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HomeMy WebLinkAboutMiscellaneous - 757 TURNPIKE STREET 4/30/2018 (6)t �I f t 0 I I i P� O ' u V ..l O uIiI a; N •C ° Con +■ bA O wawa 5i - i U C d A � a W O N i C U c a'C U L1. O C C C � O 0 r y o a o 0 e o 8n .O+ 7 7t7 N O � 'O sem, J5 U 34 F- o "a W T N a z N O w U W W E" Y G a a W 0 r y w y d a a. Y A a y cn y d C �I es U ( kn G O0 p � •fl O p C O. v� 0 0 i 13 h �. u ^C v, f Q C � kni kn o o u y V Oca as i G7 GL U c-0 a N c C7 C4 �D * :rtI'U U f t 0 0 y N P� O ' V ..l O a; N •C ° 3 U C d A � a h O N U a'C U L1. 0 r y o a o 0 e o 8n .O+ 7 7t7 N O � 'O J5 U a o "a o o T N a z N O w U W W Y G a a 0 r y w y d a Y A a y cn y d es o y V1 OS � •fl �'! C °� North Andover Health Department (ommunity Development Division October 8, 2010 Stop and Shop 757 Turnpike Street North Andover, MA. 01845 Attn: Lorraine Marsden Dear Ms. Marsden, This letter is in regards to the change in the renovation plan for Stop and Shop, previously approved on April 22, 2010. According to the explanation provided to the Health Department this plan for renovation was scaled down due to economic changes and a reduction in retail food needs in the North Andover area. It is important to note however that all food code related items agreed upon must remain a priority over cosmetic improvements. The concern of this office was to verify that all items important to the health and safety related to food service are addressed, as was done in the previous plan. The Health Department has reviewed your renovation establishment form and plan that was submitted on October 4, 2010 and this plan has been approved. Once all the equipment is in place, please call the health office for a construction inspection. At that time the changes will be verified. At that time, if necessary, a punch list of outstanding items will be provided to you. Finally, at minimum, 48 hours in advance please place a request for a final inspection. Please note that if any changes are made to the plan during the construction phase this office must approve them. Thank you for your anticipated cooperation and look forward to our continued relationship. Sin e ely, Michele E. Grant Health Agent North Andover Health Department North Andover, MA. 01845 978-688-9540 Cc building dept Susan Sawyer 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com North Andover Health Department (ommunity Development Division October 8, 2010 Stop and Shop 757 Turnpike Street North Andover, MA. 01845 Attn: Lorraine Marsden Dear Ms. Marsden, This letter is in regards to the change in the renovation plan for Stop and Shop, previously approved on April 22, 2010. According to the explanation provided to the Health Department this plan for renovation was scaled down due to economic changes and a reduction in retail food needs in the North Andover area. It is important to note however that all food code related items agreed upon must remain a priority over cosmetic improvements. The concern of this office was to verify that all items important to the health and safety related to food service are addressed, as was done in the previous plan. The Health Department has reviewed your renovation establishment form and plan that was submitted on October 4, 2010 and this plan has been approved. Once all the equipment is in place, please call the health office for a construction inspection. At that time the changes will be verified. At that time, if necessary, a punch list of outstanding items will be provided to you. Finally, at minimum, 48 hours in advance please place a request for a final inspection. Please note that if any changes are made to the plan during the construction phase this office must approve them. Thank you for your anticipated cooperation and look forward to our continued relationship. Sincere y, V n JA"'� ` d) Michele E. Grant Health Agent North Andover Health Department North Andover, MA. 01845 978-688-9540 Cc building dept Susan Sawyer 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 918.688.9540 Fax 918.688.8416 Web www.townofnorthandover.com 2 0 2 � a I� � \_ 0 f C) k% / on q 2q '§ 1/ N CN o C f�i, c= �E @���— ��@mo / %'2 % o § CU = !E! mo U) LL U) k « N z � § W t ° f §kƒ c g V)LL%2 / . ~&�u2 / 40— Q) >- v g o �2k ���v� ƒ LLU)or- = O 7\$ 2 � � E / f ro m 2 E V) - c o 7 § § \ E � k 2 § / § 2f � g // /0 � � E 2 to � ] L- 0 0 / ƒ / $ g k � > m 4� c2 k \ >CL� a) / 4C - a) . 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Z Y N LLI w \ E3 c 13 z V)U — v 3S w , m �' � J W ;, m Q Pq O = ` N W O O L'i in 0 ti 0 U W � v O 1-4 d � O � O q m O 3 C v RVZC30 & RVZC30BB Specifications dP s• '0 Reach -In Freezer Case. .. Energy Data [LINE-UP DATA1E_ irs 46 INDIVIDUAL CASE DATA 1.59 138 2-12 �.. -7 -16 -7 -16 -7 -16 -7 -16 Refrigeration -7 -16 Evaporator Temperature ff) Baseline Evaporator Btuh ''23-' 1,100 1,170 2,400 2,550 3,440 3,660 4,490 4,780 5,550 5,920 Discharge Air Temp. (°F) (with 8°F Superheat) -3 -12 -3 -12 -3 -12 -3 -12 -3 -12 Btuh Deducts 70 1.45 174 1.94 233 2.42 290 2.91 349 Door Heaters (I 15V) Anthony 101 (Std. Energy Doors) 2'3 Back -To -Back (Model BB) 8tuh Adders -75 -85 N/A N/A -215-255 587 -300 -340 -375 -425 Shaded Pole Motor 80 80 160 160 240 240 320 320 400 400 Permanent Split Capacitor (PSC) 30 30 60 60 90 90 120 120 150 150 Standard Energy Doors 200 210 400 420 600 630 800 840 1,000 1,050 See Example Standard Solid End 90 100 90 100 90 100 90 100 Optional Glass -Windowed End Below 900 1,000 900 1,000 900 1,000 900 1,000 Notes: 1. Baseline Evaporator Btuh based on parallel rack system, T-8 lighting, high efficiency electronic fan motors, low energy doors and NO end panels. 2. Door Options: Standard Energy = Heated Glass and Rails; Low Energy = No -Heat Glass and Heated Rails. 3. Individual case data reflect connected right -end perimeter anti -sweat heaters. 4. For conventional condensing units (non -rack system), multiply total Btuh rating by 1.04. 5. Amps are based on electrical nameplate values, watts are based on laboratory observations of actual energy use. Physical Data Refrigeration Suction Line O.D. (Std. Refrig. Exit) 0.53 irs 46 1.06 M111111 92 1.59 138 2-12 184 2.65 230 Shaded Pole Motor Permanent Split Capacitor (PSC) 0.23 33 0.46 66 0.69 99 0.92 132 1.15 165 High Efficiency Electronic 0.60 25 1.20 50 1.80 75 2.40 100 3.00 125 Lighting System r N/A T-8 Electronic 0.58 ff-XiiUM-71MIM-1i 70 1.45 174 1.94 233 2.42 290 2.91 349 Door Heaters (I 15V) Anthony 101 (Std. Energy Doors) 2'3 1.61 186 3.55 408 5.10 587 6.67 767 8.27 951 Gemtron Polar (Std. Energy Doors) 2'3 1.67 192 3.50 403 5.09 585 6.71 772 8.33 958 Anthony ELM (Low Energy Doors) 2.3 0.90 104 2.13 245 2.97 342 3.83 440 4.72 543 Gemtron Polar LE (Low Energy Doors)z3 1.25 143 2.66 319 3.83 460 5.03 604 6.23 748 Defrost Heaters r Defrost Heater 4.04 840 1 8.08 1,680 12.16 2,530 16.15 3,360 20.19 4,200 Notes: 1. Baseline Evaporator Btuh based on parallel rack system, T-8 lighting, high efficiency electronic fan motors, low energy doors and NO end panels. 2. Door Options: Standard Energy = Heated Glass and Rails; Low Energy = No -Heat Glass and Heated Rails. 3. Individual case data reflect connected right -end perimeter anti -sweat heaters. 4. For conventional condensing units (non -rack system), multiply total Btuh rating by 1.04. 5. Amps are based on electrical nameplate values, watts are based on laboratory observations of actual energy use. Physical Data Refrigeration Suction Line O.D. (Std. Refrig. Exit) Outlet Size 7/8 Number *. Weight (lbs.) h .: -CaseCapacity- 27.8 51.0 Doors RVZC30 , 2 -Dr 675 N/A 2 or 3 Door Suction Line O.D. (Top Retrig.) 5/8 3 -Dr 925 1,850 41.4 76.0 4 or 5 Door Suction Line O.D. (Top Refrig.) 7/8 4 -Dr 1,235 2,475 55.1 101.0 Liquid Line O.D. (Electric Defrost) 3/8 5 -Dr 1,575 3,150 68.7 125.9 Liquid Line O.D. (Hot Gas Defrost) 1/2 End Panel 30 60 N/A N/A Case designed to operate in an ambient temperature of 75° F or lower and relative humidity of 55% or lower. Specifications are subiect to change without notice. 4/07/2006 E40LUTION Series... The next step toward perfection Zero Zone, Inc. 110 N Oakridge Dr. North Prairie, WI 53153-9792 ��� us NSF. (800) 247-4496 fax (262) 392-6450 www.zero-zone.com Y U v a_ C O N 'C v CL E O U 4Z .0 v O. v U W c W L. N i 0 C N i I �,,.. V 10 T'. N N r N N 1� N Q V. Lf;V'. n CL O<. V rl h tn M .O. CC) t� O co � a It. 00 Map VQ-, M r1:04 to c i tQLO �' (Y) ao r N N Q n: 'V N .p Ni, P +• '� <I M d. O N. .p Q,'. D.. o Ami r� C Ot N: IN O P Q; O M it 1 U LO IEN o CA N o o L. N i 0 C N i I �,,.. V 10 T'. N N r N N 1� N Q V. Lf;V'. n CL O<. V rl h tn M .O. CC) co a It. VQ-, Dp ' (Y) O o O� .N N °ia'!I M CO i I T'. P �::a-�; •: �G V IJP, W co a It. VQ-, Dp ' (Y) O o O� .N N N Q n: a Lo Q: Ql. .p O0 O. q, No �c d. O N. Q,'. D.. o Ami r� C Ot N: IN O P Q; O M it 1 U LO IEN o CA N o o w P N. P tflu, % OPTIONAL REFRIGERATION EGRESS (TYP.) 3 3/4" (TYP.) RVZC30 & RVZC30BB Specifications ADD 2 1/2" FOR STANDARD T END OR INSULATED DIVIDER ELECTRIC/ ' BOX (TYP.) i ii .,, N 64 INTERIOR HEIGHT 1/2" 813/8" CASE HEI 2 -Dr 62 118" 31 1/16" 46 1/4" O o o 22" _ 3 -Dr 92 1/2" X35 9/16"- —36 9/16" -17" 1315/16" 4 -Dr 123" 61 1/2" 5 -Dr 153 3/8" 76 11/16" IN 3 3/4" (TYP.) OPTIONAL TOP REFRIGERATION CONNECTIONS Reach -In Freezer Case O -4 i-- 2" i n 24" 8 1/2" Li 30 3/16" --� 5 3/8" 33 5/16" 2 1/4" E40LUTION Series.,. The next step toward perfection 2 1/8" FLOOR TOrLOF DRAIN 41 21 - rL -- 1" PVC DRAIN DRAIN TRAP (TYP.) (REVERSIBLE) (OPTION FOR DRAIN TO EITHER SIDE) • Top refrigeration connections or top electrical connections increase case height by up to 4 inches. • BB available in 3, 4, and 5 -door sizes. • 4'/" bases available; increases exterior height by 1". • All dimensions are nominal. Zero Zone, Inc. 110 N Oakridge Dr. North Prairie, WI 53153-9792 KSF (800) 247-4496 fax (262) 392-6450 www.zero-zone.com 4 1/2" • 2 1/4" 1 04/07/06 1 1 64 INTERIOR HEIGHT 1/2" 813/8" CASE HEI HT O o o a i O o o 22" o X35 9/16"- —36 9/16" -17" 1315/16" �-68 5/8" (KICKPLATE)--� 70 5/8" (BUMPER) --- 711/2' (DOOR HANDLE) 8 1/2" Li 30 3/16" --� 5 3/8" 33 5/16" 2 1/4" E40LUTION Series.,. The next step toward perfection 2 1/8" FLOOR TOrLOF DRAIN 41 21 - rL -- 1" PVC DRAIN DRAIN TRAP (TYP.) (REVERSIBLE) (OPTION FOR DRAIN TO EITHER SIDE) • Top refrigeration connections or top electrical connections increase case height by up to 4 inches. • BB available in 3, 4, and 5 -door sizes. • 4'/" bases available; increases exterior height by 1". • All dimensions are nominal. Zero Zone, Inc. 110 N Oakridge Dr. North Prairie, WI 53153-9792 KSF (800) 247-4496 fax (262) 392-6450 www.zero-zone.com 4 1/2" • 2 1/4" 1 04/07/06 1 1 CR -28 & CR -32 ROTISSERIE & HOLDING OVEN FLOOR MODEL - GAS FIRED Cleveland Standard Features ■ Single Convection Rotisserie Oven has the capacity for 7 or 8 cooking skewers or 28 or 32 chickens per unit, cooked to perfection in about 90 minutes. ■ Reliable, easy to use Electric Controls with LED Indicators. ■ Automatic Oven Preheat controls -16 Programmable Recipe memory settings -Automatic Holding Cycle -Product Co -cook Feature -Oven Cavity Temperature "Set -Back' Feature -Rotisserie advance control for loading and removing skewers -Door Safety Switch ■ Powerful 60,000 BTU "High Stage" or "48,000 BTU" Low Stage Ceramic Gas Burner System with Electronic Spark Ignition for easy start-up operation. Power switch automatically ignites burners and starts fans and preheat cycle. ■ Unit comes with 1 set of Stainless Steel Skewers. ■ The Cleveland Rotisserie Oven comes standard with a heavy-duty stainless steel stand with two hinged doors and bottom shelf. Mounted on four heavy-duty adjustable casters: 2 locking and 2 swivel. ■ External mounted Oven Light for enhanced visual appeal. ■ Standard Left Hand Door hinging and Large Glass Window. Fully insulated cooking compartment. Safety Switch stops fans, burners and rotisserie when door is open. ■ Standard 115 volt, 60Hz. Single phase with cord & plug. ■ Oven Catch Pan with skimmer drain for safe, easy cleaning. ■ "Set -Back' control automatically lowers temperature to 200°F after 20 minutes of idle use. ■ Approvals: ETL, ETLC, ETL Sanitation. Options & Accessories O Prep Table, 42" x 32" (PRT4232) O CBS -32 Cabinet Base Stand O Small Skewers (under 3 lbs), set of 7 (SK -28S), set of 8 (SK -32S) O Large Skewers (over 3 lbs), set of 7 (SK -28L), set of 8 (SK -32L) O Skewer Rack (RSR) O TB -32 Turkey Breast Basket, leach MODEL: ❑ CR -32 ITEM NUMBER JOB NAME / NUMBER CR-_ Rotisserie Oven: Dual rate, high and low fire stage burner Three rotisserie speeds to dial in the right combination for perfect browning capabilities. 16 programmable menu buttons with auto hold feature. O TBW -32 Turkey Breast Basket Wrench, set of 2 O PB -7 Planetary Bearings, set of 7 O PB -8 Planetary Bearings, set of 8 O RI -32 Roller Tray Assembly for transporting Skewers O SKH-32 Skewer Handling Tools, set of 2 O CSH-32 Skewer Adapter Holder for countertop SECT. XZPAGE 3 0402 n- © 3.47 a 5.47- HOT .47- HOT AIR o 2.00 EXHAUST 14.13 0 0 0 3.00 16.00 0 00 0 DRAIN 150: 40.3- 76.04 C 34.00 3.00-A 41.00 ecmu� a —J I d 0 NOTE: THE UNIT MUST HAVE BETWEEN 5 AND 14 OF NATURAL GAS PRESSURE WITH THE FACILITY 41,00:: � IN FULL OPERATION. 30.25-- , 1 31.25-1 H 37.88 24.00 I I J00.63 4 PLACES 31.250 200 2.13 x 1.84 DRAIN OPENING FRONT TOP VIEW OF ROTISSERIE SHOWING MOUNTING LOCATIONS SECT. XV PAGE 4 0402 Litho in U.S.A. nt or modifications, as warranted. Cleveland Range reserves right of design improveme INSTALLATION NOTES SERVICE CONNECTIONS MODEL CAPACITY INPUT CHART for installation on Gas Input Ratings - Skewers tl Gas Natural Electrical Connection- © with 8 R. cordRatings Suitable combustible floors shown are for Natural and LP Gas installations CR -32 8 or 8 Turkey 60,000 BTU per supplied -I PH grounded outlet Min. clearance to combustible •. or non-combustible walls: Specify altitude of project if over 2000 K. (610 meters P fY Baskets hours max. - g qMp max. Sides - 3', Bade - 6' For other gases specify type, calorific value, ^ Gas Connection - Gas Pressure Required: specific gravity and pressure at appliance lA) 314' NPT Natural- 5"-14* WC Drain - O Propane - 11"- 14" WC specify a 9 NOTE: When ordering s eci type of gas to be used Drain Kit supplied Normal Supply Pressures with Rotisserie SECT. XV PAGE 4 0402 Litho in U.S.A. nt or modifications, as warranted. Cleveland Range reserves right of design improveme 2 a X � v W � u W J W m a o LA E N Z Z in u,r CL _ Z o _j e v � b Y N m J 00 00 Giant StopBShop° October 4, 2010 Town of North Andover Health Department 1600 Osgood Street Bldg. 20, Suite 2-36 North Andover, MA 01845 Attn: Ms. Susan Sawyer Dear Ms. Sawyer: RECEIVED OCT - 4 2010 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT This letter will serve to confirm the following items will be completed as part of the construction remodel. ,/Deli Prep Area — Install Hand Sink and Prep Sink per attached drawings :✓Deli Cases — Replace Broken Kick Plates Deli Prep Area -Remove Sandwich Prep. Refrigerators and ins`ttalll U neo Re�}c�eratQrr & Table Deli Prep. Area — Clean and/or replace all tiles ''� Deli Prep. Foods — Replace Rotisserie Deli Prep. Foods — Clean Barbeque Hood as required ,/ Produce Prepack — install prep sink per attached Drawings ,/Sushi Area — Install hand sink and prep Sink per attached Drawings -JSalad Bar Walk In — Replace rusty Hinges and Coving Bakery — Remove Donut Proofer Seafood Dept. — Clean and/or replace all tiles J Floor Drain issues — will be addressed and corrected as required. We wish to thank you for all your help to date in reviewing our application and looking forward to satisfying all your concerns and requests. Sincerely, Lorraine Marsden Construction Project Manager Cc: Michele E. Grant D. Moniz File RQ VOM � 0 -e w/n {' o r naQAr G -yo r�✓1 H o od-Y i ✓) wv 5k Ger 2ry Giant of Maryland LLC The Stop & Shop Supermarket Company LLC 00 Companies of Ahold USA Food Establishment 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 1600 Osgood Street, Building 20; Suite 2-36, gNorth Andover, MA 011845 Date: /d / //y I�YI �IYI �i 1�5 J" /fail 6`CGi 6t) NEW - New construction, not yet built REMODEL - partial or major renovation of existing establishment OCT � � X010 ["TOWN NORTH ANDOVER CONVERSION — existing establishment that you are purchasing EALTH DEPARTMENT Name of Establishment: S f -4P t- Show 500'e'1/n i✓/C�' Z -/—c I( Corporate Name: Categorv: Restaurant , Institution , Daycare ,Retail Market ,Other Sm��/C Establishment Address: '7-5-7 /(/4?) %& it. /fid, /% vl UVZ M19 G'/&Vr Phone: (at location if available) /- 9 -) - G 9 3- 966 E-mail Contacts: kffca he e /%1 �/J den C- Shoo aA4 Sh4n. &W�n Name of Owner: dl - /- Z & e)e-d-e41j2zr7f- Mailing Address: 01,31 &/4141 k, , j /5744-0- 4-0c /274 61 e4l(r e vp Telephone: 7 7e' Applicant's Name (if different than owner): Title (owner, manager, architect, etc.): [ 9017q4&1111 Mailing Address:. Telephone: j D yd / - Q 2 0)-7 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 1 of 20 Technical Assistance with the Permitting 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 oreclin) (circle one) participation in the TRC process. General Information Hours of Operation: looAq- Sun gco Mon Tues Wed Thurs Edd Ibn - Fri `• Sat `' ➢ Number of Seats for customers: ➢ Number of Staff.- (Maximum taff:(Maximum per shift) ➢ Total Square Feet of Facility: ➢. Number of Floors on which operations are conducted ➢ Maximum Daily Meals to be Served: (approximate number) Type of Service: (check all that apply) ➢ Breakfast ➢ Lunch ➢ Dinner Sit Down Meals 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 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) 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 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 of each piece of equipment. Each must be clearly labeled 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 the menu dictates to preclude contamination and cross -contamination of raw and ready -to -eat foods. 6. Clearly designate adequate hand washing lavatories for each toilet fixture and in the immediate area of food preparation, cooking and ware washing. (a hand sink should be located within 10 feet of each area for easy access for all food handlers) 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. 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; 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 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; (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 mop sink or curbed cleaning facility with facilities for hanging wet mops; h. Garbage can washing area/facility; i. Cabinets for storing toxic chemicals; j. Dressing rooms, locker areas, employee rest areas, and/or coat rack as required; k. Site plan (plot plan for new construction) PLEASE CIRCLE/ANSWER THE FOLLOWING QUESTIONS 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) ( ) ( ) 1.2. Thick meats, whole poultry (roast beef; whole turkey, chickens, hams) ( ) ( ) 3. Cold processed foods (salads, sandwiches; vegetables) ( ) ( ) 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, 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: 1. Are all food supplies from inspected and approved sources? YES / NO 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 41'F (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 yes, how will cross -contamination be prevented? 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 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 FTHAWING FROZEN POTENTIALLY HAZARDOUS FOOD: ndicate 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 *Thin/Portioned Frozen i Refrigeration 1 Running Water Less than j 70°F(21 °C) j 11 Microwave (as part of cooking process) 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. 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 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 Will employees have paid sick leave? YES / NO 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: Concentration: Test Kit: YES / NO 6. Will ingredients for cold ready -to -eat foods such as tuna, mayonnaise and 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? 7. Will all produce be washed on-site prior to use? YES / NO Is there a planned location used for washing produce? YES / NO Describe 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 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? 10. Please list all PHF's you plan to serve which will/may not be cooked to the previously listed minimum temperatures. A proper "consumer advisory" warning notation must be printed on menu or menu boards. 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. 12. Will the facility 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 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 ➢ 145°F (15 sec) ➢ eggs: ■ Immediate service 145°F (15 sec) pooled* 155T (15 sec) (*pasteurized eggs must be served to a highly susceptible population) ➢ pork ➢ 1457 (15 sec) ➢ comminuted meats/fish ➢ 155°F (15 sec) ➢ poultry ➢ 165°F (15 sec) ➢ reheated PHF's ➢ 165°F (15 sec) 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 HOT/COLD HOLDING: 1. How will hot PHF's be maintained at 1407 (60°C) or above during holding for service? Indicate type and number of hot holding units. 2. How will cold PHF's be maintained at 417 (5°C) or below during holding for service? Indicate type and 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 j THIN MEATS -THIN SOUPS/ TRICK � RICE/ � 'METHOD MEATS GRAVY SOUPS/ NOODLES I GRAVY Shallow Pans I i Ice Baths - E Reduce ji Volume or Size I 3 f' Rapid Chill I Other (describe) 1 } 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 2. How will reheating food to 1657 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) Kitchen FLOOR ` COVING WALLS CEILING E j Bar j k ' � l Food Storage 3 i 9 Other Storage { t 3 Toilet Rooms ; 1 �liJ�7rns F aih i j f i � 7 i Dressing Rooms s I V t c E Kitchen Garbage & 1 Refuse Storage 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 B. INSECT & RODENT CONTROL APPLICANT. PLEASE CHECKAPPROPRIATE BOXES. 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 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? 3. Do all openable windows have a minimum #16 mesh screening? 4. Is the placement of electrocution devices identitied 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? 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. 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 9. Do all containers have lids? YES N0 N/A 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. Frequency of Pick -Up? Indicate days and how often 13. Will a compactor be used? Number: Size: Frequency of Pick -Up 14. Will garbage cans be stored outside? 15. Describe surface and location where dumpster/compactor/garbage cans are to be stored. 16. Describe location of grease storage receptacle 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. r� 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 t� Equipment Code Confirmed Describe/ Comments Requirements by Operator please initial Dish Machine Backflow prevention device � � y //� �ed✓�/2iTv�e /,�,Gl� 7 /D✓�✓�� I Indirect Waste Steam Jacketed Backflow prevention Kettle device i Indirect Waste � Steamer Backflow prevention –�- �''� t,✓��f � 9f�j ��l S�c,1-ood/ device�✓C'�(C/��-Cl�/��t/C� '�✓ . i�fG�/ Indirect Waste o >'/oo/ti�,� Pec f�c%�✓�0,/� Garbage Disposals Backflow prevention or dish table device troughs; Submerged inlets N � i ' At all hose Backflow prevention 70 / t,✓o4�d connections device T �a � � f r�al�,7�c�� �. ✓uN�''� /�t��"✓ I (Garbage can Backflow prevention washer device Carbonated Carbonated Backfl ow beverage prevention device dispenser �'►/� Refrigerator Indirect Waste jS fe t� condensate/ drain / lines ear.' ,ed C seS Chess '1 r' Ice storage bins Indirec waste � �,►� �„/� S� l/ c-LICA � �cl✓e �✓�.r d -FfoolQ,/J'c i�2� f'�f�4�f /�.✓ /7n e 07c- AR cAll sinks Air Gap i���/G�p/SSlQ'^ �j' �a ✓�5; Ice Cream dipper Air Gap _wells i i e OtherWer � r • `S�-� s e j���l✓r¢CC.fg)— /> /`Ce ° 3 41C, 19. Aifloor ramr i s ovi . d & Basil c eana 1 lif so, indicat locatio f /¢Sfg,VC, E. WATER SUPPLY 20. Is water supply public � or private ( ) ? 21. If private, has source been approved? YES ( ) 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 (4NO ( ) Describe provision for ice scoop storage: Provide location of ice maker or bagging operation 23. What is the capacity of the hot water 42-0 -"A' AV i,Dn Com," el AM �kl 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 VIA 24. Is the hot water generator sufficient for the needs of the establishment? Provide calculations for necessary hot water es 25. Is there a water treatment device? YES ( ) NO If yes, how will the device be inspected & serviced? 26. How are backflow prevention devices inspected & serviced? er f,. '44 ce Scj F. SEWAGE DISPOSAL A-2e-n/f 5P. M. f 27. Is building connected to a municipal sewer? 28. If no, is private disposal system approved? Please attach copy of written approval and/or permit. 29. Are grease traps provided? YES (V/ NO ( ) YES ( ) NO ( ) PENDING ( ) YES ( NO ( ) AV. 9-I If so - where? A,10,'e--, aT VA <' � IPI Je �f�-ate t,✓�,.ffG, sy�¢�.,, � Apecific; Note: Grease raps must have the following sign. The language in bold 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). hop /j�� ` I "���1 ^'? infG��cw<e /oVi.e-$ fl"/ e -11r, 0 of fe ��'a� /tac �• o /6 re-a4e r G. DRESSING ROO S y 30. Are dressing rooms provided? YES( )NO( ) 31. Describe storage facilities for employees' personal belongings (i.e., purse, coats, boots, umbrellas,etc.) 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 H. GENERAL 32. Are insecticides/rodenticides stored separately from cleaning & sanitizing agents? YES ( ) NO ( ) Indicate location: 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 4/fNO ( ) 34. Are all containers of toxics including sanitizing spray bottles clearly labeled? YES( PNO ( ) Note: Material Safety Data Sheets (MSDS) are required to be kept for all chemicals on the premises. Where will the MSDS information be kept on display for easy access in an emergency? �4-t 1�r� /►'1 qtr a��—�-c� 35. Will linens be laundered on site? YES ( ) NO (Jf If yes, what will be laundered and where? If no, how will linens be cleaned? 36. Is a laundry dryer available? th YES( ) NO ( ) 37. Location of clean linen storage: y111 38. Location of dirty linen storage: /U/R 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 WOR I SQUARE FEET FIRE AIR CAPACITY I AIR MAKEUP EXTRACTION PROTECTION 1 CFM CFM DEVICES E { I I 1 i 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 41. How is each listed ventilation hood system cleaned? I. SINKS 42. Is a mop sink present? YES (6 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 J. DISHWASHING FACILITIES 44. Will sinks or a dishwasher be used for warewashing? Dishwasher( ) Two compartment sink ( ) Three compartment sink ( ) 45. Dishwasher Type of sanitization used: 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? YESNO ( ) 50. What type of sanitizer is used? ❑Chlorine ❑Iodine quaternary L a ed AM ammonium ❑Hot Water ❑Other 51. Are test papers and/or kits available for checking sanitizer concentration? YES (1-j/N0 ( ) K. HANDWASHING/TOILET FACILITIESn�(� 52. Is there a handwashing sink in each food preparation, cooking and warewashing area? YES (1%<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 (/NO ( ) 55. Is hand cleanser available at all handwashing sinks? YES (�NO ( ) 56. Are hand drying facilities (paper towels, air blowers, etc.) at all handwashing sinks? YES (l�) NO ( ) 57. Are covered waste receptacles available in each restroom? YES (�/ NO ( ) 58. Is hot and cold running water under pressure available at each handwashing sink? YES (V/ NO ( ) 59. Are all toilet room doors self-closing? YES (4NO ( ) 60. Are all toilet rooms equipped with adequate ventilation? YES (V�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 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 Can openers _ Mixers Floor mats Other 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: /_-ejr/�,� JI owner(s) or responsible representative(s) Date: /U //Ile9 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 Series 09 Reduced Pressure Zone Assemblies 909 Sizes: 3/4", 1 " (20, 25mm) 909M1 Sizes: 11/4 ", 11/2", 2" (32, 40, 50mm) Series 909 Reduced Pressure Zone Assemblies are designed to provide superior cross -connection control protection of the potable water supply in accordance with national plumbing codes and containment control for water authority requirements. This series can be utilized in a variety of installations, includ- ing health hazard cross -connections in plumbing systems or for containment at the service line entrance. With its exclusive, design incorporating the patented "air-in/water-out" principle it provides maximum relief valve discharge during the emergency conditions of combined backsiphonage and backpressure with both checks fouled. Model 909QT, standardly furnished with full port, resilient seated and bronze ball valve shutoffs. Sizes 3/4" and 1 " (20 and 25mm) shutoffs have tee handles. Features • Modular design • Replaceable seats • Compact for installation ease • Horizontal or vertical (up or down) installation • No special tools required for servicing ' Specifications A Reduced Pressure Zone Assembly shall be installed at each cross -connection to prevent backsiphonage and backpres- sure of hazardous materials into the potable water supply. The assembly shall consist of a pressure differential relief valve located in a zone between two positive seating check valves. Backsiphonage protection shall include provision to admit air directly into the reduced pressure zone via a separate channel from the water discharge channel, or directly into the supply pipe via a separate vent. The assembly shall include two tightly closing shutoff valves before and after the assembly, test cocks and a protective strainer upstream of the No. 1 shutoff valve. The assembly (specify Model 909 for temperatures up to 140°F (60°C) or Model 909HW for temperatures up to 210°F (99°C)) shall meet the requirements of ASSE Std. 1013; AWWA Std. C-511-92 CSA 364.4; FCCCHR of USC Manual Section 10. Listed by IAPMO (UPC). SBCCI (Standard Plumbing code). The assembly shall be a Watts Regulator Company Series 909QTS or 9090TSHW. 1'/z" (40mm) Supply Pressul Channel to Relief Valve Relief Valve Assembly Ball Valve Test Cocks Water Outlet Air Inlet and Check Aodule >sembly Now Available WattsBox'Insulated Enclosures. For more. information, send for literature ES -WB'. Watts product specifications in U.S. customary units and metric are approximate and are provided for reference only. For precise measurements, IMPEMILM IMIMM please contact Watts Technical Service. Watts reserves the right to change or modify product design, construction, specifications, or materials with- out prior notice and without incurring any obligation to make such changes and modifications on Watts products previously or subsequently sold. wWAM I Models Suffix C&T Cap and tether test cocks PC Internal polymer coating QT Quarter -turn ball valves S Bronze strainer HW Stainless steel check modules for hot and harsh water conditions LF Without shutoff valves LH Locking ball valve handles (open position) HC Inlet/outlet fire hydrant fitting (2" only) Prefix C Clean and check strainer - 3/4" and 1 " (20 and 25mm) only U Union - 3/4" and 1 " (20 and 25mm) only FAE Flanged adapter ends - 11/4", 11/2", 2" (32, 40, 50mm) only NOTE: The installation of a drain line is recommended. When installing a drain line, an air gap is necessary. Materials Body: Bronze Check Seats: 909 Celcon® Relief Valve Seats: Stainless steel 909HW Test Cocks: Bronze Celcon is a registered trademark of Celanese, Limited Connections 3/4" —1" (20 — 25mm) 909 -NPT Female threaded body connection 11/4" — 2" (32 — 50mm) 909 -M1 -NPT Male threaded body connection Standards AWWA C-511-92 FCCCHR of USC Manual Section 10 IAPMO (UPC), SBCCI (Standard Plumbing code) Dimensions — Weights When installing a drain line use 909AG series Air Gaps on Series 909 backflow preventers. *909EL series elbows are for air gaps on backflow preventers in vertical installations. Series 909AG Air Gaps Iron Body Sizes Sizes A Na. Desc. in. mm in. mmm MM in. B in. mm lbs. I kg. 909 -AG -C Air Gap 3/4,1 20,25 1 25 31/4 83 41/8 124 11/2 .7 909 -EL -C Elbow* 3/4,1 20,25 - - 23/8 60 23/8 60 3/8 .2 909 -AG -F Air Gap 11/4-2 32-50 2 50 43/8 111 63/4 171 31/4 1.5 909 -EL -F Elbow* 11/4-2 32-50 - - 35/8 92 35/8 92 2 .9 Approvals c Listed by IAPMO fl9� `� ® u �c C us O Listed by SBCCI 1013 1364.4 *Approved by the Foundation for Cross -Connection Control and Hydraulic Research at the University of Southern California. Horizontal and vertical "flow -up" approval on 3/4" (20mm) and 1" (25mm) sizes (models 909QT, 909PCQT, and U909QT). Pressure — Temperature Temperature Range: 33°F —140°F (0.5°C — 60°C) continuos, 180°F (82°C) intermittent Maximum Working Pressure: 175psi (12.1 bar) Series 909HW: Temperature Range: 33°F — 210°F (0.5°C — 99°C) Maximum Working Pressure: 175psi (12.1 bar) How it Operates The unique relief valve construction incorporates two channels: one for air, one for water. When the relief valve opens, as in the accompa- nying air-in/water-out diagram, the right-hand channel admits air to the top of the reduced pressure zone, relieving the zone vacuum. The chan- nel on the left then drains the zone to atmosphere. Therefore, if both check valves foul, and simultaneous nega- tive supply and positive backpressure develop, the relief valve uses the air- in/water-out principle to stop potential backflow. WATER OUT AIR IN Patent# 4,241,752 Model 909QT-S Model 909QT U I Capacity As compiled from documented Foundation for Cross -Connection Control and Hydraulic Research of the University of Southern California lab tests. * 3/4" (20mm) * 1" (25mm) ,kPa psi _ 110 83 55 28 0 0 kPa r-' 138 103 69 35 138 103 69 35 5 1u 15 20 25 30 35 gpm 0 5 10 15 20 25 30 35 40 45 50 ' 55 60 gpm 19 38 57 76 95 114 133 Ipm 0 19 38 57 76 95 114 133 152 171 190 209 228 Ipm 5 7.5 10 15 20 fps 5 7.5 10 15 20 fps 1.5 2.3 1'/d'0(32mm) 4.6 6.1 mps 11/z" (40mm) IeP, n,i 138 103 69 35 0 10 20 30 40 50 60 70 80 90 100 gpm u 1u zu su au 5u au ru au au 1uu gpm. 0 38 76 114 152 190 228 266 304 342 380 Ipm 5 7.5 10 15 20 fps 0 38 76 114 152 190 228 266 304 342 380 Ipm 1.5 2.3 3.0 4.6 6.1 mps 5 7.5 10 15 fps 2" (50mm) kPa psi 138 2 103 1 69 1 35 U Z5 5U /5 1UU 125 15U 1/5 zuu gpm 95 190 285 380 475 570 665 760 Ipm 5 7.5 10 15 fps 1.5 2.3 3.0 4.6 mps Suffix HC - Fire Hydrant Fittings dimension "A" = 233/4" (603mm) A AsB C D E Es L P OT OT -S in. mm in. mm in. mm in. mm in. mm in, mm in. mm in. mm in. mm lbs. kgs. lbs. kgs. *909QT, 909QT-S Dimensions 3/4" 143/8 365 181/16 459 83/4 222 4 102 43/4 121 63/4 171 103/is 259 75/16 186 3'/a 98 14 6.4 15.6 7.1 1" 153/8' 391 195/8 498 83/4 222 4 102 43/4 121 7 178 11 279 75/16 186 37/8 98 15 6.8 17.5 7.9 11/4"M1 18'/2 470 237/1s 595 115/8 295 5'/z 140 6'/z 165 7'/z 191 123/6 310 103/a 264 5'/4 133 40 18.1 42.8 19.4 1'/2"M1 19 483 243/8 619 115/a 295 5'/z 140 6'/z 165 7'/2 191 125/8 321 103/8 264 5'/4 133 40 18.1 44.0 20.0 2"M1 191/2 495 2515/16 659 115/8 295 5Yz 140 6'/z 165 73/4 197 1315/16 354 10% 264 5'/4 133 40 18.1 47.4 21.5 *U909QT Dimensions - with integral body unions (Prefix "U") 3/4" 145/8 371 19'/6 484 83/4 222 4 102 43/4 121 63/4 171 103/1s 259 75/6 186 37/8 98 14 6.4 15.6 7.1 1" 155/8 397 2015/16 532 83/4 222 4 102 43/4 121 7 178 11 279 75/1s 186 37/a 98 15 6.8 17.5 7.9 *FAE909QT - Dimensions with flanged adapter ends (Prefix TAE") 11/4" 19 483' 241/2 622 115/8 295 5'/2 140 61/2 165 71/2 191 123/16 310 103/8 264 51/8 133 40 18.1 42.8 19.4 1'/z 193/8 502 261/8 664 115/8 295 5Yz 140 6Yz 165 7'/z 191 125/e 321 103/s 264 51/4 133 40 1 8. 1 44.0 20.0 2" 21 533 283/8 721 11% 295 5'/z 140 61/z 165 73/4 197 1315/6 354 103/8 264 51/4 133 40 18.1 47.4 21.5 Subscript'S' = strainer model For additional information, visit our web site at: www.watts.com C�45'7ei i r"-� A Watts Water Technologies Company aaauo�Nc W� ;r MfMBEP ISO'll I11 IIF USA: 815 Chestnut St., No. Andover, MA 01845-6098; www.watts.com Canada: 5435 North Service Rd., Burlington, ONT. L7L 5H7; www.wattscanada.ca ES -909S 0927 © 2009 Watts Job Name Job Location ES-9DM3/M2 Contractor Approval Engineer Contractor's P.O. No Approval Representative — Series Dual Check Valve with Intermediate Atmospheric Vent Sizes: 1/2"M3 (15mm), 3/4"M2 (20mm) Series 9D is specially made for smaller supply lines and ideally suited for laboratory equipment, processing tanks, sterilizers, dairy equipment and similar applications. It is particularly recom- mended for boiler feed lines to prevent backflow when supply pressure falls below system pressure. Series 9D is suitable for use on hot or cold water and can be used under continuous pressure. It features a primary check valve utilizing a rubber disc seating against a mating rubber part to ensure tight closing. A secondary check valve utilizes a rub- ber disc -to -metal seating. In the event of fouling of the down- stream check valve, leakage would be vented to atmosphere through the vent port thereby safeguarding the potable water system. Construction is brass body with stainless steel working parts, integral strainer and durable rubber discs. Female union inlet and outlet connections. Sizes 1/2" (15mm) and 3/4" (20mm). Drain is 1/2" (15mm) thread connection. Features • True line -sized construction allows the check modules to open further allowing dirt and debris to pass more freely reducing check fouling • Stainless steel internal parts • Maximum flow at low pressure drop • Furnished with union connections to facilitate removal and replacement for maintenance • Compact for economy combined with performance • Design simplicity for easy maintenance • Can be installed vertically or horizontally Specifications For Backflow Preventers with Atmospheric vents A Dual Check Valve with Atmospheric Vent shall be installed at referenced cross -connections. Valve shall feature stainless steel and rubber internals protected by an integral strainer. Primary check shall be rubber to rubber seated, backed by the secondary check with rubber to metal seating. The device shall be ASSE approved under Std. 1012 and shall be a Watts Series 9D. 9D -M2 May also be installed vertically Union outlet Secondary. check valve Rugged mesh strainer screen check valve nt and drain connections Brass body construction and stainless working parts throughout Available Models Suffix: S - for 1/2" (15mm) union end solder connections. SC - for satin chrome finish LU - less union IMPORTANT INQUIRE WITH GOVERNING AUTHORITIES FOR LOCAL INSTALLATION REQUIREMENTS Watts product specifications in U.S. customary units and metric are approximate and are provided for reference only. For precise measurements, please contact Watts Technical Service. Watts reserves the right to change or modify product design, construction, specifications, or materials with- out prior notice and without incurring any obligation to make such changes and modifications on Watts products previously or subsequently sold. Materials Forged brass body construction Stainless steel internal parts Durable, tight seating rubber check valve assemblies Pressure — Temperature Temperature Range 33°F — 250°F (0.5°C — 121'C). Maximum Working Pressure: 1 75psi (12.1 bar) Minimum Required Pressure: 25psi (172 kPa). Standards ASSE 1012 CSA B64 Approvals S P ® 39769 H55E Certified by CSA N.Y.C. BSA 104 -75 -SM Tested and approved Conformance with Standard 1012 of the American Society of Sanitary Engineers and by all principal cities, states and areas having these requirements. IMPORTANT. This valve should only be used and properly installed so that spillage of water could not cause damage. To avoid water damage due to valve operation, a drain pipe must be installed. It should terminate approximate 12" (305mm) above a floor drain or through an air gap piped to a floor drain, or other suitable place of disposal. Under no circumstances, should the vent opening or drain line be plugged. Dimensions — Weight I Capacity kPa psi Performance Curve 207 30 n 172 25 2 0 138 20 Cn 103 15 a a 69 10 cc 34 5 Installations Boiler Installation Watts 9DM3 Heating System Installation . Integral Watts Watts Model 1156F Feed Supply Strainer 9DM3 Valve with Union Vent y O FDrain- Return Boiler --0 Floor Drain Livestock Drinking Fountains Watts Water Hammer Shock Arrestor A Watts Water Technologies Company ES-9DM3/M2 0328 �aeulLO�,,C �W CC J-K6I 1 1 ' MfMBEa~^ USA: 815 Chestnut St., No. Andover, MA 01845-6098; www.watts.com Canada: 5435 North Service Rd., Burlington, ONT L7L 51-17; www.wattscanada.ca 0 2009 Watts Up Stream Drain Control Valve Air Gap Drinking Cul B i Water ----------- E1 ------ -------- -- EKM Supply Line 11 i A B E E1 in, mm in. mm in. mm in. mm in. mm lbs. kg, 9DM3 1/2 15 4t1/16 125 29/6 65 115/16 49 29/6 65 1'/2 .68 9DM3-S '/2 15. 43/8 111 29/6 65 115/16 49 29/6 65 11/2 .68 9DM2 3/4 20 41/2 114 29/s 65 115/16 49 29/6 65 13/4 .79 9DM2-S 3/4 20 41 /16 122 29/s 65 2'/16 52 23/4 70 13/4 .79 A Watts Water Technologies Company ES-9DM3/M2 0328 �aeulLO�,,C �W CC J-K6I 1 1 ' MfMBEa~^ USA: 815 Chestnut St., No. Andover, MA 01845-6098; www.watts.com Canada: 5435 North Service Rd., Burlington, ONT L7L 51-17; www.wattscanada.ca 0 2009 Watts Lu J 5 G LL 0 ry 0 LL 0 0 0 S The Model 24 and B24 are anti -siphon, vacuum /in1� on ti—SiphWOODFORD breaker protected wall faucets designed for use in /y�/ II mild climate areas. The Model B24 is enclosed all Fauces in a flush mounted wall box. Both models are designed to we blend with modern architecture for installation on or in homes, service stations, churches, motels, drive- „ti ,.., � 24/VVY24 in restaurants, etc. The Model Y24 is desi ned to be �t►,t�1!t used on a stand pipe in the lawn and garden, etc. SPECIFICATIONS: VACUUM BREAKER -ANTI-SIPHON: • NIDELO Model 34HF with % inch male hose thread • ASSE Standard 1011 approved • IAPMOO listed • Canadian Standards Association EPDM PACKING: Prevents leaking. PACKING NUT: Adjustable brass nut with deep stem guard. VALVE SEAT: Standard "0" size washer. HANDLES: Furnished with polycarbonate wheel handle and loose tee key. Optional: Metal wheel handle. INLETS: Model 24 as shown below. Model B24: 24P-'/ or 24P % only. Model Y24: 3/4 " FPT. MAX PRESSURE: 125 p.s.i. MAX TEMPERATURE: 120° F SHIPPING WEIGHT: (per unit) MODEL 24 & Y24: 1 Ib MODEL B24: 13 lbs (brass or chrome box) 6 lbs (aluminum box) Inlet Descriptions MODEL 24/824 P-% Inlet YT FPT P-3/4 Inlet 3/" FPT 11 I ffrt MODEL 24 ONLY CP Inlet COMBINATION %_" COPPER TUBE '/2' MPT 1 MODEL 24 ONLY I C Inlet COMBINATION I '/z' COPPER TUBE %" COPPER TUBE I ©2007 WOODFORD Mfg. o r E MODEL 24 Exterior Finish: Standard - Chrome (CH) Optional- Rough Brass (BR) or Polished Chrome (PC) MODEL B24 Exterior Finish: Standard - Chrome (CH) Optional- Rough Brass (BR) or Polished Brass (PB) Other Options: Anodized Aluminum Box (AL) MODEL Y24 -� Exterior Finish: Standard - Chrome (CH) Optional- Rough Brass (BR) or Polished Chrome (PC) Rev. 2/07 Form No. 24.105 co IN � MODEL 2 4/B24N24 PARTS LIST J MODEL B24 ITEM PART# DESCRIPTION Rough -in Dimensions 1 30009 Washer Screw -- - ---- -- --2 I 30008 Washer _ i �f 3 —30104 Operating Stem 4 30105 Packing Support Washer 3 7/8" j 5 I. 30247 I EPDM Packing f 6 30109 Packing Nut - Chrome i 3/4INLET 8 3/4^ ® A 30107 - I Packing Nut Brass _ _ _f i E { 7 I 30120 Wheel Handle - Clear i L7'1 R T ` { 30233 _ Wheel Handle --Tan 9 21 Handle Screw -Nickel 8 I 301 - - i 33/4" 71/8" 30002 Handle Screw - Brass WALL THICKNESS 9 34HF-CH 34HF Vacuum Breaker - Chrome 34HF-BRVacuum Breaker - Brass END OF 3 1/2" 10. RK— I3—4HF THREAD STK I Tee Key I IN 1 ---- � 11 B24BX I Box/Door Assembly'-Ghrome _ �� � MODEL 24 WET - 2 3/4" 3 3/8" B24BX-BR Box/DoorAssembly - Brass B24BBrass--'; } .._.. , - X -PB Box/Door Assembly -Polished Brass—y � I B24BX-AL Box/Door Assembly- Anodized Aluminum i -- -- -- -� _�.._._ RK -24 — - _ _—.__.�( Chrom_e Repair Kit (Includes 1-8) RK -H34 I Brass Repair Kit (Includes items 1-8) Manufactured under one or more of the following patents: U.S. Patents: 3,414,001; 3,543,786; 4,178,956; 4,316,481; D216,790; D216,791; D277,365; D277,366; Canada Patents: 822,458; 852,529; 865,995 For more information contact... WOODFORD MANUFACTURING COMPANY 2121 Waynoka Road, Colorado Springs, Colorado 80915 • Phone: (800) 621-6032 • Fax: (800) 765-4115 To view our complete product line visit: www.woodfordmfg.com or email: sales@woodfordmfg.com A Division Of WCM Industries, Inc. w Job Name Contractor Job Location Approval Engineer Contractor's P.O. No. Approval Representative Series LF008PCQT Health. Hazard, Anti -Siphon, Spill -Resistant Backflow Preventer Sizes: 3/B",1/2", 3/a" and 1 " (10, 15, 20, 25mm) Series LF008PCOT is designed for indoor point -of -use applica- tions to prevent backsiphonage of contaminated water back into the potable water supply. Separation of the water supply from the air inlet is accomplished by means of a diaphragm seal. This feature protects against any spillage during start-up or operation. The LF008PCOT features Lead Free* construc- tion to comply with Lead Free* installation requirements. Features • Standardly supplied with internal polymer coating • Standardly supplied with Tee handles • Available less Tee handle with stem wrench flats. For use where space is limited • Available in left-handed or right-handed outlet • Patented design • Spill -resistant design for indoor use • Affordable design • Modular cartridge for ease of service • Vent uses an 0 -ring for reliable operation • Lead Free* Bronze body for durability • Compact space saving design • Satin chrome finish available • Available with strainer Installation The LF008PCQT is designed to be installed at the point -of - use. When factory installed deck/machine mounted on machines or equipment, the critical level of the LF008PCQT shall be not less than 1 " (25mm) above the flood rim. If field applied for general plumbing applications, the critical level of the LF008PCQT shall be a minimum of 6" (150mm) above the flood rim. Specifications A spill -resistant vacuum breaker (SVB) shall be installed, in accordance with the manufacturer's instructions, as noted on the plans. The valve shall consist of a one-piece modular check and float assembly made of engineered thermoplastic and housed in a Lead Free* bronze body. Springs shall be stainless steel. The Health Hazard, Anti -Siphon, Spill Resistant Backflow Preventer shall be constructed using Lead Free* materials. Lead Free* Health Hazard, Anti -Siphon, Spill Resistant Backflow Preventer shall comply with state codes and standards, where applicable, requiring reduced lead con- tent. The valve shall be constructed with a molded diaphragm separating the air inlet from the potable water supply to pre- vent spillage. The valve shall be a Watts Series LF008PCQT Hood ---------- Bonnet --------- 0-ring--------- Vend------------ 0-ring Body ----------- Retainer ----- Check--------- Assembly Size: 3%", Y2" (10, 15mm) Hood -- Bonnet Bonnet ------ 0-ring------- Vent---------- 0-ring Body --------- Retainer ----- Check ------ Assembly M Size: 3/a", 1" (20, 25mm) LF008PCQT L (Left Handed) Handed) Hood Screws (2 Required) Vent Spring Air Bleed Screw Bleed 0 -ring Z!:;D:PL—, (not shown) Test Cock Shutoff Valve Assembly (2 Required) -- Hood Screw. Vent Spring - --- Air Bleed Screw Bleed 0 -ring (not shown) ---� Test Cock Shutoff --- Valve Assembly (2 Required) *The wetted surface of this product contacted by consumable water contains less than one quarter of one percent (0.25%) of lead by weight. Watts product specifications in U.S. customary units and metric are approximate and are provided for reference only. For precise measurements, e please contact Watts Technical Service. Watts reserves the right to change or modify product design, construction, specifications, or materials with- out prior notice and without incurring any obligation to make such changes and modifications on Watts products previously or subsequently sold. I Materials Springs: Stainless steel Bonnet: PPO Vent Disc: EPDM Disc Holder: PPO Check Disc: Silicone rubber Body: Lead Free' Bronze Pressure - Temperature Temperature Range: 33°F —180°F (0.5°C — 83°C) Maximum Working Pressure: 150psi (10.3 bar) End Connections Female NPT - Ball Valve shutoffs Capacity As compiled from documented Foundation for Cross -Connection Control and Hydraulic Research at the University of Southern California lab tests. 'Typical maximum system flow rate (7.5 feettsec.) Standards Meets requirements of IAPMO. Approvals 01us 0 1056 864.1.2 Listed by IAPMO, Approved by the Foundation for Cross - Connection Control & Hydraulic Research at USC. LF008PCOT-S Watts P60 -Ml Solenoid Valves Pressure Reducing Valve fW-0- min--- Test cock �11 Smm———--————— Shutoff W (20mni Hose Adapter wi strainer washer Supply Hose Dispensing Inducers Typical Installation kPa psi 97 14 83 12 69 10 AP 55 8 41 6 28 4 14 2 0 0 0 0 1 2 3 4 5 6 7 3.8 7.6 11.4 15.2 19 22.8 27 FLOW 7.5 2.3 Dimensions — Weights Ike %VWX1 1* A Watts Water Technologies Company ES-LF008PCQT 0940 2.3 reps 1" (25mm) kPa psi 69 10 55 8 0P 41 6 28 4 14 2 0 0 0 5 I15 20 25 30 35 40 45 50 gpm 8 9 10 38 gpm 0 19 36 57 76 95 114 135 152 171 190 Ipm flan FLOW 7.5 fps mss ps 2.3 mps Note: A strainer is recommended to be installed ahead of the backflow preventer to prevent the fouling of the check assembly and resulting spillage from the valve during repressurization. Do not install in concealed locations or areas where water leakage due to normal wear of the internal parts can cause damage. LF008PCOT SIZE (Dh� DIMENSIONS 3/8 10 77/8 in. mm in. B mm in. D mm E in. mm lbs. kgs. 3/8 10 51/2 140 315/ 6 3/4 20 100 31/8 79 1.6 .73 1/2 15 53/4 146 4'/16 284 106 33/8 86 1.7 .77 3/4 20 7 178 45/a 117 41/2 114 3.8 1.72 1 25 71/2 191 51/a 130 47/8 124 4.8 2.18 LF008PCOT-S Bs 3/8 10 77/8 200 315/ 6 100 31/8 79 3.4 1.54 1/2 15 81/4 216 43/6 106 33/8 86 3.5 1.59 3/4 20 101/4 260 45/8 117 41/2 114 5.6 2.54 1 25 113/6 284 51/8 130 47/8 124 7.6 3.45 agUILD�M1,C u� MEM6EP ^ I$o'II III ERTIFIED USA: 815 Chestnut St., No. Andover, MA 01845-6098; www.watts.com Canada: 5435 North Service Rd., Burlington, ONT. L7L 51-17; www.wattscanada.ca 0 2009 Watts I Job Name Contractor Job Location Engineer Approval Contractor's P.O. No Approval Representative Series N9 Dual Check Vacuum Breakers for In -Line Applications Size 1/4" and 3/s" (8 and 10mm) Series N9 Dual Check Vacuum Breakers for In -Line Applications are used for continuous pressure, non -health hazard, applications. These valves have NPT female inlet and outlet connection and brass body construction. Models N9C - same as N9 except comes with chrome body Pressure -Temperature Temperature Range: 33°F - 140°F (5°C - 60°C) Maximum Working Pressure: 125psi (8.6 bars) Applications Series N9 should be installed on each parlor sink where a hose is attached. This series is for use on continuous pressure applications. Parlor Sinks Open End, -.K-only outlet on fixture Mixed Water Line FF N9 Drain Dimensions — Weights II I DIMENSIONS in. mm A in. mm B in. mm in. 81 mm lbs. kgs. N9C 1/4 6 23/8 60 1'/4 32 1 25 .38 .17 N9C 3/8 10 23/8 60 1'/4 32 1 25 .38 .17 N9 I/4 6 23/8 60 1'/4 32 1 25 .38 .17 N9 3/e 10 23/8 60 1'/4 32 1 25 .38 .17 Capacity kPa psi 345 50 310 45 276 40 a 241 35 p 207 30 172 25 N aNi 138 20 a` 103 15 69 10 35 5 0 0 ES -N9 0 1 2 3 4 5 6 7 gpm 0 3.8 7.6 11 15 19 23 271pm Flow USA: 815 Chestnut St., No. Andover, MA 01845-6098; www.wattsreg.com Canada: 5435 North Service Rd., Burlington, ONT L7L 51-17; www.wattscda.com a - B Standards CSA B64.8 A 63 WA • 9001 CERTIFIED REGULATOR Watts product specifications in U.S. customary units and metric are approximate and are provided for reference only. For precise measurements, please contact Watts Technical Service. Watts reserves the right to change or modify product design, construction, specifications, or materials without prior notice and without incurring any obligation to make such changes and modifications on Watts products previously or subsequently sold. ES -N9 0314 ©Watts Regulator Company, 2003 Printed in U.S.A. A Job Name Job Location Engineer Approval Series N9 Dual Check Vacuum Breakers for In -Line Applications Contractor Approval Contractor's P.O. No. Representative — Size 1/4" and 3/s" (8 and 10mm) - Series N9 Dual Check Vacuum Breakers for In -Line Applications are used for continuous pressure, non -health hazard, applications. These valves have NPT female inlet and outlet connection and brass body construction. N9 Models Capacity . kPa psi N9C - same as N9 except comes with chrome body 345 50 -310 45 Pressure -Temperature 276 40 Temperature Range: 33°F -140°F (5°C - 60°C) a 241 35 Maximum Working Pressure: 125psi (8.6 bars) o 0 207 30 Applications 172 25 Series N9 should be installed on each parlor sink where a hose is 138 20 attached. This series is for use on continuous pressure applications. a 103 15 Parlor Sinks 69 10 Open End, 35 5 -.(-only outlet on fixture 0 0 ES -N9 1/4 " 3/8 " W Mixed 0 1 2 3 4 5 6 7 gpm Water 0 3.8 7.6 11 15 19 23 27lpm ilgA=:::::::x Line Flow N9 B --- Dimensions — Weights Standards MODEL SIZE (ON) DIMENSIONS WEIGHCSA B64.8 A B 61 in. mm in. mm in. mm in. mm lbs. kgs. A N9C 1/4 6 23/8 60 11/4 32 1 25 .38 .17 N9C 3/8 10 23/8 60 VA 32 1 25 .38 .17 N9 1/4 6 23/8 60 11/4 32 1 25 .38 .17 N9 1 3/8 10 23/8 60 11/4 32 1 25 .38 .17 61 - Imm�UMAEr"l USA: 815 Chestnut St., No. Andover, MA 01845-6098; www.wattsreg.com IM9001 Canada: 5435 North Service Rd., Burlington, ONT L7L 51-17; www.wattscda.com CERTIFIED REGULATOR Watts product specifications in U.S. customary units and metric are approximate and are provided for reference only. For precise measurements, please contact Watts Technical Service. Watts reserves the right to change or modify product design, construction, specifications, or materials without prior notice and without incurring any obligation to make such changes and modifications. on Watts products previously or subsequently sold. ES -N9 0314 ©Watts Regulator Company, 2003 Printed in U.S.A.