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Town of Barnstable BOARD OF HEALTH
John T. Norman
Board of Health Donald A.Gaudagnoli,M.D.
aAr�sr�o F.P.(Thomas)Lee
Daniel Luczkow,M.D.,Alt.
639. 200 Main Street, Hyannis, MA 02601
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: 224 Issue Date: 01/01/2022
DBA: SPOON AND SEED
OWNER: SPOON AND SEED OF CAPE COD INC
Location of Establishment: 12 THORNTON DRIVE-UNIT A HYANNIS MA 02601
Type of Business Permit: FOOD SERVICE
Annual: YES Seasonal:
IndoorSeating: 50 OutdoorSeating: 0 Total Seating: 50
FEES
FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2022
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2022
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST:
MOBILE-FOOD:
MOBILE- ICE CREAM: Q�
FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
I i
sue d dA
+"J For Office Use Only: Initials:
Town of Barnstable
Date Paid 20 V-Aid$ SC—
,�,,�,,. ; Inspectional Services
39. Public Health Division
Thomas McKean,Director ,.
200 Main Street,Hyannis,MA 02601 7
Office: 508-862-4644 Fax: 508-790-6304
APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
DATE I NEW OWNERSHIP RENEWAL
NAME OF FOOD ESTABLISHMENT: 5 Poo//)
/_ L
ADDRESS OF FOOD ESTABLISHMENT: / L iO l/142 2
MAILING ADDRESS(IF DIFFERENT FROM ABOVE):
E-MAIL ADDRESS: eL1011 C $' j / Q
TELEPHONE NUMBER OF FOOD ESTABLISHMENT: 20 6 3� .vX
TOTAL NUMBER OF BATHROOMS: OZ
WELL WATER:YES NO ... (ANNUAL WATER ANALYSIS REQUIRED)
ANNUAL: V SEASONAL: DATES OF OPERATION: / / TO
NUMBER OF SEATS: INSIDE: _16) OUTSIDE: 2O TOTAL: 5C�
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? ✓ S
IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)? W.,-5
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 FocrosTOODAPP 2020.doc
OWNER INFORMATION:
FULL NAME OF APPLICANTtf;jt_4,t) Q rLG
SOLE OWNER: YES/NO D.O.B OWNE PHONE# ycf ay 3 VK
ADDRESS Id y .X 5k!0Ce Et, 02-C-34
CORPORATE OWNER: YYJGi TCll,f&/-G
CORPORATE ADDRESS: 12— Zb::� 40 2 C v�
PERSON IN CHARGE OF DAILY OPERATIONS: G► �� �Z
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
cdf'j-YeA-6
Z Z-
SIGNATURE OF APPLI 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
OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited.
NOTICE: Permits run annually from January 1 st to Dec.3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st.
Q:\Application FormsTOODAPP REV3-2019.doc
t
i
t ; Town of Barnstable BOARD OF HEALTH
John T.Norman
Board of Health Donald A.Gaudagnoli,M.D.
.NSTAB[.c, Paul J.Canniff,D.M.D.
M' ' F.P. Thomas Lee Alternate
200 Main Street, Hyannis, MA 02601
Phone: (508) 862-4644 Fax: (508)790-6304
www.townofbarnstable.us
Permit to Operate a Food Establishment
In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections
305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to:
Permit No: 224 Issue Date: 01/01/2021
DBA: SPOON AND SEED
OWNER: MATTHEW TROPEANO
Location of Establishment: 12 THORNTON DRIVE-UNIT A HYANNIS„ MA 02601
Type of Business Permit: FOOD SERVICE
Annual: YES Seasonal:
IndoorSeating: 50 OutdoorSeating: 0 Total Seating: 50
FEES
FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2021
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2021
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST:
MOBILE-FOOD:
MOBILE-ICE CREAM:
FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
I
For Office Use O Initials:
Town of Barnstable
Date Paid
lARNSTABLE. ; Inspectional Services
MAN. Check# .' a _ ic�aL-p
—
�Eo; •�� Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508=862-4644 Fax: 508-790-6304
APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
DATE NEW OWNERSHIP RENEWAL
NAME OF FOOD ESTABLISHMENT: i2 00 n ''lA`/
ADDRESS OF FOOD ESTABLISHMENT:_�� -rk�rvi TU n "-plr
MAILING ADDRESS(IF DIFFERENT FROM ABOVE):
E-MAIL ADDRESS: 00 ;( ze, /'YLGI •' G�/'7
TELEPHONE NUMBER OF FOOD ESTABLISHMENT:
TOTAL NUMBER OF BATHROOMS:
WELL WATER: YES NO ".. (ANNUAL WATER ANALYSIS REQUIRED)
ANNUAL: 11� SEASONAL: DATES OF OPERATION: / / TO
NUMBER OF SEATS: INSIDE: OUTSIDE: !2 TOTAL: 5-
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. 1 _
IS WAIT STAFF PROVIDED FOR OUTSIDE DINING? 1 bl i A- �� �� 4r, 0L4'�-,-
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)
CATERRING ... (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 �pQ
Q:Application FormsTOODAPP 2020.doc
OWNER INFORMATION:
FULL NAME OF APPLICANT
SOLE OWNER: OESNO D.O.B f /5 OWNER/ L ,PHONE # � fi Z
ADDRESS / 2 /f�r:��� 0/, ( ` S /' 2 60 /
CORPORATE OWNER:�/�Gj
CORPORATE ADDRESS:
PERSON IN CHARGE OF DAILY OPERATIONS: L---p"ol �Ile
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
Z '&C
1.
ry s
2. �?�-�
SIGNATURE OF AP LICANT DATE
***FOOD POLICY INFORMATION***
SEASONAL FOOD SERVICE: All seasonal food establishments, including mobile trucks must be inspected by the Health Div.
prior to opening!! Please call Health Div. at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance.
FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter,
with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert
Permit until the above terms are met.
CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering
event. You must complete a catering notice found at htti)://www.townofbarnstable.us/healthdivision/apt)lications.asp.
OUTDOOR COOKING: Outdoor cooking,preparation,or display of any food product by a food establishment is prohibited.
NOTICE: Permits run annually from January 1 st to Dec. 3 1"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1 st.
' t
Q:\Application For'*FOODAPP REV3-2019.doc
i
Town of Barnstable
tt� BOARD OF HEALTH
John T.Norman
Board of Health Donald A.Gaudagnoli,M.D.
URNWABLA Paul J.Canniff,D.M.D.
MA 200 Main Street, Hyannis, MA 02601 F.P.SS 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, 3056, 146, 189 and 189A; Chapter 111, Sections 5 and 127A, a permit is hereby granted to:
Permit No: 224 Issue Date: 12/10/2019
DBA: SPOON AND SEED
OWNER: MATTHEW TROPEANO
Location of Establishment: 12 THORNTON DRIVE HYANNIS, MA 02601
Type of Business Permit: FOOD SERVICE
Annual: YES Seasonal:
IndoorSeating: 50 OutdoorSeating: 0 Total Seating: 50
FEES
FOOD SERVICE ESTABLISHMENT: $300.00 YEAR. 2020
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2020
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST:
MOBILE-FOOD:
MOBILE-ICE CREAM: Qh
FROZEN DESSERT: Thomas A. McKean, RS, CHO, Health Agent
TOBACCO SALES:
FOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
G�
�3
Town of Barnstable For Office L Z3OnI�(f'Amt
Initials:
P Date aid Pd$ UV
STABLB. : Inspectional Services MASS' 3
�f0 MAC e
`� Public Health Division cheek#
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 �2 �3 Ick NEW OWNERSHIP RENEWAL
+
NAME OF FOOD ESTABLISHMENT: '5PC�Oh Q J Rd -ee6
ADDRESS OF FOOD ESTABLISHMENT: �2• r ����� , l'�.RCZ i� , Wk� 0Z60I
MAILING ADDRESS(IF DIFFERENT FROM ABOVE):
E-MAIL ADDRESS: r � 5p�n� s e�cl q m 0��`• cc�h�
TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( q)-+40- 46341
TOTAL NUMBER OF BATHROOMS: 2
WELL WATER: YES NO ... (ANNUAL WATER ANALYSIS REQUIRED)
ANNUAL: k- SEASONAL: DATES OF OPERATION:_/ / TO
NUMBER OF SEATS: INSIDE: OUTSIDE: TOTAL:
SEATING: MUST OBTAIN A COMMON VICTUALLER'S LICENSE FROM LICENSING DIV.
***OUTSIDE DINING REMINDER***
OUTSIDE DINING,MUST BE APPROVED BY THE HEALTH DIV.AND LICENSING,AND MEET OUTSIDE DINING
REQUIREMENTS.
IS WAIT STAFF PROVIDED FOR OUTSIDE DINING?
IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)?
TYPE OF ESTABLISHMENT: (PLEASE CHECK ALL THAT APPLY BELOW)
III 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
rr
OWNER INFORMATION:
FULL NAME OF APPLICANT rely ��n
SOLE OWNER: YES/NO D.O.B t— OWNER PHONE # � 2,U Z���l 8 5
ADDRESS_ l�-�1� Z� t�06Q 'ee . Cr R ente"1 �^l 2. M rT OZb 3Z
CORPORATE OWNER:
CORPORATE ADDRESS: T
PERSON IN CHARGE OF DAILY OPERATIONS: `" �--L W 1'le.C� 1 C0 GLn0
List(2) Certified Food Protection Managers AND at least (1) Allergen Awareness Certified Staff
All FOOD ESTABLISHMENTS must have 1 Certified Food Protection Manager PER SHIFT.
**ATTACH COPIES OF CERTIFICATES** The Health Div. will NOT use past years' records. You
must provide new copies and POST THE CERTIFICATES at your food establishment.
Certified Food Managers Expiration Date Allergen Awareness Expiration Date
2.
SIGNATURE OF APPLICANT DATE
***FOOD POLICY INFORMATION***
SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div.
prior to opening!! Please call Health Div.at 508-862-4644 to schedule your inspection. Please call at least(7)days in advance.
FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter,
with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert
Permit until the above terms are met.
CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering
event. You must complete a catering notice found at httl)://www.townofbarnstable.us/healthdivision/applications.asp.
OUTDOOR COOKING: Outdoor crooking,preparation,or display of any food product by a food establishment is prohibited.
NOTICE: Permits run annually from January 1st to Dec. 31"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st.
Q\Application FormsTOODAPP REV3-2019.doc
f BOARD OF HEALTH
Town of Barnstable
�rtltE tQ�
Paul 1 Canniff,D.M.D.
Board of Health Donald A.Gaudagnoli,M.D.
C DAWNSTAOLL : John T. Norman
200 Main Street Hyannis MA 02601 F.P. Thomas Lee Alternate
Phone: (508) 862-4644 Fax: (508)790-6304
www.townofbarnstable.us
Permit to Operate a Food Establishment
In accordance with regulations promulgated under authority of 105 CMR 590.000 M.G.L. Chapter 94 Sections
305A, 305B, 146, 189 and 189A; Chapter 111,Sections 5 and 127A, a permit is hereby granted to:
Permit No: 224 Issue Date: 03/01/2019
DBA: SPOON AND SEED
OWNER: MATTHEW TROPEANO
Location of Establishment: 12 THORNTON DRIVE HYANNIS MA 02601
Type of Business Permit: FOOD SERVICE
Annual: YES Seasonal:
IndoorSeating: 50 OutdoorSeating: 0 Total Seating: 50
FEES
FOOD SERVICE ESTABLISHMENT: ~ $300.00 YEAR: 2019
RETAIL FOOD:
COTTAGE FOOD OPERATION: Permit Expires: 12/31/2019
B&B-FULL BREAKFAST:
CONTINENTAL BREAKFAST: ---- - -- - — --
MOBILE-FOOD:
MOBILE-ICE CREAM: C��
FROZEN DESSERT: Thomas A. McKean, IRS, CHO, Health Agent
TOBACCO SALES:
IFOR ESTABLISHMENTS WITH SEATING:
PERMIT IS NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALER LICENSE
Restrictions:
I
For Off Initials:
Town of Barnstable `` f�
Date Paid I `'f Amt_Edit 66
t �MAPA� = Inspectional Services 2�.Y,
6 " Check� Public Health Division ` , ��
Thomas McKean,Director fi f 9 l - ,
200 Main Street, Hyannis,MA 02601 ,
Office: 508-862-4644 Fax: 508-790-6304
C-N
APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
DATE �Z-Z�- LR NEW OWNERSHIP RENEWAL
NAME OF FOOD ESTABLISHMENT: can c IRC-
ADDRESS OF FOOD ESTABLISHMENT: Z 1'C TWxnAR ��11S I-t-r 0�dl
MAILING ADDRESS(IF DIFFERENT FROM ABOVE):
E-MAIL ADDRESS: GJ j2a:)n cRa G.6P 9 mQ\1-C CC
I— t
TELEPHONE NUMBER OF FOOD ESTABLISHMENT: dEb WO -
TOTAL NUMBER OF BATHROOMS:
WELL WATER: YES NO )( ... (ANNUAL WATER ANALYSIS REQUIRED)
ANNUAL:_� SEASONAL: DATES OF OPERATION:_/ / TO
NUMBER OF SEATS: INSIDE:5—D 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:1Application FortnsW00DAPPREV2018.doc
I
PLEASE CALL 508-862-4644
OWNER INFORMATION:
LiA
FULL NAME OF APPLICANT � i V f r V.,W C�
SOLE OWNER: `av NO D.O.B 13— ff OWNER PHONE# 31�4 Z— 2-44 )96 3
ADDRESS -q '`4.0 -2er 4A Ce-Yy rV l I� �ZC-�J2
CORPORATE OWNER: FEDERAL ID NO. :
CORPORATE ADDRESS: / -,-> �I/� Tho0on t o1me- LannJI
02(D I
PERSON IN CHARGE OF DAILY OPERATIONS: TC(,' l pozL
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 ller en Awareness Expiration Date
pTO
SIGNATURE F APPLICANT DATE
***FOOD POLICY INFORMATION***
SEASONAL FOOD SERVICE: All seasonal food establishments,including mobile trucks must be inspected by the Health Div.
prior to opening!! Please call Health Div.at 508-8624644 to schedule your inspection. Please call at least(7)days in advance.
FROZEN DAIRY DESSERTS: Frozen desserts must be tested by a State Certified lab prior to opening and monthly thereafter,
with sample results submitted to the Health Div. Failure to do so will result in the suspension or revocation of your Frozen Dessert
Permit until the above terms are met.
CATERING POLICY: Anyone who caters within the Town of Barnstable must notify theTown by fax or mail prior to catering
event. You must complete a catering notice found at htti)://www.townofbarnstable.us/healthdivision/applications.Ssl).
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.3It"each calendar year. IT IS YOUR RESPONSIBILITY TO RETURN
THE COMPLETED APPLICATION(S)AND REQUIRED FEES BY DEC 1st.
Q:41ppGcation FormsTOODAPPREV2018.doc
LP06H1 QP11OD77
BK Y
M
C
i
oF114E TOWN OF BARNSTABLE HEALTH.INSPECTOR'S Establishment Name: Date: 7 Page:. of
1''" `OFFICE HOURS
PUBLIC HEALTH DIVISION 8*00-9:30A.M.
3:30-4:30 P.M. _
BARNSTARLE. ` 200 MAIN STREET I Item Code C Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
� Me39. .m� HYANNIS,MA 02601 M-8 -FRI. No Reference R-Red Item PLEASE PRINT CLEARLY-
prFO MA'S° S08-862-4644 '
FOOD ESTABLISHMENT INSPECTION REPORT
Name Date Type o T e of Insoection
on s
Address ) JI Risk Food Servlce Re-inspection c-
Level Retail Previous Inspection J
Telephone Residential Kitchen Date: O
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
❑ 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) .�T Corrective Action Required:_ to ❑ Yes
Ib
Non-critical(N)violations must be corrected immediately or Overall Rating
within 90 days as determined by the Board of Health. Fi I ❑ 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 B=One critical violation and less than 4von-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.
26.Water,Plumbing and Waste (FC-5)(590.006) establishment permit and cessation of food establishment operations. If ,no hot
Seriously Critical Violation
2 critical violations and less than 9non-critical. If no critical water,sewage back-up,
ioliol infestation of rodents or insects,ation=F is scored automatically if:f: lack of
27.Physical Facility (FC-6)(590.007) aggrieved by this order,you�have a right to a hearing. Your request must
28.Poisonous or Toxic Materials (FC-7)(590.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non critical violations. If 1 critical refrigeration.
within 10 days of receipt of this order. violation,4 to non-critical violations=C.
29.Spec' I Requirements (590.009) Y P
30.Oth DATE OF RE-INSPECTION: Ins ector S' tur 7Print:
31.D Aster screened from public view
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N
#Seats Observed Frozen Dessert Machines: Outside Dining Y N P y
Self Service Wait Service Provided Grease,Trap Size Variance Letter Posted Y N ^ 4
Dumpster Screen? Y N L �'/
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.* * 19 PHF Hot and Cold Holding
2-103.11 Person-in-Chazge Duties 3-302.14"' Protection from Unapproved Additives - '
Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F
EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated * .
ated from Each 7-101.11 Identifying Information-Original Containers*
2 590.003(C) Responsibility of the Person-in-Charge to Other* * 3-501.16(A) Hot PHFs Maintained At or Above 140°F*
7-102.11 Common Name-Working Containers
Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F*
Applicants* 3-302.11(A) Food Protection* 7-201.11 Separation-Storage*g 20 Time as a Public Health Control
590.003(F) Responsibility of A Food Employee or An 3-302.15 Washing Fruits and Vegetables 7-202.11 Restriction-Presence and Use* 3-501.19 Time as a Public Health Control*
Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements
3-304.11 Food Contact with Equipment and Utensils * ( ) 9
590.003(G) Reporting by Person in Charge* 7-203.11 Toxic Containers-Prohibitions
Contamination hrom the Consumer
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
7-204.12 Chemicals for WashingProduce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated �
Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
4 Food and Water From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004(A-B) Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and
* 4-501.111 Manual Warewashing-Hot Water 7.206.12 Rodent Bait Stations '
3-201.12 Food in a Hermetically Sealed Container Sanitization Temperatures 7-206.13 Tracking Powders,Pest Control and Raw Seed Sprouts Not Served*
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served*
3-202.13 Shell Eggs* Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 1 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or
5-101.11 Drinking Water from an Approved System* gg
Equipment* Not Otherwise Processed to Eliminate'
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Ef cti°e 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
Chemical Stuffing Containing Fish,Meat,Poultry or 590.009
3-201.15 Molluscan Shellfish from NSSP Listed * (A)-(D) Violations of Section 590.009(A)-(D)in cater-
Ratites-165°F 15 sec*
Sources* ing,mobile food,temporary and residential
10 Proper,Adequate Handwashing 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under
Game and Wild Mushrooms Approved By 2-301.11 Clean Condition-Hands and Arms*
Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to
3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors.
590.004(C) Wild Mushrooms* 3401.l1 2-301.14 When to Wash* A 1 b All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
( )( )( )
3-201.17 Game Animals* 11 Good Hygienic Practices 1 Reheating for Hot Holding practices should be debited under 929-Special
2-401.11 Eating,Drinking or Using Tobacco* * Requirements.
$ Receiving/Condition g• g g 3-403.11(A)&(D) PHFs 165°F 15 sec
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(C) Commercially Processed RTE Food-140°F* Blue Items 23-30)
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* Lu Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
* 13 Handwashing Facilities 3-501.14 A
3-202.18 Shellstock Identification ( ) Cooling Cooked Fr from 140°F to /45°F
Conveniently Located and Accessible Within 2 Hours andnd From 70°F to 41°F/45 Item Good Retail Practices FC 590.000
3-203.12 Shellstock Identification Maintained*
Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003
5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004
3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005
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. 1 Special Requirements 1.009
3-502.11 Specialized Processing Methods* 130. 1 Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc
`Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
7(7
OF THE T TOWN OF BARNSTABLE. •HEALTH INSPECTOR'S Establishment Name: Date Page-__of
W OFFICE HOURS '
PUBLIC HEALTH DIVISION 8:00-§30A.M.
BARNSTABLE. • 200 MAIN STREET 3:3b-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
�A ,639.p`q� HYANNIS,MA 02601 5M088- -FRI.62-4644 No Reference R-Red Item PLEASE PRINT CLEARLY:
Teu MPr
OD ESTABLISHMENT INSPE T N REPORT
Name Date e o Tvoe of Ins ep ction
Routine
Address Risk 'food Service Re-inspe ion
Level Previo s tl
Telephone Residential Kitchen Date:
Mobile Pre-opJr I
Owner HACCP YIN Temporary Suspect IInes
Caterer General Complaint
Person in Charge(PIC) Time Bed&Breakfast HACCP
Other -r
Inspecto
Each violation checkedrequires an explanation on the narrative p ge(s)and a citation of specific provision(s)violated. rJ
Violations Related to Foodborm 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) C LQ '
FOOD PROTECTION MANAGEMENT - ❑ 12.Prevention of Contamination from Hands
❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS '
❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives
❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals
FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures
❑ 5.Receiving/Condition ❑ 17.Reheating O
❑ 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
l Total Number of Critical Violations
Critical(C).violations marked must be corrected immediately. (blue&red items) 3 q
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 ❑ Employee ❑ P ❑ Emergency P
Y y ❑ Voluntary Compliance Em to ee Restriction/Exclusion Re-inspection Scheduled Emer enc Suspension
C N Official Order for Correction:Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other:
checked indicate violations of 105 CMR 590.000/Federal Food Code.
23.Management and Personnel (FC-2)(590.003) This report,when signed below b a Board of Health member or its agent P 9 Y 9 A=Zero critical violations and no more than anon-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. _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 Seriously Critical Violation=
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)(59o.008) be in writing and submitted to the Board of Health at the above address violations observed,7 to 8 non- ritical violations. If 1 critical refrigeration.
violation,4 to 8 non-critical vio lion C.
29.Special Requirements (590.009) within 10 days of receipt of this order. 1
30.Other DATE OF RE-INSPECTION: I e s Sign atu kwvQ 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 Signatu Print:
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N
Dumpster Screen Y N
.. .. _ � �. .. _.r,-- _ _ _. _� ..•r_ � � - _. _, ! r ` i � __�_ _ _ _,- try _ �.� K,.�
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.* 19 PHF Hot and Cold Holding
2-103.11 Person-in-Charge Duties _ 3-302.14 Protection from Unapproved Additives*
Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F
EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* 590.004(F)
7-102.11 Common Name-Working Containers*
590.003(C) Responsibility of the Person-in-Charge to
Other* 3-501.16(A) Hot PHFs Maintained At or Above 140°F*
2
Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130*F*
7-201.11 Separation-Store 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(F) Responsibility of A Food Employee or An 3-302.15 WashingFruits and Vegetables 3-501.19 Time as a Public Health Control*
Applicant To Report To The Person In Charge* g 590.003(G) * 7.202.12 Conditions of Use* 590.004 11 Variance Requirements
* 3-304.11 Food Contact with Equipment and Utensils* 7-203.11 Toxic Containers-Prohibitions* ( ) q
Reporting by Person in Charge Contamination from the Consumer
3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* REQUIREMENTS FOR
3-306.14(A)(B)Returned Food and Reservice of Food* 7-204.12 Chemicals for Washing Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions Disposition of Adulterated or Contaminated g
Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
4 Food and Water From Regulated Sources g Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004 A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and
( ) P _ 4-501.111 Manual Warewashin Hot Water 7.206.12 Rodent Bait Stations
3-201.12 Food in a Hermetical] Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served*
y Pe 7-206.13 Tracking Powders,Pest Control and
3-201.13 ' Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served*
3-202.13 Shell Eggs* I Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or
5-101.11 Drinking Water from an Approved System* gg
Equipment* Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg ctiw 11112001
4-602:11 Cleaning Frequency of Utensils and Food Animals-155*F 15 sec*
590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell
Shellfish and Fish From an Approved Source 3-401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min Eggs*
4-702.11 Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) Ratites,Injected Meats-155"17 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*
Shellfish* - 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
4-703.11 Methods of Sanitization-Hot Water and Stuffing Containing Fish,Meat,Poultry or 590.009(A)-(D) Violations of Section 590.009(A)-(D)in cater-
3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Ratites-165`F 15 sec*
Sources* ing,mobile food,temporary and residential
10 Proper,Adequate Handwashing A 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145*F* kitchen operations should be debited under
Game and uthoushrooms 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 Shellstoek 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 Hygienle Practices 17 Reheating for Hot Holding Requirements.practices should be debited under#29-Special
5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-403.11(A)&(D) PHFs 165*17 15 sec*
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* 3-403.11(B) Microwave-165*F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
* 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30)
3-202.15 Package Integrity O y Critical and non-critical violations,which do not relate to the foodbome
3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 3-403.11(E) Remaining Unshced Portions of Beef Roasts* illness interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstoek 590.004(E) Preventing Contamination from Employees* 1 g Proper Cooling of PHFs •following sections of the Food Code and 105 CMR 590.000
* 13 Handwashing Facilities 3-501.1 A CoolingCooked PHFs from 140*F to 70*F
3-202.18 Shellstoek Identification ) Item Good Retail Practices FC 590.000
3-203.12 Shellstoek Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F[0 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 29.7 special Requirements 1.009
3-502.11 Specialized Processing Methods* 30. Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 Conformance with Approved Procedures* S:590Fomtback6-2doc
*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.
j�1( /�/' d♦'
TOWN OF BARNSTABLE, ;: HEALTH INSPECTOR'S Establishment Name: 1 Vim(/>{/,l Date: / Page: of
4 OFFICE HOURS
PUBLIC HEALTH DIVISION 8:60'9:30A.M.
RARNSTARLE. = 200 MAIN STREET 3:30-4:3o P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
MASS. g MON.-FRI.
�p .e3v,per• HYANNIS,MA 02601_ No Reference: R-Red It m, PLEASE P�NT C EARLY
TFD Ma+ 508-862-4644 •,n s i A
FOOD ESTABLISHMENT INSP CTOON REPORT
Name Date " Type of I s ec ion / I
�' �/�r Rou' e9 [
Address ( isk 6 ood S ice `Re-Inspection I 1,t
I I Level ail Previpe7tX)
i7Telephone v Residential Kitchen Date: /� �IMobile Pre-o ♦W r AEUM Ai IV
Owner HACCP Y/N Temporary Suspect Illness
Caterer General Complaint "
Person in Charge(PIC) Time Bed&Breakfast r HACCPVAY) / d
Other
Inspector
Each violation checked requires an explanatiorron the narrative pag (s)and_a citation of specific provision(s)violated. u
Violations Related to Foodborne Illness Interventions and Risk Factors(Red Items) Anti-Choking 590.009(E) ❑ 1
Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ f
Action as determined by the Board of Health. Allergen Awareness 590.009(G) 01 v
P /'
FOOD PROTECTION MANAGEMENT ❑ 12.Prevention of Contamination from Hands /
❑ 1.PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities
EMPLOYEE HEALTH PROTECTION FROM CHEMICALS / 1
❑ 2.Reporting of Diseases by Food Employees and PIC ❑ 14.Approved Food or Color Additives
❑ 3.Personnel with Infectious Restricted/Excluded ❑ 15. Toxic Chemicals 5 _
FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) �-
❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures
❑ 5.Receiving/Condition ❑ 17.Reheating
❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling r I °
❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holding
PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control �
❑ S.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP
i
❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY
❑ 11.Good Hygienic Practices ❑22.Posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Itemsl Total Number of Critical Violations I F / -
Critical(C)violations marked must be corrected immediately. (blue&red items) ` ' Corrective Action Required: ❑ No ❑ Yes.
Non critical(N)violations must be corrected immediately or Overall Rating
within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension
C N Official Order for Correction: Based on an inspection today,the ite s ❑ 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 4 rion-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.ly 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 non-critiFl viol fions. If 1 critical refrigeration. .
29.Special Requirements (590.009) within 10 days of receipt of this order. 4v
iota 4 to 8 non-critical violations=C.
30.Other DATE OF RE-INSPECTION: In or's ignat,re privet:
31.Dumpster screened from public view
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N y f Y I
#Seats Observed Frozen Dessert Machines: Outside Dining Y N PI s Slgnat Pnnt:
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y dQV
Dumpster Screen? Y N
Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) [Demonstration
gnment of Responsibility* 8 Cross-contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*
590.003(B) of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202:12° Additives* 3-501.15 Cooling Methods for PHFs
2-103.11 Person-in-Charge Duties Conked and RTE Foods.* 3-302.14 Protection from Unapproved Additives* I 19 _ PHF Hot and Cold Holding_
Contamination from Raw Ingredients 15 1, Poisonous or Toxic Substances ' 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F
(F)
7 EMPLOYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers* - _ 590.004 -
Other* 83-501.16(A) Hot PHFs Maintained At or Above 140°F*
2 590.003(C) Responsibility of the Person-in-Charge to 7-102.11 Common Name-Working Containers* *
Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F
7-20Li1 Separation-Storage*
Applicants* 3-301.11(A) Food Protection* P g 20 Time as a Public Health Control
590.003(F) Responsibility of A Food Employee or An 3 3 7-202.11 Restriction-Presence and Use*02.15 Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control*
590.003(G)
Applicant To Report To The Person In Charge*Reporting by Person-in Charge* Contamination from the Consumer * 7.202.12 Conditions of Use* 590.004(11) Variance Requirements
3-304.11 Food Contact with Equipment and Utensils 7-203.11 Toxic Containers-Prohibitions* q
- - - -
3 590.003(D) I Exclusions and Restrictions* * 7-204.11 Sanitizers,Criteria-Chemicals* , _ REQUIREMENTS FOR
3-306.14(A)(B)Returned Food and AdulteReserrated
or of Food 7-204.12 Chemicals for Washing Produce,Criteria*, HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions g )
Disposition ofAdulterated or Contaminated
Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
4 Food and Water-From Regulated Sources 9 Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004(A-B) Compliance.with Food Law* 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 Hermetically Sealed Container* Sanitization Temperatures*
Raw Seed Sprouts Not Served*
Y P F�o
6.13 Tracking Powders,Pest Control and
3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served*
3-202.13- Shell Eggs*_ - - - Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 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 IS sec 22 3-603.11 Consumer Advisory Posted for Consumption of
4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or
- 5-101.11. Drinking Water from an Approved System*_ gg
Not Otherwise Processed to Eliminate
Equipment*
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Effective 11112001
4-602.11 Cleaning Frequency of Utensils and Food Animals-155°F 15 sec*
590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell
Shellfish.and Fish.From an Approved Source, _ 3 401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs*
'4'-702.11 'Frequency of Sanitization of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*
Shellfish* 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs SPECIAL REQUIREMENTS
4-703.11 Methods of Sanitization-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
Ratites-16
Game and Wild Mushrooms Approved By 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 145°F* kitchen operations should be debited under
Regulatory Authority 2-301.11' Clean Condition-Hands and Arms* 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to
F 3-202.18 Shellstock Identification Present* - 2-301.1.2 Cleaning Procedure* 165°F* foodbome illness interventions and risk factors.
2-301.14 When to Wash* * Other 590.009 violations relating to good retail
I _ 590.004(C).• Wild Mushrooms* - _ - 3-401.11(A)(1)(b)All Other PHFs-145°F 15 sec
3-201.17 Game Animals* 11 Good Hygienic Practices -17 Reheating for Hot Holding practices should be debited under#29-Special
2-40.1.11 - Eating,Drinking or Using Tobacco* * Requirements.
5 Recei4ing/Condition - -' -_ - ' � g, g g 3-403.11(A)&(D) PHFs 165°F 15 sec
3-202.11 PHF's Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and Mouth* - 3-403.11(B) Microwave-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
* 3-301.12 Preventing Contamination When Tasting* 3-403.11 C Commercial] Processed RTE Food-140°F* (Blue Items 23-30)
3-202.15 Package Integrity ( ) Y
12 Prevention of Contamination from Hands � * Critical and nori-critical violations,which do not relate to the foodbome
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 PHF9 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°17 Item Good Retail Practices FC 590.000
3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F to 41°F/45°F
Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours* 23. Management and Personnel FC-2 .003
* 5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient . 24. Food and Food Protection FC-3 .004
3-402.11 Parasite Destruction Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005
3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients* Supplied with Soap and hand Drying Devices _ 27• Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11- Handwashing Cleanser,Availability 28. 1 Poisonous or Toxic Materials FC-7 1.008
HACCP Plans 6-301.12 Hand Drying Provision 129. 1 Special Requirements 1.009
3-502.11 Specialized Processing Methods* 130. 1 Other
3-502.12 Reduced-Oxygen Packaging Criteria*.
8-103.12 1 Conformance with Approved Procedures* S:590Formback6-2doc
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
°p THE Jp� �V TOWN OF BARNSTABLE - HEALTH INSPECTOR'S Establishment Name: // I,, Date:J / 1 / Page:��` JJ /�of
b OFFICE HOURS
PUBLIC HEALTH DIVISION 6:00-9:30A.M. '
BARNSTABLE, • 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
HYANNIS,MA 02601 508-862-4R644 No Reference R-Red Item PLEASE PRINT CLEARLY
MP,a FOOD ESTABLISHMENT INSPOCT)OJN REPORT,
1 o
Name Date e o Type of Insoection
in I /t�560--p tugType
Routine
Address Risk Food Service Re-inspection J
Level Retail Previous Inspection L j / a
Telephone Residential Kitchen Date: r / /
Mobile Pre-operation '
Owner HACCP Y/N Temporary Suspect Illness ►�,°✓/
Caterer General Complaint
Person in Charge(PIC) Time Bed&Breakfast HACCP f " LEY
In: Other l y
Inspector %� Out:
r+ W v
Each violation checked requires an a lanation 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) ❑ T .-
Violations marked may pose an imminent health hazard and require immediate corrective Tobacco 590.009(F) ❑ fi
Action as determined by the Board of Health. Allergen Awareness 590.009(G) ❑ ° /)
ar a / i
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 7 Y at
FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) v
❑4.Food and Water from Approved Source ❑ 16.Cooking Temperatures (- L
❑ 5.Receiving/Condition ❑ 17.Reheating n
❑ 6.Tags/Records/Accuracy of Ingredient Statements ❑ 18.Cooling
❑ 7.Conformance with Approved Procedures/HACCP Plans ❑ 19.Hot and Cold Holdingtv
PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control
�4
❑ 8..Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) �J
❑ 9.Food Contact Surfaces Cleaning and Sanitizing ❑ 21.Food and Food Preparation for HSP
❑ 10.Proper Adequate Handwashing CONSUMER ADVISORY
❑ 11.Good Hygienic Practices ❑ 22.Posting of Consumer Advisories
Violations Related to Good Retail Practices(Blue Items) Total Number of Critical Violations
Critical(C)violations marked must be corrected immediately. (blue&red items) Corrective Action Required: ❑ No Yes
Non-critical(N)violations must be corrected immediately or Overall Rating ❑
within 90 days as determined by the.Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension
C N Official Order for Correction:Based on an inspection today,the items Embargo
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 6=One critical violation and less than 4non-critical violations g
)( ) 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 viol tion,4 to 8 on critical violations=C.
29.Special Requirements (590.009) within 10 days of receipt of this order.
30.Other DATE OF RE-INSPECTION: Ins e,tor's i na Print,
31.Dumpster screened from public view
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y N t v /////
#Seats Observed Frozen-Dessert Machines: Outside Dining Y N PIC SigntrJr Print:
Self Service Wait Service Provided Grease Trap Size Variance Letter Posted Y N
Dumpster Screen? Y N
Violations related to Foodborne Illness Violations Related to Foodborne Illness Interventions
Interventions and Risk Factors(Red Items 1-22) and Risk Factors(Red Items 1-22) (Cont.)
FOOD PROTECTION MANAGEMENT PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
1 590.003(A) A
ssignment of Responsibility* 8 Cross contamination 14 Food or Color Additives Law Cooled to 41°F/45°F Within 4 Hours*
590.003(B) onstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* 3-501.15 Cooling Methods for PHFs
Cooked and RTE Foods.* - 19. PHF Hot and Cold Holding
2-103.1-1 Person-in_Charge Duties - _ 3-302.14 Protection from Unapproved Additives*
Contamination from Raw Ingredients 15 Poisonous or Toxic Substances 3-501.16(B) Cold PHFs Maintained At or Below 41°F/45°F
"
EMPL 590.004(F)
OYEE HEALTH 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*
2- 590.003(C) i 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 7-201.11 Se 3-501.16(A) Roasts Held At or Above 130°F*
Separation-Storage*
Applicants* 3-30211(A) Food Protection* P g 20 Time as a Public Health Control
7-202.11 Restriction-Presence and Use*
590.003(F) Responsibility of A Food Employee or An _ 3-302.15._ _ Washing Fruits and Vegetables 3-501.19 Time as a Public Health Control*
Applicant To Report To The Person In Charge* * 7.202.12 Conditions of Use* 590.004 11 Variance 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 hrom the Consumer
3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* - .REQUIREMENTS FOR
3-306.14(A)(B)Resumed Food and Reservice of Food* 7-204.12 Chemicals for Washin Produce,Criteria* HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal of Exclusions and Restrictions Disposition ofAdulterated or Contaminated g
Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 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* 3-801.1](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 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 16 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
3-202.16 Ice Made From Potable Drinking Water* Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
4-601.11(A) Clean Utensils and Food Contact Surfaces of Eggs-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or
5-101.11 Drinking Water from an Approved System* _ gg. Not Otherwise Processed to Eliminate
Equipment*
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meals&Game Pathogens* ege°"°e miaow
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 Sanitiza[ion-Hot Water and 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 - 2-301.11 Clean Condition-Hands and Arms*
Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave the appropriate sections above if related to
3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 165°F* foodborne illness interventions and risk factors.
590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec* Other 590.009 violations relating to good retail
3-201.17 Game Animals* 11 Good Hygienic Practices 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 3-403.11E Remaining Unsliced Portions of Beef Roasts* Critical and non-critical violations,which do not relate to the foodborne
3-101.11 Food Safe and Unadulterated ( ) g illness interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
* 13 Handwashing Facilities 3-501.14 A CoolingCooked PHFs from 140°F to 70°F
3-202.18 Shellstock Identification ( ) Item Good Retail Practices FC 590.000
3-203.12 Shellstock Identification Maintained* Conveniently Located and Accessible Within 2 Hours and From 70°F[0 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 1.009
3-502.11 Specialized Processing Methods* 30. Other
3-502.12 1 Reduced-Oxygen Packaging Criteria*
8-103.12 1 Conformance with Approved Procedures* S.590Fonnback6-2doc
'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.
_ HEALTH INSPECTOR�s Establishment Name: �1 N Date:' &I/Kage:TOWN OF BARNSTABLE of
4 __L
OFFICE HOURS
PUBLIC HEALTH DIVISION 8:00-9:30 A.M.
BARNSTABLE. ` 200 MAIN STREET 3:30-4:30 P.M. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date Verified
oy
. HYANNIS,MA 02601 soe-ss2 4saa No Reference R-.Red Item e, PLEASE PRINT CL RLY
�p'EDMP,e OOD ESTABLISHMENT INSPOCTAON REPORT
Name ate Tyne of Tyne of Inspection
Routine
Address Risk pod Servi Re-inspe tion
Level 'Retail Previous rW ti n� "
Telephone Residential Kitchen Date:
11 Mobile Pre- r♦ J
Owner HACCP YIN Temporary 40 1 01 r
Caterer -General Comp '
Person in Charge(PIC) Time Bed&Breakfast
G Other j
tw
Inspector :12(Mhd -7-aill t LAN /,10
Each violation checked requires an explanation on the narrative pag ( 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)
❑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 c
PROTECTION FROM CONTAMINATION ❑20.Time As a Public Health Control A ZIO
❑ 8.Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
r%
❑ 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 l Total Number of Critical Violations
Critical(C)violations marked must be corrected immediately. (blue&red items) � �� Corrective Action Required: ❑ No ❑ Yes
Non-critical(N)violations must be corrected immediately or Overall Rating Jli 1
within 90 days as determined by the Board of Health. ❑ Voluntary Compliance ❑ Employee Restriction/Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension
C N Official Order for Correction: Based on an inspection today,the items ❑ Embargo ❑ Emergency Closure Voluntary Disposal ❑ Other:
checked indicate violations of 105 CMR 590.000/Federal Food Code.
23.Management and Personnel (FC-2)(590.003) This report,when signed below by a Board of Health member or its agent A=Zero critical violations and no more than 3 non-critical violations. F=3 or more critical violations.9 or more non-critical violations,
24.Food and Food Preparation (FC-3)(590.004) constitutes an order of the Board of Health. Failure to correct violations regardless of the number of critical,results in an F.
25.Equipment and Utensils (FC-4)(590.005) cited in this report may result.in suspension or revocation of the food B=One critical violation and less than 4 hon-critical violations 9
if no critical violations observed,4 to 6npn-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-crl ical violations. If 1 critical refrigeration.
28.Poisonous or Toxic Materials (FC-7 590.008 9 ,4 to 8 non-Critical viol ns=
29.Special Requirements (590.009) within 10 days of receipt of this order.
a i' nat Print:
ors
i 30.Other PATE OF RE-INSPECTION: : I spe
31.Dumpster screened from public view U
Permit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered Y IN L�
#Seats Observed Frozen Dessert Machines: Outside Dining Y N PIC's Si at 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) (Cant.)
FOOD PROTECTION MANAGEMENT_ _ PROTECTION FROM CONTAMINATION PROTECTION FROM CHEMICALS 3-501.14(C) PHFs Received at Temperatures According to
Law Cooled to 41°F/45°F Within 4 Hours*
1 590.003(A) Assignment of Responsibility* 8 Cross-contamination 14 Food or Color Additives
3-501.15 _ Cooling Methods for PHFs V
590.003(B) Demonstration of Knowledge* 3-302.11(A)(1) Raw Animal Foods Separated from 3-202.12 Additives* g
Cooked and RTE Foods.* * _ 19 __ _ PHF Hot and Cold Holding _
2-103:11 --'-Person-in=Charge Duties- -• •- - -- - - - _- - 3-302.14 Protection from-Unapproved Additives Below 41 F/45
Contamination from Raw Ingredients 5 Poisonous or Toxic Substances I 3-501.16(B) Cold PHFs Maintained At or e ow °F
I 590.004(F) *-
EMPLOYEE HEALTH _ 3-302.11(A)(2) Raw Animal Foods Separated from Each 7-101.11 Identifying Information-Original Containers*
* 3-501.16(A) Hot PHFs Maintained At or Above 140°F*
2 590.003(C) Responsibility of the Person-in-Charge to - _ _ - _ Others - - _ -. - _ - _ t 7-102:11 Common Name-Working Containers* *
Require Reporting by Food Employees and Contamination from the Environment 3-501.16(A) Roasts Held At or Above 130°F
"
-- - - Applicants* - - - -- - - - - 1-201.11 Separation-Storage**
-302.11(A)- Food Protection*- � -�+ P g 20 Time as a Public Health Control
7-202.11 Restriction-Presence and Use*
_ 5.90.003(F) Responsibility of A Food Employee or An _ _ __ _ _ 3-302:15 Washing Fruits and V_egetables__ 3-501.19 Time as a Public Health Control* -
Applicant To Report To The Person In Charge* Utensils* 7.202.12 Conditions of Use* 590..004(11)_ Variance Requirements
f 3-304.11 Food Contact with Equipment and
t _ 590.003(G) ,-Reporting by-Person-in-Charge _ - _ _ ._._ 7-203.11 Toxic Containers-Prohibitions I ,
1 Contamination from the Consm&
3 590.003(D) Exclusions and Restrictions* 7-204.11 Sanitizers,Criteria-Chemicals* _ w °, _ REQUIREMENTS FOR-
_ _3-306.14(A)(B)Returned Food and AdulteReserrated
or of Food* 7-204.12 Chemicals for Washing Produce,Criteria*; - HIGHLY SUSCEPTIBLE POPULATIONS HSP
590.003(E) Removal:of Exclusions and Restrictions g
Disposition ofAdulterated or Contaminated
Food 7.204.14 Drying Agents,Criteria* 21 3-801.11(A) Unpasteurized Pre-Packaged Juices and
FOOD FROM APPROVED SOURCE 3-701.11 Discarding or Reconditioning Unsafe Food* 7-205.11 Incidental Food Contact,Lubricants* Beverages with Warning Labels*
4 `} - -- ` Food and VMter From Regulated Sources -- - 9 - - - Food Contact Surfaces 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(B) Use of Pasteurized Eggs*
590.004A-B Compliance with Food Law* * 3-801.11(D) Raw or Partially Cooked Animal Food and
( ) P _ _ _ _ -_ 4-501:111 - Manual Wazewashin Hot Water 7.206.12 Rodent Bait Stations
3-201.12 Food in a Hermetical) Sealed Container* Sanitization Temperatures* Raw Seed Sprouts Not Served*
Y P 7-206.13 Tracking Powders,Pest Control and
3-201.13 - -Fluid Milk and Milk Products* 4-501.112 - Mechanical Warewashing-Hot Water Monitoring* 3-801.11(C) Unopened Food Package Not Re-Served*
_3-202.J3 _ ShellEggs.!_ . _ _ _ __ _-_ Sanitization Temperatures* TIME/TEMPERATURE CONTROLS
3-202.14 - Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-Temp.,pH. 18 Proper Cooking Temperatures for PHFs CONSUMER ADVISORY
3-202.16 Ice Made From Potable Dunking Water* - - - - - - -Concentration and Hardness* 3-401.11A(1)(2) Eggs-155°F 15 sec 22 3-603.11 Consumer Advisory Posted for Consumption of
4-601.11(A) Clean Utensils and Food Contact Surfaces of E s-Immediate Service 145°F 15 sec* Animal Foods That are Raw,Undercooked or
5-101.11 Drinking Water from an Approved System* __ - ___ _ _ . _ gg
- Equipment* Not Otherwise Processed to Eliminate
590.006(A) Bottled Drinking Water* 3-401.11(A)(2) Comminuted Fish,Meats&Game Pathogens* Eg cH,e 11112001
_ __ 4-602.11 - Cleaning.Frequency of Utensils and Food Animals-155°F 15 sec*
590.006(B) Water-Meets Standards'm 310 CMR 22.0* Contact Surfaces of Equipment* * 3-302.13 Pasteurized Eggs Substitute for Raw Shell
Shellfish and Fish From an Approved Source _ _ 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min Eggs*
4-702.11- - Frequency of Sanitization-of Utensils and Food 3-401.11(A)(2) I Ratites,Injected Meats-155°F 15 sec*
3-201.14 Fish and Recreationally Caught Molluscan Contact Surfaces of Equipment*
Shellfish*- - _ - - _ 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 D Violations of See ion 590.009 A D in cater-
3-201.15- Molluscan Shellfish from NSSP Listed __ _ _ Chemical* ( ) ( ) 4 ( ) ( )
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-WAd Mushrooms Approved-By-- -- - 2-301.11 - Clean Condition-Hands and Arms*
Regulatory Authority 3-401.12 Raw Animal Foods Cooked in a Microwave foodbthe appropriate sections above if related to
3-202-18` - -Shellstock Identification Present* - -- - - 2 3.0.1.12- _-Cleaning Procedure* 165°F* Other 90 illness interventions and risk factors.
2-301.14 When to Wash* * Other 590.009 violations relating to good retail
590.004 C Wild Mushrooms* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec
3-201.17 ) Game Animals* 11 Good Hygienic Practices -17 Reheating for Hot Holding 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* z_ _ : 3-403.11(B).: Microwave:-165°F 2 Minute Standing Time* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-403.11(Q) Commercially Processed RTE Food-140°F* Blue Items 23-30)
12 Prevention of Contamination from Hands * Critical and non-critical violations,which do not relate to the foodborne
3-101.11 Food Safe and Unadulterated* 3-403.11(E) Remaining Unsliced Portions of Beef Roasts illness interventions and risk factors listed above,can be found in the
6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from Employees* 18 Proper Cooling of PHFs following sections of the Food Code and 105 CMR 590.000
* 13 Handwashing Facilities 3-501.14 A 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 413/45°F
Tags/Records:Fish Products 5-203.11 Numbers and Capacities* Within 4 Hours*.
23. Management and Personnel FC-2 .003
5-204.11 Location and Placement* 3-501.14(B) Cooling PHFs Made from Ambient 24. Food and Food Protection FC-3 .004
3-402.11 Parasite Destruction* Temperature Ingredients to 41°F/45°F 25. Equipment and Utensils FC-4 .005
3-402.12 Records,Creation and Retention* 5-205.11 Accessibility,Operation and Maintenance Within 4 Hours* 26. Water,Plumbing and Waste FC-5 .006
590.004(J) Labeling of Ingredients'
Supplied with Soap and hand Drying Devices
_• 27. Physical Facility FC-6 .007
7 Conformance with Approved Procedures/ 6-301.11 Handwashing Cleanser,Availability 28. Poisonous or Toxic Materials I FC-7 1.008
HACCP Plans 6-301.12 Hand Drying Provision 29. Special Requirements 1.009
3-502.11 Specialized Processing Methods* 130. 1 Other
3-502.12 Reduced-Oxygen Packaging Criteria*
8-103.12 Conformance with Approved Procedures* - S:590Fofmback6-2doc
*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.
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"Back Again Cafe or the old Murphy Is Recession " TOTAL SmA77JVO 50 SEA7W
12 Thornton Drive, Hyannis, Ma. 02601 ,
scAL�•�_L' [�r6 Gt/f=/ff L]/aAWN AM'V.MAw07'TA
Assessore Map: 295 Parcel: 006
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' Lfl- CATION `
SEWAGE PERMIT NO.
VILLAGE
t/,CwJ�I
INSTA LLER'S NAME & ADDRESS
I C,Cf
B U It DE R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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S P O 0 N AND S E E
KIDD'S HILL BREAKFAST...9.95
` TWO FARM EGGS ANY STYLE,TOAST,HOUSE SMOKED BACON OR SAUSAGE PATTY,STEAK FRIES
j EGGS BENNY...10.25
TWO POACHED EGGS,HOUSE MADE CANADIAN BACON,REAL HOLLANDAISE,GRIDDLED ENGLISH MUFFINS
OMELET...6.95
FARM INSPIRED,MADE WITH THE FRESHEST INGREDIENTS,SERVED WITH A SMALL GREEN SALAD
EGGS N'HASH...8.95
TWO FARM EGGS,HOUSE MADE CORNED BEEF HASH,STEAK FRIES,TOAST
BREAKFAST BISCUIT...7.25
FRESH BUTTERMILK BISCUIT,DENVER OMELOT,MELTED CHEDDAR,STEAK FRIES
BUTTERMILK PANCAKES...7.95
TOPPED WITH HONEY-LEMON WHIPPED RICOTTA
FRENCH TOAST...7.95
3 SLICES THICK CUT HOUSE MADE BRIOCHE
GASHOUSE EGGS...7.50
2 EGGS23
CHEESEY GRITS ...8.25
SLOW COOKED BEANS,PULLED PORK,OVER EASY EGG
2 MINUTE- SREAKF/AS-T SMES
HOUSE SMOKED BACON 4.
EGGWICH...4.50 COUNTRY SAUSAGE PATTIES 3.50
ENGLISH MUFFIN,FARM EGG,FARMHOUSE STEAK FRIES 3.25
CHEDDAR SINGLE PANCAKE 3
ENGLISH MUFFIN 3.25
FRESH FRUIT 6.25
EMPANADA...5.00 SLOW COOKED BEANS 3.95
EGGS,CHEESE,AND BACON OR EGGS& CORNED BEEF HASH 4.95
POTATOES BAKED IN A FLAKY,HALF MOON CHEESEY GRITS 2.75
PASTRY CRUST
POWER BREAKFAST...7.50
12 OZ BLUEBERRY-KALE SHAKE,BOILED EGG,
COFFEE
WARM BREAKFAST CEREAL...5.95
STEEL CUT OATS,WHOLE GRAINS,CINNAMON,
NUTMEG,BANANA,GOLDEN RAISINS
PLEASEALERT YOUR SERVER OF BEFORE
PLACING YOUR ORDER IF YOU HAVEANYFOOD
ALLERGIES.
CONSUMING RAW, CURED OR UNDERCOOKED
MEAT, POULTRY, EGGS,SHELLFISH OR
SEAFOOD MAY INCREASE YOUR RISK OF FOOD-
BORNE ILLNESS.
12 THORNTON ST.
HYANNIS,MA.02632
www.spoon&seed.coln
- S P O O N & S E E D I
C O O K S H A C K
CRAFTED SANDWICHES
SALAD PANTRY
"CUBANO-ITALIANO" 8.95
TOASTED FARRO &WHITE BEAN HAM, PORCHETTA,SWISS, HOUSE PICKLES,
SALAD 6.95 i DIJON MUSTARD, PRESSED ON A SUB ROLL
MARINATED MUSHROOMS, ROASTED RED
PEPPERS, FETA CHEESE,GOLDEN RAISINS, THE PARM 9.95
GRILLED FENNEL, RED WINE VINAIGRETTE BREADED CHICKEN CUTLET,TOPPED WITH
ROASTED TOMATO SAUCE, PARMESEAN &
ORGANIC BEET&SPINACH SALAD MOZZARELLA ON A SUB ROLL
7.50 52ND STREET FALAFAL 7.50
SHREDDED LOCAL BEETS, BABY SPINACH,
CASHEWS, DRIED CRANBERRIES,GOAT CHICKPEA FRITTERS, LETTUCE, ONION,
CHEESE, RYE CROUTONS,YOGURT-LIME TOMATO,CUCUMBER,TZAZIKI SAUCE, HOT
DRESSING SAUCE, ON A PITA,WITH FETA CHEESE
LOCAL LETTUCE SALAD 5.95 OVEN ROASTED TURKEY 7.95
MUSTARD VINAIGRETTE, FRESH HERBS, SLICED APPLE,CRANBERRY MOSTARDA,
FOCACCIA CROUTONS,CUCUMBER& BOURSIN CHEESE,WILD CRESS,ON TOASTED
CARROTS MULTIGRAIN
BAHN MI 8.95
LUNCH PLATES PULLED PORK, PORK PATE,CUCUMBER,
PICKLED CARROTS,CILANTRO, MINT,SOY-
MAYO ON A BAGUETTE
HOUSE MADE RICOTTA CAVATELLI
13.95
BEEF SHORT RIB&MUSHROOM RAGU, BURGER SHACK
FINISHED WITH PECORINO ROMANO FRESH GROUND,100%ALL NATURAL BEEF PATTIES,
ALL BURGERS COOKED MEDIUM UNLESS OTHERWISE REQUESTED,SERVED
WITH HOUSE FRIES
FREE RANGE CHICKEN CURRY
12.95 SPOON BURGER 9.95
BONE IN CHICKEN SIMMERED IN HOUSE MADE LETTUCE,TOMATO, MELTED CHEESE,SECRET
CURRY,CARROTS, POTATOES, PEAS, BASMATI SAUCE, MARTIN'S POTATO BUN
RICE, MANGO CHUTNEY
SMOKED BACON BURGER i 1.95
LOCAL HARVEST RISOTTO 1 1.95 HOUSE SMOKED BACON, LETTUCE,TOMATO,
PEAS,STRING BEANS,MUSHROOM AND FRESH MELTED CHEESE,SECRET SAUCE, MARTIN'S
HERB RISOTTO FINISHED WITH EXTRA VIRGIN POTATO BUN
OLIVE OIL AND PECORINO ROMANO STREET BURGER 13.95
HOUSE SMOKED BACON, PINEAPPLE-MANGO
A LIST OFSOME OUR SOURCES& CHUTNEY,CRUSHED CHIPS, FRIED FARM EGG,
PURVEYORS.' SPECIAL SAUCE, MARTIN'S POTATO BUN
CAPE COD ORGAN/C FARM-BARNSTABLE
l'VANNA BEE FARMS-CUMMIQUID
SURREY FARMS-BREWSTER
NOT ENOUGH ACRES FARM-DENNIS PLEASE ALERT YOUR SERVER OF BEFORE
RING BROTHERS-DENNIS PLACING YOUR ORDER IF YOU HAVEANYFOOD
CHATHAM FISH&LOBSTER-CHATHAM ALLERGIES.
REEL TIME FISHING- BARNSTABLE VILLAGE
CROWES FARM-SANDW/CH CONSUMING RAW, CURED OR UNDERCOOKED
,WEETINGHOUSE FARM- WEST BARNSTABLE MEAT, POULTRY, EGGS,SHELLFISH OR
SEAFOOD MAY INCREASE YOUR RISK OF FOOD-
BORNE ILLNESS.
I
12 THORNTON ST.
HYANNIS,MA.02632
www.spooii&seed.com
Message Page 1 of 1
McKenzie, Marybeth
To: spoonandseed@gmail.com
Subject: Application requirements for new establishment
Morning Matthew Tropeano,
My name is Marybeth McKenzie, I am the health inspector for this region, and I am currently reviewing the
application for Spoon and Seed that you left at the office for approval. These are the items that are missing and
will need to be submitted as soon as possible so I can move forward the process for staff approval:
1) Need one more certified food manager certificate and an allergen certified person.
2) Floor plans with the required layout of the facility: hand sinks, mop sink, dry storage, personal item storage,
chemical storage ect. Please check the long form which tells you what is required for a permit. If you don't have a
long form you can come by the office and get one.
3)You are proposing a total of 56 seats, but you will be limited to 50 seats because you only have 2 bathrooms.
Over 50 seats you are required to have 4 bathrooms or you can apply for a variance.
4) You need the consumer and allergen advisories on the menu:
5) A finish schedule will have to be submitted along with the floor plan. These must be approved surfaces for floor
walls and ceilings in the different areas.
6)An outside dining application will have to be submitted. Do you have an air curtain? If you plan on serving food
outside one will be required. You will also need an outside hosebib. What is the surface for the outside dining
area. It must be a washable surface as well as the table and chairs. Please see the permit for all requirements.
7) Equipment specifications will have to be submitted. All handsinks are required to be hands free type. Splash
guards may be needed if the sins are located need food prep areas or storage of food.
I will be able to go into more specifics once you submit more information. If you have any questions please
contact me I would be happy to help. You mention that you plan to open June 1st and all this information has to
be submitted for approval before anywork is done. As I mentioned before that staff approval will be required and
the next staff meeting is May 6th. Please submit all the information required at least a week prior to the staff
meeting so I can go over the it and contact you incase I have any questions. My office hours are 8-930 Tues.- Fri.,
I can also meet you there to go over any questions if you would like.
Sincerely,
Marybeth McKenzie R.S.
�6k
4/24/2015
S P O O N AND S E E D
KIDD'S HILL BREAKFAST...9.95
TWO FARM EGGS ANY STYLE,TOAST,HOUSE SMOKED BACON OR SAUSAGE PATTY,STEAK FRIES
EGGS BENNY...10.25
TWO POACHED EGGS,HOUSE MADE CANADIAN BACON,REAL HOLLANDAISE,GRIDDLED ENGLISH MUFFINS
OMELET...6.95
FARM INSPIRED,MADE WITH THE FRESHEST INGREDIENTS,SERVED WITH A SMALL GREEN SALAD
EGGS N' HASH...8.95
TWO FARM EGGS,HOUSE MADE CORNED BEEF HASH,STEAK FRIES,TOAST
BREAKFAST BISCUIT...7.25
FRESH BUTTERMILK BISCUIT,DENVER OMELOT,MELTED CHEDDAR,STEAK FRIES
BUTTERMILK PANCAKES...7.95
TOPPED WITH HONEY-LEMON WHIPPED RICOTTA
FRENCH TOAST...7.95
3 SLICES THICK CUT HOUSE MADE BRIOCHE
GASHOUSE EGGS...7.50
2 EGGS23
CHEESEY GRITS ...8.25
SLOW COOKED BEANS,PULLED PORK,OVER EASY EGG
2 iMV�IN,U-TE BREAKFAST SIDES
HOUSE SMOKED BACON 4.
EGGWICH...4.50 COUNTRY SAUSAGE PATTIES 3.50
ENGLISH MUFFIN,FARM EGG,FARMHOUSE STEAK FRIES 3.25
CHEDDAR SINGLE PANCAKE 3
ENGLISH MUFFIN 3.25
EMPANADA...5.00 FRESH FRUIT
SLOW COOKEDD BEANS 3.95
EGGS,CHEESE,AND BACON OR EGGS& CORNED BEEF HASH 4.95
POTATOES BAKED IN A FLAKY,HALF MOON CHEESEY GRITS 2.75
PASTRY CRUST
POWER BREAKFAST...7.50
12 OZ BLUEBERRY-KALE SHAKE,BOILED EGG,
COFFEE
WARM BREAKFAST CEREAL...5.95
STEEL CUT OATS,WHOLE GRAINS,CINNAMON,
NUTMEG,BANANA,GOLDEN RAISINS
PLEASE ALERT YOUR SERVER OF BEFORE
PLACING YOUR ORDER IF YOU HAVE ANY FOOD
ALLERGIES.
CONSUMING RAW, CURED OR UNDERCOOKED
MEAT, POULTRY, EGGS,SHELLFISH OR
SEAFOOD MAY INCREASE YOUR RISK OF FOOD-
BORNE ILLNESS.
12 THORNTON ST.
HYANNIS,MA.02632
www.spoon&seed.com
S P O O N & S E E D
C O O K S H A C K
CRAFTED SANDWICHES
SALAD PANTRY
"CUBANO-ITALIANO" 8.95
TOASTED FARRO &WHITE BEAN HAM,PORCHETTA,SWISS, HOUSE PICKLES,
SALAD 6.95 DIJON MUSTARD, PRESSED ON A SUB ROLL
MARINATED MUSHROOMS, ROASTED RED
PEPPERS, FETA CHEESE,GOLDEN RAISINS, THE PARM 9.95
GRILLED FENNEL, RED WINE VINAIGRETTE BREADED CHICKEN CUTLET,TOPPED WITH
ROASTED TOMATO SAUCE, PARMESEAN&
ORGANIC BEET&SPINACH SALAD MOZZARELLA ON A SUB ROLL
7.50 52ND STREET FALAFAL 7.50
SHREDDED LOCAL BEETS, BABY SPINACH,
CASHEWS,DRIED CRANBERRIES,GOAT CHICKPEA FRITTERS, LETTUCE,ONION,
CHEESE, RYE CROUTONS,YOGURT-LIME TOMATO,CUCUMBER,TZAZIKI SAUCE,HOT
DRESSING SAUCE, ON A PITA,WITH FETA CHEESE
LOCAL LETTUCE SALAD 5.95 OVEN ROASTED TURKEY 7.95
MUSTARD VINAIGRETTE, FRESH HERBS, SLICED APPLE,CRANBERRY MOSTARDA,
FOCACCIA CROUTONS,CUCUMBER& BOURSIN CHEESE,WILD CRESS, ON TOASTED
CARROTS MULTIGRAIN
BAHN MI 8.95
LUNCH PLATES PULLED PORK, PORK PATE,CUCUMBER,
PICKLED CARROTS,CILANTRO, MINT,SOY-
MAYO ON A BAGUETTE
HOUSE MADE RICOTTA CAVATELLI
13.95
BEEF SHORT RIB&MUSHROOM RAGU, BURGER SHACK
FINISHED WITH PECORINO ROMANO FRESH GROUND,100%ALL NATURAL BEEF PATTIES,
ALL BURGERS COOKED MEDIUM UNLESS OTHERWISE REQUESTED.SERVED
WITH HOUSE FRIES
FREE RANGE CHICKEN CURRY 12.95 SPOON BURGER 9.95
BONE IN CHICKEN SIMMERED IN HOUSE MADE LETTUCE,TOMATO, MELTED CHEESE,SECRET
CURRY, CARROTS,POTATOES,PEAS, BASMATI SAUCE, MARTIN'S POTATO BUN
RICE, MANGO CHUTNEY
SMOKED BACON BURGER 1 1.95
LOCAL HARVEST RISOTTO 1 1.95 HOUSE SMOKED BACON, LETTUCE,TOMATO,
PEAS,STRING BEANS, MUSHROOM AND FRESH MELTED CHEESE,SECRET SAUCE, MARTIN'S
HERB RISOTTO FINISHED WITH EXTRA VIRGIN POTATO BUN
OLIVE OIL AND PECORINO ROMANO STREET BURGER 13.95
HOUSE SMOKED BACON, PINEAPPLE-MANGO
A LIST OF SOME OUR SOURCES& CHUTNEY,CRUSHED CHIPS,FRIED FARM EGG,
PURVEYORS.' SPECIAL SAUCE, MARTIN'S POTATO BUN
CAPE COD ORGANIC FARM-BARNSTABLE
WANNA BEE FARMS-CUMMIQUID
SURREY FARMS-BREWSTER
NOT ENOUGH ACRES FARM-DENNIS PLEASE ALERT YOUR SERVER OF BEFORE
RING BROTHERS-DENNIS PLACING YOUR ORDER IF YOU HAVEANY FOOD
CHATHAM FISH&LOBSTER-CHATHAM ALLERGIES,
REEL TIME FISHING- BARNSTABLE VILLAGE
CRowES FARM-SANDWICH CONSUMING RAW, CURED OR UNDERCOOKED
MEETINGHOUSE FARM- WEST BARNSTABLE MEAT, POULTRY, EGGS,SHELLFISH OR
SEAFOOD MA Y INCREASE YOUR RISK OF FOOD-
BORNE ILLNESS.
12 THORNTON ST.
HYANNIS,MA.02632
www.spoon&seed.com
B rt astKYD.D'S )III L BREAIrAS I... 9.9r POACHED OACHED & TOASTED.., 5
_ k "'o Earm eggs any
gh S style, rnultigrain toast, 5.2,E
apple wood smoked bacon or mint gra iitll Poached small 01,aroasted
sausage patty, home fries garden salad
4 ,k, Add bacon, sausage patty- or Add Home Fri.es...1.25
` smoked
< *� � pork loin...1.95
r EGGS IN JAIL... 8.50
EGGS I3E '-!1�,... 10.25� Two eggs cooked in toasted house-made
:serve Two poached eggs, house smo.lced pork challah bread, topped with ba^ora
d bet.��eery 7:O�aan to 10:59ana
loin, -real Lc
smoked tomato P.r:son bars"anti market greens
I'caesday to Friday
salsa, griddled Enghslz muffins Add Home I Y'ies...1.25
• THE OPEN I`ACED... Add Horne .Fries...1.25
9.95 CHEESY
vo e�<> GP.1TS... 10.95
�s a.nI st};le over apple ��rood Crispy fll'ck cut sip hour braised zrorl -
smolced bac't�n, avocado, grilled tomato, 130IZTC)_.BI ,\? ;' '2. ..,.I0.5®
melts d ::.. I Nvo Poached eggs slow cooped reel beans, over Geeehie. f3ob`.�Till
�rrnont chcddar,on toasted `� r over grilled porrobello hou`c .rnatic challah, house fries �nuslZ.rooms, sauteed baby spinach, sweet cf'eddar grits, topped with an over cosy egg
potato puree, toasted f-'arro topped -.vit.lz
1-3LITT-ER NAU '. real hollandaise 8 red quinoa. I3:f36�1 -'! I312EA1�I AST.., �.
1 I I Ai' �,A-ICES... 7.95
? 1 I..2,>
c> I'an ,akes topped wii1; 1'wo Farm eggs airy- style, house smoked
:encti 1. I II1FAS1':BISCI €'T... �,9ti pulled pork, l;imchi, sesame }rbq sa.ucc,
rnon «hr r e(j ricotta;
?tm Vermont cheddar Iris„
.erved ��-ith crruonr maple syrupuit:,
Ad-i luez3errres/chocolate chip,-, scrambled
house-,,,,dlede se s toasted -'errnont cheddar biscuit
" '� �. arid house .rnolsec?
P
I3.ARNS'-.IA13L BIZEA_IUAST
1 RF,J�'C H TOAST_ 9.25 O:�-1.EI;ET... 7.95 13L�R.IZITO...7.50
14`n thick• cut house:-made challah. bread House smoked cht:)rio breakE�3st beans,
Inspired daily, rnrade «-ith tl:c: Fresht,st
slrcc ;, iopl}c cl �t ith caramelize rr:gred:ents, served «-ith chimichurri Potatoes, peppers, onions, ergs avocado.
d bananas
and �-h.:ippei.l ricotta sauce and grilled Eoccacia bread mozzarella, tivra •
ppecl in a,%vhole wheat
Fresh %g'g��.hi.tes...l,g5 tortilla served > th smoked tomato salsa.
1V1O.RNl.NG I R1.;1T PARFAIT ...... 5.75 Add Home Fries...1.25
Hone & lemon scented CYreelc voe• Add Dome I'zies...1.25
curt topped Add bacon, sa.ta.sage patty or smoked
with house-made granola.and fresh Eiop
Pork- Ioirr, house made cliorzzo....1.�5 S<=�'DA'NECIa.EGCB
WICh.1... 4.50
0
T Hr�.SH 9 �� Griddled house-made Vermont cheddar
RGANrC:i�IApI..E.-CIllT\TA.r�IOl! E'A.RRO EGGS �T,
c& C�ITI�TOA biscuit, farm egg and cheese
"PORRIDGE".•.6.25 Two farm eggs any style, house-made Add bacon, Sausage
Warm farm & quinoa grain cereal with corned beef hash, home fries, multi�r'ain toa t port:I® patty, or
bananas, house made granola & fresh berries smoked 1.25
r `
Add Home F
g afid Serty-17g II ith L«vet I
Total Utilization:
"Don't throw away BEVERA.GF
axVVthing!jPjP spoo _,S SIDES & SUCH
I pie wood smoked bacon... 4.75
SP0011 and Seed ,,vas built with al'o See-0 SPeeiafOv Dink, Ap
an old school p Saffron Iced Tea...2.95 House-made breakfast bilosophy of Hibiscus Flower Iced Tea..._9._')., ast sausage patiy..
ss and - 2.95 ea
-ind Hou-se-inade corned beet'hash... 5.75
I-11genufty. Iced I-lorchata...1.95
The sani, -Vz7ay that a great chef Old Fashioned Hot Cocoa._3.00 Thick Cut Pork Belly...6.25
does not waste a. morsel 111 th e LocallY Roaited Bean,jtocX, Col., House Smoked Chorizo Sausage...4.175
kitchen and creates• a flavorful Iced Coffe ree..,1.95 Slo-'v cool-zed red beans...
meal �o,71fl, hunj)] e...2-55 3.95
�c 1,jigredients, HotTea...1.95 Creectile B(�y Mill Chees�3/ 3.25
e design Of SPOon and Seed UnsNveetened Iced Tea...2.15 Local Duch egg (when available)...2.25
was executed b A-0,13Urposill Milk...2.55
1�u r 9' Chocolate A111k.-.2,555 C95
f _nItUre. wood pallets and 11 Egg White... 1.95
Assorte(] jz1_L1:,_ Multi he gooc[ SM-Ips available. Tables . i, IcIraln't-fou-se-IMade White
ec."
PS .Dave been Large-2.55 Sinall...1.75 T(-)ast/Focaccia,.
hand crafted Orange Juice, Apple Juice, .1-2.5
s�-.Ik-aged .floor-jj, ice, Cran
&O-In a 'Derr-yjI.1, _.l -)use icc H( CI_lt 1-jort-le fries... 3.2 r
SandNN,_1cjj, s1111ple -Natalle's Natural V�'rnoriade Bottle...3.00 INlarket Vegetable...3.75 0
Adason jars are ch
189LI I sed as fie-lit Soft Drinks Half Avocajc.)...21.25
RA-tures, ancl e-ve n. the breakfast Coke, a ...1-55 Ff'esh Fruit... 6.25
Counter ',vas C0.1-1struct• ed from
let Colize., Sprite Single butterryi,111c the Njur, San Pellegrim paxicake... 4.25
• h I s Recess lo,-,, s old bar Assorted FLivops,-1.75 W/ Honey lernon hipped ricotta....5
pine woodfroin N,
with P, v Fip' 'Water... 1.75 V .50
Hallips ire. S Perrier Sparkh erfnont Maple SY"Up...1.75
.I-,' Don and S-'cued ITIcg' Water...1.75 Organic
',,vas env I ChUnIchurri Isioned to 6, an j.,o 1 Sauce...1-95
nest Srnoked House
local eatery CO"11-11ifnentizty I-efilj,, 0,,z et�#eeanO -Made ToinatoS,"Isa...1.95
cOoldng and servLng 1-f-fidweetened iced, tea i" Armwe nly. Real Hollandaise Sauce... 1.25
vc>ith love"year round. The SOI-/..y 120t&�,go.
Tropeano F - Spudriuts...2.15
aj-n1jV Welcomes vou. tZlel't !10111',fervel-17elble
order tfyoll 15a.ve 1'117,Y)'ooda11e,g1'e,;. Scone...215
BRUNCH EVERY Co/7f"'"ZZ.I?q/W.10, cared Chocolate Chip Cookies...2.15
SATURDAY AJ\TD SUNDAy poultl 1111derwokedMea,�,
or Chocolate
172ay 4.llcrea,ye ... 1.75
Your r6ik of frond-borne illneft. Vermont cheddar biscuit ... 9.25
House-I'vlade Jam... 0.50
SALADS
�.RA.F 7"�.T: S_ N[)N�,._
Add Tuna salad or grilled chicken 3.25 All Sandwiches are served with house c
Add Catch of the Day or 3 Shrim
- nc< p•..5.95 use cut fries,
.. substitute greens add .1.25
THE CHOPPED... 8.25 C.FillVIIC.
Shredded butternut sclua.sh, kale, toasted Earro, red HUI2Rr C FIICI�Ej�T 9.25
Grilled chicken breast, thinly sliced pickled reel
cluinoa dried cranberries, diced apples, pumpkin
seeds tossed with apple eider dressing °n'.on, smoked tomato salsa, avocado
r� ,r # chim�churrr sauce on house made foccacia
THE GR.EE]k:... 7.25 SECRET RECIPE �IEAT13 AL L HE, r
9.95
Ser'�ed between :11:€)Oam to 2:3Upm pepnRorn In lettuce,
Fe, cucumbers,
s, roasted
to de re Nonna's meatballs slow cooked in Fresh
1l tomato sauce, topped « ith warm, and rnozzarella,
Ttresdzay to Friday. r ressing, topped Nvith a Kalamai.a olive crostinek served Or' house rna<�e Italian bread.
PORTO-BE NNII Y 2.0...:.
(Can be made into a -v -HOUSE SMOKED PULLED P�:�1IIC.. c
0.50 hole wheat wrap)
Two poached eggs, over 'lied SIDE NI UI Sesame BBQ sauce, .Napa cabbage 8..)5
portobellos, sauteed baby spin ch, sweet 1` T S�LI�'.•5.25 k.i.mch.i slaw, toasted house .made challah bun
Farm lettuce, tornatoes, pickled onion,
potato puree toasted Fargo topped with
cucumbers; lemon vrnaia-rette Ti
�1E NII�DITEI2R,-�1�;F.A ... 9.50
real. hollandaise �' red cluinoa.
CURRIED CHICKEN ON A BED OF Parrnesan &: Herb D.i pe(-1 E'
tomato, basil, roa; p' ggPlant cutlets, sliced
THI C�I'Fiii Fr4CEE�••.9..95 L I�TTUC`.I ,..5.25 I�rtlarnata olive rapeadc,lorr house rrcro
hummus,
T_�vo egf;, rr ti stye over angle v�ood nCurriec] chicken salad with: celery, cil jade locaccia smoked bacon', avoc a.do, ille d tomato, r Intro and
gulden raisins c.ishe�vs served.on mctrkEt lett:uc�c�
melt d Verniont c.heddar,or1 toasted ,r Funs or served in a whole -, hea.t Nn ra-D TIII 1' ?,I�NI... y 95
Breaded chicken cutlet, top.( mato sauce,
made challah, house fries parm mozzarella, ser�e,ca on house mad red with toe.
z>t Italian bread
"I r�
OMELET..,.. 7.95 RICO 'Tl CAS i��'Ef L.I B£:>r.0 T�;ItIKF ,y BLT... t
��NESE... 13.25 3.25
Arced all natural roast(-
Inspired turkey- breast; apple
Inspired daily na.de ,vith the freshest house rna.cle c_avate.11i pasta tossed ��-itlr
1 snnmered ��ith arornat.ic ve th --round beef wood smoked bacon, tomato, lettuce, mayo
s o�v , served on a.llotrse rnade. claa}la.h bun
ingredients, St.rtied with chimicht.trri finished with Pecorino Rornarzo cheese
ge ,
sauce and grilled foccacia bread. TIJi\?� i4III'I'...
SHRIMP &_GRITS...1.5.`5 8.95
Four Florida Gulf shrimp, sauteed �.vith bell peppers, Z'un.a salad topped \,with melted farm. house
SOI�P ��' SA.LAD... $ J0 cheddar,<:heese, avo� ado, :,,,ry 1
Cup of sou of th.e dad• onions, garlic, ch.di pepper smoked tomato panauce bi open faced
on a Vermont cheddar biscuit
p and a. small over creamy Geechie BoyZill grits
Greek, Chopped or Side IMarlcet Salad SPOON BUR. r
BURGER.... I.U..,U
LOCAL H.ARVF_.ST RISOTTO... 10.95 Fresh ground beef. lettuce, tomato, rlelted Vermont
SOUP OF THE DAY Seasonal vegetables, Fresh herbs, with extra Cheddar cheese, toasted house made r_hallah bun
CUP...4.50 BOWL...5.5o vrr-gin olive oil and. Pecorino Ron-rano cheese
Add apple wood smoked bacon... 2.75
,' Add Chicken...4.95 Add an e
Ask us about catering, Add Ditch of-'the Day, or 3 Shrimp...5.95 Add local duck e gg..•I.8,5
gr, (w.hen available)...2.25
business lui-xches, and CATCH OF THE,DAY... M.P.
THE:HIPPIE 13 URGER... 9.95
Private events" Seasonal, sustainable and thouqahtF'ull .
P eats created fish special of the day Herbed peppers,
pea patty, pickled red onions, roasted
red peppers, feta, hot pepper yyogu rt sauce; on
house made Foccacia or bed of greens
Total uti-lgzatio': BEVERAGES
"Don't tlzrotiv a-way arnythitrg•!" SIDES �.._
oon .S acBep�t �rz0 Seem SPee"'Z f�;Dtinkrf
� ���� deed. was built with Saffron-Gin�-
ber Iced Tea...2.95 douse Cut Fries... 3.25
all old school pllil.osop.hv of Hibiscus ,
Flower Iced !ea...2.25 Halt'Avacado...2.10
resourcefulness and zngC-,j-tuit�yr. Iced Iforchata....1.95 Chimichurri Sauce...1.95
The sa.rle Wa , Old Fashioned Hot Cocoa...3.�p Smoked House-Made Z'01-i-lato Salsa..
,y that a great Chef 1.95
does not waste a, loots Spudntrts...2,15
e.l .iz1 the Locay Raafted Bearz ftocX Coffee...i.9
-Itehell a.nd creates a flavorful Scone...215
• Iced Coffee. Chocolate Chi .
nl.ea.l. tivith h11111ble ix1 P Cookies...2.15
gredients, Hot Tea...
1_ ��11 IVIu f f-Ins— L 75 the design of `' Uns',rreetened Iced Tea... � ~ Vermont cheddar biscuit ... 2.25
� p0®�x and Seed 2.0�
«ra.> executed bzT .re Milk...2.55 House-Trade Iarn... {).50
purpc�s.l-ng Chocolate iti'Iilk...
eta �nzt'�ix'e, vv-ood 2.5J
pallets and -11.1
t1l.e good s aVal.la.0 sera. 1�l.�' II%J,zeaevcr pn<<ril�le�ve.lcet,�rcrrt cuz<1<fnrzr'ce arz✓'in re rent,
� .
gables9
frnrr t/.e folL
tops have beezl hazed Assorted. I�rtrit Juice nwI/za a I tz<lar7.j arzds .1 zl'1170r f. d-
crafted front salva - Large...2.55 rna.11....1.75 Cape Cod Organic �.gee$ floc?Z'1n�Q 1 drtn (I�ar'nstalrle= -'iilaS'e)
{�ra12`e Juice
Apple Juice, Cranberry Wanna Bee Farms at Long, n
from a house i.t1 � 7 Ju.Ic`C' a Pasture Cum
a r_tjjdN-L,:icb., dot .1✓nau h.Acres mIgUid)
simple M, Farm I',
Iaso,I" -� � . - �'atalie's Natural Lemonade B -" `r
-t�c...i":s ct.x't:. �1.�� 7 � 1_�� 7nis)
�''ul.seCl
as light [(� , of%lc:...j,Q(} Surrey Farms {h 1.1.. I3r.e�vs to r)to xttlres, a11Ct eti'en the Fresh Picked b • �1fz�nso ;.
1 1
Soft Drinks ... r~ .Y (,_,• I almouth)
rep.-.i_fast counter I-u� Vleetir7�
"7 wa.s Coke, Diet Coke S chouse Farm (N1. Barnstable)
COnstrtlCtE'd fx'ozn the .vjurPtn's sprite Beanslock Coffee Roasters � '-, -
( ���.Ifkc.t)
�2eeess-toll's old bar « l.th RFel Time Fishing
pzlle San Pellegrrno l�ssorted Flavors. (T3arztstabie. Viiia.ge)
`Food fz' 1.7, Capabilities Ta.rrn I7 .
one 1Ve«Y �a.lnpsll.i.re.
y ( EIlI11S)
Fiji 'Water... 5 �'auset Middle School (0,lea.ns)
®ern a:nd Seel was
Perrier S Geechie Boy 11'Iills Farm (S. Carolina)
e-riv sioned to be an honest local Sparkling Water...1.75
Guaranteed Fresh Produce
eatery "cook' o Co.-(Hyannis)
b a.xld serving �'oraap(trrtentczr-�d i'e�//d oia coffee czn�
with love"year round. un-oveetened feed teez tsz /�o
The Plecz<fe alci•t yozrr ,fer'ver'�efnretrlizcin�your
ttrie osz/f.
Tropeano family welcomes �4orr y lzot to tjo. order zf yozz have nor f•. '.)
you. _1., ,;, 011er,yed.
Cnn<rurnzzz r aw, cured or undercooked rneezl;
� ' fznczLtr y, e��r,,!/aeli�ir/a r 7 r-,,cafonc)rn�r.y cncrez,re
you/.r•i,f,(of firod-1?nr ne i/lrte r,r.
-
l2 A ��r►rL�'D►'� L�6ive
l+y M W o 26 Of
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EylS
-iz Y L �e Berkshire HathawayGUAgj
*,
_ u�Comp•Buslnessowner's•Au`o•�„-,hr,;rr�� P.O. Box A-H • 16 S. River Stree
Wilkes-Barre, PA 18703-002
570-825-990
www.guard.com
Proposal of Insurance
Matthew Tropeano
Prospect Number MABP749118
Renewal of MABP619352 for 07
/21 2016
to 07 OWLING & O'NEIL INSURANCE AGENCY /21/2017
D /
Nancy Soule - Hyannis, MA Classification Analyst: SBU Commercial Advantage Team
Phone Number: 508-775-1620 Extension: 1300 / e-mail: SBUTea ax#: 508-778-1218 m@GUARD.comPhone Number: 570-825-9900
This quote will expire on 07/21/2016. Fax Number: 570-820-7968
Carrier: AmGUARD Insurance Company
Type of Coverage: Businessowner's
Payment Method:
Direct Bill
Total Estimated Cost: 2,708.00
The port on of the Total Estimated Cost attributable to terrorism premium is
Based on your risk profile and loss history, the above Total Estimated Cost includes an a 0.00.
(Direct billed policies will be charged a fee of$7.00 y Rplrcable discounts.
per installment.)
Information Needed to Issue:
* None
Important Notes,
* A Direct Draft electronic fund transfer option is offered which re
be mailed. A sign-up sheet is enclosed and can alternatively be downloaded from quires no installment fees and no checks to
` -w-guard.com or obtained by contacting Customer Service at 800-673-2465.
* If the insured cancels the Policy, m our web site at
that case the amount of premium due to the insured will lc 90% of the unearned
the final premium may be calculated on an other than pro rata basis. In
premium will not be less than the full minimum premium,
premium and final
Page 1 of 7 YOur Busin
PROP-2/2008 es is Our Business Sir,You may cal/ Customer Service at 1-800-673-2465 */
Prepared: 06/06/2016 XX - 24 hours a day, 7days a week. �`v Berkshire Hathaway
"All, G U e RD Insurance
�
Companies
TOWN OF BARNSTABLE INSPECTION WORKSHEET
CERTIFICATE NO: ICANCELLED: MAP: 295
DBA: ISPOON AND SEED PARCEL: 006 OOA
NAME/MANAGER: ISPOON AND SEED
STREET: 112 THORNTON DRIVE
VILLAGE: BARNSTABLE STATE: MA ZIP: 02630- SEQ NO: 10
BUSINESS TYPE: RESTAURANT
CONSTRUCTION TYPE:
STORY1: CAPACITY: USE1: A-2 Capacity Under 50: ❑�
STORY2: CAPACITY: USE2:
STORY3: CAPACITY: USE3: Outside Seating: 0
BY PLACE OF ASSEMBY OR STRUCTURE
CAP1: 42 LOCI: DINING AREA CAPS: LOC8:
CAP2: 3 LOC2: COUNTER CAP9: LOC9:
CAP3: 5 LOC3: PATIO AREA CAP10: LOC10:
CAP4: LOC4: CAP11: LOCI 1:
CAPS: L005: CAP12: LOC12:
CAPE: LOC6: CAP13: LOC13:
CAP7: LOCI: CAP14: LOC14:
INSPECTION: DATE ISSUED: EXPIRATION: acln TefScr�en
COMMENTS:
Crocker, Sharon
Subject: FW: Spoon and Seed outdoor seating
From: Crocker, Sharon
Sent: Tuesday, May 15, 2018 10:24 AM
To: 'spoonandseed@gmail.com'
Cc: McKean, Thomas; Miorandi, Donna
Subject: FW: Spoon and Seed outdoor seating
TO: Matthew and Paula Tropeano
Thomas McKean, Director,asked me to notify you. Tom has determined that you will not need to come to the
Board of Health meeting as you are not increasing your seating;you will be moving 10 of the seats from inside to
outside.
This is to notify you that I am removing you from the May 22, 2018 Board agenda. Thank you.
Sharon Crocker
Office Manager
From: Crocker, Sharon
Sent: Wednesday, May 09, 2018 11:07 AM
To: McKean,Thomas; Miorandi, Donna
Subject: FW: Spoon and Seed outdoor seating
FYI,
We have received Spoon and Seed's plan for seating on patio in writing as requested (below).
Sharon
From: Spoon and Seed [mailto:spoonandseed@gmail.com]
Sent: Tuesday, May 08, 2018 4:36 PM
To: Crocker, Sharon
Subject: spoon and seed outdoor seating
To Whom It May Concern,
To stay within our 50 person occupancy, we plan to move 10 seats & tables from indoors, to our outdoor patio
leaving 40 seats inside and 10 outside. Please feel free to call or email for any more clarifications.
Kind Regards,
Matthew and Paula Tropeano
SPOON and SEED
12 Thornton Rd.
Hyannis, Ma. 02601
347-276-9285
347-244-1863
spoonand seed.corn
i
--� i
V-I'n
SP o n and
�
ro 12A Thornton Drive, Hyannis, MA
774-470-4634
sl2oonandseed@gmail.com
I
I
April 27, 2018
Dear Mrs Donna Miorandi and Mr. Thomas McKean,
I hope this email finds you well! It's finally looking like Spring! Which leads me to the
following request.
1, Paula Andrea Tropeano, owner/manager of Spoon and Seed of Cape Cod, am
requesting permission for outdoor seating. I understand that our occupancy is 50 people
and do not wish to exceed that.
During wanner weather days in the Spring, Summer and Early Fall I will take away 10
seats from our indoor seating, and set up for 10 seats outside on our covered patio area,
thus not exceeding our capacity limit of 50 people.
There is a hose available as a water source for cleaning. We currently have an air curtain
at the exit/entrance to our patio. We will also dedicate wait staff to maintaining and
cleaning the outdoor patio.
Thank you in advance for considering our request.
Kind Regards,
Paula Andrea Tropeano
Owner/Manager Spoon and Seed
1
--------------
ASSESSORS MAP NO:
PARCEL NO.:
-7
Yzig...... ............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.................0F.7 ------------------------------
pphration for Dhopooal Works Tonstrurtion ramit
Application is hereby made for a Permit to Construct or Repair �anIndividual Sewage Disposal
System at:
H.�.l vs r
. ................. ........ ........................ ...........................
Location-4dress or Lot No.
.................(
Owner
L
.....F.4........... L ----------------------------------------
Installer Address
Type of Building Size Lot.a. ,.&A--...-..Sq feet*
Dwelling No. of Bedrooms............................................Ex ansion Attic Garbage Grinder
a4Other—Type of Building ':tZ.S5JA(1&QV.No. of persons......_...q.....----------- Showers — Cafeteria
Otherfixtures ... ........ -----------------------------------------------------------------..............
Design Flow.......... ........................gallons per person per day. Total daily flow__.... ......................... Ions.
9 Disposal Trench
Tank—L A* o......uld capacit) ..gallons Length...............: Width................ Diameter..._......_..._. Depth..,.'-.,.........
W '�.. .... Width.................... Total Length..... ....... Total leaching area................ ...sq. f t.
h V-N
Seepage Pit No..................... Diameter..........__.__..... Depth below inlet........._.......... Total leaching area..................sq. f t.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date.............._.................._......
Test Pit No. 1V4A-4- minutes per inch Depth of Test Pit-----I'Z......... Depth to ground water..
Test Pit No. 2te$AN.Ammutesper inch Depth of Test Pit......1.Z........ Depth to ground water........................
..12........ ......qMAIL
0 Description of Soil.... .. k !i ?
;��-"K----------------_ ri J, S AV
--------------*--------------------LV'-""0-1........ ..... ....................>..I--------------------------------------------------------------------------------------------------------
------------------------------------------------------------W---IV-Y.....��&.......................................................................................................
U Nature of Repairs or Alter tions—Answer when gplicable.........bq 5.YW.-_U.........� 0!0........AP-.-.LL0.t)......................
......................................................t.....................................................
...........Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TL ITL U 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been iss d by the board of health.
d ...................... .......
Application Approved By.................... ....... ......... ....................... ........ ........
Date
Application Disapproved for the following reasons:..............................................................................................................
.........................................................................................................................................................................................................
Date
PermitNo.... T. ................................... ......... IssuedL........... ...............................
Date
-——-------------------------------- --- - --
No.�.............��... FEs.....
THE COMMONWEALTH OF MASSACHUSETTS
_l BOARD OF HEALTH/
.................0 F � �� L—L).............................
Appliration for Dispaxi l Works Tonstrur#ion Frrnti#
Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal
System at:
.......... ................. ........ ..........................................................
Location-Address or Lot No.
c� .-- ..... W; .. .---` ....4Q...�:.t.. . r. rtL:..-- -
R' Owner t� I y�� t�¢dr
a 4.ST,.4l�..... L,�.. 1 ...--••--• i•• �.J�LI!!j.f{f1�gQ�l( ,J ��ie.-........._.1.::'....::/:f.�._17A.........................................
I
Installer Address
Type of Building Size Lot.22 . +1) q. feet
r _.......5
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building _`k S At.(1A? No. of persons._.__..._�1..._....... Showers ( ) — Cafeteria ( )
Other fixtures ...I......1t.000......AqiM 5.-----.7.M.Ps>------------------- -----•------ -----•--•---------..........----•-------------
Design Flow.......... __...:...................gallons per person per day. Total daily flow......41.6......__..._......._....gallons.
Septic Tank—L• capacit} -1 .0..gallons Length................ Width................ Diameter................ Depth................
uid
x Disposal Trench o......� -�(: Width.................... Total Length----A___6....... Total leaching area...................sq. ft.
Seepage Pit No............ .._-__ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft,
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results mP�e-rformed by.......................................__....___...___....._______.__.___. Date........................................
� Test Pit No. 1•�"'.:A!!Minutes per inch Depth of Test Pit.....]_�_I_.._..... Depth to ground water.. --}
(z, Test Pit No. 2,¢&in: iinutes per inch Depth of Test Pit......Lt....... Depth to ground water..^`.
Description of Soil....
....................................... [; ,---...S Aw; .....*Il
.......................................................... •-----.c`".-��----•- .................................f-- •••....-•••--•......_........ •---...-••---•-•-........ ......
x ........................................................... - e}...MILL............... ----........._.....-----....-----....._..------......••...•••••-
V Nature of Repairs or Alter tions—Answer when a plicable.........W M"1L....._.. _�0 !.......APkL1 Aa.....................
--------------------------------------------------------------------------
Agreement: z
The undersigned agrees to install the aforedescribed Individual/Sewage Disposal System,in accordance with
the provisions of TITLE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been iss d by the board of heal h.
ned.......... ..
Application Approved BY................ .tom ..-��..`. ..:. :... ......... Day ........
Date
Application Disapproved for the following reasons_..........................................................................................................___
-•......-•----••-------------•-•--•--..................------............-•---....._......-•---..............----------........._....------------------......--------.........._......---•--•.-•-••--•--
- Date
Permit No......-ate .... ...........
......... Issued.......... -- .. .......................
Date
THE COMMONWEALTH OF MASSACHUSETTS S S
BOARD OF HEALTH
... OF........ t-. r:I� ..
f�rrtif irtt#r o f�,antphanrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (. Y
by....... ; i .4.1_........ 1:k `, ° - --- ................ - --...... ---•-•-----•--...................... ......_............ ..._..._
..... ..... ..�.
Installer
has been installed in accordance with the provisions of TITLE of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No._-- .i_"•.7... dated.........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTI N SATISFACTORY.
1/6-//F
DATE............................................. ................ ............ Inspector........------C_..�._..._........--•••••--•-•••-•...•-•.......____.............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
N ?.-`. 1-7 ..... ..... ...0...............O F....? 11.c.%) ► .........................
Fg$ ............
Disposal ur� � s#rUdiVtt VMAU
Permissionis hereby granted.......... ......A._•-•-•- ..C....__..... -____............_---•--••-•-........................................................_....
to Construct ( or Repair an Individual Sewage Ispo System
atNo.... U �� � ._...... .. j��A; ................. __ fl --------------......--•---•-•---•.....
Street.'
as shown on the application for Disposal Works Construction Permit Dated......_j--!'l' ..................
..................... .............................................._
Board of Health
DATyyE.........: b �J.L.���j.........................
FORM''"1.2AS A. M. SULKIN, INC.. BOSTON
IL0•CATION ., SEW_AGE PERMIT NO.
yT I -1?4oruu-raoJ D � 7
VILLAGE
I N S T A LLER'S NAME & ADDRESS
-
14A re Get cA
BUILDER OR OWNER
�JL/
DA T E PERMIT ISSUED _s2 5--. �
DAT E COMPLIANCE ISSUED x
9
i h tE�
C�
_ t
_ / .2;
N� ...
THE COMMONWEALTH OF MASSACHUSETTS
BOA F HEALTH
0 F......14 v....T..TP..Q_C...................
Appliration for Diipos al Works Tonstrurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
S stem at
tipn d r s -- or Lot No
.........
..::_Q_1:t�:_��__�-•---M....... ".: ...................... ......�'�:... 1 t7.+ i. _ ....Er.,+_>_:.t..............................
er dd ss
a ...: :0.�CA_I`::_.:J..V° n .......................................... C f": :c . ........ -
Installer Address
` Type of Building Size Lot_5. .a_0J9.0..._Sq. feet
-� DwellingNo. of Bedr000s............................ . Attic ( ) Garbage Grinder ( )
— K .. .�. P
Other—Type of Building5[A► ""�_ o. of persons ________________ Showers —
a yp p x anslo ` ( ) Cafeteria ( )
Q' Other fixtures ._ �� ; � `�
d ..............••--------•......•--•-•-•-•- ---••-.
W Design Flow. .............. �:........_.___..gallons per pe�sonper day. Total daily flow........�_�__/..............__._....gallons.
W Septic Tank T Liquid capacity!: gal ns Length. ............. Widtj�................ Diameter................. Depth................
L > ,
x Disposal Trench-No..................... Wi ... ...�`_........ Total Length..'•. ............. Total leaching area...................sq. ft.
Seepage Pit No--------------------- Diameter............._...... Depth below inlet...... y.... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing�,�a ( `^
Percolation Test ReVt y Performed by 1�,- .-. _h114_L_t6# _ _......................... Date..... _
a Test Pit No. 1 ..____..__ minutes per inch Depth of Test+Pit ..t z-...... Depth to ground water #0 OWPA42 W,4j
(!evt ug.... t�v r-
Test Pit �,'o. 2________________minutes perinch Depth of Test Pit......._... ..... Depth to ground water........................
0 Description of Soil.....Q .!.. ' t_t_......`_�Q•� '......................................... 7�--•- . �h'`� �i -
V ........................................fie"`{4 !•r�^^
It V C ..Sja w l?---•---•---•-•_.._ .._- .. .-- ..•• ------------
Z -•--•--------------------------•------- '$W '`fit C_t - WXJ.---------------------------------•-•------------•------------•---------.-.--------------•-------....
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 TITi.L 5 of the State Sanitary ode T-- The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has a-n issued by the. rd of health.
Sign ........................ ------------Date .. _.
Application Approved By. = � "�`�" `� - `--- -7-- .... '
Date
Application Disapproved for the following reasons:------..................- _ •......-•----•--•-•-••••-••--•-••-••••-•••-•-••-•-•--••......••••••...._......
.........-•---•--•.....................................•-----------..........-------------....---------....-•--••-•------•------•------•-------•----•-•---•-•••-------•--••--•-••• - ......---•-•---
Date
PermitNo......................................................... Issued.......................................................
Date
THE,.COMMONWEALTH OF MASSACHUSETTS
BOAROF HEALTH
.............
c� .►v........:OF..... .h►'.... 1. ..��.. .........................
Trrtifirttti of ToutpliFanrr
TS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
' b l._ ..laCh_
Installer
at
has been installed in accordance with the provisions of T 5 of The State Sanitary Coc e s c� ,bed in the
application for Disposal Works Construction Permit NO.- _____.._�_s� ............ dated-....._........ "
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT.THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.....................................................•-•........._......------_. Inspector....................................................................................
,1
THE COMMONWEALTH OF MASSACHUSETTS
BOAR HEALTH
- , 1
No.:.:.......... :. ?. .. FEE...
..
Tjtion rranit
Permission is hereby granted _. .: C V :::_._ _
........--__....
to Constr�ct �_) or Rep�1' ) an Individual Sewage Disposal,'jYstern
Street
as shown on the plication for Disposal Works Construction 'e it Dated___ 't- �..................
�� $oard of Health
DATE. ..1._...'2,_!3�- ��------------------------------------------
FORM 'J255 HOBBS & WARREN, INC.. PUBLISHERS
f ti k r
/F ,cTNE^�-SFPT/C_'TAN.� /S �dRE
t M r G4
is `, .,--- e:-.•a..'_. - _ �� - - -Tf'"!A/Y:<.�2- /iV•G'h'E3 BEL'a!'v'� RAOE, ;A 2 _
1*4i%Y. `� "' _ //�[C/-1 L�/fiMETER :GONCf7ETE' >C'QVE.e.SHALL
y ='BE BROUGA/7- 7-6 aMA �Aiv: .EXTi?/a HFAVY
_ `
�- 1 P/PE _ GAS'T.iF oN,COVER SHALL 45 c�SED �F A/
CCNCRE •E .'P/7 1y -
co -
- PF
A _ _ • �-' - 2 •G4A OE� - /PVC P/i?E
• r L/4[J/pLEI/E� CGEA/v_SAND -
v ` ALC SO/L OOJVN TO
'f R
`.O 4' CAST-/ r Su/TA8Z E PERCOLATING
/AaN P/PE 2SndGAL. " : �.• •• •r.lr �.p i _ /�fATtR/AL 'TO BE RE—
N�iN. PircH
• � SEPTIC- TAit/K _ D/ST. e , .o +I •._>.'.�\s • a�a� /yDi�EO A/YO. REFJ EO II
p �9 ",oER FT _ BOX q�sl�ji r i • • i
o To'iv o TABULATION
SECT/ON OF • o , ° r O D:. , o
• 'a ;,;<' D/MENS/ON A 3 FT.
SEWAGC' D/SPa5AL SYSTEM 7i 4rTl rT/ / /,7'• p� 0 , O/MANSION B ._�-F r
LEACH) VCv TRENCH su/T
�L.89. AC La,:- O/MENS/ON C F7-
_ , r PERC�LAT/O/V� MA7---c/.4� A/MENS/On! Q Z(o FT
LC SCALE : �y - / - j i..
- GROU, U yi/,gTER 7;o45LE D/MENS/DN E 2._FT. " I
CL EA/V, . SOIL TEST
SOIL
LOG
Si�ivO: z x SOIL TEST �#1 SD/L TEST 2 `,
2"LA YE/? aF SATE .�F -50 TE5"T /d a I� ELEV. g S E=EV j
?�-,A.,b -.•.Zs�•-j ./ I'le - 318 WASHED S /C`
, n °+n.,Q. 4w• -STONE RESL'LTSW17-NESSEb BY/� ✓N/K�S�i.. _
o
to �� M 4 couB�E PERcc, ATiOn/RATE / - ,
• o ° ►° .�E,ppoRA7 pERG.?�T/O/V/3ATE# 2 y'H.a M/N.�/NCH u3 s o i� �
o �, Pvc U 3 4-
B , • 3/a - /z o pESl�sJN A
4 4 ° • WAYHE0 F
/?�Slj�+va.a-�✓T - ¢6 sE=�Ts =4 6 I- 3-0�y
• . p `° S7oNE ° Nr1Y7$€r? �i�—�4,F3$�. ..�:. '' G;A?A✓' L ' .-_"-
_ ,� e � .� y *
Su/TA/3LE —STi/JATED FLON/ /V 6AL �.4 S�4�✓n A*- I
PERCOLATiO 1! 6 L ✓ F i
/+Il1TE�Z/A L LEACr///V G fa.4E�1 /�S:, T r-` �/Z^✓�G
SECTION X X r RE F!e✓E A.eE� •_ ' L�-_� SO.FT., ��
.SCALE : 'l/4' _ / '- O" _ - t.. A/0 GROUNU WATER ENCOU/V7ERED I
- r r ''`^!c?, U/V WA7 AT .ELEV �
..___.T r -e ; �r M ss :^/1%El?T ELF✓AT/O/�/S + .. _: _ � i
D2NT0 / E �
ROBERTi y�, /NVeRr f+ r H[//LO/NG �cT MfrGC/4/2T1f /•/y 1V /Y I S
P. *^ �!�•ST� - - INLET .SE/�TiC: TANK -
v BUNiKIS ti '
ET SEPTIC TANK 6
w0.22162 0 ouT�. 9 G o. T. EL C�gEOGE EN6.Ive'6�/N6 CGt/NG.
- .40 9 w INLET D/S.TiK/fJUT/oN Boir- _� F"I,
�p G/ TEP 33 /Vo.z Sr
' - DI/TLtT, OiSTR/BUT/ON BD)C: __sY FT,
+ - HYANHiS
_ AL _ - MASS -,SO. Ys7RMOUTH, MASS- ,
END. 4 LE/kC1-//NG TRENCH
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