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HomeMy WebLinkAboutMiscellaneous - 127 WAVERLY ROAD 4/30/20187 w Town of North Andover HEALTH DEPARTMENT fi nATF• /-",/ LOCATION: H/O NAME: Type of Permit or License: (Check boxrl Septic - Soil Testing ❑ Animal $ ❑ Body Art Establishment $ ❑ Body Art Practitioner $ ❑ D mpster $ Septic Disposal Works Installers (DWI) © Food Service - Type:' �N/,�/ $��✓� �2j ❑ Funeral Directors�j�/�C! $ ❑ Massage Establishment $ ❑ Massage Practice $ ❑ Offal (Septic) Hauler $ ❑ Recreational Camp $ ❑ Sun tanning $ ❑ Swimming Pool $ ❑ Tobacco $ ❑ Trash/Solid Waste Hauler $ ❑ Well Construction $ . SEPTIC Systems: ❑ Septic - Soil Testing $ ❑ Septic - Design Approval $ ❑ Septic Disposal Works Construction (DWC) $ ❑ Septic Disposal Works Installers (DWI) $ ❑ Title 5 Inspector $ ❑ Title 5 Report $ ❑ Other: (Indicate) $ Health Agent Initials k White - Applicant Yellow - Health Pink - Treasurer liAJUI f, . Food and Drug Administration and Conference for Food Protection FOOD ESTABLISHMENT PLAN REVIEW GUIDE 2000 SECTION I FOOD ESTABLISHMENT PLAN REVIEW APPLICATION TO BE COMPLETED BY THE OPERATOR AND SUBMITTED TO THE REGULATORY AUTHORITY Date: 6 // RECEIVED Regulatory Authority JUN 13 2008 TOWN OF NORT ANDOVER. HEALTH DEPARTMENT FOOD ESTABLISHMENT PLAN REVIEW APPLICATION NEW REMODEL CONVERSION Name of Establishment: 17q C'l�1 1A _ (A Category: Restaurant , Institution , Daycare , Retail Market , Other Address: � 'ri Aj ` iz L`t o f2T-v� Ilia OIS7445­ y / Phone if available: c7 7 `� • 7� S ��3 / ��� Name of Owner: ee / 11enll6ye ✓ Mailing Address: ! Q'7 IyatltlZ � A�1Z �IJ� Q -,/Z• ' o �Y5 Telephone: % 7 7-7p ' 133-9, Applicant's Name: /- eyA/ 1/"/1U Title (owner, manager, architect, etc.):r' Mailing Address: Telephone: I have submitted plans/applications to the following authorities on the following dates: http://www.cfsan.fda.gov/–dms/Prev-l.html 3/24/2008 Governing Board of Council Zoning Planning Building Conservation Hours of Operation: Number of Seats:_ Number of Staff _%` (Maximum per shift) Sun /P Mon i/-' Tues t % fT/ 4 Wed Wyk- q phi Total Square Feet of Facility: 415F -&Q(9 Number of Floors on which operations are conducted Maximum Meals to be Served: (approximate number) Projected Date for Start of Project: of/" 0 Thurs 11 P —Cl Ply] Fri r/4/0- q 60 Sat // /hA '4t/IAA Breakfast_ Lunch Dinner Projected Date for Completion of Project: 6 Type of Service: (check all that apply) Sit Down Meals Take Out V'- Caterer /Caterer Mobile Vendor Other O -e /i v e v� Please enclose the following documents: __zProposed Menu (including seasonal, off-site and banquet menus) Plumbing, Electric.. Police Fire Other ( ) Manufacturer Specification sheets for each piece of equipment shown on the plan i Site plan showing location of business in building; location of building on site including alleys, streets; and location of any outside equipment (dumpsters, Well, septic system - if applicable) ' JPlan _drawl _to scale _of food establishment showing location of equipment, plumbing, electrical services and mechanical ventilation http://www.cfsan.fda.gov/-dms/prev-l.html 3/24/2008 r Equipment schedule CONTENTS AND FORMAT OF PLANS AND SPECIFICATIONS 1. Provide plans that are a minimum of 11 x 14 inches in size including the layout of the floor .plan accurately drawn to a minimum scale of 1/4 inch = 1 foot. This is to allow for ease in reading plans. 2. Include: proposed menu, seating capacity, and projected daily meal volume for food service operations. 3. Show the location and when requested, elevated drawings of all food equipment. Each piece of equipment must be clearly labeled on the plan with its common name. Submit drawings of self-service hot and cold holding units with sneeze guards. 4. Designate clearly on the plan equipment for adequate rapid cooling, including ice baths and refrigeration, and for hot -holding potentially hazardous foods. 5. Label and locate separate food preparation sinks when the menu dictates to preclude contamination and cross - contamination of raw and ready -to -eat foods. 6. Clearly designate adequate handwashing lavatories for each toilet fixture and in the immediate area of food preparation. 7. Provide the room size, aisle space, space between and behind equipment and the placement of the equipment on the floor plan. 8. On the plan represent auxiliary areas such as storage rooms, garbage rooms, toilets, basements and/or cellars used for storage or food preparation. Show all features of these rooms as required by this guidance manual. 9. Include and provide specifications for: a. Entrances, exits, loading/unloading areas and docks; b. Complete finish schedules for each room including floors, walls, ceilings and coved juncture bases; c. Plumbing schedule including location of floor drains, floor sinks, water supply lines, overhead waste -water lines, hot water generating equipment with capacity and recovery rate, backflow prevention, and wastewater line connections; d. Lighting schedule with protectors; (1) At least 110 lux (10 foot candles) at a distance of 75 cm (30 inches) above the floor, in walk-in refrigeration units and dry food storage areas and in other areas and rooms during periods of cleaning; (2) At least 220 lux (20 foot candles): (a) At a surface 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; (b) Inside equipment such as reach -in and under -counter refrigerators; http://www.cfsan.fda.gov/-,dms/prev-l.html 3/24/2008 (c) At a distance of 75 cm (30 inches) above the floor in areas used for handwashing, warewashing, and equipment and utensil storage, and in toilet rooms; and. (3) At least 540 lux (50 foot candles) at a surface 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. e. Food Equipment schedule to include make and model numbers and listing of equipment that is certified or classified for sanitation by an ANSI accredited certification program (when applicable). f. Source of water supply and method of sewage disposal. Provide the location of these facilities and submit evidence that state and local regulations are complied with; g. A color coded flow chart demonstrating flow patterns for: -food (receiving, storage, preparation, service); -food and dishes (portioning, transport, service); -dishes (clean, soiled, cleaning, storage); -utensil (storage, use, cleaning); -trash and garbage (service area, holding, storage); h. Ventilation schedule for each room; i. A mop sink or curbed cleaning facility with facilities for hanging wet mops; j. Garbage can washing area/facility; k. Cabinets for storing toxic chemicals; 1. Dressing rooms, locker areas, employee rest areas, and/or coat rack as required; m. Completed Section 1; n. Site plan (plot plan) FOOD PREPARATION REVIEW Check categories of Potentially Hazardous Foods (PHF's) to be handled, prepared and served. CATEGORY* (YES) (NO) 1. Thin meats, poultry, fish, eggs (hamburger; sliced meats; fillets) ( Vj ( ) 2. Thick meats, whole poultry (roast beef; whole turkey, chickens, hams) (Vc ( ) 3. Cold processed foods (salads, sandwiches, vegetables) ov� ( ) 4. Hot processed foods (soups, stews, rice/noodles, gravy, chowders, casseroles) (t 5. Bakery goods (pies, custards, cream fillings & toppings) 6. Other F/ Z;bi . f- & U-tolve--_S : * A .generic HACCP plan for each category of food may be available from the regulatory- -authority for reference. " PLEASE CIRCLE/ANSWER THE FOLLOWING QUESTIONS http://www.cfsan.fda.gov/—dms/prev-l.html 3/24/2008 FOOD SUPPLIES: 1. Are all food supplies from inspected and approved sources? es /NO 2. What are the projected frequencies of deliveries for Frozen foods _ Cf. Refrigerated foods ' b$e; and Dry goods / J2 3. Provide information on the amount of space (in cubic feet) allocated for: Dry storage Refrigerated Storage yoo 6.r. , and Frozen storage 3o .F, 4. How will dry goods be stored off the floor? COLD STORAGE: 1. Is adequate and approved fre er and refrigeration available to store frozen foods frozen, and refrigerated foods at 41 °F (5°C) and below? Uy NO Provide the method used to calculate cold storage requirements. 2. Will rawmeats, poultry and seafood be .stored in the .same refrigerators .and freezers. with .cooked/ready-to-eat foods? O If yes, how will cross -contamination be prevented? �IjleS - g � S��l f crc - !'-( /u L�;c��r� �✓� �I 3. Does each refrigerator/freezer have a thermometer? 6/ NO Number of refrigeration units: 3 Number of freezer units: 2.- 4. Is there a bulk ice machine available? YES &O THAWING FROZEN POTENTIALLY HAZARDOUS FOOD: Please indicate by checking the appropriate boxes how frozen potentially hazardous foods (PHF's) in each category will be thawed. More than one method may apply. Also, mdicate where thawing will take place. Thawing Method *THICK FROZEN FOODS *THIN FROZEN FOODS Refrigeration Running Water Less than 70'F(2 I' hup://www.cfsan.fda.gov/—dms/Prev-l.html 3/24/2008 C) 130°F (121 min) solid seafood pieces Microwave (as part of cooking process) other PHF's 145T (15 sec) Cooked from Frozen state Immediate service 145°F (15 sec) Other (describe) pooled* 155T (15 sec) *Frozen foods: approximately one inch or less = thin, and more than an inch = thick. COOKING: 1. Will food product thermometers be used to measure final cooking/reheating temperatures of PHF's? S)1 NO What type of temperature measuring device:ll�ae,[1, Minimum cooking time and temperatures of product utilizing convection and conduction heating equipment: beef roasts 130°F (121 min) solid seafood pieces 145°F (15 sec) other PHF's 145T (15 sec) eggs: Immediate service 145°F (15 sec) pooled* 155T (15 sec) (*pasteurized eggs must be served to a highly susceptible population) pork 145°F (15 sec) comminuted meats/fish 155T (15 sec) poultry 165°F (15 sec) reheated PHF's 165°F (15 sec) 2. List types of cooking equipment. W, HOT/COLD HOLDING: 1. How will hot PHF's be maintained at 140T (60°C) or above during holding for service? Indicate type and number of hot holding units. http://www.efsan.fda.gov/—dms/Prev-l.html 3/24/2008 2. How will cold PHF's be maintained at 41'F (5°C) or below during holding for service? Indicate type and number of cold holding units. t w 1K a JiYt- t/,5 COOLING: wJ Please indicate by checking the appropriate boxes how PHF's will be cooled to 41'F (5°C) within 6 hours (140°F to 70° F in 2 hours and 70°F to 41 °F in 4 hours). Also, indicate where the cooling will take place. COOLING THICK THIN MEATS THIN SOUPS/ THICK RICE/ METHOD MEATS GRAVY SOUPS/ NOODLES GRAVY Shallow Pans / V Ice Baths Reduce Volume or Size Rapid Chill Other Vj (describe) Lt's 0d 0 � e b -�f ,dies REHEATING: 1. How will PHF's that are cooked, cooled, and reheated for hot holding be reheated so that all parts of the food reach a temperature of at least 165°F for '15 seconds. Indicate type and number of units used for reheating foods. '?'0s , � � yf h /1 , r*5 2. How will reheating food to 165°F for hot holding be done rapidly and within 2 hours? j ItA) http://www.cfsan.fda.gov/—dms/Prev-l.httnl 3/24/2008 PREPARATION: 1. Please list categories of foods prepared more than 12 hours in advance of service. f 4A W_ 0 2. Will food employees be trained in good food sanitation practices? / NO Method of training: S� Number(s) of employees: Dates of completion: ill disposable gloves and/or utensils and/or food grade paper be used to prevent handling of ready -to -eat foods? t's", NO 4. Is there a written policy to exclude or restrict food workers who are sick or have infected cuts and lesions? EE�S / NO Please describe briefly: Will employees have paid sick leave? YES /�JO 5. How will cooking equipment, cutting boards, counter tops and other food contact surfaces which cannot be submerged in sinks or put through a dishwasher be sanitized? Chemical Type; ' o'11 tom-. 'x Concentration: S7 e/n Test Kit YES / NO 6. Will ingredients for cold read eat foods su as tuna, mayonnaise and eggs for salads and sandwiches be pre - chilled before being mixed and/or assembled? /NO If not, how will ready -to -eat foods be cooled to 41 °F? http://www.efsan.fda.gov/—dms/Prev-l.htrnl 3/24/2008 t - )AIUI,F: r ooa hstaolisnment Pian Keview t_rume - aections i 7. Will all produce be washed on-site prior to use?S / NO Is there a planned location used for washing produce? S NO 1 { r Describe el'41Yc/ /V� I�f� � ��J'L! ��t/ F ✓' . / �/ /!/%ice If not, describe the procedure for cleaning and sanitizing multiple use sinks between uses. Ile pkle '4W yc 4e'415-/" 11.o .; rage y ui i y 8. Describe the procedure used for minimizing the length of time PHF's will be kept in the temperature danger zone (41 T - 140T) during preparation. e T 9. Provide a HACCP plan for specialed processing methods such as vacuum packaged food items prepared on-site or, otherwise required by the regulatory authority. /j 10. Will the facility be serving food to a highly susceptible population? YES /NO If yes, how will the temperature of foods be maintained while being transferred between the kitchen and service area? A. FINISH SCHEDULE http://www.cfsan.fda.gov/—dms/Prev-l.html 3/24/2008 Applicant must indicate which materials (quarry tile, stainless steel, 4" plastic coved molding, etc.) will be used ita the following areas. Kitchen FLOOR COVING WALLS CEILING Bar Food Storage �i 0 lot,e S�va F �C ( Other Storage Toilet Rooms r/ rW Dressing Rooms Garbage & Refuse Storage' Mop Service Basin C e r a OA G Area Warewashing v �J Jv � �' ✓. S Area Walk-in f Refrigerators and / Freezers B. INSECT AND RODENT CONTROL APPLICANT: Please check appropriate boxes. YES NO NA http://www.efsan.fda.gov/—dms/Prev-l.htrnl 3/24/2008 PUA/UI Y: 1~ooa Establishment Flan tceview uuicie - aections i rage 11 01 iy 1. Will all outside doors be self-closing and rodent proof ? (41 2. Are screen doors provided on all entrances left open to the outside? ( () ( ) 3. Do all openable windows have a minimum # 16 mesh screening? 4. Is the placement of electrocution devices identified on the plan? 5. Will all pipes & electrical conduit chases be sealed; ventilation systems exhaust and intakes protected? 6. Is area around building clear of unnecessary brush, litter, boxes and other harborage? 7. Will air curtains be used? If yes, where? +n Ws l 6A34". rOV'M- Vj fl - C. GARBAGE AND REFUSE Inside 8. Do all containers have lids? 9. Will refuse be stored ipside? l O (vY ( ) If so, where? Oe 10. Is there an area designated for garbage can or floor mat cleaning? Outside v 11. Will a dumpster be used? 7 Number �_ Size a Frequency of pickup a Contractor IV2)14k�jrk 12. Will a compactor be used? Number Size Frequency of pick up Contractor 13. Will garbage cans be stored outside? () ( ( ) 14. Describe surface and location where dumpster/compactor/garbage cans are to be stored 1 4 TV -C'S •59-i$ http://www.cfsan.fda.gov/—dms/Prev-l.html 3/24/2008 li�vc;rr: 15. Describe location of grease storage receptacle 3� vv. 16. Is there an area to store recycled containers?• f Indicate what materials are required to be recycled; ( ) Glass ( ) Metal O Paper O Cardboard O Plastic 17. Is there any area to store returnable damaged goods? Wi// �vT ��� <v,P� ,Dec ^-�� J-Cc9 �� � •� D. PLUMBING CONNECTIONS O O (/x, http://www.cfsan.fda.gov/—dms/Prev-l.htrnl 3/24/2008 AIR GAP AIR BREAK *INTEGRAL TRAP *"P" TRAP VACUUM BREAKER CONDENSATE PUMP 18. Toilet 19. Urinals 20. Dishwasher 21. Garbage Grinder 22. Ice machines http://www.cfsan.fda.gov/—dms/Prev-l.htrnl 3/24/2008 r lif-vur r: r ooca Lstaonsnment rian xeview kjuiae - aectnons i Page u of i g http://www.cfsan.fda.gov/—dms/prev-l.httnl 3/24/2008 23. Ice storage bin Q ' 24. Sinks a. Mop b. Janitor c. Handwasli d. 3 Compartment e. 2 Compartment E l Compartment g. Water Station 25. Steam tables 26. Dipper wells 27. Refrigeration condensate/ drain lines 28. Hose connection 29. Potato peeler 30. Beverage Dispenser w/carbonator 31. Other http://www.cfsan.fda.gov/—dms/prev-l.httnl 3/24/2008 rliAit-rr: rooa Lstaonsnment rian xeview tjuiae - 6ecnons i rage 14 oI 1 Y * TRAP: A fitting or device which provides a liquid seal to prevent the emission of sewer gases without materially affecting the flow of sewage or waste water through it. An integral trap is one that is built directly into the fixture, e.g., a toilet fixture. A ?P? trap is a fixture trap that provides a liquid seal in the shape of the letter ?P.? Full ?S? traps are prohibited. 32. Are floor drains provided & easily cleanable, if so, indicate location: E. WATER SUPPLY 33. Is water supply public (vor private ( ) ? 34. If private, has source been approved? YES ( ) NO ( ) PENDING Ofx� Please attach copy of written approval and/or permit._ i V� 35. Is ice made on premises ( ) or purchased commercially ( ) ? /)C/ /� �- If made on premise, are specifications for the ice machine provided? YES ( ) NO () 1 I Describe provision for ice scoop storage: %v 4 Provide location of ice maker or bagging operation. 36. What is the capacity of the hot water generator? CCA-.Ito� 37. Is the hot water generator sufficient for the needs of the establishment? Provide calculations for necessary hot water (see Part 5 & Part 9 Under Section III in this manual) YeS7 ' 38. Is there a water treatment device? YES ( ) NO ('<*� If yes, how will the device be inspected & serviced? 39. How are backflow prevention devices iinspected.& serviced? F. SEWAGE DISPOSAL http://www.cfsan.fda.gov/-dms/prev-l-.htrnl 3/24/2008 rlifvt,rr: rooa Lstannsnment Tian xeview uuiae - 6ecnons i 40. Is building connected to a municipal sewer? YES (q'NO ( ) 41. If no, is private disposal system approved? YES ( ) NO ( ) PENDING () l Please attach copy of written approval and/or permit. 42. Are grease traps provided? YES 6^0 ( ) If so, where? Provide schedule for cleaning & maintenance cc M L--1JA . . G. DRESSING ROOMS 43. Are dressing rooms provided? YES ( ) NO (�,K 44. Describe storage facilities for employees' personal belongings (i.e., purse, coats, boots, umbrellas,etc.) H. GENERAL 45. Are insecticides/rodenticides stored separately from cleaning & sanitizing agents? YES (')NO (* Indicate location: 1564V V MV) Page i of i g 46. Are all toxics for use on the premise r for retail sale (this includes personal medications), stored away from food preparation and storage areas? YES VNO ( ) 47. Are all containers of toxics including sanitizing spray bottles clearly labeled? YES(J< O ( ) 48. Will linens be laundered on site? YES ( ) NO (N/ If yes, what will be laundered and where?. If no, how will linens be cleaned? �t� 4'�` Se vL,� u �" �IWtt"c"`� 4D1� 4-eLl 49. Is a laundry dryer available? YES () NO (\K 50. Location of clean linen storage: 4e OAJ 6 http://www.cfsan.fda.gov/—dms/Prev-l.html 3/24/2008 rlifvt-rr: rooa rstaoiisnment rian Keview Uuiae - �ecnons t 51. Location of dirty linen storage: IV/ 52. Are containers constructed of safe materials to store bulk food products? YES O�NO ( ) Indicate type: «, ! e. S5 ST { /��/Zc 111 ( -f- cc)V 53. Indicate all areas where exhaust hoods are installed: rage 1 o Or 1 y LOCATION FILTERS SQUARE FIRE AIR AIR WOR FEET PROTECTION CAPACITY MAKEUP EXTRACTION CFM CFM DEVICES OV Lo's , 54. How is each listed ventilation hood system cleaned? I. SINKS 55. Is a mop sink present? YES ( NO ( ) If no, please describe facility for cleaning of mops and other equipment: http://www.cfsan.fda.gov/-dms/Prev-l.htrnl 3/24/2008 rilA/l.rr: rood Lstaonsnment rlan Keview llUlae - �ecuons 1 56. If the menu dictates, is a food preparation sink present? YES ( ) NO ( ) J. DISHWASHING FACILITIES 57. Will sinks or a dishwasher be used for warewashing? Dishwasher ( ) Two compartment sink Three compartment sink ( ) 58. Dishwasher , Type of sanitization used: �V Hot water. (temp. provided) Booster heater Chemical type Is ventilation provided? YES ( ) NO ( ) 59. Do all dish machines have templates with operating instructions? YES ( ) NO ( ) /,V//4 rage 1 / or 19 60. Do all dish machines have temperature/pressure gauges as required that are accurately working? YES N ( ) 61. Does the largest pot and pan fit into each compartment of the pot sink? YES (v NO O If no, what is the procedure for manual cleaning and sanitizing? 62. Are there drain boards on both ends of the pot sink? YES ( ) NO 63. What type of sanitizer is used? Chlorine (v� Iodine Quaternary ammonium ( ) Hot Water ( ) Other ( ) 64. Are test papers and/or kits available for checking sanitizer concentration? YES (vj ( ) K. HANDWASHING/TOILET FACILITIES http://www.cfsan.fda.gov/—dms/prev-l.html 3/24/2008 65. Is there a handwashing sink in each food preparation and warewashing area? YES (4 ( ) 66. Do all handwashing sinks, including those in the restrooms, have a mixing valve or combination faucet? YES NO( ) 67. Do self-closing metering faucet provide a flow of water for at least 15 seconds without the need to reactivate the faucet? YES( ) NO ( ) /\IC)NL 68. Is hand cleanser available at all handwashing sinks? YES (,41NO ( 69. Are hand drying facilities (paper towels, air blowers, etc.) available at all handwashing sinks? YES (VY/NO ( ) 70. Are covered waste receptacles available in each restroom? YES (Vy O ( ) t. 71. Is hot and cold running water under pressure available at each handwashing sink? YES (v�NO ( ) 72. Are all toilet room doors self-closing? YES (--40 ( ) 73. Are all toilet rooms equipped with adequate ventilation? YES ( q4<0 ( ) 74. If required, is a handwashing sign posted in each employee restroom? YES ('AO ( ) L. SMALL EQUIPMENT REQUIREMENTS 75. Please specify the number, location, and types of each of the following: Slicers Cutting Can op Mixers �uC1% Floor mats 9 ,i Other lYI���W� — -Pp �f��ii���.C/ STATEMENT: I hereby certify that the above information is correct, and I fully understand that any deviation from the above ryjt4ut j)ripr pgx_mission from this Health Regulatory Office may nullify final approval. R Signature(s) owner(s) or responsible representative(s) Date: % http://www.cfsan.fda.gov/—dms/Prev-l.hftffl 3/24/2008 rlii-vurr: rooa r-staousnment Tian xeview Uume - 6ecnons i rage 19 of 19 Approval of these plans and specifications by this Regulatory Authority does not indicate compliance with any other code, law or regulation that may be required --federal, state, or local. It further does not constitute endorsement or acceptance of the completed establishment (structure or equipment). A preopening inspection of the establishment with equipment in place & operational will be necessary to determine if it complies with the local and state laws governing food service establishments. Home I Plan Review: Table of Contents Hypertext updated by dms/ces 2000 -MAR -30 http://www.cfsan.fda.gov/—dms/Prev-l.html 3/24/2008 -a /9m) C, I' f. 1-,21;? 7-OCIA E, f poRrH qw- b.. 0 ~ ft 13 Dip cocwicwwiwrtw 1 PUBLIC HEALTH DEPARTMENT Community Development Division June 30, 2008 Leo Altovino Amici's Pizzeria 127 Waverly Road N. Andover, MA 01845 Re: Plan review "Amici's Pizzeria" Dear Mr. Altovino, The Health Department has received your application submitted on June 13, 2008 for the change of ownership of a food establishment formerly known as "The Upper Crust". As there are no structural or equipment changes being proposed, the application did not include applicable specification sheets. This pian has been approved by the Health Department. In regards to the establishment's grease trap, the Health Department was recently notified of requirements in the plumbing code that may affect you. The language in bold is specific; please do not change it in any way. If you have one or more interior grease traps please note the plumbing code 248 CMR 10.09 (m): 1. A laminated sign shall be stenciled on or in the immediate area of the grease trap or interceptor in letters one -inch high. The sign shall state the following in exact language: IMPORTANT This grease trap/interceptor shall be inspected and thoroughly cleaned on a regular and frequent basis. Failure to do so could result in damage to the piping system, and the municipal or private drainage system(s). Prior to receiving your permit to operate you must have the Health Inspector, Michele Grant, conduct an inspection. Be advised that you must address any conditions not identified in the application that are in violation of the food code. Please contact Ms. Grant to set up the initial walk through as soon as possible to minimize any problems that may arise. She can be contacted 7:30AM to 3:30 PM at 978 688-9540. Some items needed to receive the permit to operate are: 1) The establishment will be clean 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com 2) The handsink and bathroom will be stocked with a wall mounted paper towel and soap dispensers 3) The ladies room will have a covered trash can for feminine item disposal 4) Bathroom must have "employee must wash hands before returning to work" signage 5) Handsinks should be labeled "hand wash only" 6) There must be test strips for the Chlorine sanitizer on site. Your application showed "Iodine" as an alternate sanitizer. If it is in use, please have testing capability for the iodine as well. 7) _ Sanitizer buckets should be set up for review of locations you are keeping them throughout the kitchen. 8) The three -bay should be labeled "wash, rinse, sanitize" in the direction of the intended cleaning procedure. 9) Gloves must be on site. Please note that the state does not recommend the use of latex gloves due to some person's sensitivity to latex that may cause them illness. 10) You must obtain copies of the state and federal food codes and keep them on premises 11) At minimum, employees should be trained on the sick policy and sanitation basics. If you intend to replace any equipment, please contact our office before purchasing the item so that the specification sheets can be approved prior to the order being submitted. We look forward to working with you in the opening of this establishment and its successful operation in North Andover. Sincerely, r� Susan Sawyer, REHS/RS Public Health Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Page 1 of 1 DelleChiaie, Pamela From: DelleChiaie, Pamela Sent: Thursday, July 10, 2008 1:30 PM To: Eaton, Janet Subject: L.C. - Amici Pizzeria - Common Victualler License Request Skst Ragwad8, Pa�waQw Dal�l�aG�lfiwia Health Department Assistant Town of North Andover 1600 Osgood Street Building 20, Suite 2-36 North Andover, MA o1845 11978.688.9540 - Phone A, 978.688.8476 - Fax httL//-.8,mw.townofnorthandover.com healthdept@towvofnorthandover.com From: noreply@yourcopier.com [ma i Ito: noreply@you rcopier.com] Sent: Thursday, July 10, 2008 2:22 PM To: DelleChiaie, Pamela Subject: Message from KMBT 600 7/10/2008 w NORTH 10- p 41 �SSACHUSEt PUBLIC HEALTH DEPARTMENT Community Development Division TO: Janet Eaton Assistant Town Clerk FROM: Michele E. Grant Public Health Inspector DATE: July 10, 2008 SUBJECT: Amici Pizzeria — Common Victualler License —127 Waverley Road This memo is in regards to the application to the Licensing Commission from Amici Pizzeriz for a Common Victualler License. A food plan review application was received on June 13, 2008 by Leo Altovino and the plan was reviewed by the Health Department, and approved on June 30th. The site was formerly known as the Upper Crust. A new food permit will be issued upon a final inspection once the establishment is prepared to open for operation. The Board of Health has no objection to the approval and granting of the request, as long as the new establishment owner complies with the 105 CMR 590.000 of the State Sanitary Code, and the Federal Food Code. 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax. 978.688.8476 Web http://www.townofnorthandover.com JUL-11J-2-21L,18 12:_"i� TOWN OF NORTH ANDOVER OFFICE OF LICENSING COMMISSION 120 MAIN STREET NORTI-I ANDOVER, MASSACHUSETTS 01345 Richard A. Nardella, Chairman Mark J.T, Caggiano Daniel P. Lam -Rosemary C. Smedile Tracy M. Watson O 9 � r SSAtNUg�' Memorandum To: Building Inspector Chien` of Police Fire Chief Board. of Health Commission or! Disability Issues From:J e oven Clerk Date: May 29, 2008 Subject: Common Victualler — Amici Pizzeria Telephone (978) 688-9500 FAX (978) 688-9557 Attached please find an application for a Common Victualler License from Leo Altovino and Dan Sarno d.b.a. Amici's Pizzera, 127 Waverley road. (formerly the Upper Crust) Please review and respond by Wednesday, July 3, 2008 as this will be on the agenda for the Licensing Commission on July 14, 2008. If you would like to E-mail your response, my E-mail address is ieaton(i2)towtiofnorthandover.coiii. Thank you in advance for your immediate attention in this matter. P. 01/04 ILII —1U '*2UU 1 1c . .4 THE Ct)M11 QNWEALTH OF Mp w ,.et as of APPLICATION FOR LICENSE r H. 02/04 20 To rHT; L1cENsiNc Au'rxoRrrm: The undersigned hereby applics for a Licctysc in acccc with the provisions of Oa Statures reiating the: _. L 30 (fruu dum 01 apsro fres dr anrmu.�eA uPi a ay+cac+onl STATE CLEARLY PURPOSE FOR WHICH UC15NSE IS REQUESM E GIVE LOCATIQN BY STREET AND NUM SEP in said City of rOVM in accord=* with to rules and rq;Wadans rhe raider authority of said St: Uuzes- I certify under the penalties of perjury that 1, to my best Imawled$c and belief, have ailed all state tax tenons and paid 0 state taxes rewired under law. /I(- , -- - - - " 5W WUM of {amndum or Co PWMN&M#Ineso 6 or Fe�mva6 lmusw'�mf� Nurhpa .e, sr ea��wx QQ3�r It1l1a4mnrY. �! �ppli�hl�y " This bruise will not be issued Mess this =6fkation clause is .signed by the atpplic=. Your racial s=m ity number wtM be fum shed to the Massarhusctu Deparrmtnt of Re�=nue to determine whether you have met tax filing or tax payment obligations. Uc=m who fail to Mcirr= their non -fig or ciYlinquency will he subject to tie=use suspension or r>rwvcation. This rcquan is made unuer tiic tha G -L. C. 62C s. 49A. Rec,2�vcd' 20 A.M. ='our Y +.Qurp� Anx rc wed 20 LC=CC cr:..-zted 20 �10RTy 6 O �n AK PUBLIC HEALTH DEPARTMENT Community Development Division June 30, 2008 Leo Altovino Amici's Pizzeria 127 Waverly Road N. Andover, MA 01845 Re: Plan review "Amici's Pizzeria" Dear Mr. Altovino, The Health Department has received your application submitted on June 13, 2008 for the change of ownership of a food establishment formerly known as "The Upper Crust". As there are no structural or equipment changes being proposed, the application did not include applicable specification sheets. This plan has been approved by the Health Department. In regards to the establishment's grease trap, the Health Department was recently notified of requirements in the plumbing code that may affect you. The language in bold is specific; please do not change it in any way. If you have one or more interior grease traps please note the plumbing code 248 CMR 10.09 (m): 1. A laminated sign shall be stenciled on or in the immediate area of the grease trap or interceptor in letters one -inch high. The sign shall state the following in exact language: IMPORTANT This grease trap/interceptor shall be inspected and thoroughly cleaned on a regular and frequent basis. Failure to do so could result in damage to the piping system, and the municipal or private drainage system(s). Prior to receiving your permit to operate you must have the Health Inspector, Michele Grant, conduct an inspection. Be advised that you must address any conditions not identified in the application that are in violation of the food code. Please contact Ms. Grant to set up the initial walk through as soon as possible to minimize any problems that may arise. She can be contacted 7:30AM to 3:30 PM at 978 688-9540. Some items needed to receive the permit to operate are: 1) The establishment will be clean 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 918.688.9540 fax 918.688.8416 Web www.townofnorthandover.com } 2) The handsink and bathroom will be stocked with a wall mounted paper towel and soap dispensers 3) The ladies room will have a covered trash can for feminine item disposal 4) Bathroom must have "employee must wash hands before returning to work" signage 5) Handsinks should be labeled "hand wash only" 6) There must be test strips for the Chlorine sanitizer on site. Your application showed "Iodine" as an alternate sanitizer. If it is in use, please have testing capability for the iodine as well. 7) Sanitizer buckets should be set up for review of locations you are keeping them throughout the kitchen. 8) . The three -bay should be labeled "wash, rinse, sanitize" in the direction of the intended cleaning procedure. 9) Gloves must be on site. Please note that the state does not recommend the use of latex gloves due to some person's sensitivity to latex that may cause them illness. 10) You must obtain copies of the state and federal food codes and keep them on premises 11) At minimum, employees should be trained on the sick policy and sanitation basics. If you intend to replace any equipment, please contact our office before purchasing the item so that the specification sheets can be approved prior to the order being submitted. We look forward to working with you in the opening of this establishment and its successful operation in North Andover. Sincere0ly, rf Susan Sawyer, REHS/RS Public Health Director 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com i pORrh 2 O PLANNING DEPARTMENT Community Development Division TRC Meeting Agenda June 11, 2008 (Wednesday) 1600 Osgood Street, main conference room 10:00 AM 10:00 AM —127 Waverly Road (formerly.Canty's kitchen). Gaetano Leo Altovini & Daniel Sarno are the new owners and propose to open a pizza parlor and use the same floor plan (attached). Two to four employees, hours of operation 11 am to 10 pm within the G -B zoning district. Participating Divisions/Denartments: ❑ Building Department ❑ Conservation Department ❑ Community Development Division ❑ Division of Public Works ❑ Fire Department - - ❑ Health Department ❑ Planning Department ❑ Police Department ❑ Town Manager's Office ❑ Town Clerk's Office PZ11✓. ,--t...- .—c,,, L --%G s - Q,, S,q (Z (V (2 Pc�Ss'rl�� cam- �p z 1600 Osgood Street, Bldg. 20, Suite 2-36, North Andover, Massachusetts 01845 Phone 978.688.9535 Fax 978.688.9542 Web www.townofnorthandover.com Page 1 p �t�eo 164��y0 i o 'A x - � PLANNING DEPARTMENT Community Development Division TRC Meeting Agenda June 11, 2008 (Wednesday) 1600 Osgood Street, main conference room 10:00 AM 10:00 AM —127 Waverly Road (formerly Canty's kitchen). Gaetano Leo Altovini & Daniel Sarno are the new owners and propose to open a pizza parlor and use the same floor plan (attached). Two to four employees, hours of operation 11 am to 10 pm within the G -B zoning district. Participating Divisions/Departments: ❑ Building Department ❑ Conservation Department ❑ Community Development Division ❑ Division of Public Works ❑ Fire Department ❑ Health Department ❑ Planning Department ❑ Police Department ❑ Town Manager's Office ❑ Town Clerk's Office 1600 Osgood Street, Bldg. 20, Suite 2-36, North Andover, Massachusetts 01845 Phone 978.688.9535 Fax 978.688.9542 Web www.townofnorthandover.com Page 1 Osgood Landing, Town ofNorth Andover, 1600 Osgood Street - Bldg. 20, Suite 2-36, b North Andover,'MA 01845 " Phone: 978-688-9535 Fax 978-688-9542 mippolitownofnorthandover.com Planning Department Technical Review Committee: Meeting (information form). Please submit this information to -the North Andover Planning Department c/o Mary Ippolito no later than the Wednesday preceding the scheduled Technical Review Committee Meeting. Applicant will confirm with.Ms Ippolito the date and time of the meeting on Wednesday prior to the actual TRC meeting date. It is important that either the applicant -or-the applicant's representative attend the TRC meeting. Please type or print clearly. LApplicant: 2.Applicant's Address: J /�Z_z,$ PO 03d/d- o c l 9 /JZIiW�_ ,40 AQC6 Oi 8i(.0%%i� 3.Applicant's phone number 0' 91,79-"- rFb6 - �1�2 55' _- 4.Address of proposed location: _ ,2 r7 Wg VC i2L PD k'tAyI y& - Stoning District of proposed location: 6.Square Footage of proposed project: I c U W� 7.Number of employees _ ' � �� Z / o DCS 8.Hours of operation PM 9.Par)* requirements 57 -A; e5 % D� � l0.Is there food preparation required?S 11.Description of project: T��asf6rt r ily/l�rf/�lE �F �x�li rti6 ��zr.� ���i2ro2 If you are proposing to open a business in an existing location please submit a copy of a site plan (you can obtain this from the landlord). It is not the intention of the Planning Department to ,have the applicant incur Architectural or Engineering expenses for submittal of a plan of land. 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