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Home My WebLink AboutPERSEVERANCE WAY (2) Porky's,Concessions/ Cafe 75 _21 5 011 75 Perseverence Way_ i s ,K-F Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. nARNISTA see, F.P.(Thomas)Lee,. $ 200 Main Street, Hyannis, MA 02601 Daniel Luczkow M.D. Alt. ASa Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstablems Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 305B, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 594 Issue Date: 01/01/2022 DBA: PORKY'S CONCESSIONS/CAFE 75 OWNER: AUDREY MAROTTA Location of Establishment: 75 PERSEVERENCE WAY HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 48 OutdoorSeating: 0 Total Seating: 48 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2022 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE- FOOD: MOBILE- ICE CREAM: Q� FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: I 28-Dec-2021 16:50 From Audrey Marotta. Phone #5086486613 FaxZero.com p.2 Mad -61cl� For Office UsC Qnly7 Initials: Town of Barnstable 6 \ Date Paid Amt Pd$ BARNMABIE. : Inspectional Services mAsa Check# �.q Public Health Division 9 FD MP't Thomas McKean, Director 200 Main Street,Hyannis,NU�02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE 12/28/2021 NEW OWNERSHIP RENEWAL X NAME OF FOOD ESTABLISHMENT: Cafe 75 Audrey Marotta ADDRESS OF FOOD'ESTABLISHMENT: 75 Perseverance Way, Hyannis,MA 02601 r -- MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: catering@capecodspecialevents.com TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 5( O8 ) 775 - 4227 TOTAL NUMBER OF BATHROOMS: 1 WELL WATER: YES__NO X ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: X SEASONAL: DATES OF OPERATION: / / TO NUMBER OF SEATS: INSIDE: 10 OUTSIDE: 0 TOTAL: 0 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? No IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? No TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) X 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) x 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:ApplicitionFormSTOODAPP 2020 doc 28-Dec-2021 16:50 From Audrey Marotta. Phone #5086486613 FaxZero.com p.3 rT OWNER INFORMATION: FULL NAME OF APPLICANT Audrey Marotta and Vito D. Marotta (co-owners) SOLE OWNER: YES/NO D.O.B 8/5/84 1212/87 OWNER PHONE#508-648-6613 ADDRESS 190 Beth Lane, Hyannis, MA 02601 CORPORATE OWNER: CORPORATE ADDRESS: PERSON IN CHARGE OF DAILY OPERATIONS: Audrey Marotta 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 ,.Vito Marotta 05 / 10 ; 2026 1. Carlo Marotta 08 / 11 A026 2 Carlo Marotta 06 / 11 / 2026 Amdlz4y 12 /28 /2021 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 Penn it 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 lilln://www.iownoibarnstable.us/he-,klthdivision/aPplications.asn. OUTDOOR COOKING: Outdoor cooking,preparation or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec. 3151 each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. 0oApplication FormsiFOODAPP REVS^019.doc I w pYt Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. axsexsia�ee :' 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: 594 Issue Date: 01/01/2021 DBA: PORKY'S CONCESSIONS/CAFE 75 OWNER: AUDREY MAROTTA Location of Establishment: 75 PERSEVERENCE WAY HYANNIS„ MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 48 OutdoorSeating: 0 Total Seating: 48 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2021 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: i aIC� �oFtHE rpk, For OfficeInitials: _ do Town of Barnstable '" Date Paid � Amt Pd$,� : .AMSTABLE : Inspectional Services Public Health Division Check# _ p�fD MAC Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE NEW OWNERSHIP RENEWAL V e C U/�n,� - n�6)0 Lake OF FOOD ESTABLISHMENLake 15 �-e j,� ay--o l�J� L, lX� ADDRESS OF FOOD ESTABLISHMENT: mij MAILING ADDRESS(IF'DIFFERENT FROM ABOVE): ,n E-MAIL ADDRESS: CG1�P�YL-GnG G�(: e- C,U cy S'-� eG�Ge� P✓eV1 �DV�A TELEPHONE NUMBER OF FOOD ESTABLISHMENT: k2b TOTAL NUMBER OF BATHROOMS: WELL WATER: YES NO_1y_ ...(ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: _ SEASONAL: DATES OF OPERATION:_/ / TO NUMBER OF SEATS: INSIDE: OUTSIDE: a 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? WO IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED& BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) _CATERING ...(CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsWOODAPP 2020.doc n r OWNER INFORMATION: FULL NAME OF APPLICANT A u�d a4z Tl o-- V Co- C�wN.e�.s SOLE OWNER: YES/0 D.O.B OWNER PHONE# IZ� ADDRESS_ «b � fne— ` 0�V\&\S 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 I 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 bate ct 69 -3^al 1. (o 2 1. 2. V I `V \M 6(A"JJu-, 1 )MV, 12 / 3a 2026) 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 openiniz!! 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 htta://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 I st to Dec.3 V each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q\Application FonnsTOODAPP REV3-2019.doc w Town of Barnstable BOARD OF HEALTH John T.Norman Board of Health Donald A.Gaudagnoli,M.D. s a,�tufseeu� + Paul J.Canniff,D.M.D. 59 200 Main Street, Hyannis, MA 02601 F.P. Thomas Lee Alternate a ,d' Phone: (508) 862-4644 Fax: (S08)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: 594 Issue Date: 12/10/2019 DBA: PORKY'S CONCESSIONS/CAFE 75 OWNER: AUDREY MAROTTA Location ofEstablishment: 75 PERSEVERENCE WAY HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 48 OutdoorSeating: 0 Total Seating: 48 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR. 2020 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: MOBILE-FOOD: MOBILE-ICE CREAM: Q.� FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: Use Offly; For Office Initials: Town of Barnstable (� / Date Paid Amt Pd$ + BMWSTABL6 : Inspectional Services \\ MASS. 5 i679 Public Health Division Check# ' CEO MAC� Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A gOOD ESTABLISHMENT DATE Z '?� �� NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT: CA�C �J �dr�.,� �G�CP—�'S in/ -3 ADDRESS OF FOOD ESTABLISHMENT:—IS 0f1(sTeQV-aV\U— 1 C.. Ck1i(1 IS q,, G G(co MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: 4 CA�� C TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 6—MA 7 1 -Ll 7-1- TOTAL NUMBER OF BATHROOMS: 2 WELL WATER: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: NP SEASONAL: DATES OF OPERATION:_/_/_ TO NUMBER OF SEATS: INSIDE: LLq� 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? 1\10 IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?A` A TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY"DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING ... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) *** SEASONAL,MOBILE & NEW FOOD ONLY*** REQUIRED TO CALL HEALTH DIV.FOR INSPECTION PRIOR TO PERMIT BEING ISSUED PLEASE CALL 508-862-4644 Q:\Application FormsTOODAPP 2020.doc OWNER INFORMATION:. FULL NAME OF APPLICANT SOLE OWNER: YES JVO• D.O.B PIS OWNER PHONE # 7 V� y VJU[3 ADDRESS CORPORATE OWNER: `l car CUnce� CORPORATE ADDRESS: ,--,eVLCC ca - C,--,N_ 0, PERSON IN CHARGE OF DAILY OPERATIONS: fife 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. ti 64— '6 Jrl d.,N 2. Is / ZY11 SIGNATURE OF A CANT DATE ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asp. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. NOTICE: Permits run annually from January 1st to Dec. 3151 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 �w WKE Town of Barnstable BOARD OF HEALTH Paul J Canniff,D.M.D. Board of Health Donald A.Gaudagnoli,M.D. t rAznsrABM' John T. Norman MAS& F.P. Thomas Lee Alternate �$g 200 Main Street, Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508)790-6304 www.townofbarnstable.us Permit to Operate a Food Establishment In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections 305A, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to: Permit No: 594 Issue Date: 12/20/18 DBA: PORKY'S CONCESSIONS/CAFE 75 OWNER: AUDREY MAROTTA Location of Establishment: 75 PERSEVERENCE WAY HYANNIS, MA 02601 Type of Business Permit: FOOD SERVICE Annual: YES Seasonal: IndoorSeating: 48 OutdoorSeating: . 0 Total Seating: 48 FEES FOOD SERVICE ESTABLISHMENT: $250.00 YEAR: 2019 RETAIL FOOD: COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019 B&B-FULL BREAKFAST: CONTINENTAL BREAKFAST: - -- -_ _.- _ - MOBILE-FOOD: MOBILE-ICE CREAM: FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent TOBACCO SALES: FOR ESTABLISHMENTS WITH SEATING: PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE Restrictions: oFIKEroyti Town of Barnstable Office For Use Only: Initials: Date Paidr ,� Amt Pd$ MAS& Inspectional Services . 16.19. Public Health Division Check# Thomas McKean,Director ' 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT DATE IZ'2 l - 1 9' NEW OWNERSHIP RENEWAL NAME OF FOOD ESTABLISHMENT:��2.1�� CSYI e e�a��nc I ADDRESS OF FOOD ESTABLISHMENT: -I ( S Q,�� C r. c.� ("J`a MAILING ADDRESS(IF DIFFERENT FROM ABOVE): E-MAIL ADDRESS: C, cy-, TELEPHONE NUMBER OF FOOD ESTABLISHMENT: al-li� TOTAL NUMBER OF BATHROOMS: 2- WELL WATER:YES NOA ... (ANNUAL WATER ANALYSIS REQUIRED) ANNUAL: _ SEASONAL: DATES OF OPERATION:_/ /_ TO NUMBER OF SEATS: INSIDE: SD OUTSIDE: TOTAL: SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV. ***OUTSIDE DINING REMINDER*** OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING AND MEET OUTSIDE DINING REQUIREMENTS. IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW) FOOD SERVICE RETAIL FOOD-ONLY required for TCS foods(foods requiring refrigeration/freezer) BED&BREAKFAST CONTINENTAL BREAKFAST COTTAGE FOOD INDUSTRY(formerly residential kitchen) MOBILE FOOD FROZEN DAIRY DESSERT MACHINES ... (MONTHLY LAB ANALYSIS REQUIRED) CATERING... (CATERING NOTICE REQUIRED BEFORE EVENT(SEE PAGE#2) 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 FormsT00DAPPREV2018.doc PLEASE CALL 508-862-4644 OWNER INFORMATION: `- FULL NAME OF APPLICANT \ �` r 1 p �A#,,—o v,-c— SOLE OWNER: YES'lJ D.O.B iS C��I OWNER PHONE # ADDRESS t�� 1 V�o.. �Z 6 2$ 1)", CORPORATE OWNER: FEDERAL ID NO. : CORPORATE ADDRESS: 7) / /�C/G��v-� tA)Z) �-f•�,�,y�,) U PERSON IN CHARGE OF DAILY OPERATIONS: � /'rs-6 , List (2) Certified Food Protection Managers AND at least(1)Allergen Awareness Certified Staff All FOOD ESTABLISHMENTS must have I 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 � DOA / CO /Zk ,6 4J 2. SIG URE OF APPLICANT DATE II ***FOOD POLICY INFORMATION*** SEASONAL FOOD SERVICE:All seasonal food establishments,including mobile trucks must be inspected by the Health Div. prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance. FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter, with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert Permit until the above terms are met. CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering event. You must complete a catering notice found at http://www.townofbarnstable.us/healthdivision/applications.asy. OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited. TOBACCO ESTABLISHMENTS: All tobacco establishments must complete an.Application for Tobacco Sales Permit and Employee Signature Form. NOTICE: Permits run annually from January 1st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st. Q:VApplication FormsTOODAPPREV2018.doc oF.HE TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: I< Date: A J� Page: of P` �• PUBLIC HEALTH DIVISION OFFICE-HOURS BARNSTABLE. 200 MAIN STREET 3:3o-a:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MASS. MON.-FRI. HYANNIS, MA 02601 508-862-4644 No Reference .R-Red Item PLEASE PVT CLEARLY FOOD ESTABLISHMENT INSPECTION REPORT .Name. �_ Date a Type of c ion sJ p R utine Address Risk Food a Re-inspection Level KetailPrevious Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness n Caterer General Complaint Person in Charge(PIC) �® Time Bed&Breakfast HACCP Other In: 5 Inspector _ Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ' VE�6 I ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM.CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures _ ❑ 5.Receiving/Condition ❑ 17.Reheating ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control. ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑ 22.Posting of 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) zLij I Corrective Action Required: No ❑ Yes Non-critical(N)violations must be corrected immediately or Overall Rating. within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusio ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure Voluntary Disposal Other: checked indicate violations of 105 CMR 590.000/Federal Food Code. 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4(590.005 B=One critical violation and less than 4nora-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 C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address 29.Special,R quirements (590.009) within 10 days of receipt of this order. olation,4 to 8 non-critical violations=C. 30.Other DATE OF RE-INSPECTION: Insp to' n ur 31.Dump er screeried from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PI ignature Print- Frozen / Self Service Wait Service Provided Grease Trap Size Variance Letter.Posted Y N ' 1V. `1 a r 00- DumPster Screen? Y N n A Violations related to Foodborne Illness - Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* F8 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 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* Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage* 20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* 7.202.12 Conditions of Use* 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements - 590.003(G) Reporting by Person in Charge* Contamination from the Consumer 7-203.11 Toxic Containers-Prohibitions* 3 590.003(D) Exclusions and Restrictions* 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 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 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,Pastcurized* , 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 scc* 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* ey cn�1112001 4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 3-201.15 Molluscan Shellfish from NSSP Listed * Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009 A - D in cater- Chemical ( ) ( ) Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11 C 3 Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By ( )( ) Pe 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 929-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g° g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES * 3-301.12 Preventing Contamination When Tasting* 3-403.11 * (Blue Items 23.30) 3-202.15 Package Integrity (C) Commercially Processed RTE Food-140°F Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 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 3 402.11 Parasite Destruction* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 * 5-205.11 Accessibility,Operation and Maintenance Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402. Records,Creation and Retention 590.004(4(J) Labeling of Ingredients* Supplied withth P Soap and hand Drying Devices Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006. 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12. Reduced-Oxygen Packaging Criteria* 8-103.12 Conformance with Approved Procedures* 5:590Formback6-2doc *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. F. r TOWN OF BARNSTABLE HEALTH INSPECTOR'S Establishment Name: O``�`�\ Date: ( 1 Page: of. OFFICE HOURS � PUBLIC HEALTH DIVISION a:oo-ssoA.M. BARNSTABLE. • 200 MAIN STREET s:3o-a:so P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified MONMe3q �•� HYANNIS,MA02601 -F No Reference ..R-Red Item PLEASE P NT CLEARLY 508-88-862�644 "" FOOD ESTABLISHMENT INSP CTION REPORT Name Qom. Date' boll? Tyne of T ns ection Routi Address �� gj-�Q� Risk od Se, ction . Level Retail Previous Inspection Telephone Residential Kitchen Date: Mobile Pre-operation Owner HACCP Y/N Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP In: Other _ Inspector Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned(Knowledgeable./Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives ❑3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) 1714.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 POP,,ULATIONS(HSP) ❑9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP- ❑ 1.0.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories �' � ✓ Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: o ® 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 todaIthtems F] Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Emergency Closure ❑ Voluntary Disposal Other: ❑ 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4)(590.005 B=One critical violation and less than 4non-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 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non-critical violations. If 1 critical refrigeration. 28.Poisonous or Toxic Materials (FC-7)(590.008) 9 ))lion,4 to_8 no -critical violations=C. 29.yDree 'ements (590.009) within 10 days of receipt of this order. 30. DATE OF RE-INSPECTION: Inspect r g ture P 31. ned from public view \_D- Permit Posted? N Grease Trap Previous Pumping Date Grease Rendered Y N J #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's ignature Pri . Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N \/ 9 Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F 590.004(F) EMPLOYEE HEALTH. 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* Other* 8 g 3-501.16(A) Hot PHFs Maintained At or Above 140'F* 2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 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 Separation20 Time as a Public Health Control 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use** 3-501.19 Time as a Public Health Control* Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use 590.004 11 Variance Requirements 3-304.11 Food Contact with Equipment and Utensils * ( ) 9 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions Contamination from the Consumer 3 590.003(D) I Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Resumed Food and Rrated or of Food* 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* Y P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 183-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or 5-101.11 Drinking Water from an Approved System* Equipment* gg Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathogens* eg cep:11112001 4-602.11 Cleaning Frequency of Utensils and Food Animals.-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 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- Sources* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3A01 I Ratites-165°F 15 sec*I(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special Requirements. 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 * (Blue Items 23-30) 3-202.15 Package Integrity ( ) Commercially Processed RTE Food-140°F 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands ( ) Critical and non-critical violations,which do not relate to then the me 3-403.11E RemainingUnsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70'F 3-203.12 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 * 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices 27. 1 Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 009 3-502.11 Specialized Processing Methods* 30. Other 3-502.12 1 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 ro., TOWN OF BARNSTABLE: ..HEALTH INSPECTOR�s Establishment Name '�( �4/ Date: Page: of '40 OFFICE HOURS PUBLIC HEALTH DIVISION 8:00-9:30 A.M. RARNSTABLE. • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified ,MASS. �r. _ MON.-FRI. ,,,q,a. HYANNIS,MA 02601 No Reference R-Red Item Ci PLEASE PRINT, sos-ss2-asaa k.. 'fDN1�` FOOD ESTAB SHMENT INSPE T N REPORT ] Name ate Tvne of Inspection O s Rout-in Address k od Serv' e-mspecti n vel Previo s� � Telephone Residential Kitchen Date: - Mobile Pre-oper ion Owner HACCP YIN Temporary Suspect Illness Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP Other Inspector Ou `" Each violation checked requires an explanation on.the narrati a page(s)and a citation of specific provision(s)violated. Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ a .FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities /C1 . EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2.Reporting of Diseases by Food Employees and,PIC ❑ 14.Approved Food or Color Additives ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures ❑ 5.Receiving/Condition ❑ 17.Reheating ❑6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling d ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control ❑8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY - ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations 2_ Critical(C)violations marked must be corrected immediately. (blue&red items) c� g Corrective Action Required: ❑ No ❑ Yes Non-critical(N)violations must be corrected immediately or within 90 days as determined b the Board of Health. Overall Rating ry p ❑ ❑ p ❑ p y y ❑ Voluntary Compliance Employee Restriction/Exclusion Re-inspection Scheduled EmergencySus ension C N Official Order for Correction:Based on an inspection today,th it ms Embargo checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23..Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations re ui ment and Utensils (FC 4 590.005 B=One critical violation and less than 4 non-critical violations regardless of the number of critical,results in an F. 25.E 9 Equipment )( ) 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 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 no -critical violations. If 1 critical refrigeration. 29.Special Requirements590.009 within 10 days of receipt of this order. violation,4 to 8 non-critical latio =C. P ( ) . 30.Other DATE OF RE-INSPECTION: I ctor' Sig ature Q Print: 31.Dumpster screened from public view Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's nature Print: Self Service Wait Service Provided Grease Trap Size Variance Letter Posted •Y N �' .)/� Dumpster Screen? Y N Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont) FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to i 1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours* 590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs Cooked and RTE Foods.* Additives* 19 PHF Hot and Cold Holding 2-103.11 Person-in-Charge Duties 3-302.14 Protection from Unapproved �I Contamination from Raw Ingredients 1 g Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*' 590.004(F) * 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 2 Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F* * 7-201.11 Separation-Storage* Applicants 3-302.11(A) Food Protection* 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control* 3-304.11 Food Contact with Equipment and Utensils Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* Variance Requirements590.004 11 ( ) 590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR, 3-306.14(A)(B)Returned Food and Rrated or of Food 7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated � ) Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations* 3-801.11(D) Raw or Partially Cooked Animal Food and 3-201.12 Food in a HermeticallySealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served* P 7-206.13 Tracking Powders,Pest Control and 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served* y 3-202.13 Shell Eggs* Sanitization Temperatures* TIMEITEMPERATURE CONTROLS 3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of 5-101.11 Drinking Water from an Approved System 4-601.11(A) Clean Utensils and Food Contact Eggs t Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or _ _ Equipment* Not Otherwise Processed to Eliminate 590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 11112001 4-602.11_ Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surf 4-702.11 Frequency Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* faces of Equipment* Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS 4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009 A Violations of Section 590.009 A D in cater- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* ( ) �) ( ) ( ) Sources* Ratites-165°F 15 sec* ing,mobile food,temporary and residential 10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Game and Autifildhority Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165'F* foodbome illness interventions and risk factors. 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail 3-201.17 Game Animals* 11 Good Hygienic Practices 17 Reheating for Hot Holding practices should be debited under#29-Special 2-401.11 Eating,Drinking or Using Tobacco* * Requirements. 5 Receiving/Condition g. g g 3-403.11(A)&(D) PHFs 165°F 15 sec 3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-301.12 Preventing Contamination When Tasting* * (Blue Items 23-30) 3-202.15 Package Integrity* g g 3-403.11(C) Commercially Processed RTE Food-140°F 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 FF 13 Handwashin Facilities 3-501.14 A g 3-202.18 Shellstock Identification* g ( ) Cooling Cooked PHFs from 140°F to 70°F Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41'F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 Destruction* 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 Creation aTemperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3 402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients` Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 30. 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. Op THE r TOWN OF BARNSTABLE _HEALTH INSPECTOR,s Establishment Name: a r�s 0- c Date: K f Page: of OFFICE HOURS -PUBLIC HEALTH DIVISION 8:00-9:30 A.M. BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Ven"d M63q. �0� HYANNIS,MA 02601 eoa-62-4644 No Reference R-Red Item PLEASE PRINT CLEARLY .. P'EDN1"p FOOD ESTABLISHMENT INSPECTION REPORT + 1 1 Name Date Q I ' T e o T of Inspection o 4'' \ io S Routi `f Address C N Q r C L Risk od Servi Re-inspection C .0 '^ Level Retail Previous Inspection J r 1 V Telephone Residential Kitchen Date: O Y D Mobile Pre-operation . /1 cA Owner HACCP Y/N Temporary Suspect Illness I V Caterer General Complaint Person in Charge(PIC) Time Bed&Breakfast HACCP y 5s C, to CA r-1 In: Other e Inspector ;f� Out: lr O -t Each violation checked requires an explanation narrative page(s)and a citation of specific provision(s)violated.Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ T ( It Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ n V_ FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands ❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities a EMPLOYEE HEALTH PROTECTION FROM CHEMICALS MV l ' ❑2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives Ii �' Y I -f r uv- -� ❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals �7 1 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 I oc ` ❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling ' e d ✓ ❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding pp PROTECTION FROM CONTAMINATION ❑ 20.Time As a Public Health Control UfiC' I ❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑21.Food and Food Preparation for HSP ❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories 9- Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations f Critical(C)violations marked must be corrected immediately. (blue&red items) Non-critical(N)violations must be corrected immediately or Overall Rating Corrective Action Required: 1ANo ❑ Yes within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension C N Official Order for Correction:Based on an inspection today,the items checked indicate violations of 105 CMR 590.000/Federal Food Code. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other: 23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations, 24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F. 25.Equipment and Utensils (FC-4 590.005 6=One critical violation and less than 4non-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. Serious) 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 Y y C=2 critical violations and less than 9 non-critical. If no critical water,sewage back-up,infestation of rodents or insects,or lack of 27.Physical Facility (FC-6)(590.007) aggrieved by this order,you have a right to a hearing. Your request must violations observed,7 t 28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address anon-critical violations. If 1 critical refrigeration. violation,4 to 8 non itical violations=C. 29.Special Requirements . (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: Inspector's Signature Print: 31.Dumpster screened from public view WA4 'Dy 1,60 Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N #Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC' ig re Pri �n Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N Dumpster Screen? Y N JJJ 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* i 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 7 5 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F * - EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F) 2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F* 7-102.11 Common Name-Working Containers * Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F 7-201.11 Se aration-Stora e* Applicants* 3-302.11(A) Food Protection* P g 20 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.003(17) Responsibility of A Food Employee or An -3-302.15 . Washing Fruits and Vegetables * 3-501.19 Time as a Public Health Control*Applicant To To Report To The Person In Charge* 7.202.12 Conditions of Use 3-304.11 Food Contact with Equipment and Utensils* 590.004(11) Variance Requirements 590.003(G) Reporting by Person in.Charge* 7-203.11 Toxic Containers-Prohibitions* Contamination from the Consumer 3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR 3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for WashingProduce,Criteria* �, HIGHLY SUSCEPTIBLE POPULATIONS HSP 590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels* 4 Food and Water From Regulated Sources y Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 590.004(A-B) Compliance with Food Law* _ 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 1 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. Proper Cooking Temperatures for PHFs CONSUMER ADVISORY 3-202.16 Ice Made From Potable Drinking Water* Concemnation and Hardness* 183-401.11A(l)(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 scc* 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* eg cnvc 11112001 4-602.11 .Cleaning Frequency of Utensils and Food Animals-155°F 15 sec* 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* 3-302.13 Pasteurized Eggs Substitute for Raw Shell Shellfish and Fish From-an Approved Source_ _ 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* Eggs* 4-702.11- Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 sec* 3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater- 3-201.15 Molluscan Shellfish from NSSP List ed- Chemical* Ratites-165°F 15 sec* Sources* 10 Proper,Adequate Handwashing ing,mobile food,temporary and residential Game and Wild Mushrooms Approved By * 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under Regulatory Authority r2l. 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* 12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors. 590.004(C) Wild Mushrooms* 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 I I Eatin Drinkin or Usin Tobacco* * Requirements. 5 Receiving/Conditiong• g g 3-403.11(A)&(D) PHFs 165°F 15 sec3-202.11 PHF's Received at Proper Temperatures* .12 Discharges From the Eyes,Nose and Mouth* 3403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES :. 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30) ' 12 Prevention of Contamination from Hands Critical and non-critical violations,which do not relate to the:foodborne 3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the $ Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000 * 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F 3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000 3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004 3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005 3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006 590.004(J) Labeling of Ingredients' Supplied with Soap and hand Drying Devices 27. Physical Facility FC-6 .007 7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials FC-7 .008 HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements .009 3-502.11 Specialized Processing Methods* 130. 1 Other 3-502.12 Reduced-Oxygen Packaging Criteria* . - 8-103.12 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. co f] Porky's BBQ has been serving your catering -4 v; o ti er QI'1b �- 4 needs for New England for over 19 years { Q N O specializing in Southern Style BBQ.Whether v o 3 you are looking for a drop off or full service N o co ;r D` _ catering company,we customize our catering o rn M to your needs. Along with our award winning Sk delicious mouth watering BBQ we offer a 0 �C full compliment of side dishes,desserts,and 3. �Q. Co fio�s drinks. T ,ITS' From 25 people to 5000 we will be happy to Real Southern Style BBQ and provide you with a quote for your next event. Home Cooked Comfort Foods Eat-in orTake-out Let Porky's BBQ take the worry out of "what do I serve my guest".Let our experienced catering staff help you plan your next event. Please contact us at 508-745-5700 TAR [- OUT MINU info@porkysbbecapecod.com Delivery Available 11AM until 2:30PM or visit our website HOURS www.porkysbbecapecod.com Monday thru Saturday to use our Request a Quote feature 7:OOam until 3:1.00pm Closed Sundays Starting in May Dinners from S:OOpm until 9:OOpm Thursday, Friday,& Saturday nights Accepting Cash,Visa,MC,Discover and AMEX To order, contact: Gift Certificates available upon request Phone: 508-775-48BQ(4227) Fax: 508-790-4227 www.porkysbbecapecod.com info@ porkysbbecapecod.corn ,J BREAKFAST LUNCH -CCQ UNCH CONTINUE EGGS TRADITIONAL FARE SANDWICHES RIBS A la carte w/ 2 sides Farm Fresh X-large eggs served with home fries and choice 6oz Angus Burger................................................................4.50 St.Louis I/3 rack..................6.95....... ...:..........:........:.....9.50 of toast.White,Wheat,Marble Rye,Sourdough,or Raisin. Jumbo All-Beef Hot Dogs 114 lb......................................3.95 St.Louis 1/2 rack............... 1 1.95.................................13.75 Single Egg...............................................................................3.25 Grilled Cheese......................................................................3.75 St.Louis Full Rack............. 19.95.................................21.25 Two Eggs................................................................................3.95 W/ Ham................................................................................4.50 Baby Back 1/3 rack...............7.95................................. 10.50 Two Eggs with Meat............................................................5.75 Turkey Gobbler.....................................................................6.50 Baby Back 1/2 rack............ 12.95...................... ..... 14.75 (Apple wood Bacon,Sausage,Ham,or Italian Sausage) Grilled-Meatloaf ................................................................7.95 Baby Back full rack............20.95.................................22.25 Grilled Tips ................................ .........6.95 3-EGG OMELETS e The Hambo..:..............:. ....................... ..:. ..5.95 BBQ-LUNCH PLATTERS Classic BLT....:. ...........................................4.95..... 3 egg omelet's served with home fries.and choice of toast '' Served with two sides and cornbread. Your choice: Tuna,Chicken or Egg Salad.... .::...4.95 P_ ulled„Pork......::................................................................9.50 Chicken, 5.95 Grilled Cheese,Ham,Bacon,Sausage,Veggie,or Hash Omelet....61.50 M Italian Sausage w/, a ers & onions. Pulled Chicken. 8.95 V��estern Omelets 6.95 p pF :;: 6.50 Texas Brisket.... .....................................................9.75 4Vastern Omelets ....................... ......... 6 50 s :; Smoked Turkey ............................... ................8.95 Daily Special Omelets COMFORT MEAL$ Smoked Hot Links............................................................8.95 ` :' American Chop Sue 5 95 Y . HOT FROM THE GRIDDLE Chili Mac&Cheese ... .................. 7.50 .:; ` COMBO'PLATTERS short stack or full stack SIDES Chicken Pot Pie` ......... : 6.95 Served'with two sides and cornbread. Shepherd's Pie. ., ....: ...............::.....6.95 Choose from-Pulled Pork,Pulled Chicken, Basic Griddlecakes SIN.GLE EGG........... 125 Mac & Cheese. 5.95 Beef Brisket,SmokedTurkey, or Texas Hot Links Blueberry Griddlecakes FRENCHTOAST......1.50 '' Turke w/ Fixins' ... 2-Meat ComboGRIDDLECAKE...::..1.50 ................................................. 12.50 ENGLISH MUFFIN..1.00 Steak Tips'I/2"1b (Steakhouse or bourbon] ..... .. 8.95* 3-Meat Combo 14.50 WAFFLES "' ' HOME FRIES.............1.M Meatloaf _6.95 4-Meat Combo ........ 15.95 * .. Choices: basic,fruit topping BAGEL ......................1.25 ;'Chicken Fingers ...... .... z 6.75* 1/3 rack Baby Backs w/ (1) meat choice.................. 13.50 or with meat `" 7.95* CREEL W/CREAM 175 cod Chicken'2 pc ... ............... 1/3 rack St Lows w/ (1) meat choice....................... 14.95 Frie Belgian Waffle * mes with your choice of;(2) sides Basic Waffles BACON;HAM,OR SALADS Stuffed Waffles SAUSAGE,;HASH.....1.75 ' French toast AUTHENTIC BBQ SANDWICHES ,, Garden. ..... ..........................................................3.95 ITALIAN SAUSAGE. Pulled Pork...... .....:'::. ..... .................6.95' ......4.75 French Toast HOLLANDAISE 1.99 . . Cobb :.. Pulled Chicken ..6.50 Taco .5.50 Texas Smoked Brisket ............. 6 95 HOME STYLE BREAKFAST Texas Smoked Hot Links......... 6 95 Served with home fries and choice of toast: (sliced'or chopped) PIZZA .'-. Steak& Eggs........................................... Available by the slice.......................................................3.00 ............... Hash & Egg............................................................................695 ,-: ` ahetyVaries Daily) Tips & Eggs 9.95 DRINK$-, » Pgg ........................................................................... BB Meat& Eggs 8.95 ' `rCoffee or Tea.. Reg .1:79 .... . ..Cg`2.19 SIDES........................................................... 1.75 ea Q gg ............................................................. OJ,Tomato,Grapefruit, Apple,Pineapple, BBQ PIT BEANS SIZZLIN' SKILLETS Milk,or Chocolate Milk.................................(one size) 1.89 GARLIC MASHED Three scrambled eggs over home fries w/cheese. HAND CUT FRIES Soda................................Reg. 1.59...... Med. 1.79......Lg. 1.99 SWEET CREAMY SLAW / Basic Skillet...........................................................................6.50 � ! C� 6v Western Skillet......:................................................:............6.95 Bottled Water..................................................(one size) 1.79 POTATO SALAD MAC& CHEESE Hash Skillet..................................................:.......................6.95 Energy Drinks ..(one size) 3.99 CORN NIBBLETS BBQ.Skillet...........................................................................6.95 FRESH POTATO CHIPS 0-1 co 0 0110 v Porky's BBQ has been serving your catering v,' a f� e alrb needs for New England for over 19 years N a o I specializing in Southern Style BBQ.Whether PO o 3 -3 V N you are looking for a drop off or full service o *• Y g P o� catering company,we customize our catering < cM rn to your needs. Along with our award winning 12e delicious mouth watering BBQ we offer a 0 full compliment of side dishes,desserts,and 3. - � Co�„ to drinks. Real Southern Style BBQ and From 25 people to 5000 we will be happy to Home Cooked Comfort Foods provide you with a quote for your next event. Eat-in or Take-out 0 Let Porky's BBQ take the worry out of "what do I serve my guest".Let our experienced catering staff help you plan your next event. Please contact us at 508-745-5700, TAKE-OUT MINU info@porkysbbqcapecod.com Delivery Available 11AM until 2:30PM or visit our website y HOURS www.porkysbbqcapecod.com Monday thru Saturday to use our Request a Quote feature 7:00am until 3:00pm Closed Sundays Starting in May Dinners from 5:00pm until 9:00pm Thursday, Friday,& Saturday nights Accepting Cash,Visa,MC,Discover and AMEX To order, contact: Gift Certificates available upon request Phone: 508-775-4BBQ(4227) Fax: 508-790-4227 www.porkysbbqcapecod.com *X5,. info@porkysbbec pecod.com ` [LUNCH LUNCH CONTINUED EGGS TRADITIONAL FARE SANDWICHES RIBS A la carte w/ 2 sides Farm Fresh X-large eggs served with home fries and choice 6ozAngus Burger................................................................4.50 St.Louis 1/3 rack..................6.95....................................9.50 of toast.Wh`ite,Wheat,Marble Rye,Sourdough,or Raisin. Jumbo All-Beef Hot Dogs 1/4 lb......................................3.95 St.Louis 1/2 rack............... 1 1.95................................. 13.75 Single Egg...............................................................................3.25 Grilled Cheese.....................................................................3.75 St.Louis Full Rack............. 19.95.................................21.25 Two Eggs................................................................................3.95 W/ Ham................................................................................4.50 Baby Back 1/3 rack...............7.95................................. 10.50 Two Eggs with Meat............................................................5.75 Turkey Gobbler..:...::...... : -- ............6.50 Baby Back 1/2 rack............ 12.95................................. 14.75 ..................................... (Apple wood Bacon,Sausage,Ham,or Italian Sausage) Grilled'Meatloaf.............. ............. ....7.95 Baby Back full rack............20.95.................................22.25 Grilled Tips .........:... I' .. :...6:95................ 3-EGG OMELETS ' , `f The Hambo .... !'. ...5.95 - �`�BBQ`LUNCH PLATTERS -' Classic BLT !.... ...........................................................� 4.95 ' 3 egg omelet's served with home fries'and choice of toast. Served with two sides and cornbread. Tuna;Chicken or Egg Salad............................................! ..4.95 -'pulled.Pork.'....:-..... Your choice: ;` \_� �, •. .....................................................9.50 Cheese,Ham,Bacon,Sausage,Veggie,or Hash Omelet.....6.50 �, Grilled Chicken Breast............................. `...5.95-.,_ --Pulled Chicken.... ``t 8.95 .. ..................................................... + r / Italian Sausage w/ peppers&onions................................6.50 Western Omelets .............................................................. ti ,., ➢ Texas Brisket .... 9.75 [n Omelets ....................................:` ................6.50 ;� .., (� {+` �,�' , , Smoked Turkey:.. ...........8.95 Special Omelets COMFORT`MEALS i ''! Smoked Wot Links ..........................................................8.95 t .American ChopLLSuey. .:.............°° �....... 5.95 f ' Chili Mac&.Cheese...........:::::`........................................7.50 ;` COMBO PLATTERS HOT FROM THE GRIDDLE .................... . J short stack or full stack SIDES Chicken Pot Pie...............................:...........:.......................6.95 Served with two sides and cornbread. Shepherd's Pie........................... ............................6.95 Choose from-Pulled Pork,Pulled Chicken, Basic Griddlecakes SINGLE EGG.............1.25 5.95 'Mac& Cheese....:.............................................................. Beef Brisket,Smoked Turkey, or Texas Hot Links Blueberry Griddlecakes FRENCH TOAST......1.50 - ,:�,�.-- � Y� GRIDDLECAKE.......1.50 Turkey w/ Fixins'............................:...............................`... 6.95* 2-Meat Combo.....�......................................................_ 12.50 E=NGLISH MUFFIN..1.00 SteakTips 1/2 lb (Steakhouse or bourbon) . :.:... 8.95 3-Meat Combo.. 14.50 WAFFLES HOME FRIES.............1.35 Meatloaf.............................................................. 6.95*........ :... 4-Meat Combo ...................................................... 15.95 Choices: basic,fruit topping gtAGEI.................... Chicken Fingers 6.75* ...1.25 g •••• 1/3 rack Baby Backs w/ (1) meat choice.................. 13.50 or with meat Fried Chicken`-2- c.............................................. ........7.95* BAGELW/CREAM P, •••••••• I/3 rack St.Louis w/ I meat choice....................... 14.95 Belgian Waffle CHEESE .....................1.75 *comes with our'choice-of 2 sides ( ) Basic Waffles BACON,HAM,OR SALADS/ ,f• Stuffed Waffles SAUSAGE,HASH.....1.75 � AUTHENTIC`B'BQ SANDWICHES Garden.......... "..............................................................3.95 French toast ITALIAN SAUSAGE..1.99 95 { Basic French Toast '�' Pulled Pork........ 6.95 Cobb....... ,n, ��`....................................................4.75 HOL^LANDAISE........1. �e�( PulledChicken......................:...... :......................6.50 Taco . .... .................................................5.50 Texas Smoked Brisket .......................................................6.95 4 -HOME STYLE BREAKFAST / .. I_ Texas Smoked Hot Links....................................' `.•..........6.95 ` - - PIZZA Served with home fries and choice of toast.>ji , /7,_ '----.(sliced or chopped) A e Steak& Eggs ''�'I 8.95' . _. _ _.__ vail able by the slice.......................................................3.00 gg .......................................................... Hash & E .........6 95 n r, ,, _ (Variety Varies Daily) ........................................................................... J ' j DRINKS Tips& Eggs 9.95 .+ ., 1� BBQ Meat& Eggs .............................................................8.95 OjTomato`Grapefruit, A lle Pineapple,... . ..�Lg:2.19 SIDES........................................................... 1.75 ea BBQ PIT BEANS SIZZLIN' SKILLETS Milk,or Chocolate Milk................................. GARLIC MASHED (one size) 1.89 HAND CUT FRIES Thr a scrambled eggs over home fries w/cheese. .� Soda................................Reg. 1.59...... Med. 1.79......Lg. 1.99 SWEET CREAMY SLAW C(�`' �',� We ,ern Skillet....................................................................6.95 Bottled Water..................................................(one size) 1.79 POTATO SALAD Hash Skillet...........................................................................6.95 MAC&CHEESE Energy Drinks..................................................(one size) 3.99 CORN NIBBLETS BBQFRESH POTATO CHIPS reakroom Cafe Chem�I SS Hend r--------- --- --- h S I g Rack Sink Sink Slnk N Food Prep Convection StOVe[GdII Griddle f olafor Oven 1__H00d-----------------OOd--- Jani or SS Table SS Table Steam Table rn ® Steam Table Refngn 0 Office, Walkin ' Salad Bar Walkin Freezer Drop In Refrig Storage Sink Room Hood ' Pizza - Hend Sink r s. .Whit I VSVAI If-M7 � q b ut •6F _ - x➢ ,. 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' Chicken flrgers 75R fr '.Chlil lV►ac & Cheese 750 t r f v,c �. r ws'. { 'ra` srfr• Chlcken�ot Rreg 6 95Y 5hepherrls Pie �6 5 F q yy T ur�Cey�w/ Ixrns b 95 .Teak8�95�� x PO PKYS C ?RNBREi} i 6,1 .s .F , v �'i-3 to a < ry /, P (.SteQkhousevBaurbon�ai/2 ib �BBQTBEANS r r r ANI cu R S A .,, �� r Puked Fark b 95 sex s amoked 80,iA& i 95(sl ced or�chop/rec�J F � s PfJT�tTOSA°l gC� `' Pullcl ickenb,5(}�TexQSmaked Hates l.n� 6 9 � 5 ,..� a• /,+ /� Et� r 6�'/y�l;`"' i� � ✓, L /r " ,� 13 � ,ice � ' FCV k �{.r{ ,r1C�� ,' � �, .: �la�eirfie �1!r�te GORCN NIBBLEI S 'rLda j v 'i r:t� ' rt REDS �UT� s� s �� F H PO-TAT ,. �i owls 413�ack 6�95 9 50� � , R 11 95 � CHIPS 13 75 ri R £w rRNHECO St i ours<Ful! ack ° 19 95=L 21Nsp,s EASONTIN r � x % 8ab" 8ack1/3K ck '� R .. Y '° 7 95 10 50a, �, t ' • »+ �v,�Wt33^�rd" r iak' £ � y 8ack1/2 rQck � 12 95 1475 ra a y 8Qc fuii rock 20 95 2225aF Y � g a \ r ' f .... ..; � � � , w .� K f t `-a �� C GMi YrrF ' JuaIs�- _`, fiv 'P N aSF` aktY' '.YQX �aa•S AW P ller �i?ork 9 a5O, Pulled Chicken 8 95� Texas Brisket p _n _ okec �urkeyF1afi--Links.. �- 1-01 al ' 'Alm. „ t�� k �r l r � Lek S✓n f- Y'"- �S'�. � 3\ \A 3c � yx:� sM, , t Q w "` c f i No. TJ1Feed THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: , Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Migozal *p9tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Ad and? o. ` �j� Assessor's Map/Parcel n 'A�(' Ali Installer's Name,Address,and Tel.No. esigner's Name, ddress and Tel.No. o T I C& 16 Q�ZZ� vC� s `10V 1 N _ K& v6-d35740tO Type of Building:PJW'5 y t fll� 10 Dwelling No.of Bedrooms l Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria(�) Other Fixtures Design Flow gallons per day. C Iculated daily flow g Ions. Plan Date ( r o sheets Revision Date D Title C—E: MAMW5 4 UW& EVLI%-- Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been P's uediby this Poar4of Health. Signed r - . _ — Date Application Approved by Date 7 Application Disapproved for th follo ng reasons Permit No. �9— c �i/ Date Issued No. - - --- •- F Fee_ i Q i - 5 THE COMMONWEALTH OF MASSACHUSETTS_—_`'.,,, Enteredin;computer: tF - \ Yes -PUBLIC HEALT,W-DIVISION -TOWN OF BAR NSTA.BLES MASSACHUSETTS ..•_ ' ,21pp icatfon for Mt!5p'r 6pgtem Congtruction ermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Complete System EfIndividual Components Location Address or Lot No. Owner's Name,Add ss and o. Exc�� 1W i-T n j Assessor's Map/Parcel Installer's Name,Address,and Tel.No esigner's Narne,jAddress and Tel.No. < ��r Q lr c PA fib Type of Building��d`�` R OG� Ql� .., Dwelling f:No.of Bedrooms 1 Lot Size sq.ft. . Garbage Grinder( ) _Other Type of Building(j2M14E I�( No.of Persons Showers( ) Cafeteria( , Other Fixtures r' '•, ,'�►�Design Flow gallons per day, Calculated daily flow gallons. i Plan Vale N mbdr-of sheets Revision Date Title t , Size of Septic Tank Type of S.A.-S.. r �. Description of.Soil Nature of Repjrs or Alterations(Answer when.applicable) `° Date last inspected. `� Al A Agreement: ` The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposatsystem- - in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been 'ssue by this Boar of Health. Signed f �,� Application Approved by Date A plication Disapproved for the follow rig reasons Permit No. Date Issued '1� j Y ------- ! THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS :4 'Certificate of,Compliance THIS IS 11)�C TIFY,that the On-site Se age 'sposal System onstrueted( )Repaired( )Upgraded( ) Abandoned(_ )by h at `]. 5'rS - i` "'t has been constructed in accordance with the provisions of Title 5 and&for Disposal`System Construction Permit No. �� datedt' Installer �' Designer Pn , The issuance of this permit sha be o d as a guarantee that the sy e f c 'og'fa de� "@d. ` Date Inspector I �) Vit V %,I,I I _S1 No. ✓�!J ——————----------------------Fee THE COMMONWEALTH OF MASSACHUSETTS _ rPUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS loigogar 6potem o"n5truction Permit Permission is hereby granted to C struct )Repair( )U grade( )A andon( ) System located at_ ys and as described in the above Application for.Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: Approved by -Ul nar �1 • . . ' I f 1YX •. I�/i _ r• /�ssl i; .fie• +/� �]� ECUm—(0)v io —i �� ♦1 .aea�t• ;•, • - a % ®r, :• 1, � ,�� _ !s'� :�°°sus°•°�°��ii�:°i�•� ,i • �- er ♦e ♦ ♦ 17 fly♦ / tc I•Ic ..., , (3 t - POO ICUL r. IMAM grA V4-, i .•;a °1 • MEOW .� •• 1• 1/ NO. . ......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O� HEA ............... ......OF......... ..... . . ............ ........................... Appliratiou for Dhqpviial Work��T untitrurtiou rantit Application is hereby made for a Permit to Construct t4 or Repair an Individual Sewage Disposal Syste!r 3V: ........ .... . .......%PA....E..........A........................... ... .... .... ... e /Vpcation-Address..) e` or Lot No. ........ . ............ .................................................................................................. Owner Address .... . .... .. ---------------------------------- -------------------------------------------------------------------------------------------------- Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( 4 P4 Other—Type of Building A_44 f-_'v6&.4!@FNo. of persons............................ Showers Cafeteria ( Pq Other fixtures A? .....r-.. 5? :�,o a S D ............................. .. ........................... ................ Design Flow................................................................gallons gallons per person per day. Total daily flow....... ---- ------------_g�allons. W If 1:4 Septic Tank L Liquid capacity?Q..as3gallons Length.,.�-�.�.C>."�Vidth..a-f�c>-'Diameter-------_------- Depth5_77.,K.. W I , Disposal Trench—No. .................... Width-----_____--______-_ Total Length____................ Total leaching area....................sq. f t. Z -2— P a Seepage Pit No..................... Diameter._/0,___"';_'.'. Depth below ml I leaching area,.;F�;�q. ft. Z Other Distribution box ( z,�� Dosing tank ( ) — //6 Z.a 9.;�° Z> , Percolation Test Results Performed by_._-- ............................... DatezZ.Y_5� ZC2, ............ Test Pit No. I..-ft_—_.:?-m..minutes per inch Depth of Test Pit.Z�.... Depth to grounfl. aler...,.QRIV25!�77 Test Pit No. 2...-`__Z..minutes per inch Depth of Test Pit../ily-l".. Depth to ground water._____.._._.`.......___ -------..... . ---------- 0 Description of Soil..... .. ..... ------------------- ........ ............................."................;......... ........--------------- ................ ......ip;zn ....... U ............................ .... . _.�Z.....0.=. _0_ ... -4— It ♦— , = ------------- .... -------------------------------------------- ......;.... .... U Nature of Repairs or Alterations—Answer when applicable.................................................. ............................................ ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL-1':LEE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sigoe ... ..../., ...g . ............................................... ................................ Date Application Approved By....... ....... . . . .......71�....... Date ............................................................................Application Disapproved for the following reasons:.................... .................................................... ;. ...................... .7........................V_ ------------------------------------------------------------------------ Dat Permit No................. ........ . .... ......... Issued..... ... ............. Date j � r No.......jF Fims..............1�1............... y THE COMMONWEALTH OF MASSACHUSETTS '- BOARD O HEA , E Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewa a Disposal System .......fr`......- ... ........ ............ `c tion-Address or Lot No. fit/ e Address W •.... • q' . Installer - Address 1 UType of Building A' Size Lot............................Sq. feet Dwelling No, of Bedrooms............................................Expansion.Attic ( ) Garbage Grinder ( ) »;lOther—Type of Building of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ... c`✓ g✓ ................ ... _......... Design Flow`_____________________________ __..gallons per person per day. 'Total daily flow___.__._de't.2,� _.. __gallons. WSeptic Tank-Liquid capacity:'"� _gallons Length_,_t r �? Vidth___ A. Diameter................ Depth+ '-.X_-" x Disposal Trench No ____________________ Width.................... Total L4�gth..................... Total leaching area....................sq. ft. Seepage Pit �To. _______ Diameter___. !? ___ Depth below inl :.._'"e_t al leaching area____= _ 3q. ft. Z Other Distribution box ( �. Dosing tank ( ) c *' f 1+ r�• --••---• Date-e!Zlel a Percolation Test Results Performed by.. - _ ` a Test Pit No. 1__ ._minutes per'inch_ Depth of Test Pit ....._ ._... Depth to ground water_ _Zx;.fie_.....w Test Pit No. 2......4`-_.:?-::minutes per inch Depth of Test Pit___ Depth to ground water................... a -----•... ••-••----- ........................ ------------ ... ........................... D Description of Soil----� ==' '�:..................................�� ej,e €"-= Jam, ->, = G y " - / w -- . �e .--.�',•J �.i c....'� ..o ... s�,5 .��'ee e w �.rr. c�__-' W T // 7-.-._.. -----G....... ---`-----> /.ate >�.5�•3�i _ __._ 4` Af _C. 2_/ S� UNature of Repairs or Alterations—Answer when applicable.________________________....................................................................... --------------------------------------------------------------------•.•---'=-----._..................--•---•-••--••••......-------••--•--••-•-•-------------•-----•-••-•-•-•----••-•--•......--....---•-• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of-I T—L7 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance_has been issued by the board of health. S> .n .................................. -------------------------------- Date j ......� __•/� �� Date Application Approved BY = '- - �1 . -----------•. 1� •---------1�--?...-•--- Date Application Disapproved for.the following reasons:.................,:._............................... --------------------- - Date Pe;mit No......................................................... Issued.... _,,,r*`'' •-•-------- --•-- � ...----------- Date THE COMMONWEALTH OF MASSACHUSETTS , ..,rs,4.h- BOARD QF�Ileoog!� .... O F.....: Trr ifir`alr d � ntplinu.rr TY IS CE FY, T at e Individual Sewage Disposal System constructed (/-'-)-or Repaired ( ) by . , has bee`�n installed in accordance with the provisions of r of The State Sanitaryan(. a described'in the application for Disposal Works Construction Permit No. -�r------------- dated_--- zr_-l/t.t _! THE'ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS 4NTEE THAT THESYSTEM WILL FUNCTION SATISFACTORY. ' I. DATE._••-•-•-•-•--•-•--•--...-- z''= --- . --- Inspector--••- �•----- -------- -•-- p... ....... •--•---- TFiE COMMONWEALTH OF MASSACHUSETTS +� -,, BOARD Z `HEALTH .......fo. OF.... oW.I .......................... r� No................. ....... - FEE........................ �i��rnr 1 r �t�t� Uan r�ntt# = Permissio • hereby,`ranted....�1--'-_.._. .___A....>I Yg � to Constr ( ) or a it ) ;Pdiv ed 1 ewa e D po stem -� s�� •at No. -• � ..t.__ . Stree gr as shown on the application for Disposal Works Construction Pe it o.._ _ _ __.__. _ ted... . . /P`. l..'.....::. ........... "* ✓ � Board of ealth DATE.... = = ....................... ............. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 1 L fir , TOWN OF BARNSTABLE •LOCATION` -�-"1�S l�t�i�S�11L�+Ctc�tG� f.J1"��) SEWAGE # 91-S94, VILLAG ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. lZenz: �-�n'`1 �n. � -1-71 SEPTIC TANK CAPACITY =C3r k kP Ze0 -4 ft-- LEACHING FACILITY: (type) NO. OF BEDROOMS BUILDER OR OWNER � PERMITDATE: . q4q COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by O O r ►w��►_ AsBuilt Page 1 of 1 w LO CATION 7.5 SEWAGE PERMIT NO. r, • � ��-5� �E�PSrV�Jf'�i�C'� V'r i�� VILLAGE INSTA LLER'S NAME i ADDRESS J-/o C o-.-s. GUILDER OR OWNER DATE PERMIT ISSUED 14_,1/ 7g DATE COMPLIANCE ISSUED ,9 a _ J M 10 C•' • http://issgl2/intranet/propdata/prebuilt.aspx?mappar=295011&seq=1 1/5/2016 Tj HOLLY MANAGEMENT & SUPPLY CORPORATION 297 North Street Hyannis,Massachusetts 02601 (508) 775-9316 FAX(508)775-6526 November 21, 2008 Town of Barnstable - Board of Health 200 Main Street Hyannis, MA 02601 Attn: Thomas Mc Cann , N) _ Re: 75 Perseverance Way, Hyannis, Massachusetts , -V ei T . Dear Tom, o r- rn We checked with the architectural firm that did the work for Excel Switchi in the 1980's when they were erecting the new buildings and discovered that the then existing structure at 75 Perseverance Way and the septic system were removed to make way for the present buildings. If you should need further information please do not hesitate to call. Sincerely, I Stuart Bornstein I 0 7- L_ , i A C 17 \TOWN OF BAMSTABLE LOCATION I-Sr + 7c5' I��'i Z'Vt�e�-7,t6� f.� ,j SEWAGE # VILLAGE !T,4-iz'— S--< ,M i ASSESSOR'S MAP & LOTS. j INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY --50c--10 eA-L_ LEACHING FACILITY: (type) o-'Ik '1 e^)'q i NO. OF BEDROOMS BUILDER OR OWN{E/RJ t tJ/f f��l I / 1: J CO PERMTTDATE MPLIANCE DATE: , t Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching.facility) Feet Furnished by 1 - 1 -37 I Vol 15'-0"1. s 14, 0„ t _ 24" DIA.•COVERS PRECAST REINFORCED: C I I CON . GREASE TRAP ;o 0 PLAN VIEW 24" DIA. FINISH MANHOLE FRAME GRADE $" DtA. AND COVER INLET --� 1--•6" WALLS =r ° r ° OUTLET. COMPACTED SELECT COMMON �3� Fill .' o 0 5,.`0„ 1' MIN. ' ° I LIQUID,„ LEVEL ' -H Aa 6" MIN , 0.0 0 n d 00 000 . f - CROSS SECTION VIEW CRUSHED STONE- *OR COMPACTED ARE AST GREASE TRAP SHALL BE H-20 DESIGNED BY ROTONDO k SONS, INC. SCREENED GRAVEL P ` REHOBOTH, MA OR APPROVED EQUAL Precast 3,000 Gallon" Grease Trap(HS-20) ' S. N.T.S. REV,- A-' Ul Ae fir/1-7 A.1 7- 5 A-/ T- Oc>' V. /WSW- -4 + 5 46 C) 7-0 t-;3 oop �L AC k 'A f--- KIXI ZLV� Y:i3 f IoL 4?,-UU-7a '"r-cf1ja 'e A--?(0Ae Ile 5c' AqZ_ C— 7-/ OAJ V L 0 Ae �000 CoA4. SEPTIC 7/qA./AIL _ __C �I Z " 0 f /,0 '- 0- .5 Firm 5 7- a 0 X 4- 4C— 7 -- - � C— 5 / 46 &,l - - - - e c Ie Q r &- a -L,7 /A,, /,,,v c l-f Oill C'- oq 7-6- C-5 IX? c 6 /,Pg )I- 6- A=2 r., C- 7— A? 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