HomeMy WebLinkAboutCBPR-07-2016-24286.TIF C3Pi2-07- 9010 — sa-Vi
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\ ' e /� Catawba County Public Health
�, s�? f -Cy www.catawbacountvnc.gov/environmentalhealth\
COUNTY
Environmental Health
North Carolina_n ' P.O. Box 389, 100-A South West Blvd., Newton, NC 28658
Phone (828) 465-8270. Fax (828) 465-8276
Food Establishment Plan Review Application
Type of Construction: NEW I REMODEL EXISTING ❑
Name of Establishment: khYMonn,S (lfleXimn lrY ii
If existing, please give name of old establishment if known: h FT.
Address: { 1 YIO(Eh (tfrel;nrz nve
City: nno ii den Zip Code:Cfl& iQ
Phone (if available): - - Fax: - -
Owner or Owner's Representative: _—M I , I . 'i-l'`QC\ es
Address: (9:2)O i -)C00 * dr.
City & State: ne-kon ¶7C1`Off1 13.0 Zip Code: O1
Telephone: & -Q(;) -4871 Fax: - -
E-mail Address: even}P5 Y i ford° 3D-79 e[ rill i• COM
Submitter: The I T. Men eti fs
Company: 3 He lQiiO5 RIexiron Crri I I
Contact Person: J of t T Pwn/ec
Address: ornonf Dr.
City & State jfnn5 ein Or Zip Code: )7io7
Telephone: 33k - i - 532 1 Fax: - -
E-mail Address:
Title (owner, manager, architect, etc.): Cilia lPY
I certify that the information in this application is correct, and I understand that any deviation without
prior approval from this Health Regulatory Office may nullify plan approval.
Signatureer0/ . i—
v wner or Responsible Representative)
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Hours of Operation: •
SunlI-9pnMon pTuej/-lm WediLape ThufJ al Fri 11-10froSatifjoloi
Projected number of meals served between product liveries: ti'lO
Breakfast: Lunch: Dinner:
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Number of seats: In Facility total square feet: Y.,
Projected start date of construction: Projected completion date: `13 rn \kAn
TYPE OF FOOD SERVICE: CHECK ALL THAT APPLY
bestaurant VSit-down meals
n Food Stand ✓Take-out meals
❑ Drink Stand ❑ Catering
n Commissary Single-service (disposable):
Plates (Glassware Silverware
n Meat Market
Multi-use (reusable):� ,/
n Other (explain): Tates I<Glassware Efgllverware
Indicate any specialized processes that will take place:
n Curing n Acidification (sushi, etc.) ❑ Reduced Oxygen Packaging (eg: Vacuum)
n Smoking Sprouting Beans n Other
Explain checked processes:
Indicate any of the following highly susceptible populations that will be catered to or served:
n Nursing Home n Child Care Center n Health Care Facility
n Assisted Living Center n School with pre-school aged children
❑ NA
Please Enclose the Following Documents
• Proposed menu items (including seasonal variations in the menu).
• Manufacturer specification sheets for each piece of equipment shown on plans.
• Site plan showing location of business in building, location of building on site including alleys, streets
and location of any outside facility (dumpster, walk-ins, etc.).
• Plan of facility drawn to scale showing location of equipment, plumbing, electrical service and
mechanical ventilation, including location of all electrical panels.
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• Contents and Format of Plans and Specifications
1. The plans should be a minimum of 11 X 14 inches in size and the layout of the floor plan accurately drawn to a
minimum scale of 1/4 inches= 1 foot. This is to allow for ease in reading.
2. Information accompanying the plans should include;the proposed menu, seating capacity, projected daily meal
volume for food service operation.
3. The plans should show the location and when requested elevated drawing of all food service equipment. Each
piece of equipment shall be clearly labeled on the plan with its common name.
4. Adequate rapid cooling including ice baths and refrigeration, and hot-holding facilities for potentially hazardous
food (PHF) should be clearly designated on the plan.
5. When menu dictates, separate food preparation sinks should be labeled and located to preclude contamination
and �1u,s-sontantination of raw and ready to eat foods.
6. Adequate hand washing facilities used for no other purpose should be designated for each toilet facility and in
the immediate area of food preparation and dishwashing area.
7. The plan layout should contain room size, aisle space, space between and behind equipment, and the placement
of the equipment on the floor.
8. Auxiliary areas such as storage rooms, garbage rooms, toilets, basements and/or cellars used for storage or food
preparation should be represented on the plan and all features of these rooms shown as required by the
standards.
9. The plans and specifications should also include:
A. Entrances, exits, loading/unloading areas and docks;
B. Completed finish schedules for each room to include floors, walls, ceilings and coved juncture bases;
approved materials for food preparation, handling and storage areas include quarry tile, ceramic tile, sealed
concrete, commercial linoleum, fiberglass reinforced panels, stainless steel, wall board painted with
washable, nonabsorbent paint, vinyl coated ceiling tiles, and brick, cinder blocks, slag blocks, or concrete
blocks, if glazed,tiled, plastered or filled so as to provide a smooth surface. If specifying the use ofa
material not on this list, include a sample of the material for evaluation.
C. Plumbing schedule to include location of the floor drains, floor sinks and water supply lines, overhead
waste water lines, hot water lines, hot water generating equipment with capacity and recovery rate,
backflow prevention, waste water line connections. Electrical layout, electrical panels and disconnects.
10. Lighting Requirements;.
A. Surfaces where a food employee is working with food or working with utensils or equipment such as
knives, slicers, grinders or saws where employee safety is a factor at those levels: 50 foot candles (540 lux)
B. In walk-in refrigeration units and dry food storage areas and in other areas and rooms during periods of
cleaning at a distance of 30 inches (75 cm) above the floor: 10 foot candles (108 lux)
C. Lighting in utensil washing area and on food contact surfaces shall be measured at 30 inches (75 cm) above
the floor and/or at the work levels and equipment and utensil storage and toilet rooms: 20 foot candles (215
lux)
D. At surfaces where food is provided for consumer self-service such as buffets and salad bars or where fresh
produce or packaged foods are sold or offered for consumption, inside equipment such as a reach-in and
under-counter refrigerators: 20 foot candles (2151ux)
E. Light bulbs in food preparation, storage, and display areas shall be shatter-proof or shielded so as to
preclude the possibility of broken bulbs or lamps falling into food. Shatter-proof or shielded bulbs need not
be used in food storage areas where the integrity of the unopened packages will not be affected by broken
glass falling onto them and the packages, prior to being opened, are capable of being cleaned. Heat lamps
shall be protected against breakage by a shield surrounding and extending beyond the bulb, leaving only the
face of the bulb exposed in food preparation area.
11. Insure that all food service/kitchen equipment is NSF International (NSF) listed, Underwriters
Laboratories Inc., Classified for Sanitation or if not NSF or UL listed/classified, be constructed to meet NSF
standards as specified according to 15A NCAC 18A .2600, Rule .2617 paragraph (d).
12. Source of water supply and method of sewage disposal. The location of these facilities should be shown and
evidence submitted that state and local regulations are to be complied with.
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13. As specified according to I5A NCAC I8A .2600, Rule .2632 "Storage Spaces". All items stored in rooms
where food or single-service items are stored shall be at least 12 in. (30.48 cm.) above the floor when placed on
stationary storage units or 6 in. (15.24 cm.) above the floor when placed on portable storage units or otherwise
arranged so as to permit thorough cleaning.
14. Ventilation schedule for each room.
15. A mop sink with facilities for hanging wet mops and storage of mop buckets. As specified according to 15A
NCAC 18A .2600, Rule .2626, "Disposal Of Waste". Facilities shall be provided for the washing and storage of
all garbage cans and mops. These facilities can be incorporated into a janitor closet.
16. Garbage can washing area/facility. As specified according to 15A NCAC 18A .2600, 2009 NC Food Code
Manual 5-203.13. "Plumbing Systems". Adequate facilities shall be provided for the washing and storage of all
garbage cans. The cleaning facilities shall include a combination faucet, hot and cold water, a threaded nozzle
and a curbed impervious pad, a minimum recommended size of 36" x 36" x 4" with walls finished being easily
cleanable and nonabsorbent to a height of 48 inches. A shelf may also be provided for the storage of cleaning
supplies and/or chemicals.If the unit is utilized as a combination can wash/mop sink than the minimum
recommended size for this unit is 36"by 36".
17. Dumpster pad and location as specified according to 15A NCAC 18A .2600, 2009 NC Food Code Manual 5-5
Refuse, Recyclables and Returnables".
18. Grease traps and/or grease interceptor location.
19. Grease storage containers and storage location.
20. Cabinets/shelves for storing toxic chemicals.
21. Dressing rooms, locker area, employee rest area, and/or coat rack as required.
22. Completed checklist.
23. Site plan (plot plan)
COLD STORAGE
Method used to determine cold storage requirements:
Cubic-feet of reach-in cold storage: Cubic-feet of walk-in cold storage:
Reach-in refrigerator storage: ft' Walk-in refrigerator storage: ft'
Reach-in freezer storage: ft' Walk-in freezer storage: ft'
Number of reach-in refrigerators: /
Number of reach-in freezers:
HOT HOLDING
Food that will be held hot:
R1cx, m ecac.4m\, { round koeef1 CV\.e Stn . S'c?&cS
COLD HOLDING
Food that will be held cold:
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. COOLING
Indicate by checking the appropriate boxes how cooked food will be cooled to 45°F (7°C) within 6 hours.
If"Other" is checked indicate type of food:
Cooling Process Meat Seafood Poultry Other
Shallow Pans ❑ ❑ ❑
Ice Baths .4 0
Rapid Chill ❑ ❑ ❑ ❑
THAWING
Indicate by checking the appropriate boxes how food in each category will be thawed.
If"Other" is checked indicate type of food:
Thawing Process Meat Seafood Poultry Other
Refrigeration • 17✓/ �� ❑
Running Water less than 70°F (21°C) ❑ ❑ ❑
Cooked Frozen ❑ ❑ ❑ ❑
Microwave ❑ ❑ ❑ ❑
FOOD HANDLING PROCEDURES
Explain the following with as much detail as possible. Provide descriptions of the specific areas of the
kitchen and corresponding items on the plan where food will be handled.
Explain the handling procedures for the following categories of food. Describe the process from receiving to
service including:
• How the food will arrive (frozen, fresh,packaged, etc.)
• Where the food will be stored
• Where (specific pieces of equipment with their corresponding equipment schedule numbers) and how
the food will be handled (washed, cut, marinated, breaded, cooked, etc.)
• When (time of day and frequency/day) food will be handled
1. READY-TO-EAT FOOD HANDLING (edible without additional preparation necessary, e.g.,
salads, cold sandwiches. raw molluscan shellfish)
NcD
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2. PRODUCE HANDLING
a. Will produce be washed or rinsed prior to use? Yes ✓ No
b. Is there an approved location used for washing or rinsing produce? Yes No
c. Will it be used for other operations? Yes No
Please indicate location of produce washing equipment and describe the procedures. Include time of day and
frequency for washing or rinsing the produce at this location:
Otep <tnK of r txALV4
3. POULTRY HANDLING
a. Will poultry be washed or rinsed prior to use? Yes Y No
b. Is there an approved location used for washing or rinsing poultry? Yes ,// No
c. Will it be used for other operations? Yes No
Please indicate location of poultry washing equipment and describe the procedures. Include time of day and
frequency for washing or rinsing the poultry at this location:
\ Prep in \4; CHC 0()L1 .1(y
4. MEAT HANDLING /
a. Will pork and red meats be washed or rinsed prior to use? Yes No ✓
b. Is there an approved location used for washing or rinsing pork and red meats? Yes ./ No
c. Will it be used for other operations? Yes No
Please indicate location of seafood washing equipment and describe the procedures. Include time of day and
frequency for washing or rinsing the seafood at this location:
noA ustS iry)
5. SEAFOOD HANDLING
a. Will seafood be washed or rinsed prior to use? Yes \/o
b. Is there an approved location used for washing or rinsing seafood? Yes / No
c. Will it be used for other operations? Yes No
Please indicate location of seafood washing equipment and describe the procedures. Include time of day and
frequency for washing or rinsing the seafood at this location:
F3i,chel- fiCr ser-1-034 only
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. DRY STORAGE
Provide information on the frequency of deliveries and the expected gross volume that is to be delivered each
time: A-1.lYl25 A uce med and vC'y ekbtrzs
Square feet of dry storage shelf space: ft2
Where will dry goods be stored? Gcf 40 Y472, oseck •
FINISH SCHEDULE
Indicate floor, wall and ceiling finishes (e.g., quarry tile, stainless steel, vinyl coated acoustic tile)
Area Floor Base Walls Ceiling
Kitchen 10E- 064we tl5 C 1 1 rPra-C
Bar it 1� it �I COtin
lilR
Food Storage 1( 1 / 4A,c"U I -4
Dry Storage U I 1( �l 7 II
1, l�n
Toilet Rooms 1 I le Cei
I V-
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Dressing Dressing Rooms
Garbage & Refuse
Storage
Service Sink f t It
) toottA p-cof
Ceiling I-HIe
Other
Other
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WATER SUPPLY - SEWAGE
I. Is water supply: Municipal 2/Wan Is sewer: Municipals Septic
2. Will ice: be made on premises 77;purchasedn
3. Water heater:
• Tank type:
a. Manufacturer and model:
b. Storage capacity: WD gallons
▪ Electric water heater: kilowatts (kW)
• Gas water heater: ('%0A2 BTU's
c. Water heater recovery rate (gallons per hour at 80°F temperature rise): GPH
(See Water Heater Calculator on the Plan Review Unit website to calculate recovery rate needed)
o Tankless:
a. Manufacturer and model:
b. Quantity of tankless water heaters:
4. Check the appropriate box indicating equipment drains:
Indirect Waste Direct Waste
Plumbing Fixtures Floor sink Hub Drain Floor Drain
Warewashing Sink ❑ ❑ ❑
Prep Sinks -❑/ ❑
Handwashing Sinks ❑ L2' ❑ ❑
Warewashing Machine ❑ ❑ ❑
Ice Machine ❑ ❑ ❑
Garbage Disposal ❑ ❑ ❑ ❑
Dipper Well ❑ ❑ ❑ ❑
Refrigeration ❑ ❑ ❑ ❑
Steam Table ❑ ❑ ❑ ❑ deck-C
Other ❑ ❑ ❑ ❑
Other ❑ ❑ ❑ ❑
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. W`1REWASHING EQUIPMENT
a. Manual Warewashing
1. Size of sink compartments (inches): Length: Width: Depth:
2. What type of, ssaanitizer will be used?
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Chlorine: �f Iodine: ❑ Quaternary Ammonium: ❑ Hot Water: 6tther (specify): ❑
b. Mechanical Warewashing �/
1. Will a warewashing machine be used? Yes/ Non
Warewashing machine manufacturer and model:
2. Type of sanitization: Hot water (180°F) V Chemical EV..-
c. General
1. Describe how cooking equipment, cutting boards, slicers, counter tops and other food contact surfaces
that cannot be submerged in sinks or put through a dishwasher will be cleaned and sanitized:
atesc ileri S t be LOraed crrt)bbzd then
. po{ .1-he d1sh.oashe(•
srf' re Sr rubbed .l�\h bit-cce.rd
San;:liter
2. Describe location and type (drainboards, wall-mounted or overhead shelves, stationary or portable
racks) of air drying space:
no
Square feet of air drying space: ft2
HANDWASHING
Indicate number and location of handwashing sinks:
EMPLOYEE ACCOMMODATIONS
Indicate location for storing employees' personal items:
\C\ fl l VQh,de)
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REFUSE AND RECYCLABLES ;
1. Will refuse be stored inside? Yes❑ No
If yes, where
2. Provision for refuse disposal: Dumpster/Compactor n
3. Provision for cleaning dumpster/compactor: On-site n Off-site
If off-site cleaning, provide name of cleaning contractor:
4. Describe location fpr storage of recyclables: (cooking grease, cardboard, glass, etc.):
Eht�
SERVICE SINK
1. Location and size of service (mop) sink/can wash: [-Xt (t
2. Is a separate mop storage area provided? Yes fr<o ❑ If yes, describe type and location:
INSECT AND RODENT CONTROL
1. How is protection provided on all o tside doors?
Self-closing door / Fly Fan _ Screen Door n
2. How is protection provided on windows? r
Self-closing n Fly Fan ❑ Screening 0110 I� OQLT)
LINEN
1. Indicate location of clean and dirty linen storage:
POISONOUS OR TOXIC MATERIALS
1. Indicate location of poisonous and/or toxic materials (chemicals, sanitizers, etc.) storage:
51vrc15-P
Catawba County Environmental Health
P.O. Box 389, 100-A South West Blvd., Newton, NC 28658
Phone (828) 465-8270. Fax (828) 465-8276
www.catawbacountvnc.gov/environmentalhealth
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