HANDWASHING FACILITIES Thermometers provided and conspicuous 34 :.f> Number,convenient,accessible,designed,installed 60 Q;.. 'Potentially hazardous food properly thawed 35 %>?> Toilet rooms enclosed,self-closing doors:fixtures,good repair,clean: hand cleanser,sanitary towels/hand-drying 61 !1k Unwrapped and potentially hazardous food not re served > 36 ,2 devices provided,proper waste receptacles Food protection during storage,preparation,display, "'::`•` ., i-� DISPOSAL ` . 37 GARBAGE & REFUSE service,transportation -•�. 38 Containers or receptacles,covered: adequate number 62 in use,food(ice),dispensing utensils properly stored {_? 39 -insect/rodent proof,frequency,clean - ;�::�>• Outside storage area enclosures properly constructed, "'""�' PERSONNEL > ' clean;controlled incineration :f 63 . Personnel with infections restricted :fir:?E 40 Hands washed and clean,good hygienic practices, 41 ' INSECT, RODENT,ANIMAL CONTROL �%$� Clean clothes,hair restraints ( 6X4` try 42 ""> Presence of insects/rodents—outer openings protected, no birds,turtles,other animals a4 64 FOOD EQUIPMENT & UTENSILS t�..,,,�`>;-t Food(ice)contact surfaces: designed,constructed,main- FLOORS S ,WALLS & CEI LINGS "liQ . :T e.-c>., 43 r`........ > tained,installed,Located Floors,constructed,drained,clean,good repair,covering/ installation,dustless cleaning methods 65 l Non-food contact surfaces: designed;constructed,main- 9 #;g 44 .; tained,installed,located "" Walls(ceiling attachecl equipment: constructed,good66 Dishwashing facilities: designed,constructed,maintained, repair,cle n,surfaces,dustless cleaning methods 46 >;;.; installed,located.operated ':;;a:; '. . �, / v}��;;,,� �-.��`i �ys,•,�� i * Accurate thermometers chemical test kits provided,gauge ! G,11e a r� as LIGHTING aca4.�. --� cock(1/4"I PS valve) 'zf� Pre-flushed,scraped,soaked. � rs-I- 47 lr i htin9 Provided as re uired,fixtures shielded 67 •. 00 Wash,rinse water:clean,proper temperature 48 VENTILATION Sanitization rinse:clean,temperature,concentration;ex- yet' *`* 49 Rooms and equipment=vented as required gg :•(:: # : osure time;equipment,utensils sanitized �? - zt Wiping cloths:clean,use restricted ' �V ` ,> 50 DRESSING ROOMS ? F od-Contact surfaces of eq,! rr�ant and uterlsi s clean, ; free of abrasives,detergents Frw c s -t,, 1�-(�2 51 Rooms,area,lockers provided,located,used - ;;2 Non-food ycontacisurfaces ofequlpmentand_utensll :clean ; 52 OTHER OPERATIONS Storage,handling of clean equipment/utens)Is 4 53 `--"-< ` Toxic items properly stored,labeled,used 70 ;.; Single-service articles,storage,dispensing ` 't 54 »> Premises maintained free of litter,unnecessary articles, ?z No re-use of single service articles 55 '" < cleaning maintenance equipment properly stored. Author- 3 71 !zed personnel WATER Complete separationfrom living/sleeping quarters.Laundry.::¢ ? 72 '= Water source,safe: hot&cold under pressure </i4E Clean,soiled linen properly stored si1E#;; 73 < '` 56 A r 1'� FOLLOW-UP RATING SCORE 75-77 ACTION Received by: name U p" / Yes .......74-1 100 less weight of Change..... 78-C title No ... ..... 2 Items violated♦ Delete.........D ' Inspected by: name t'.Critical•Items Requiring Immedlate.Attentlon. Remarks on back(80-1) FORM FDA 2420(8/80) PREVIOUS EDITION MAY BE USED USE REVERSE FOR REMARKS" ITEM NO. REMARKS CORRECTED BY t3 HA�f !'cs Fi�i9�r�`kS w h©� O b5�r.i�� 17 U-* J *44 �w /L e 4 h . a �,�� 04-5 FOOD ESTABLISHMENTS Name: Cummaquid Golf Club Address: off Main gt. Village: Cummaquid a Telephone No.: 362-2022 Seating Capacity: D LICENSES Date Food Milk Frozen Dessert 7��7 3 as -4 3 a3 - �10 l- 7Y' INSPECTION DATA Date Score 5�3o%S .TG 97 z S- 9a 7z ,7s' J6Z7 9 94so06 7 - 90 S- 9n 1/a7 -77 �� % �z i/- /- '29 98 a 9 e V 9� —/ sr/ 1 Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. g_ BARNSTABLE, � Paul J.Canniff,D.M.D. 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, 30513, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to: Permit No: 274 Issue Date: 01/01/2021 DBA: CUMMAQUID GOLF CLUB OWNER: CUMMAQUID GOLF CLUB Location of Establishment: 35 MARSTONS LANE CUMMAQUID„ MA 02637 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 172 OutdoorSeating: 28 Total Seating: 200 j, FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: 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: 1 �t�rqk, Initials: � Town of Barnstable Date Paid A m t Pd , : Inspectional Services v `MASS. Check# 3(� Eo .�.`• Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE D NEW OWNERSHIP RENEWAL_Z NAME OF FOOD ESTABLISHMENT: ADDRESS OF FOOD ESTABLISHMENT: n f� G �C MAILING ADDRESS(IF DIFFERENT FROM ABOVE): T . 6LJ D QI'mVA A D E-MAIL ADDRESS: TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NOA..(ANNUAL WATER ANALYSIS REQUIRED) i ANNUAL: � SEASONAL: DATES OF OPERATION:_/ / TO r 7z . —— —01 pjrm-*- NUMBER OF SEATS: INSIDE: j2L OUTSIDE: Zf TOTAL: I41 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? yes IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)9 do - TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) V FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REOUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc f t O.WNER INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/QO OWNER PHONE ADDRESS � # 50�' �(¢D ' )1O (� he r� rlmav OO� CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List(2) Certified Food Protection Managers AND at least (1) Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. nad 3 i JIB i'ZoAl I. knaod lei o f L go-2,1 2. Erik bl f D 1.2D99- III yr. SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1 st to Dec.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:\Application FormsTOODAPP REV3-2019.doc r;z , Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. •' BAWMasLE, + Paul J.Canniff,D.M.D. ins 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: 274 Issue Date: 12/10/2019 DBA: CUMMAQUID GOLF CLUB OWNER: CUMMAQUID GOLF CLUB Location of Establishment: 35 MARSTONS LANE CUMMAQUID, MA 02637 i Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 172 OutdoorSeating: 28 Total Seating: 200 FEES FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: For Office Use Only: Initials: S Town of Barnstable �y� �g ` Date Paid I '1 Amt Pd$ 3 OD Inspectional Services Aqqj � 5 a s6jg;& Public Health Division Check# '7 Thomas McKean, DirectorJ+C( :` 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 a APPLICATION F LICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATFjQ 24_, 0n NEW OWNERSHIP RENEWAL ✓ NAME OF FOOD ESTABLISHMENT: C,5V/' k" e �C� clu 6 ADDRESS OF FOOD ESTABLISHMENT: J e-rp JAAA. r� MAILING ADDRESS(IF DIFFERENT FROM ABOVE): D. ►✓ �� ��� r� U� E-MAIL ADDRESS: rl*3161e�v12144ipfffcec TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS: 41 WELL WATER: Y S NO V ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE) 9& OUTSIDE: VV TOTAL: Oft 2v—,-z> 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? E'S IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOORS)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) /FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE &NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc • e OWNER INFORMATION: FULL NAME OF APPLICANT �� QYIGt JCI el ob SOLE OWNE//R://YES NO - OWNER PHONE# �o�—� p — �l��a ADDRESS (� N CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: List (2) Certified Food Protection Managers AND at least (1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT. **ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You must provide new copies and POST THE CERTIFICATES at your food establishment. Certified Food Managers Expiration Date Allergen Awareness Expiration Date 1. / /Vl/(/l 1. 1 ✓� IkLz 40L Ap &rV/� SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.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.31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q:Wpplication FormsTOODAPP REV3-2019.doc I t s Town of Barnstable BOARD OF HEALTH Paul 1 Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. t 0MIxsrABLE = John T.Norman � 1 1659� 0..� 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: 274 Issue Date: 12/20/18 DBA: CUMMAQUID GOLF CLUB OWNER: CUMMAQUID GOLF CLUB Location of Establishment: 35 MARSTONS LANE CUMMAQUID, MA 02637 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 172 OutdoorSeating: 28 Total Seating: 200 FEES --------- - - - FOOD SERVICE ESTABLISHMENT: $300.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit-Expires: 12/31/2019 B&B- FULL BREAKFAST: CONTINENTAL BREAKFAST: - -- - - -- -- - - - MOBILE-FOOD: MOBILE-ICE CREAM: Ga� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: i PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: t— FTwe�iy Town of Barnstable For Office Use Only: Initials: o Date Paid Amt Pd$1 MAS& Inspectional Services �. p °ieet1639. s�0$ Check# �0 31 5 � Public Health Division Thomas McKean, Director Ate, 200 Main Street,Hyannis, MA 02601 �J Office: 508-862-4644 Fax: 508-790-6304 / APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE�` NEW OWNERS RENEWAL- " N ` f AME OF FOOD ESTABLISHMENT. �'Y!1'ti G 9e�__/tj 1-3 ADDRESS OF FOOD ESTABLISHMENT: �� / �"S�y-y� � MAILING ADDRESS (IF IFFERENT FROM ABOVE): E-MAIL ADDRESS: fe�i/ TELEPHONE NUMBER OF FOOD ESTABLISHMENT: TOTAL NUMBER OF BATHROOMS• 5. 7 WELL WATER:YES , NO (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL. ✓ SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL: O 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)? TYPkOF 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) TOBACCO SALES ... (ANNUAL TOBACCO SALES APPLICATION REQUIRED) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED Q:\Application FonnsTOODAPPREV2018.doc PLEASE CALL 508-862-4644 OWNER INFORMATION: / FULL NAME OF APPLICANT SOLE OWNER: YE5EC-atiea OWNER PHONE # fJO�- 1o0 -�f IlO ADDRESS_ (� G;bae vim_ CORPORATE OWNER: M F EDERAL ID NO. : 04-1 L " 710 O CORPORATE ADDRESS: �o1k VaP U-*. np t,- 7-J' PERSON IN CHARGE OF DAILY OPERATIONS: , C-le:g� 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 11 r en Awareness Expiration Date 2. SIGNATURE OF APPLICANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1 st to Dec. 3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st. Q\Application FormsTOODAPPREV2018.doc . own yof Barnstable • �, ! ��i d 'k, Regulatory Services a�D ` Thomas F. Geiler,Director • �nnNsr�s� • . �� ,,; ,,r Public Health Division 19. RFD Mp►'l� Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 _ Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: NAME OF FOOD ESTABLISHMENT: 1,4011'1lyal I'd of (91111 ADDRESS OF FOOD ESTABLISHMENT: MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: o,2 PARCELS) .So TELEPHONE NUMBER OF FOOD ESTABLISHMENT: Oi NUMBER OF SEATS: INSIDE.- OUTSIDE: TOTAL: TOTAL NUMBER OF BATHROOMS: ANNUAL OR SEASONAL.OPERATION: TYPICAL HOURS OF OPERATION MON-FRI: ZZ TO DAYS CLOSED EXCLUDING HOLIDAYS (I.E.MONDAYS) IF-SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY � CZ . Y FOOD SERVICE RETAIL FOOD �- BED &BREAKFAST .o CONTINENTAL BREAKFAST RESIDENTIAL I KITCHEN67 MOBILE FOOD C ­rn TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING C(OVER-+)f QAHealthlApplicatf ou FormsToodapp l.doc •***REAlMDERirlr* y IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE BO F HEALTH AND LICENSING. AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT SOLE OWNER: YES/NO ADDRESS ` PHONE # � IF APPLICANT IS A.PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL , PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. D /a 716 STATE OF INCORPORATION / ,5,19�zz-1 e 6�- _ FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION(EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DON'T PREPARE FOOD AND CONTINENTAL BREAKFAST): , LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 20041, EACH FOOD SERVICE.ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION'CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE- NAME OF THE ESTABLISHMENT ON, THE CERTMCATE*** 1. ✓ CMG _f l�/a - - = .- -- EXPIRATION DATE:/ f 2. �'��". EXPIRATION DATE: II 3. EXPIRATION DATE. / / 4. A IRATION DATE:` ' -0 SIGNATURE OF APPLICANT AND DATE Q:\Health\AppHcatioa Fw=\Foodappl.doo PERMIT NO rj TOWN OF BARNSTABLE' JANUARY 1, 2004 �M 274 r 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: ANDREW ELDRIDGE, PRES. D/B/A: CUMMAQUID GOLF CLUB Whose place of business is: 35 MARSTONS LANE, P.O. BOX 182 , CUMMAQUID, MA 02637 Type of business and any restrictions: FOOD SERVICE ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE RESTRICTIONS IF ANY' SEATING: 243 ANNUAL: YES SEASONAL: TEMPORARY: FEES BOARD OF HEALTH RETAIL FOOD STORE: Wayne Miller, M.D., Chairperson FOOD SERVICE ESTABLISHMENT $170.00 RESIDENTIAL KITCHEN FOR RETAIL SALE Sumner Kaufman, M.S.P.H. RESIDENTIAL KITCHEN FOR BED+BREAKFAST Susan Rask, R.S. MOBILE FOOD UNIT: Permit expires: TOBACCO SALES: December 31, 2004 FROZEN DESSERT: Thomas A. McKean, IRS, CHO MILK: CATERER: Director of Public Health NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE G J Town of Barnstable OFIHE TOwti Regulatory Servicgs '��° M� D o� - IN z � Thomas F. Geiler,Director �� . Public Health DivisionRECEIVE® prFD �639. a Thomas McKean,Director 200.Main_Street, Hyannis, MA 026 31 NOV 15 2004 Office: 508-862-4644 TOWN OF BARNSTAV 08-790-6304 HEALTH DEPT. APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE: 11/05/04 NAME OF FOOD ESTABLISHMENT: Cummaquid Golf Club ADDRESS OF FOOD ESTABLISHMENT: 35 Mars tons Lane, Cummaquid, MA 02637 Aa MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP: 001 PARCEL(S)S350 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( O8 ) 362- - 2022 NUMBER OF SEATS: INSIDE: 243 OUTSIDE: TOTAL: 243 TOTAL NUMBER OF BATHROOMS: 3 ANNUAL OR SEASONAL OPERATION: Annual TYPICAL HOURS OF OPERATION MON-FRI: 11 00 AM TO 8 :00 PM DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) None IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO / / ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY X FOOD SERVICE RETAIL FOOD BED & BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING OUTSIDE DINING (OVER—+) Q:\Health\Application Formffoodappl.doc ***RENIINDER*** IF OUTSIDE DINING YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING AND MEET ALL OF THE OUTSIDE DINING CRITERIA , IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? CONTACT INFORMATION: FULL NAME OF APPLICANT Curi>inaquid Golf Club SOLE OWNER: YES/NO ADDRESS PHONE # L� - IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 04-12222710 STATE OF INCORPORATION Massachusetts FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DON'T PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME_ OF THE ESTABLISHMENT ON THE CERTIFICATE*** EXPIRATION DATE: /2/ G 7 h 2. EXPIRATION DATE: 3. EXPIRATION DATE: 4. EXPIRATION DATE: / / SIGNATURE OF APPLICANT AND DATE Q:\HealthWpplication FormsToodappl.doc ti. Town of Barnstable gulatorv,SeMces EDEC j Thomas F. Geiler,Director Q�.BARN�A8 Public Health Division °5� 12003i639� �� Thomas McKean,Director �an srae�E DcPT. 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE:_ 11/24/03 NAME OF FOOD ESTABLISHMENT: Cummaquid Golf Club ADDRESS OF FOOD ESTABLISHMENT• 35 Marstons Lane, Cummaquid 02637 MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP:'001 PARCEL(S) R350 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( Og ) 362 - 2022 NUMBER OF SEATS: INSIDE: 243 OUTSIDE: TOTAL: 243 TOTAL NUMBER OF BATHROOMS: 3 ANNUAL OR SEASONAL OPERATION: Annual TYPICAL HOURS OF OPERATION MON-FRI: 11 : 00 AM TO 8 . 00 PM DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) None IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO ***REMINDER*** SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY X FOOD SERVICE RETAIL FOOD BED &BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING (OVER---4 OUTSIDE DINING Q:1HWWApplication FormslFoodappl.doc ***REMINDER*** IF OUTSIDE DINING,YOU MUST,BE APPROVED BY THE BOARD OF HEALTH AND .v. LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? C CONTACT INFORMATION: FULL NAME OF APPLICANT Cummaquid Golf Club SOLE OWNER: YES/NO ADDRESS PHONE #U - IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 04-1222710 STATE OF INCORPORATION Massachusetts FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DON'T PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE"* * 1. p/j y r o DO C'AFC,CA, C41`3ov sS9,f EXPIRATION DATE: 7 2. �l�1ce I t a�e�, n EXPIRATION DATE: a./V3 / 0�S v 3. EXPIRATION DATE: 4. EXPIRATION DATE: SIGNATURE OF APPLICANT AND DATE I Q:\HealthWpplication FormslFoodappl.doc J J Z U) w ONON O Ip O TABLE ® `W a M W TAe.� 127SF DRY STOR./PREP I I ~ w LJ 3 Q ��_3� 0 xx < TV. 59'BEEP COOLER O F Z j p W O ' LLO <.z N..1-r- 31-EGRE88 EXIT OZO00U~�Ow W� DOOR TO GRAD I W�QUV�Z>OLL2I Za - LLOUir NI+OwO~� rtEFa�c. "STOR.RM. iz�omoorco�a"�iR STOR.RM. 26SF mJyomwLL�rc¢w¢o'o 'i . 2'915 TABLE 36 SF WASH • iyNFw Z=ZYNZNWV. e ¢ozgW�UaZW ZF� smyINK Ex sl BATH RM. z��f-°'So. o� �"oo NOT NNK.C.UKK K�Um 12NB 0.H. - u.EG 40 SF ,H - o.wmmwi-°mow=LL DOOR O OOUi� �Uw_�w_ill t0 -. HAND O F7 O - T T -O m LL o 4 2v9' WAeH 1` V U 5i?U O 1-O TABLE 91NK 5-r 90'9ANOWICH' fD STATIONd FRIG. I-{�/AO L•�M d 37 SF m J uJ.BAT M. U STORAGE RM. 27 SF Y L z 4 4 653 SF 5-r q 27'_1„ 11,_6 Q 0 J S� N Z C•,,'^L iv STORAGE RM. vA, VQ VZ Q 125SF �0 cc:) 4 �EXIT ��oQ 1210.0.H.DOOR O LS<5� - DOOR TO GRADE c D Lo UMU 40'-0"t SCALE : TOTAL BLDG.AREA GROSS 1,600 S.F. 1/4"= 1'-0" nGROUND FLOOR PLAN TOTAL BLDG.AREA NET 1,462 S.F. DATE : TOTAL NET AREA USED 1,271 S.F. 02/25/2015 EXIT BUILDING EXIT TO GRADE 5 (4) PERSON TABLES = 20 SEATS DWG.NO.: ROOM NOT IN USE A-1 � ' �tymmaanuieallJlr CY�aQoac�iiaella- enC vxe` ervi�.eis �.. .�`�'�'._".` . A&Y- Notification for Removal or Closure of In Place Storage Tanks Regulated Under 527 CUR 9.00 onward completed form,signed by kxai fire department.to:Aftm US7'Comphancs Unit _ .. - • lept:of Frre Services,P.O.Box 1025-State Road Stow,MA 01775 Date Received: elephone(978) 567-3302 Fire Dept.ID# Fire Department retains one copy of FP-290R) Fire Dept Sig. IV -his form is to be used for notification for removal of Underground Storage Tanks/ State Use Only i a storage facility has USTs which are to remain in use,an entire amended FP-290 A. Facility Number long form) must be filed. B. Date Entered •Jote: 'Facility street address"must include both a street number and a street name. C. Clerk's Initials 3ost office box numbers are not acceptable,and will cause a registration to be D. Comments •etumed. If geographic location of facility is not provided,please indicate distance and direction from closest intersection, e.g., (facility at 199 North Street is located) 400 yards southeast of Commons Road (intersection). I. OWNERSHIP OF TANK(S) If. LOCATION OF TANK(S) owner Name(Corporation,Individual.Public Agency,or Other Entity) if known,give the geographic location of tanks by degrees,minutes,and seconds.Example:Lat.42,36,12 N Long.85.24,17W Cttnnacirti d Golf r'.l,th s Tnr• Latitude Longitude Marston's Lane Street Address Oistartee and oireann from tlosest ntersemn(see note above) Villiage of Cummaquid Cummaquid Golf Club, Inca Facility Name or Carnp1111 Site identtli.r.as applicable Barnstnblp n2h47 Marston's Lane City rate P street Address(P.O.Box.rat ateepubts-see note above) Cummaquid MA 02637 cauffly CIry Sure rip Code (508)-362-2022 Pltarte Number(Include Area Code) OrKWs Empbyer Federal 10 a Courtly III. TANKSIPIPING REMOVED OR FILLED IN PLACE Tank Number Tank No.� Tank No. Tank No. Tank No. Tank No. 1.Tank/Piping removed or filled in place (mark all that apply) rr---�-1 A.Substance last stored B.Tank capacity gallons 2,000 gal. C. Estimated date last used (moJday/yr.) —04/30/99D. Estimated date of removal (mo./day/yr.) E.Tank was removed from ground F- F.Tank was.not removed from ground 0 Tank was filled with inert material F r-� C= L 7 Describe_material used: G.Piping was removed from ground H.Piping was not removed from ground 0 �� 0 F— I. Other, please specify :a•290R(revised 11/96) OVER Tank Number(conL) Tank Nam Tank Na_ Tank No,_ Tank ft Tank Nm , . 2.Tank dosed in accordance with 5V-CMR 9.00 -Oyu ON* O Yes O No O YN OW O Yea ONO O Yes O No A.Evldwee d leak detected . .8 Yea O No O Ya•O No O YM OW O Yu.O No O Yaa O No. B.Mass.OEP notified •Ya OW O Ya O No O Yap O No O YU O No O Yaa O No 1.Mass.DEP tracking number 4-14697 2 Agency or company performing Atlantic contanunation assessment• ------ Environmental *5V CMR 9.07(.).saa T4mmww*Wth of Technologies, Inc. Maas.ctkusatrs.UMMMMw d SO mp Tank Ctosm Ass+ wwa Mannar Apro 9.i m OEP Poky#WSC-402•9e 1 declare under penalty of perjury that i have personally examined and am familiar with the information submitted in this and Iall attached documents,and that based on my inquiry of those individuals Immediately responsible for obtaining the informa- don, I believe that the submitted information is true.,axurate,and complete. i, Name and official title of owner or owner's Signature: Date: authorized representative(Print) BARNSTABLE FIRE DEPARTMENT rrt ' O n- c 3249 Main Street s s ♦a o� 18 27 o F Barnstable, Massachusetts 02630 H C n„� 508-362-3312 WILLIAM A. JONES III, CHIEF GLENN B. COFFIN, CAPTAIN FIRE PREVENTION i UNDERGROUND STORAGE TANK REPORT Property Address: Marstons, Lane Property Owner: Cummaquid Golf Club Removal Date: April 30, 1999, 1300hrs COMMENT: Witnessed the removal of a 2,000 gallon U.G.S. Tank used for the storage of gasoline from this location. The tank appeared to be OK, with no signs of leaking. The excavation site appeared to be clean with no residual odors of fuel or discoloration. On location, representing the owners, inspecting and overseeing this removal and cleanup was Mr. Eric Cardinal from Atlantic Environmental Technologies, Inc., P.O. Box 1051, Sandwich, MA 02563.The contractor was advised to remove the tank from this location and the back filling of the hole will be under Mr. Cardinal's supervision. William A ones, III Fire Chief Make application to local Fire Department. Fire Department retains original application and issues duplicate as Pe opy —__ �Q�?Z?YLQ'JLLCtCrz��12 a���%�"Ga/JQCZG12��i1��- �ofiao�fir�ze�zto/>C 6� _e- CJe��vrce� — :✓c aa�rtz�o��� ire ✓"IrP/Ue42�G09Z APPLICATION and PERMIT" Fee: F for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by: { .3,570OC Tank Owner Name(please print) i —�' �;, :� X ignalure(ap!lying or permit Address v�no_•� O — Street city state zip Company Name F—y,i/ Co.or Individual Print Prcn( Address LI ,.3e Lv�--'t Ma Address E F r.u�;r D Pun( ( Li`=-:h { t 1/pL�f'itnG t`I-(� /�� �7 7 Signature (if applying for permit) 0.�7 y 5 Signature(if applying for permit) Pnnr (Ui. 0 IFCI Certified Other 01FCI Certified i/LSP # Other Tank Location C u,„ M;• (j C [ �T {1 Steel Address City Tank Capacity(gallons) __ 2 C) t l) S Substance Last Stored Tank Dimensions (diameter x length) C/ l Z r Remarks: Firm transporting waste f'✓ cL,A (.Q.r•'3 Stale Lic. # Hazardous waste manifest# '!'LI � j 1 ,� CZ—E.P.A. # —61 2 5 U 3 62 2,Z 7 S— Approved tank disposal yard A /!�1 �r l_�_y i1 Tank yard# OC? Type of inert gas ij r•�{ j Tank yard address L S C� City or Town N�`�� FDID# v ' I Permit# Date of issue 3 0 ���� Date of expiration 7 Dig safe approval number: % / (' U ' ? ig Safe Toll Free Tel. Numbe 800 322 4844 Signature/Title of Officer granting permit After removal(s)send Form FP-290R signed by Local Fire Dept. UST Regulatory Compliance Unit, One Ashburton Place, Room 1310, Boston, MA 02108-1618. :,...,--r;F-.,•,..�_-.,.Z.�Y.,.r:..,...--R....-.. 5.,�--_. .r ...-von--..Fr- .. ...,w ,r� < w .��{t . f„ TOWN OF BARNSTABLE - UN—DE2GRUUND :FUEL AND CHEMICAL STORAGE REGISTRATION MAP 5�(� PARCEL NO. 66 TAG NO. �35 ADDRESS OF TANK: GOUIVTRv CLuA Dlzlvie VILLAGE: cummol cau 10 N u m b• Olt r••! MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : OWNER NAME: C.(,mm,A a u /CJ C9'c G F C`U,B PHONE: INSTALLATION DATE: 7 30 BY: INSTALLER ADDRESS: FRAuK 6,6/2P FAJV. -3FRV/CLrS -CERT.NO. 61,?1 *TANK LOCATION: ABOVE BELOW /- (DamonIDG TANK LOCATION WSTH I%QOP@CT TO SUILDINa) CAPACITY / 6 d O TYPE OF TANK AS_r GE AJPQJYRS. FUEL/CHEMICAL G�4S pIFsE�. TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [ ] YES [x NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NO DATE CONSERVATION [ ) CHECK IF N/A DATE HOARD OF HEALTH TAG NO. [ /,� SI ] DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD TOWN OF BARNSTABLE — tftd$E-R.RUUND FUEL AND CHEM I QAL STORAGE REGISTRATION t MAP NO. 5 d PARCEL NO.�, 66 TAG NO. 13 S ADDRESS OF TANK: �QuN?Va�f 'G'Lcua D/zIyie VILLAGE: Cc. Q,CIIJ r. fvumb� •lr��! f MAILING ADDRESS ( IF DIFFERENT //FROM ABOVE ) : OWNER NAME: A U e;a 4 F C LU,6 PHONE: S'o 4 2 "' 2 a.02. INSTALLATION DATES 3_-IL7- BY : INSTALLER ADDRESS: FRA,IJK C,612P FA) V �FRV�Ck`'� -CERT.NO. 61�?I ? f STANK LOCATION: ABOVE BELOW t (o a m o R:a a TANK L O C A r S O N W S r H A a 0 m a c r T O m u S-L o I N 0) CAPACITY ff 0 TYPE OF TANK A S- POE IVRCOYRS. FUEL/CHEM I CAL GAS p/ES£L /Q F u. /eJ /R? TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [ ] YES [A NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NO DATE CONSERVATION [ ] CHECK IF N/A DATE --e , Q BOARD' OF HEALTH TAG NO. [ DATE # PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD i C7:CE'ClL�LOG o/CG --Ie--W-I01!/A�� opW1 DANIEL S.GREENBAUM Commissioner GILBERT T.JOLY AU 6 2 2 � k Regional Director HALT H �E►T. COPY, August 15, 1991 Cummaquid Golf Club RE: YARMOUTH--Cross Connections P.O. Box 182 Proposed Backflow Prevention Yarmouthport, Massachusetts 02675 Device at Cummaquid Golf Club, PWS ID #4351000, (92-036) Transmittal No. 16246 ATTENTION: Mr. Ed Fruean Gentlemen: The Department of Environmental Protection, in response to a request submitted on your behalf dated July 17, 1991, has reviewed plans of a proposed backflow prevention device for the subject location. The plans consist of one sheet which is titled: CAPE COD CUMMAQUID GOLF CLUB YARMOUTHPORT MA BACKFLOW PREVENTER DETAILS FIRE SAFETY SERVICES DATE 7-16-91 .The Administrative Completeness Review and Technical Review have been completed on the above referenced submittal. The plans propose to install one 6" Febco 805 double check valve assembly on the water line feeding the fire sprinkler system equipped with siamese connections. The plans are hereby approved with the following provisions: 1. The water lines affected may be shut down during normal business hours, after reasonable notice and after written permission is received from the local fire department having jurisdiction to permit necessary testing and maintenance. If it is not possible to meet this requirement, it will be necessary to provide a by- pass equipped with an approved type backflow prevention device. Recycled Paper J _ 1 -2- 2 . The installation must be readily accessible for testing and maintenance. 3 . A complete set of spare parts for each device must be available for future maintenance. 4 . The fire sprinkler system will not be equipped with storage capability. 5. The fire sprinkler system will not be treated with chemicals which include any type of anti-freeze. 6. The fire sprinkler system will not have a direct connection to an unapproved source of water. In addition, the Department requires that the installation be completed within ninety (90) days after receipt of this communication. After the work has been completed please notify the Yarmouth Water Department so that arrangements can be made for an inspection. The application for a cross connection permit will be issued after the inspection. If you have any questions, please contact Mr. Richard 0. Wiles at (508) 946-2767 . Very truly yours, awrence S. Dayian, hief Water Supply Section - - - - - D/ROW/bh cc: Water Department 102 Union Street, P.O. Box 31 - Yarmouthport, MA 02675 Board ofHealth 1146 Rte. 28 S. Yarmouth, MA 02664 Plumbing' Inspector 1146 Rte. 28 S. -Yarmouth, MA 02664 Fire Safety Services P.O. Box 3017 Plymouth, MA 02361 -3- cc: Fire Department -- Main Street S. Yarmouth, MA 02664 DEP - SERO ATTN: Sharon Stone Permit Administrator J P�OETHET TOWN OF BARNSTABLE OFFICE OF t Haa MAS& Z BOARD OF HEALTH y ABB. 00 1639.M`� 397 MAIN STREET HYANNIS, MASS. 02601 March 11, 1976 Mr. Stephen -O'Brien, President Cummacuid Golf Club off Main Street ' Cummaquid, Massachusetts NOTICE OF VIOLATION OF STATE SANITARY CODE The operation'of your bar and food service establishment is in violation of Regulation 32.1 'of Article X. Minimum Sanitation ~- Standards for Food Service Establishments. Your permit expired December $1, 1975, and has not been renewed. We extended you the courtesy of calling you twice to renew your permit and visiting your establishment once- to remind you to obtain a permit. However, you have ignored these efforts and still have not obtained a license. You are directed to cease the serving of food or drink until your Food Service Permit is obtained. Any person who fails to. comply with an order pursuant to the State Sanitary Code is subject to a fine of not tore than $100 first offense, $500 subsequent offense. Each day's failure to comply shall constitute a separate violation. You may request a hearing before the Board of Heal th' if written petition requesting same is received seven (7) days after the date order served. PER ORDER OF THE BOARD OF HEALTH �1Y hector of Publ c Health I 7 JMK/mm C� March 111 . 1976' t - s Mr. Stephen 0 Brien .°Piesident Cummaquid Golf Club ,,off Main.' �tri oot Cummaquid Massachusetts Y. NOTXCE OF MOLATION OFF STATZ ANITARY CODE The operation, of -your. bar end � -ood 'servi ce: - talAishme'-t is in violation of _RegUlatiofi 32 1. of ,Article 'X,. Minimum' Sanitation Standards for Food service-Estililishments, December 3l, Your permit expired nb1975, and' has s x � a , . we ,extended you ,the courtesy ot, cal ling •you twice to ienew . your permit and visiting your establishment once to remind you` ". . ti to obtain• a permit, However, you have ignored ,these efforts and still, have not obtained a license. a : You' are•drected to cease 'the serving of food or drink unti]. f <your� Food Service Permit is obtained,. • D... ,. s ' ... :. '. ',a Any'-.person- who fails. to comply, Frith an order pursuant to the State sanitary Code•is-sub ject' tv a ,.fine•of not more than $100 ' first ''©ffeinpe, $500 subsequent 'offense� .Each day's failure to ` comply••shall constitute a .separate .v'iolafi6n.. ", > You:may request a 'hearing.before this Board, .of Realth if written petition requesting some is received seven ( 7) :days after ,the dato order served ¢ : . PER. ARDSR OF iE 'BOARD „QF HEALTH N John M o -kel ly Director of public Health , JMK/ism . f� 1 V/ Z lAI117T@eL6 19, �0 Mir 367 Main Sl�rrl, �yunnil, Vail. 02601 NOTICE OF HEARING, a ' CUMMAQUID GOLF CLUB OF YARMOUTH AND BARNSTABLE INC,. , Thomas J. Madden, Pres. has made application to store 2,250 gallons of gasoline, 500 gallons of diesel fuel and 250 gallons of waste oil in one (1 ) 3,000 gallon underground tank. Said tank will replace previous licensed tanks on property located on Marstons Lane, Cuimnaquid and owned by them. A public hearing on this application will be held on Tuesday, November 25, 1986 at 10:00 a.m. in the Selectmen' s Conference Room, 367 Main Street, Hyannis, Ma. A �s°�r•�DJ-vgs r17-w� x—'o Sv�k lh1,s b Martin J. Flynn rd �h'-y T/�� ��ysr►r�st�T John C. Klimm 7 G * k . John A. Weiss „c.ifr/aal. Boar.d of Selectmen Town of Barnstable Legal Ad - Barnstab4'e Patriot 9 got for 11/13/86 PLEASEBILL LEGAL AD TO: Cumnaquid Golf Club of Yarmouth & Barnstable Inc. Thomas J. Madden, Pres. off Marstons Lane Cumnaquid, Ma. 02637 77 a GENERAL MANAGER f . •., y TRUSTEES ROBERT A.LOVETT JOHN K.DAVENPORT PALMER DAVENPORT IdinConywfiy. DE WITT A.DAVENPORT .lJ' PLANNED CUSTOMERIZED BUILDING 20 NORTH MAIN STREET - SOUTH YARMOUTH - MASSACHUSETTS'02664 Phone 617-398-2293 Town of Barnstable Board of Health Hyannis, Mass. 02601 Attn: Nancy Leiner Dear Miss Leiner: Davenport Building Company plans to proceed with .the Cummaquid Golf Course Maintenance Building as of November 3, 1986, providing all permits and fees have been obtained. Estimated time of completion to be two (2) months, weather permitting. Thank you. Sincerely, ' DAVENPORT BUILDING COMPANY Neal Provost Designer NP/eh 4 _ I RESIDENTIAL & COMMER.CIAL BUILDING � •� J < •l 1• n r i,i '�a �r,{. y.a.a 'r 1' ,a` � ` " a.K { ri t. ,..� tij •� � f r� V..pa� _ ,fT� .� , ♦r�.K a. t" +.� x `� }.� F " .:....}� .4a, r rF• - - r Sa x r�+> .. r� a♦ • �t G : ? 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DATE : TOTAL NET AREA USED 1,271 S.F. 02/25/2015 EXIT BUILDING EXIT TO GRADE 5 (4) PERSON TABLES= 20 SEATS DWG.NO. ROOM NOT IN USE A-1 TRANSMITTAL BAXTER NYE ENGINEERING & SURVEYING Registered Professional Engineers and Land Surveyors 78 North Street,3,d Floor,Hyannis;MA 02601 Tel:(508)771-7502 Fax:(508)771-7622 Date: February 27,2015 To: Barnstable Health Department Total No.Pages': Attn: Donald Desmarais;R.S. BN Job No.: 2013-072 Sub jec ---Cu quid Goff`Course 35 Marstons Lane c• File We are sending you ® Attached ❑Under Separate Cover ❑*Via Fax(No.of pages including Transmittal Sheet) ❑First Class Mail/Registered#: ; ❑ Overnight ❑Pick up ®Hand Delivery (SAW) The following documents: E Prints/Plans ❑ Specifications ❑Estimates/Proposal ❑ Change Order❑ Shop Drawings ❑ Reports/Calculations ® Other DATE COPIES NO. PAGES DESCRIPTION 2/27/15 1 1 Letter to Barnstable Health Dept.—Attn: T.McKean 2/25/15 1 1 Temporary Snack Bar Plan—Sheet A-1 -Cotuit Bay Design(8 11/2'x i 1") 11/08/02 1 1 Baxter-Nye&Holmgren-Plan Sheet C-2—Layout,Dimension,Utility Plan—24"x 36" These items are transmitted as checked below: ® For Your Use ❑As Requested ❑ Returned For Corrections ❑ For Review And Comment ❑For Approval ❑ For Distribution Remarks: _ , Matthew Eddy, P.E. ,e,4 Managing Partner �— ME/spk q* .0:1201312013-072UDMIMTRANSMIITALS12013-072-TM-Sheet C-2-Letter-Sheet A-Ldocx -, a s Wd S}., J 93 4 Note: This transmittal contains privileged information.Please contact the sender immediately if this transmittal is illegible, n incomplete or not intended for your use. Thank you. � 'L}�/ 6 - � b dD OF 11.1. 30 UNDERBAR ICE CHEST - - - 5' ABOVE. 1 Y2 UND.ERBAR ICE CHEST MER WITH 115. GLASSWASHER _ O HITECT Y 123A BEER COOLER: EVAPORATOR COIL IW PIPED TO. TH ARC O - - FLOOR SINK LL BE 4. 1ND STREET. ED FOR INITIAL - - fOTE SENSORS VACUUM BREAKER . 2 j,. UNTED. -CHROME PLATED - ESCUTCHEON (NP) • _ 1 2„ L 1 12" E CO SENSOR. -� 1 � WELL MODEL E3SRMC0. SHOCK ABSORBER' - i -�--�I CONE { 112" * ( UNION ;TYPICAL STRAINER. GARBAGE DISPOSER .FURNISHED SOLENOID `VALVE BY .KITCHEN EQUIPMENT CONTRACTOR (SALVAJOR MODEL #200, FLOW CONTROLS 2 HORSEPOWER) 3. : FIRST FLOOR . W TO SEPTIC SYSTEM KW -TO EXTERIOR GREASE .INTERCEPTOR' . r _ r GARBAGE DISPOSER PIPING DIAGRAM NO SCALE - . -. ..... - - 24 H iRTfI WELL AVG.3RU Ff.00R . Project / Title. Sheet No. LJ.X/NGTON.W 02421 ._ For ..r ��y Maas:i'(781)372-3100.: .. New Ckg*xx e' For Cwn,agwd Ado Club . eb:-uvnr:aha-englneersrcoui, ane, Cemmnag�id,-MA . yy. CONSULTING 35 MetrstOtlB L' P�� ENGINEERS SK IHI Aa anta-Boston-Washington,D end, Di c Plrr g Legagram and Schedules F?rawn� KJ*H Checked . KPH Date 3/2�/14 Ref. Dwg. P01 �' N.T.S. : �k - ° .......... .......... -. .............. ?i T T 1 - a: 4 COND UP TO 77 76 . 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CO etas, Ctxn CONSULTING , � fderstona L maquid, fufA ENGINEERS PlumbkV Legend, Diagrams and ScheWes �t�l- 2 ' Adnntl•Boston-Washington,DC i f Drawn KPH COtecfcedk Date Ref, Dwg Scale: 3/25/i4 f'01 Fl.T S. , b �- . - n vv v ac t G, ' - t u ABM- GROUND K - i KW - KW - a GR E INTER.CEP.FOR '.KW KW i SE ( DIAGRAM) J V UP. V ,UP V :UP „W UP: 83t 4"KW DROP K X ,T Z_ 411 r KW UP & r c c 4"CO ND ND UP t UP & .T :3...'V..UP . - 4 { 3 UP D,ISP RISE .T • 3" _.. W U 3 . UP TO 0i -, ',: »W DN & iV .RISE TR P E=POT SINK W. t t ' »CW (SA A) t . . .. . t ";W nR(� �. LPA "14W RISE G P ATTIC .KW UP & T .,HW SA W DROP& FLAT F. _ W UP -- - KW SUP & a _ ------ ----- -- a44444 �n K UP, & T. _ tt �� : _,,KW UP & T _"KW UP .& T It t t t -- -- -- _ r-_-----___ -__-- _�-- - ---tom 2",C t 1 I .r--------- ----- --t--k-t-t- ------- --- ---- ----- ------ - -� 1/ W DROP:(SA .A - KW UP & ..T _ r ,--------- ------- ------------------ -----I.1 -t-� i t - - -- - ., - . __ A,> tt ------ - ----- --------t--ter _ 1 2 HW'DRO P SA' yTt-t KW -t , , , KW ��- - -t t KW 2"W UP. - t KW t , KW - ors t : t _ 1 2,CW UP _ 1, 2„CW UP : _ .KW UP & .T t. 2"KW . 2 W U 1 t (2) U. 1/2.HW UP - - -- 2 2 UP - --�-- ----- - 2 2 K!N l lP` i ------- ------ �� - „' , ) t 4S, & 21/ , _ t i _ P TO Fl EPLA E . - FH) rF.xNU7on�hia oa.310F r ) Ct/Title. , Sheet . von P o e Mrrie;(7R1 J 371 3000 Frr=: n�1�3,1-3roo 21 HA New Clubhouse-For: Gummaquid Golf Club alrrwagiireers.cony arstons umm A CONSULTING 35 M Lane .0 squid, M Plan ENGINEERS n,- :.At •Bosro,,.wqsn�noro,i,DC Plumbing Lovver'Level PI S KF' 3 a ate. cale.. 1/4 Dr wn: :Checked D Ref Dwg.: S KPH :. KPH 3125/14 P2.1 - : I . I • I I j . T PROVIDED D B S!E CONTRAC TO RR (SEE.CIVIL/SITE DWGS.) r ------- --- -- - I -i T.' J _+ 1 i .1 1 4 KW .SERVICE 4 :SANITARY SERVICE �I I' o. 1 - SHALL BE INSULATED TO � ,' � 1 •� SHALL :BE lN.SULATED TO j ca PREVENT FROM FREEZING . . _ ;PREV NT 1 1 1 E FLIMIT OF PLUMBING ROM FREEZING i 1 1 WORK FOR SANITARY SERVICE 1 ! . cQ) 4 1 j j ' I. • ; NOTE.' - KITCHEN WASTE PIPE EXITING BUILDING :SHALL :MAINTAIN ' t 1 t MIN/MUM 3 .FEET OF E4RTH 4'SAN , F CORER TO TOP OF PIPE. ITARY (INVELEV"== --) (FOR GONTIN.UATION SEE :CIVIL/SITE UTILITIES OWGS.) FGE=54.00' �l 90 =0 o - � i► LIMIT' OF :PLUMBING r -- FGE 54,00 WORK.FOR SANITARY SERVICE` • - 4`KW ! S 01 - 4 KW EV _ I ..V.ELEV 52. i ----- »------------ (IIVV.EL ( ) 1 52.25) 6 6,, N _ S SA /TARP (INV.ELEV.—5.1,47;) S I i S (FOR CONTINUATION SEE . �- _ __ _ 1 � CIV ITE UTILITIES DWGS.). UKW I UKW I 6"SANITARY SERVICE T � -� 6 COND .;UP TO SHALL BE INSULATED TO �---—- (INV..ELEV.=52.00') 6"S UP TO _.; (INV_ELEV.=51.57) F FREEZING PREVENT FROM F NG 71 I1A27WI L1,AYE 3RD fZCJOR. Project /Tltle.' Sheet No. . lfiXGVUlUn,iUA 021_>I . usz,r:Hari 3zz-3 00 INeW CItJ�IOUB@.For."CUInItrlBqulC! C1011 G:Iwb ,,. . HIA Lane, Cummaquid,M . Ft'eL:.a urn' ho.etrgur rnu, . - CONSULTING � Marstons A au u,t, ENGTNEERS 'BDstbn•Washington,DC P11 aribing Und"ab-Plan e R a Dram C eckeck KPH Dat 3/25/14 el. `` P2lU EQUIPMENT SCHEDULE EQUIPMENT INFORMATION ELECTRICAL SANITARY SOURCE SANITARY DRAIN ., , .xa c.... :. ..:�..n:.s'. ....,. ,. ,,ay, ,,. .......,..,,. CONDLIfG., .,�.;� VOLTAGE •,:.. I...;, •r - •- 'a NUF.A.. CONdUCT012 ,, GLH2R9dT E,QAd: .NOTE ':�i a..l(•1 3� MA C RE. Mp08"Nq d , .... ., _,. a. - .�MOCATKJN;�. NO'I'Et ,•CA� 'riON� LOCA710N, a�i','�' 'i '.SIZE . ,.r,u°la. a� : . ';'', .Rd,'�. aF '- . .�.. ,,".;. ��„ .'� :"• S GARDEN HOSEO EXISTING HOT WATER SUPPLY.ADD INSTALL .75'MPT FITTING W/ 1"DNA. A.W.G.8-90° 16AA(USE 20A SHUTOFFVALVE,LINE STRAINER, PRESSURE REG. SUPPLIED HOSE 23 15/16'W x 25 (31.75° COPPER _ DEDICATED I AND.75°MALE GA RDEN HOSE IF WATER PRESS. INTERFACE TO EXISTING 3 9116" SITE DISHWASHER HOBART LXiGC 5/16"D I A.F.F.) STRANDED 120V/60HZ BREAKER) WA MIN 140"WATER FITTING AS REQUIRED 1.5"A.F.F. >25 PSIG. DRAW AS REQUIRED A.F.F. 1.5"NPS MALE TI TO TSD241C8 24"W x 24°D EXISTING DRAINAGE AS FIELD ICE CHESTS(2) PERLICK CORP. TS0361C8 36°W x 24°D WA WA WA WA WA WA WA WA WA REQUIRED LOCATE C U M M AQ U I D INSTALL OUTLETS AS REQUIRED.DEDICATE CARRIER (1)20A BREAKERFOR GOLF CLUB COOLERS(2) BEVERAGE-AIR DW64 65"W x 26/'0 WA WA 115V/60HZ 6.3A (2)OUTLETS WA WA WA WA WA WA 3 BAY WI SPEEDRACK EXISTING WA 60"W x 24"D WA WA WA WA WA WA WA WA WA WA WA A&E FIRM 10 TURNING MILL CONSULTANTS,INC. DEVELOPERS, ENGINEERS _ AND CONSTRUCTION MANAGERS 68 TUPPER ROAD,UNIT 3 PO BOX 1159,SAND-CH,MA 02563 M9 I-)bbb-�9Bb-�Ax:(bbb)b0E-�2b 1{l," MIN CLEARANCE DRAFT /FOR HOSE TOWER -HAND SITE ADDRESS SINK _ — _ _ — — — — _ _ _ — — — _ — � -------_--- -- --- - ------- ------- --T--- aE* / ------------ --- __-- -- COMPUTER (TYP.) 35 MARSTONS LN, ---------------. -- \ YARMOUTH PORT,MA 02675 LJ 'r II t DISHWASHER t _ �000000000000000 t suBMirraLs t I ICE ICE t t 1'-0 {1g" CLEARANCE - BIN 3 BAY SINK BIN t FOR LOADING DOORS I W/ SPEEDRACK ----------J �7 - CARRIER DEEP WELL - COOLER DW64 (TYP.) t BAR TOP BAR TOP COUNTER 2' COUNTER PASS-THRU 5'-5" A 01/09/07 ISSUED FOR REVIEW _ t PROFESSIONAL STAMP I I 1 I I I I 1:_9, I t G S STORAGE SH LVING f t WALL COMPUTER (TYP.) —J DRAWN BY: J.P.R. 13'-6" CHECKED BY: M.F.J. SHEET TITLE: PROPOSED SITE PLAN 1 PROPOSED SCALE: 1/2' } BAR PLAN SHEET NUMBER: A-1 TMC 6.10 e F I Rop FINISH FLOOR EL.=126.87 i LEBARON LK110- oJ OR EQUAL. , ' OLOE BARNSTABLE ) 3 00 Qy - } - - - sr - - sx3 � x �- -------' x NOTE ' fAfRGRouNOS GOLF COURSE y'° �� ' I e ' - BRING ALL ACCESS COVERS TO WITHIN 6" OF FINISH GRADE. r -� �------------I „ L� ; ,-_ 4" PVC s= a._or ' r' L------ - --- , 1 18.21 i l•:.?41 - - - LIOUID LEVEL --- - _ ° 1�IUL - - - -- - - - - 117_11�-i u I 116_86 • LA - -- III I \\ II II I' FINISHED GRADE INSTALL ONE ACCESS COVER PER ROW I , III �\ I I I I 30 X30 X30 D•BOX w f :i , I JI I \`� I I I, , 2„ PEASTONE TOPPING MBA Pr CONC. FOOTING -� I 105.83 �� 1NGS°N A i ji ----- --- ----- � \ I1106�59 106.39 105.63 ROSF4o9YlcHARTEORO AVEN z RACE LN. ______________________________________ �---�~ -Ir - LtaU[D LEVEL s............ 'gep0. EwH RH 109 58 i - - - - - -LIOUID LEVELD.B. -9 "''�'` a^.: 105.26 (2 EFFECTIVE DEPTH ) o .N - - -- - - 1 EXISTING -----, 109.33 fi0H_20 Navi0� rn I s 500 GAL . TANK S� 106.34 � °' 105.26d.. I� „ 3,,, w�roM m ��� �p�,� r� EXISTING e"�' 1 Z TO 4 WASHED cN e =o n9 d; �� SEWER ".� -e�• STONE ALL AROUND. ` ES,DE DR• Qy� ° fR �...... �1 03.26 5• MANHOLE 103.26 6 CRUSHED STN. J 39500 GAL . 5.0' @ 1�° 39500 GAL . ( 31 .0' � 1% _1 37i% @ , SEPTIC TANK SEPTIC TANK F 1 .5' 93'S 1 ,5' SOIL ABSORPTION SYSTEM ( SAS ) L OCUS MA P t H -20 ) t H -20 ) D I STR I BU T ON 96.5' 2 -ROWS PRECAST CONCRETE CHAMBERS ( H -20 ) BOX ( 3 ' HT . . 8 . 5 ' L . 4 ' -10 "W 11 LEACHING 11 CHAMBERS PER ROW WITH 1 . 5 ' OF STONE ON CHAMBERS SIDES AND ENDS . EFFECTIVE : HEIGHT=2 . 0 ' WIDTH =7 . 84 ' TEST HOLE 41 TEST HOLE #2 ' SEPTIC SYSTEM PROFILE LENGTH =96 . 5 ' ELEV. ELEV. 0"" AP SANDY LOAM 100.2 0 AP SANDY LOAM 110.3 6"" 2.5YR4/4 99.7 1 , 4" 2.5YR4/4 109.9 N.T.S. NOTES B SANDY LOAM B SANDY LOAM 5YR4/2 5YR5/4 24" 98.2 18 108.8 I 1 . ALL EXTERIER PIPING TO BE PVC SCHEDULE 40 OR BETTER. 5. THE LOCATION OF UTILITIES SHOWN ON THE PLAN ARE APPROXIMATE. c-1 10YR8/6 SAND C-, 2 5YR5/SAND THE CONTRACTOR SHALL BE RESPONSIBLE FOR THE LOCATION i 2. PRIOR TO CONSTRUCTION OF SEPTIC SYSTEM THE CONTRACTOR j 72" 94.2 48 106.3 SHALL OBTAIN A DISPOSAL WORKS CONSTRUCTION PERMIT OF ALL UNDERGROUND UTILITIES AND SHALL NOTIFY C-2 FINE SAND C-2 SAND FROM THE TOWN OF BARNSTABLE BOARD OF HEALTH. DIG-SAFE, TELEPHNE, THE CABLE CO. + THE C. O. M.M. 10YR7/4 2.5Y7/3 108" 91.2 84" 103.3 3. NO PART OF THE SEPTIC SYSTEM SHALL BE BACKFILLED WATER DISTRICT AND OTHER UTILITIES PRIOR TO EXCAVATION. C-3 FINE SAND C-3 SANDY LOAM _ UNTIL INSPECTED AND APPROVED BY THE TOWN OF BARNSTABLE 6. DURING INSTALLATION DISTRIBUTION BOX IS TO BE 5YR8/1 1OYR6/4 \ WATER TESTED TO INSURE THAT IT IS LEVEL. 120„ BOTTOM OF HOLE 90.2 NO WATER ENCOUNTERED 120 BOTTOM OF HOLE 100.3 NO WATER ENCOUNTERED - - \ \ HEALTH AGENT AND THE BARNSTABLE DPW - ENGINEER. - - \ \ 7. THE FIRST TWO FEET OF PIPE OUT OF THE DISTRIBUTION BOX 4. THE DESIGN AND COMPONENTS OF THE SEPTIC ARE TO BE LEVEL. TEST HOLE #3 TEST HOLE #4 - J \ \ \\ - \\ SYSTEMS SHALL BE IN COMPLIANCE WITH THE STATE 8• SEPTIC TANK. DISTRIBUTION BOX, AND LEACHING CHAMBERS ELEV. ELEV. \ \ \ \ SHALL BE ABLE TO WITHSTAND AN H-20 LOAD. o„ 11a.7 0" 11a.2 \ \ \\ \\ \ OF MASSACHUSETTS SANITARY CODE TITLE V. AND AP SANDY LOAM AP SANDY LOAM \ WITH THE TOWN OF BARNSTABLE (BOARD OF HEALTH. 4„ 2.5YR4/4 110.4 4„ 2.5YR4/3 109.9 I � '�, '\ \ \ \ \ B LOAMY B LO10YAMY SAND 30" 108.2 36-' 107.2 SEPTIC DESIGN PERC TEST PERC TEST / / / 2 PERC. RATE 2 MIN./INCH PERC. RATE �u 2 MIN./INCH ( \ \ , , 2. SAND TEST HOLES DUG 9/18/02. C-1 SAND TEST HOLES DUG 9/18/02. \ \ \ \ \ \ \� , DESIGN FLOW 2.5Y7/3 SOIL EVALUATOR: B. CELIA 10YR5/8 SOIL EVALUATOR: B. CELIA ' \ \ �, \ \ �\ \ r, B.O.H. DAVE STANTON B.O.H. DAVE STANTON / \R�\POSE�� SOIL ABSORT I 0 \ \ \ f �``,, \ � , \ �� , ` TOTAL BUILDING FLOW: �. , i S1Y S T\E M ( H\2 0 ) \ _. , RESTAURANT = 35 G.P.D./SEAT X 83 SEATS = 2,905 G.P.D. , 120„ BOTTOM OF HOLE`' 100.7 NO WATER ENCOUNTERED 1 oo"' BOTTOM OF HOLE 101.9 NO WATER ENC UNTE RED1 \ \ = FUNCTION N C T I 0 N ROOM 0 M = 15 G.P.D./SEAT X 10 0 SEATS = 1 5 0 0 G.P.D.. ``, EXISTING LEACHING AREA - � _ \ v \ \ �, �' , ` TOTAL FLOW = 4,405 G.P.D. e \ \ \ \ o_ \ `\ \ \ \ \ , ( TO BE ABANDONED ) TP EXISTING SYSTEM FOR FLOW FROM KITCHEN: - , , #/ INSTALLED IN 1995 DESIGNED FOR 183 SEATS X 15 G.P.D. - 2,745 G.P.D. \gyp' \\ \��� �,- '� \\ PROPOSED UPGRADE SYSTEM FOR LAVATORY : PROPOSED SYSTEM F 0 R \L A\ tORIES \ `', \ \ \� `� `� \ FLOW ONLY DESIGNED TO HANDLE REMAINDER OF FLOW FROM BUILDING l + p, A \ \ , \ \ - 4,405 G.P.D. - 2,745 G.P.D. - 1,660 G.P.D. \ P i CHECK FLOW BASED UPON WATER USAGE: MAXIMUM ANNUAL WATER USAGE 1999-2001 = 200,000 GALLONS PER YEAR 70% OF FLOW IN 6 MONTHS ABANDON D-BOX REMOVE RISER DAILY FLOW = (200,000 GALLONS PER YEAR) (70%) / 180 DAYS = 778 G.P.D. �-- EXISTING LEACHING GALL IES ( TYP ) --- -`TL-A.PE CONC . PLUG IN D-BOX AND ° _ 200 /° OF 778 G.P.D. = 1,555 G.P.D. \�' \ BACKS I LL TO GRADE V - \ \ 1,555 G.P.D. < 1,666 G.P.D. USE 1,660 G.P.D. FOR DESIGN FLOW. ` ��- EXISTING D BOX ( TYP ) 120' ��\ \\ �R\Q� E \��BOX \ - SPR 'NK\LE \ HEAD s -` \ _ P \ \ SEPTIC TANKS ,- �,�� \ \ \ \ \ W/'�' T(R LINE \ H 20\) \ , EXISTING 5 , 000 GAL . SEPTIC TANK 200% OF DESIGN FLOW = ( 1,660) (200%) = 3,320 GALLONS PER 310 C.M.R. - 15.223 (1) (b) FOR COMMERCIAL FLOWS IN EXCESS OF 1,000 G.PD. 2 TANKS IN SERIES OR 1- 2 - - - - - --�+` � \ \ \ \\ \\ \ \ \\ \ \ \ %'' ,��' -�- \ \ \ F COMPARTTMENT TANK IS REQUIRED. �`�\// I I \ \ \ \ \ \ / O \ UT PIPE\ AND INSTALL USE 2 - 3,500 GALLON TANKS IN SERIES. \ t P C\ CAS'\. \ \. \ \ \ SOIL ABSORPTION SYSTEM ( SAS ) EXISTING ,3 + 500 GAl1 . G EASE TR\ P �l ��, \ \ \\ \\ \ \ \� \ \ \ o\ \ \ \� + - 1 h \ \ \ \ \ \ O, \ \ \ �'O USE 22 PRECAST CONCRETE (H-20) CHAMBERS (8' -6 "L X 4' -10 " W X 36 " HT EACH) I \ P\RQPQ.� �3\, 0\GALS o O WITH 1.5' STONE ON SIDES AND ENDS - IN TWO ROWS. 1 \ EACH ROW: LENGTH = ( 8.5 X 11 ) + 3 = 96.5 WIDTH = ( 4.85 + 3) = 7.84 i BOTTOM = 0.74 G.P.D. / S.F. E( 96.5 } ( 7.84 +] = 560 � SIDES = 0.746 G.P.D. / S.F. E(96.5 X 2 X 2) - (7.84 X 2 X 2 � =309 EXISTING SYSTEM FOR KITCHEN �� ,�, A >, p \ \ \, �� � RE�it�OVE ADD D SPOSE OF TOTAL PER ROW 869 G.P.D. u , \ ' `� \ �\ � \ i \EX1$TY61G : ,000 GALLON TOTAL 2 ROWS = 1,738 G.P.D. ( INSTALLED 1995) ,� ) ` \ \ I \ \ - \ \ --- CA\7,J 1 �\ SEPT,1C TANK , 1,738 G.P.D. > 1,660 G.P.D. OK CONNEC T TO EXISTING SEWER ° �\\� �► �, II \ \ \ fjiG SAFE 00-3q MAI TOWN OF BARNSTABLE 2 AaVED DEPARTMENT OF PUBLIC WORKS - ENGINEERING DIVISION \ EX%S T l NG CLUB HOUSE - \\ \ F`a z �� y° �F y�T Sao- � PL AN SHOWING PROPOSED. \ FINISH FLOOR \ 1A„ e F/N S ,, \ 1 PLANT DAM►: � BARNSTABLE, SEP T I C SYSTEM REPA I R ELEV. _ 126 . T9 -20 /0 0 20 40 FEET MASS. \ 1 >«3 ��- A T DL DE BARNSTABLE DESIGNED ib DRAWN YBY: S.C.S. SCpEd.E,OCTOBE 2D O. 2002 t \, FAIRGROUNDS GOLF COURSE j\ SCALE• i `=2O' I N MARS TONS MILLS CHECKED BY: S.G.S. VILLAGE: MARSTONS MILLS \ FILE! 0204/bo.d9n SHEET I OF j Fi )WF V, 311\1D�W0��2Rt kj�D -- - " 4F Z --- .•� - ��� 1 oqK<<, rsswC V£'km psotVf e't a6*Jqcz _C� i I YIIIN ���'. t1►7 Qf{�.S- I' `- . F -\ ,A p}tia\T S H\ Cr FS`� ` i a-AulNG , r 2.rsZ molt TO B`G J + L�`� E5�14E1RS (t��J zx� etr�eu�R � I assN. 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