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HomeMy WebLinkAboutEHPR-04-2023-44183.tif N Imo- pH- �t��3- L! ., Y, � I3 ,, . ,f'4 N, ENVIRONMENTAL HEALTH ¢ Catawba County Government Center Catawba county 25 Government Drive ) P.O. Box 389 ( Newton, NC 28658 public health Phone: (828) 465-8270 ( Fax:(828)465-8276 r►cixo.iuvixa.IIrnEa. Email: EfiAdministrativeAssisinnts@CatawbaCountyNC.gov Food Establishment Plan Review Application Type of Construction: New ❑ Remodel ® Existing 0 RTAP*❑ *Revisions to Approved Plans Provide a list of:all changes to the previously approved plans.Revise application as related For REMODEL,specify the scope of work: 'f.tr i c r- 4 ck4-e ,', rr oth r rr 3 1 #1`:,,..... 4, 0.,r r 4 .e�kn r s fr-nT 0 15.p Name of Establishment: C ...ice r, If existing,please give name of old establishment if known: C.-Le c...k..-5 Address: (3o0{ Z' St N C City: (+I .-kc r Y State:NC ZIP Code: Z gCo 0( Phone(if available): Fax(if available): Owner or Owner's Representative: v 5 -(: A 6 . 11;e Address: vo "3*s>< 2 q $ City: A v.g._et State:,K5 C. ZIP Code: 2-`Z`1.5 ca Phone(if available): St-t3 --Go'0- 3 2-t7 Fax(if available): E-mail Address: cta_kcc A 1t C. c� 3,,,r,c.42; (,c 0 M Submitter: S Cc'-f"+ 6 : I l i Company: _ 1 Fcd.4 LL L Contact Person: ' co-(+ ( i I ( :e. Address: Tr) 3a k 29$ City: (c Q.e r State:KS C ZIP Code: 241`E.S e Phone(if available): J (g'f 7 j'2_`I - 5(a 3 I Fax(if available): E-mail Address: rce-k-co" -( 1 c &34,,,1', ( . t(or-,,.\ Title(owner,manager,architect,etc.): 31:—e c_-(ti r ( ,.c I c p.,...e"fi 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. Signature &Date:, s (O er or Responsible Representative) t , i 1/Y 6(2 7 Daily Hours of Operation: Sun icu-10 Mon to-10 Tue 10-10 Wed 10—I Thu(0—(0 Fri (U --(Z Sat lO-- 12. Projected number of meals served daily: • Breakfast: © Lunch: I $ Dinner. i 0 0 Number of food deliveries received per week: Number of seats: C7 Facility total square feet: 10 Projected start date of construction: I 4 ftk Zc2 3 Projected completion date: 1 Acty lc)`3 Type of food service: (Select all that apply) [Restaurant ❑ Sit-down meals ❑ Food Stand El Take-out meals ❑ Drink Stand ❑ Catering/ 0 Delivery ❑ Commissary 0 Custom Self-Service Area ❑ Meat Market ❑ Other(explain): Type of utensils used: Single-service (disposable): Multi-use (reusable): ❑ Plates 0 Glassware {]i Silverware 0 Plates 0 Glassware 0 Silverware Will specialized processes be used as specified in Section 3-502.11 of the North Carolina Food Code? ❑Yes N.No If YES, indicate which processes will be used: ❑ Curing 0 Acidification (sushi, etc.) ❑ Reduced Oxygen Packaging (eg:Vacuum) ❑ Smoking 0 Sprouting Beans ❑ Other Explain checked processes: Indicate any of the following highly susceptible populations that will be catered to or served: ❑ Nursing Home 0 Child Care Center ❑ Health Care Facility ❑Assisted Living Center 0 School with pre-school aged children ® N/A Will any virtual brands be provided? ❑Yes No If YES, list brand names: Menu to be served: Estimated number of meals per week: 1"— North Carolina Department of Health&Human Services • Division of Public Health • Environmental Health Section •Food Protection Program 5605 Six Forks Rd• 1632 Mail Service Center •Raleigh,NC 27699 Page 2 Revised 01/2023 Cold Storage: How was the volume of cold storage indicated below determined to be adequate? Reach-in cold storage (in cubic feet): Walk-in cold storage (in cubic feet): Reach-in refrigerator storage: 4 ft3 Walk-in refrigerator storage: ' fv ft3 Reach-in freezer storage: 0 ft3 Walk-in freezer storage: r, ft3 Number of reach-in refrigerators: Number of reach-in freezers: Cold Holding: List foods that will be held cold:(include equipment used) Fri c'S, -'r i ed ,'n.r~s kr O'ns. kC);A et -e.._, c.l: c-kz.-,, b ccn 5i WAJk-fn -fr - c 0cket ; re kJ-,- 1...-.4)r_x_e_oice.It(- Hot Holding: List foods that will be held hot: (include equipment used) 'atr5-es-5 , hof dc55 Cooling: Indicate by checking the appropriate boxes how cooked food will be cooled to 41°F(7°C)within 6 hours. If"Other"is checked indicate the type of food: as se ; Iv,,- 4' -s Cooling Process Meat Seafood Poultry Other Shallow Pans ❑ 0 ❑ 0 Ice Baths ❑ 0 0 Ea Rapid Chill** 0 ❑ 0 0 (**Check only if rapid chill equipment such as blast chillers are provided.) 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 0 0 0 0 Running Water less than 70°F(21°C) 0 ❑ 0 0 Cooked Frozen 12 6/( 0 0 Microwave 0 0 ❑ 0 North Carolina Department of Health&Human Services • Division of Public Health • Environmental Health Section •Food Protection Program 5605 Six Forks Rd• 1632 Mail Service Center •Raleigh,NC 27699 Page 3 Revised 01/2023 Food Handling Procedures: (Should be provided by ownerlowner's representative) 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, hot held, etc.) • When(time of day and frequency/day)food will be handled 1. Ready to eat foods: Edible without additional preparation necessary.e.g.,salads, cold sandwiches, raw molluscan shellfish bM 4 l�""s c, r g vi re)- e C. DZ. 3 c.,.' s f=-c,)►, l{e,-.Lr•. -j r 14-.6 0 . S 4 --C 4-.1 A ( 'rl"e-Q 1z 2. Produce; grains and pasta: e.g.,beans,rice,macaroni K co t->I�•e ci (Ipc o d flu ,N1, C o Ui.tr.S r- 3. Poultry: `J ? J T�r CA t :.r"ad ` a r-/�t 1/� -�:�'G��s'1 'F.� GfyY`1 I l�! �KTG:� C.-Di it 5/-d 4. Meat: h.-tr y t-3 GI f J.:5. S c - r. ..-e .�c?-�, Q S f2 5. Seafood: , s j- fie 7c- F,5 L, .A c r r` 7r,z,E-e-N ( S f ,r 4 North Carolina Department of Health&Human Services • Division of Public Health • Environmental Health Section •Food Protection Program 5605 Six Forks Rd• 1632 Mail Service Center •Raleigh,NC 27699 Page 4 Revised 01/2023 Dry Storage: Provide information on the frequency of deliveries and the expected gross volume that is to be delivered each time: /u.it l So 64 s Where will dry goods be stored? Square feet of dry storage shelf space: '3oc)ft2 Finish Schedule: Indicate floor,wall and ceiling finishes (e.g., quarry tile, stainless steel, vinyl coated acoustic tile) Area Floor Base Walls Ceiling Kitchen � ,h (,e FA(' acct.- Bar Off ,ni A/c,. Food Storage Dry Storage Toilet Rooms A-,1- +t 1•e A o.c eLL$(1 (c Dressing Rooms ,n f eN A(4 ,• fe; (`L Garbage& Refuse Storage C cM cr•e4e. C rs'')'J{.6o c(C A/c Service Sink ( I--;(4 / Other Other. Water Supply and Sewage: Water supply: al Municipal ❑Well Sewer: RI Municipal ❑ Septic Will ice be: j Made on premises ❑ Purchased Water heater(s): Tank type: a. Manufacturer and model: i/3.O b. Storage capacity: /L n gallons Electric water heater: 76,) kilowatts(kW) Gas water heater: BTU's c. Water heater recovery rate(gallons per hour at 80°F temperature rise): GPH Tankless: a. Manufacturer and model: b. Quantity of tankless water heaters: c. Water heater recovery rate(gallons per minute at 80°F temperature rise): GPM (See Water Heater Calculators on the Plan Review Unit website to calculate recovery rate needed) North Carolina Department of Health&Human Services • Division of Public Health • Environmental Health Section •Food Protection Program 5605 Six Forks Rd• 1632 Mail Service Center •Raleigh,NC 27699 Page 5 Revised 01/2023 a Check the appropriate box indicating equipment drains: Indirect Waste Direct Waste Plumbing Fixtures Floor sink Hub Drain Floor Drain Warewashing Sink 0 21 0 0 Prep Sinks ❑ 0 0 ❑ Handwashing Sinks 0 0 0 Warewashing Machine ilk,. ❑ ❑ ❑ ❑ Ice Machine 0 ❑ g 0 Garbage Disposal in(a 0 0 0 0 Dipper Well Alc, ❑ 0 0 ❑ Refrigeration 0 0 gr 0 Steam Table 0 0 2 0 Other. 0 ❑ 0 ❑ Other: 0 ❑ 0 0 Warewashing Equipment: Manual Warewashing: L( c1,4 L Size of each sink compartment(inches): Length: Width: Depth: What type of sanitizer will be used? 0 Chlorine 0 Iodine 0 Quaternary Ammonium 0 Hot Water ❑ Other(specify) Mechanical Warewashing: Will a warewashing machine be used? 0 Yes ®-No Warewashing machine manufacturer and model: Type of sanitization: ❑ Hot water(180°F) 0 Chemical General: Describe how cooking equipment, cutting boards, slicers, counter tops, other food contact surfaces and clean in place equipment that cannot be submerged in sinks or put through a dishwasher will be cleaned and sanitized: L 4 ,,,,tk k/ r,y,x..e /so._ : -tree ,,,4_-"tl,., d Describe location and type(drainboards,wall-mounted or overhead shelves, stationary or portable racks)of air-drying space: A bay ii €, ,eNk._ Square feet of air drying space: (do ft2 North Carolina Department of Health&Human Services • Division of Public Health • Environmental Health Section •Food Protection Program 5605 Six Forks Rd•1632 Mail Service Center •Raleigh,NC 27699 Page 6 Revised 01/2023 .• 4. Handwashing: Indicate number and location of handwashing sinks: o i (4-0 ct - Employee Accommodations: Indicate location for storing employees' personal items (ex. coats, purses, medication, etc.): lG ` r, Refuse and Recyclables: Will refuse be stored inside? ❑ Yes Ca No If yes,where: Provision for refuse disposal: jgDumpster ❑ Compactor Will a contract for off-site cleaning of the dumpster/compactor be obtained? g Yes ❑ No If yes, indicate name of cleaning contractor: Will the dumpster/compactor be cleaned at the establishment? E.Yes ❑ No Describe location for storage of recyclables(cooking grease, cardboard, glass, etc.): Service Sink: Location and size of service(mop)sink/can wash: 2 (c 04- A.v < Describe location for storage of cleaning implements(e.g. mops, brooms, hoses,etc.): Insect and Rodent Control: How is protection provided on all outside doors? ❑ Self-closing door 0 Fly Fan ❑ Screen Door How is protection provided on windows(including drive-thru windows) or other openings to the outer air? ❑ Self-closing (, Fly Fan ❑ Screening ❑ N/A Linen: Indicate location of clean and dirty linen storage: ['v]"N/A(no linen storage on site) Poisonous and Toxic Material: Indicate location) of poisonouso and//orr/toxic materials (chemicals, sanitizers, etc.)storage: Y r'/ S 7�r� V�,rl• z L. Or A—ke C4 S 41. £A-z k e c< S North Carolina Department of Health&Human Services • Division of Public Health • Environmental Health Section •Food Protection Program 5605 Six Forks Rd• 1632 Mail Service Center • Raleigh,NC 27699 Page 7 Revised 01/2023 K1401-1\!.., - CATAWBA COUNTY 100A SOUTHWEST BLVD NEWTON,NORTH CAROLINA 28658 RECEIPT 3 �. PHONE:828.465.8399 Thursday,April 27,2023 (486. I8. 2 5M www.catawbacountync.gov PAYOR: Gillie,Scott PAYMENTS TRANSACTION NUMBER: TRC-62807878-27-04-2023 PAYMENT DATE: 04/27/2023 PAYMENT TYPE: Credit Card 304426751 INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT 04-23-421834 110-580200-663000 Food and Lodging Review Fee $250.00 TOTAL PAYMENTS: $250.00 EHPR-04-2023-44183 CASE TYPE: Environmental Health Plan Review WORK CLASS: Other FLI SITE ADDRESS: 1304 2ND ST NE,HICKORY NC 28601 Applicant SCOTT GILLIE,, B:8433245631 SCGILLIE@GMAIL.COM **NO PEOPLESOFT ACCOUNT ASSIGNED** receipt 04/27/2023 14:14 Page 1 of 1