HomeMy WebLinkAboutMiscellaneous - 58 PETERS STREET 4/30/2018 (5) PANDQA
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North Andover Health Department
Community Development Division
January 11, 2013
Panera Bread
58 Peters Street
North Andover, MA 01845
Re: Plan review—Panera Bread remodel, North Andover
Dear Food Establishment Operator,
The Health Department has received your application for a remodel of multiple service and
display areas within Panera Bread. This plan has been approved. This establishment will
continue to serve the public through various fazes of this project. Please refer to document
submitted on January 10, 2013 for thea reed details on the procedures for the nightly
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construction work.
When-the morning Panera shift arrives each day after construction,they must assume that the
contractors have not sanitized food contact surfaces. Please assess each food contact surface
daily and sanitize each morning before beginning the daily preparation. If Panera staff
encounters any deviation from this procedure upon the morning arrival, they must report it to the
job supervisor so that it will be corrected the next evening of construction.
Please advise the Health Department of the work schedule so that inspectors may do inspections
on the project. When work is completed, please call the health office to set up an appointment.
At that time if there are any outstanding issues a punch list will be provided. This list must be
completed prior to receiving a Building Card Sign off.
As it is difficult to anticipate details as this is a night time construction site only,please stay in
contact with the Health Inspector, Michele Grant. She will instruct you on the expectations for
this particular renovation that may not be listed in this letter. Note on Page A-1 of the plan that
the"entire space"is to be"commercially cleaned". This includes"floors,walls, equipment etc."
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com
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The inspector will assess the completion of this task as well and make any comments for
additional cleaning.
Thank you for your cooperation in this matter. We look forward to working with you in the effort
to provide safe food to our citizens.
Sincere ,
us Sawyer, HS
r Public Healt Direc r
Encl: Food Safety Procedure document dated 1/10/13
Cc: N. Andover Building Dept.
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1600 Osgood Street,North Andover,Massachusetts 01845
Phone 918.688.9540 fax 918.688.8416 Web www.townofnorthandover.com
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1/10/13
Panera Bread#3410
58 Peters St.
North Andover,MA 01845
FOOD SAFETY PROCEDURES FOR CONSTRUCTION
Nightly Set Up Procedures:
1) Construction work will not begin each night until Panera's staff has completed there
normal shut down and cleaning procedures,and removed any necessary product and
small wares from the work area(where applicable).
2) All fixed in place food preparation surfaces are covered with plastic,and any food
preparation surfaces that can be removed from the work area are relocated while work
is taking place(where/when applicable).
3) The area where baking is to take place is protected with a plastic barricade.
Nightly Clean Up Procedures:
1) General clean up of all construction tools,materials,dust, and debris to be completed
prior to removal of any plastic barricades or covering.
2) After general clean up is complete,plastic coverings are removed from the fixed in
place food preparation surfaces,and any food preparation surfaces that were removed
from the work area are put back in place.
3) ALL surfaces in the work area are wiped down.
4) Floor is swept a second time and mopped.
5) Plastic barricade is then removed.
6) Prior to restocking product or small wares,Panera s staff performs a final, sanitary
cleaning of all food preparation surfaces, and second mopping of the floor.
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Food od Estabhshnlent
Plan Review Guide
FOOD ESTABLISHMENT PLAN REVIEW APPLICATION IS TO BE
COMPLETED BY THE OPERATOR AND SUBMITTED TO THE
REGULATORY AUTHORITY—at least 60 days in advance before commencement of any
food establishment planned openings.
TOWN OF NORTH ANDOVER, MA
Regulatory Authority
1660 Osgood Street, Building 20; Suite 2-36,North Andover,MA 01845
Date: 67
NEW -New construction,not yet built
REMODEL -lel or major renovation of existing establishment
CONVERSION-existing establishment that you are purchasing
Name of Establishment: r e-r Sre;
Corporate Name:- P R R&Awmn+s
Category: Restaurant Institution ,Dayeare ,Retail Market , Other
Establishment Address: Sg Pe C.S S lreel
Phone: (at location if available)
E-mail Contacts: IV, b 6
Name of Owner: r
Mailing Address: A"1617 a.
Telephone:
Applicant's Name(if different than owner): p
Title (owner, manager, architect, etc. :eg
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Mailing Address: Roy (�
Telephone:__ (,e00_
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Town of North Andover,Health Department,1600 Osgood Street,Building 20;Suite 2-36,
North Andover,MA 0184S--Phone:978.688.9540--Fax:978.688.8476 Page 1 of 20
Date Received.BOUofficb use_only
Date Review completed BOH'office use only. Approved/Denied
Date Revised application Received: BOH office use only
Date Review completed. B:OH office use-only: Approved/Denied
Technical Assistance with the Perinittine Process
The Town Planning Department offers the option of attending a Technical Review Committee(TRC)meeting
to all applicants.As the applicant,I acknowledge that I have received an explanation and understand that the
purpose of the TRC meeting is it to assist me in the various town processes needed to open my establishment.
If declined I understand that I have forfeited this opportunity to learn more about the North Andover permitting
process.
I wish to attend or decline(circle one)participation in the TRC process.Date of TRC_(BOH only)_
General Information
Hours of Operation: Sun. Thurs
Mon Fri �a
Tues Sat
Wed
➢ Number of Seats for customers:
➢ Number of Staff.
(Maximum per shift)
➢ Total Square Feet of Facility:
➢ Number of Floors on which
operations are conducted
➢ Maximum Daily Meals to be Served: ➢ Breakfast
(approximate number) ➢ Lunch
➢ Dinner
Type of Service: Sit Down Meals
(check all that apply) Take Out
Caterer
Mobile Vendor
Other
Town of North Andover,Health Department,1600 Osgood Street,Building 20;Suite 2-36,
North Andover,MA 01845--Phone:978.688.9540--Fax:978.688.8476 Page 2 of 20
Please enclose the following documents:
Proposed Menu(including seasonal, off-site and banquet menus)
Manufacturer Specification sheets for each piece of equipment shown on the plan tFj OGG �
ASite 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)
U Plan drawn to scale of food establishment showing location of equipment,plumbing, electrical services
and mechanical ventilation
`�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 Ian 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 me I volume for food service operations.
3. Show the location of each piece of equipment. Each must be clearly 4beled on the plan with its common
name. Each unit must be sequentially numbered and the numbers must correspond to the equipment
specification sheets and an equipment schedule.All self-service hot and cold holding units must have sneeze
guards. ✓ .
5. Label and locate separate food preparation sinks when�t�e menu dictates to preclude contamination and
cross-contamination of raw and ready-to-eat foods. „ ,�5 �� � G�u V`
6. Clearly designate adequate hand washing lavatories for each toilet fixture and in the immediate area of food
preparation, cooking and ware w shing. (a hand sink should be located within 10 feet of each area for easy
access for all food handlers)
7. Provide the room si e, 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.
9. Include and provide specifications for: 1 1 _ r��Jf
a.Entrances, exits, loading/unloading areas and o, k)
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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 generatin equipment with capacity and recovery rate, backflow prevention, and wastewater
line connections; GX1f_5 ,
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Town of North Andover,Health Department,1600 Osgood Street,Building 20;Suite 2-36,
North Andover,MA 01845--Phone:978.688.9540--Fax:978.688.8476 Page 3 of 20
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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; n ��
(2)At least 220 lux(20 foot candles): /I/
(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; V"'
(b)Inside equipment such as reach-in and under-counter refrigerators;
(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; —x, , �,�
g.A mop sink or curbed cleaning facility with facilities for hanging wet mops;
h. Garbage can washing area/facility;
i. Cabinets for storing toxic chemicals;
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j.Dressing rooms,locker areas, employee rest arl, and/or coat rack as required;
k. Site plan(plot plan for new construction)
NA
PLEASE CIRCLE/ANSWER THE FOLLOWING QUESTIONS
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FOOL)PREPARATION RENEW
Check categories of Potentially Hazardous Foods (PHF's)to be handled, prepared and served.
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CATEGORY* (YES) (1NT0) M
1. Thin meats, poultry,fish, eggs(hamburger; sliced meats; fillets) ( ) ( ) 6 +a A
2. Thick meats, whole poultry(roast beef;whole turkey, chickens,hams) ( ) ( )
3. Cold processed foods (salads, sandwiches,vegetables) ( ) ( ) M 'Y
4.Hot processed foods (soups, stews,rice/noodles, gravy, chowders, casseroles)
Town of North Andover,Health Department,1600 Osgood Street,Building 20;Suite 2-36, l'
North Andover,MA 01845--Phone:978.688.9540--Fax:978.688.8476 Page 4 of 20
5. Bakery goods (pies, custards, cream fillings&toppings) ( ) ( )
6. Other
FOOD SUPPLIES:
I.Are all food supplies from inspected and approved sources? YES/NO
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2. What are the projected frequencies (daily,weekly, etc)of deliveries for Frozen foods
Refrigerated foods , and Dry goods
3.Provide information on the amount of space(in cubic feet) allocated for:
Dry storage ,
Refrigerated Storage and
Frozen storage
4. How will dry goods be stored off the floor?
COLD STORAGE:
1. Is adequate and approved freezer and refrigeration available to store frozen foods frozen, and refrigerated
foods at 4 I(5°C) and below?YES/NO
2. Will raw meats, poultry and seafood be stored in the same refrigerators and freezers with cooked/ready-to-
eat foods?YES/NO IF
If yes, how will cross-contamination be prevented?
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3. Does each refrigerator/freezer have a thermometer?YES/NO
Number of refrigeration units:
Number of freezer units:
4. Is there a bulk ice machine available?YES/NO Is ice packaged and sold for retail?YES/NO
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Town of North Andover,Health Department,1600 Osgood Street,Building 20;Suite 2-36,
North Andover,MA 01845--Phone:978.688.9540--Fax:978.688.8476 Page 5 of 20
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, indicate where thawing will take place.
Food Thawing Method "Thick or Bulk Frozen XThin/Portioned Frozen
Refrigeration
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Running Water.Less than
70°F(21°C)
Microwave(as part of cooking
process)
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Cooked from Frozen state _
Other(describe)
*Frozen foods: approximately one inch or less=thin, and more than an inch=thick.
PREPARATION:
1. Please list categories of foods prepared more than 12 hours in advance of service.
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2. Will food employees be trained in good food sanitation practices?YES/NO
Method of training: ^
Number(s) of employees:
Dates of completion:
3. Will disposable gloves and/or utensils and/or food grade paper be used to prevent handling of ready-to-eat ' V
foods?YES/NO
4. Is there a written policy to exclude or restrict food workers who are sick or have infected cuts and lesions?
YES /NO Please describe briefly:
Town of North Andover,Health Department,1600 Osgood Street,Building 20;Suite 2-36,
North Andover,MA 01845--Phone:978.688.9540--Fax:978.688.8476 Page 6 of 20
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Will employees have paid sick leave?YES/NO 'T
5. How will cooking equipment, cutting boards, counter tops and other food contact surfaces which cannot be S
submerged in sinks or put through a dishwasher be sanitized? -;
Chemical Type:
Concentration:
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Test Kit: YES/NO
r cold ready-to-eat foods such as tuna mayonnaise and
6. Will ingredients fo o y y eggs for salads and sandwiches be
pre-chilled before being mixed and/or assembled?YES/NO
If not, how will ready-to-eat foods be cooled to 41'F?
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washed on-site prior to use?YES /NO
7. Will all produce be was on-s
Is there a planned location used for washing produce?YES/NO
Describe
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If not, describe the procedure for cleaning and sanitizing multiple use sinks between uses.
8. Describe the procedure used for minimizing the length of time PHF's will be kept in the temperature danger
zone (41'F - 140°F)during preparation.
Town of North Andover,Health Department,1600 Osgood Street,Building 20;Suite 2-36,
North Andover,MA 01845--Phone:978.688.9540--Fax:978.688.8476 Page 7 of 20
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9. Where raw meats,poultry and seafood are prepared in the same work area or using the same equipment as
cooled/ready to eat foods,how will cross contamination be prevented? X
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10.Please list all PHF's you plan to serve which,will/may not be cooked to the previously listed minimum r..
temperatures.A proper"consumer advisory"warning notation.must be printed on menu or menu boards.
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11. Provide a HACCP plan for specialized processing methods such as vacuum packaged food items prepared
on-site or otherwise required by the regulatory authority. , v
12. Will the facility g be serving food to a highly susceptible population?YES/NO
If yes, List measures taken to comply with code requirements.
COOKING:
1. Will food product thermometers be used to measure final cooking/reheating temperatures of PHF's?
YES /NO What type of temperature measuring device:
Minimum cookinm time and temperatures of product utilizing convection and conduction heating equipment:
➢ 130°F(121
➢ beef roasts min)
➢ solid seafood pieces ➢ 145°F(15 sec)
> other PHF's ➢ 145°F(15 sec)
➢ eggs:
® Immediate service 145°F(15 sec) pooled* 155°F(15 sec)
(*pasteurized eggs must be served to a highly susceptible population)
➢ pork ➢ 145°F(15 sec)
➢ comminuted meats/fish ➢ 155°F(15 sec)
➢ poultry ➢ 165°F(15 sec) n /
➢ reheated PHF's ➢ 165°F(15 sec) ` �J
2.List types of cooking equipment.
Town of North Andover,Health Department,1600 Osgood Street,Building 20;Suite 2-36,
North Andover,MA 01845--Phone:978.688.9540--Fax:978.688.8476 Page 8 of 20
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HOT/COLD HOLDING:
1.How will hot PHF's be maintained at 140°F(60°C) or above during holding for service?Indicate type and
number of hot holding units.
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° in holding for service?Indicate type and
2. How will cold PHF s be maintained at 41 F(5 C) or below dung g Yp
number of cold holding units.
COOLING:
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 I
Ice Baths
{ A Reduce
( Volume or Size
Rapid Chill
Other(describe)
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.
Town of North Andover,Health Department,1600 Osgood Street,Building 20;Suite 2-36,
North Andover,MA 01845—Phone:978.688.9540--Fax:978.688.8476 Page 9 of 20
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2.How will reheating food to 165°F for hot holding be done rapidly and within 2 hours?
A.FINISH SCHEDULE.
Materials selected must be durable and appropriate to the area and its intended use.High moisture and food
splash areas must be non-absorbent,smooth and easily cleanable.All openings must be tight fitting, properly
sealed and without voids.Applicant must indicate which materials(ie. quarry tile, stainless steel,4" plastic
coved molding,etc.)will be used in the following areas. (be specific)
I hen FLOOR COVING WALLS CEILING
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Other Storage
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Toilet Rooms
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iDressing Rooms #
Kitchen � � � �
Garbage & I
Refuse Storage 1 v
Town of North Andover,Health Department,1600 Osgood Street,Building 20;Suite 2-36,
North Andover,MA 01845--Phone:978.688.9540--Fax:978.688.8476 Page 10 of 20
Mop Service
Basin Area I U
Warewashing
Area
Walk-in
1 Refrigerators and n
IFreezers ' v
B. INSECT&RODENT CONTROL
APPLICANT:PLEASE CIIECKAPPROPIdIA7E BOXES.
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YES NO N/A
1. Will all outside doors be self-closing and rodent proof?
2. Are screen doors provided on all entrances left open to the outside? 5
3. Do all openable windows have a minimum#16 mesh screening?
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4. Is the placement of electrocution devices identitied on the plan?
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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? d
7. Will air curtains be used? If yes,where?
8. Do you have a plan to have a contract pest control company?If yes, list
company name, describe frequency of inspection and type of service.
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Town of North Andover,Health Department,1600 Osgood Street,Building 20;Suite 2-36,
North Andover,MA 01845--Phone:978.688.9540--Fax:978.688.8476 Page 11 of 20
C. GARBAGE AND REFUSE
INSIDE YES NO N/A
9. Do all containers have lids?
10. Will refuse be stored inside? If so,where?
11.Is there an area designated for a garbage can or floor mat cleaning?
OUTSIDE
12. Will a dumpster be used? Number: Size of:
a. Number:
b. Size of-
c.
£c. Frequency of Pick-Up. Indicate days and how often
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13. Will a compactor be used?
Number:
Size:
Frequency of Pick-Up
14. Will garbage cans be stored outside? V
15.Describe surface and location where dumpster/compactor/garbage cans are to
be stored.
16.Describe location of grease storage receptacle f� /
17.Is there an area to store recycled containers?
18.Is there any area to store returnable, damaged goods?
Town of North Andover,Health Department,1600 Osgood Street,Building 20;Suite 2-36,
North Andover,MA 01845---Phone:978.688.9540--Fax:978.688.8476 Page 12 of 20
D.PLUMBING CONNECTIONS
The FDA Food code and plumbing requirements do not replace or supersede the MA State Plumbing Code,
which also must be fully met; instead, it highlights potential hazardous circumstances and particular types of
equipment common to food service operations that, if through improper design or installation, could result in
contamination of food or water supply.Please indicate proposed properly installed equipment.
Equipment Code Confirmed Describe/Comments
Requirements by Operator
Iplease initial
Dish Machine Backflow prevention
device 1
a Indirect Waste 1
� 1
i Steam Jacketed Backflow prevention
Fettle device
F
direct Waste --
l�—
Steamer Backflow prevention 1
device -^�-
{�
FindirectWaste
Garbage Disposals Backflow prevention
or dish table device
Itroughs;
Submerged inlets
At all hose Backflow prevention
connections device
tet'
Garbage can Backflow prevention
I washer device
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Carbonated � Carbonated Backflow
beverage prevention device
dispenser
Town of North Andover,Health Department,1600 Osgood Street,Building 20;Suite 2-36,
North Andover,MA 01845--Phone:978.688.9540--Fax:978.688.8476 Page 13 of 20
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Refrigerator Indirect Waste
condensate/drain
lines
Ice storage bins Indirect waste
All sinks Air Gap
- a
Ice Cream dipper :Air Gap r R
wells
rOther
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.19.Are floor drains.provided&easily cleanable, if so, indicate location:
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E.WATER SUPPLY
20. Is water supply public(Vjor private( ) ?
21. If private,has source been approved?YES O NO( )PENDING( )
Please attach copy of written approval and/or permit.
22.Is ice made on premises ((or purchased commercially( )?
If made on premise, are specifications for the ice machine provided?YES ( )NO ( ) AIA
Describe provision for ice scoop storage: NA
Provide location of ice maker or bagging operation
23. What is the capacity of the hot water generator?
Town of North Andover,Health Department,1600 Osgood Street,Building 20;Suite 2-36,
North Andover,MA 01845--Phone:978.688.9540--Fax:978.688.8476 Page 14 of 20
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24. Is the hot water generator sufficient for the needs of the establishment?Provide calculations for necessary
hot water
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25.Is there a water treatment device?YES O NO
If yes,how will the device be inspected&serviced? Q
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26.How are backflow prevention devices inspected& serviced?
F. SEWAGE DISPOSAL
27. Is building connected to.a municipal sewer? YES (V(NO O
28. If no, is private disposal system approved? YES O NO ( )PENDING( )
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Please attach copy of written approval and/or permit.
29.Are grease traps provided? YES ( )NO ( )
If so -where? d
Note: Grease Traps must have the following sign.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):
e
1. A laminated sign shall.be stenciled on or in the immediate area of the grease trap or interceptor in letters rA
one-inch high.The sign shall state the following in exact language:
A
IMPORTANT This grease trap/interceptor shall be inspected and thoroughly cleaned on a regular and frequent i
basis. Failure to do so could result in damage to the piping system,and the municipal or private drainage
system(s).
G.DRESSING ROOMS
30.Are dressing rooms provided? YES ( )NO (
)
31. Describe storage facilities for employees'personal belongings(i.e., purse, coats, boots, umbrellas,etc.
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Town of North Andover,Health Department,1600 Osgood Street,Building 20;Suite 2-36,
North Andover,MA 01845--Phone:978.688.9540--Fax:978.688.8476 Page 15 of 20
R GENERAL
32.Are insecticides/rodenticides stored separately from cleaning& sanitizing agents? YES O NO O X
Indicate location:
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33.Are all toxics for use on the premise or for retail sale(this includes personal medications), stored away from '
food preparation and storage areas? YES ( )NO(
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34.Are all containers of toxics including sanitizing spray bottles clearly labeled? YES( )NO O Gl
Note: Material Safety Data Sheets(MSDS) are required to be kept for all chemicals on the premises. Where J
will the MSDS information be kept on display for easy access in an emergency? 1
35. Will linens be laundered on site? YES ( )NO(
If yes,what will be laundered and where?
If no,how will linens be cleaned?
36. Is a laundry dryer available? YES ( )NO O
37.Location of clean linen storage: �1•
38. Location of dirty linen storage:
39. Are containers constructed of safe materials to store bulk food products?YES ( )NO( )
Indicate type:
40. Indicate all areas where exhaust hoods are installed:
LOCATION FILTERS&/OR SQUARE FEET FIRE V AIR CAPACITY AIR MAKEUP
EXTRACTION PROTECTION CFM CFM
i� DEVICES
Town of North Andover,Health Department,1600 Osgood Street,Building 20;Suite 2-36,
North Andover,MA 01845--Phone:978.688.9540----Fax:978.688.8476 Page 16 of 20
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41.How is each listed ventilation hood system cleaned? 'r
I. SINKS
42. Is a mop sink present? YES (�NO( )
If no,please describe facility for cleaning of mops and other equipment:
43. If the menu dictates, is a food preparation sink present?YES ( )NO( ) detail answer
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J.DISHWASHING FACILITIES
44. Will sinks or a dishwasher be used for warewashing?
Dishwasher( )
Two compartment sink( p
Three compartment sink
45. Dishwasher
Type of sanitization used:
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Hot water(temp. provided)
Booster heater
Chemical type
Is ventilation provided?YES ( )NO ( )
46. Do all dish machines have templates with operating instructions? YES ( )NO (
46. Do dish machines have temperature/pressure gauges as required that are accurate?YES ( )NO( )
48.Does the largest pot and pan fit into each compartment of the pot sink?YES ( )NO( )
If no,what is the procedure for manual cleaning and sanitizing?
Town of North Andover,Health Department,1600 Osgood Street,Building 20;Suite 2-36,
North Andover,MA 01845--Phone:978.688.9540--Fax:978.688.8476 Page 17 of 20
49.Are there drain boards on both ends of the pot sink? X
YES ( )NO( '
50. What type of sanitizer is used?
❑.Chlorine
❑Iodine
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❑Quaternary
ammonium
❑Hot Water
oOther
51.Are test papers and/or kits available for checking sanitizer concentration?YES O NO ( )
K.HANDWASHING/TOILET FACILITIES
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52. Is there a handwashing sink in each food preparation,cooking and warewashing area?YES ( )NO ( )
53.Do all handwashing sinks, including those in the restrooms,have a mixing valve or combination faucet?
YES ( )NO(
54.Do self-closing.metering faucets provide a flow of water for at least 15 seconds without the need to
reactivate the faucet?YES O NO O
55.Is hand cleanser available at all handwashing sinks?YES O NO
56.Are hand drying facilities (paper towels, air blowers, etc.)at all handwashing sinks?YES ( )NO O (�
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57.Are covered waste receptacles available in each restroom?YES ( )NO O I
58. Is hot and cold running:water under pressure available at each handwashing sink?YES O NO ( )
59.Are all toilet room doors self-closing. YES ( )NO ( )
60.Are all toilet rooms equipped with adequate ventilation?YES ( )NO( )
61.Are handwashing signs and instructions posted in each employee restroom?YES ( )NO ( )
Town of North Andover,Health Department,1600 Osgood Street,Building 20;Suite 2-36,
North Andover,MA 01845--Phone:978.688.9540--Fax:978.688.8476 Page 18 of 20
i
L. SMALL EQUIPMENT REQUIREMENTS
62. Please specify the number, location, and types of each of the following proposed for on site use:
Slicers
Cutting boards 'g
Can openers j
Mixers
Floor mats
5
Other
xXxxxxxXXXxx
STATEMENT:I hereby certify that the above information is correct,and I fully understand that any
deviation from the above without prior permission from this Health Regulatory Office may nullify final
approval.
Signature(s)
Print: y�/�n�PjEOW a, rl
owner(s) or responsible representative(s)
Date:
xxxxXxxxxxxx
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 preconstruction inspection with equipment in place and a preopening inspection of the establishment
will be necessary to determine if it complies with the local and state laws governing food service
establishments.
Page Last Updated: 10/27/2009
Town of North Andover,Health Department,1600 Osgood Street,Building 20;Suite 2-36,
North Andover,MA 01845 Phone:978.688.9540--Fax:978.688.8476 Page 19 of 20