Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - Design Layout (2)
vo-i`e-�1'nd,C l on lllQi n6ol:Iu PUBLIC HEALTH DEPARTMENT Community Development Division July 24th, 2014 North Andover Country Club 500 Great Pond Road North Andover, MA. 01845 Attn: Stephen Kohr Re: Snack Bar (Poolside) 500 Great Pond Road North Andover, MA. 01845 Dear Mr. Kohr, The Health Department received your application on May 22, 2014 for the renovations to the Snack Shack, Poolside at the North Andover Country Club at 500 Great Pond Road. This application is complete and requires no further correction. In response to the application, a walk through was conducted in June, 2014 by the Health Dept. personnel to determine the overall establishment condition. This letter serves as your approval to renovate the establishment. 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 we look forward to our continued relationship. There are two final inspections that are required by the Health Department prior to the opening of the kitchen. The first is a final construction inspection. This inspection is performed after the bulk of construction is done, equipment is in place and working, etc. The second inspection is a final food inspection. The final food inspection will need to take place 24 to 48 hours prior to the re -opening. Please call our office at the phone number listed below to schedule those inspections. Once basic construction is complete and the equipment is in place, please contact our office for a construction inspection to verify that you have built it to plan. At the final inspection, it is expected that the premises will be ready for business as follows. 1) The establishment will be clean of all construction materials 2) All hand sinks and bathrooms will be stocked with a wall mounted paper towel and soap dispensers 3) The ladies room will have a covered trash can for feminine item disposal 4) Bathrooms must have "employee must wash hands before returning to work" signage 5) Hand sinks should be labeled "hand wash only" 6) If potentially hazardous foods are being offered undercooked, such as hamburgers or eggs, to order, a disclaimer regarding foodborne illness must be posted, as the code requires. 7) There must be test strips for the Chlorine and Quaternary Ammonium sanitizer on site 8) There must be Sanitizer on site. 9) Gloves must be on site. Please note that the state does not recommend the use of latex gloves due to some person's sensitivity to latex that may cause them illness. 10) You must obtain copies of the state and federal food codes and keep them on premises 11) At minimum, employees should be trained on the sick policy and sanitation basics. 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com In general, you must meet the state code requirements to be allowed to be open for business to the public including, but not limited to the list above. This is a Health Department plan approval only. Please be advised that other departments may have specific requirements. This approval does not supersede any other department's request regarding other town or state regulations. If you have any questions regarding this approval, please contact the health office. The Health Department was recently notified of requirements in the plumbing code. 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): 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). Sincerely, Michele E. Grant Public Health Inspector 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofoorthandaver.com From: Matt Theodoros United Restaurant Equipment 1 Executive Park Drive North Billerica MA 01862 978-439-5500 (phone) 978-262-9999 (fax) NY 7Ai 1 "JA 1"1 f► Project: North Andover Country Club Sinks Cutsheets To: North Andover Country Club Steve Kohr 500 Great Pond Rd. N. Andover MA 01845 (978) 687-7414 5/21/2014 Krowne Metal HS -2L Item#:1 HAND SINKS WALL MOUNT HAND SINKS MODEL: PROJECT: ITEM #: QTY: PRODUCT IMAGES HS -2 rf , HS -2 ts^ ---tam 14 lbs. 2- tIs^ 10- 1 10" F &tl2" ir STANDARD FEATURES a Fabrication 20 gauge stainless steel. All seams tig welded and polished a Bowl Deep drawn with stamped rim to prevent spillage a Wall Mounting Bracket Offset design for added strength a Faucet 4" on center wall mount faucet included on most models n Drain Stainless Steel a Drain with Overflow Stainless Steel with plastic overflow tube and inlet a Plumbing 1/2" IPS hot and cold water.1 t/2" IPS drain outlet. Install at 36" working height. 1/2" faucet supply 12" from floor.1 1/2" drain line 231/4" from floor. (31/2" IPS drain on Model HS -20) c Low Lead Compliance Low Lead Compliant faucet options are available to meet California AB -1953 and Vermont S152 standards OPTIONAL ACCESSORIES c H-100 Chrome Plated 1 1/2" IPS P -Trap a H-101 Deck Mount Soap Dispenser o H-102 Upgrade: Low Lead Wrist Handle Faucet n H-103 Wrist Handle Kit n H-104 Wall Mount Soap Dispenser o H-105 Wall Mount Towel Dispenser n H-106 One Side Splash (Specify Side) o H-107 Two Side Splashes n H-108 Stainless Steel Skirt o H-109 Upgrade: Low Lead Royal Series Faucet n H-110 Side Support Brackets c H-111 Soap &Towel Dispenser c H-200 Upgrade: Low Lead Commercial Series Faucet APPROVED BY: CERTIFICATIONS: Due to our commitment to continued product improvement, specifications are subject to change without notice. Printed in the USA Krowne Metal Corporation Rev. 1 /2013 100 Haul Rd. Wayne, NJ 07470 • Toll Free: (800) 631-0442 • Fax: (973) 872-1129 No. 2.1 sales@krowne.com • www.krowne.com • www.facebook.com/KrowneMetal • www.twitter.com/KrowneMetal North Andover Country Club Sinks Cutsheets United Restaurant Equipment Co. MA r,7 AV aIr more durable, efficient, beautiful 4184 4184 E. Conant st. Long Beach, CA 90808 Tel. 310 -900-1000 Fax. 310-900-1077 www.turboairinc.com Project Model #: Item #: Qty Available W/H : Approval. 75 24 441/2 1 HIGH QUALITY 304 STAINLESS STEEL Model: TSA -3-12-L1 NSF, TSA -341 / TSB -342 sold seperately o ENTIRE ASSEMBLY IS FUSED, SHIELDED AND ■ DIE -STAMPED CREASED DRAIN BOARDS FOR POLISHED PROVIDING A ONE-PIECE SEAMLESS POSITIVE DRAINAGE SINK UNIT ■ SWIRL AWAY BOWL DRAINAGE to WELDED AREAS ARE HIGH-SPEED BELT BLENDED TO MATCH ADJACENT SURFACES WITH THE CONTI- ° GALVANIZED LEGS AND GUSSETS NUTTY OF A SATIN FINISH to ADJUSTABLE ABS BULLET FEET o ALL SINK COMPARTMENTS ARE COVERED ON A FULL ■ STAINLESS STEEL LEGS AVAILABLE (OPTIONAL) 5/8" RADIUS AND CONSTRUCTED USING STATE OF THE ART SEAMLESS WELDING TECHNIQUES L W 0 0 r O O O (unit: inch) Model Ga. Bowl Size (L' x W' x H') Length Width Height # of Faucet Accepted Net Weight' (lbs.) TSA -3-12-L1 18 18x18xl2 75 24 441/2 1 77 TSA -3-L1 18 18x18x11 75 24 441/2 1 75 Vec201410 Information and specifications are subject to change without notice. All net weights are approximated. Crafting fee will be added for shipping via common carriers (Please confirm at the time of the purchase). Krowne Metal 12-812L Item#:2 STANDARD SERIES PLUMBING 8" CENTER WALL MOUNT FAUCETS MODEL: PROJECT ITEM #: QTY: PRODUCT IMAGE 12-812 SHOWN ALSO AVAILABLE IN LOW LEAD BY ADDING T' TO MODEL NUMBER SPECIFICATIONS n 8" on center wall mount with 1h" NPT female inlets n Rough in: Two 7/8" round holes on 8" centers n Flow rate: 2 GPM max n Shipping weight: 4 lbs. o Quantity per case: 12 STANDARD FEATURES o Mounting flanges with eccentric fittings for quick installations o Heavy -Duty spout with double 0 -Ring construction and welded shoulder for durability n High precision machining and polished nickel chromium finish a Color -coded handles n Optional wrist blade handles available o Full replacement parts available n Low Lead Compliance T' Models meet California AB -1953 and Vermont S152 standards (Faucet models already listed with the "L" suffix (i.e. 12-806L) are only available in Low Lead Compliant model) APPROVED BY: CERTIFICATIONS: Due to our commitment to continued product improvement, specifications are subject to change without notice. Printed in the USA Krowne Metal Corporation Rev. 05/2012 100 Haul Rd. Wayne, NJ 07470 • Toll Free: (800) 631-0442 • Fax: (973) 872-1129 No. 12-8XX sales@krowne.com • www.krowne.com • www.facebook.com/KrowneMetal • www.twitter.com/KrowneMetal North Andover Country Club Sinks Cutsheets United Restaurant Equipment Co. Dormont Manufacturing WD -50 Item#:3 WD Series SPECIFICATION: Dormant WD Series PDI Certified recessed or floor mounted epoxy coated steel grease interceptor with gasketted solid steel cover, hex head center bolt(s), removable baffle assembly, deep seal trap with cleanout, no hub connections (standard), and external cast iron flow control fitting. Secured Non -slip Cover Neoprene Gasket 1 Static Water Level Baked Epoxy, Coated Body 3/B"110) Air Space— Locking Device PD1 Certified Grease Interceptors DxE FIG`^' Rate GPM Grease Capacity Lbs A Inlet & Outlet Clean-out C D Plug 1E0 8001:2000 Base to Center ro Center REGISTERED Width C WD -4 One-piece ( Air Relief — By-pass 2"(51) Removable No -hub 16"(406) Baffle K WD -7 7 F Inlet & 2"(51) 8-1/2"(216) Outlet (*) C 13"(330) Q Integral urMo TM 10 Deep Seal Trap u p C 8-1/2"(216) Fixed 21-3/4"(552) 14"(356) Sediment WD -15 Note: *Optional Threaded Inlet And Outlet Baffle 2'(51) (includes Threaded Flow Control) 3-1/2"(89) 22"(559) Interceptor Catalog Number FIG`^' Rate GPM Grease Capacity Lbs A Inlet & Outlet B C D E F Base to Center ro Center Length Width Height WD -4 4 8 2"(51) 7-3/4"(197) 3-1/4"(83) 16"(406) 10"(254) 11"(279) WD -7 7 14 2"(51) 8-1/2"(216) 3-1/2"(89) 18"(457) 13"(330) 12"(305) WD -10 10 20 2"(51) 8-1/2"(216) 3-1/2"(89) 21-3/4"(552) 14"(356) 12'(305) WD -15 15 30 2'(51) 10-1/2'(267) 3-1/2"(89) 22"(559) 15'(381) 14"(356) WD -20 20 40 3'(76) 11-1/2"(292) 3-1/2"(89) 24'(610) 15-3/4"(400) 15"(381) WD -25 25 50 3'(76) 12"(305) 4-1/2"(114) 26'(660) 16-1/2"(419) 16-1/2"(419) WD -35 35 70 3"(76) 14"(356) 5"(127) 30"(762) 18"(457) 19'(483) WD -50 50 100 4'(102) 16"(406) 5-1/2"(140) 32"(813) 22"(559) 21-1/2'(546) 31 North Andover Country Club Sinks Cutsheets United Restaurant Equipment Co. Dormont Manufacturing WD -50 Item#:3 Sizing Chart Grease interceptors are sized according to the rate of incoming flow, in gallons per minute (GPM). Associated with the incoming flow rate is an interceptor's capacity. The rated capacity, in lbs., is listed at twice the flow rate, in GPM. For example, a 10 GPM interceptor has a rated capacity of 20 lbs General Procedure: To Determine the Flow Rate of Each Sink: 1. Calculate the capacity of the sink in cubic inches: 3X 18(LENGTH) x —IS(WIDTH) x�Q(DEPTH) = 13608 2. Convert the capacity from cubic inches to gallons per minute (GPM): CU.IN. _ 231 = 59 GPM. 3_ _ Adjust for displacement: GPM x 0.75 = 4'4 GPM. Result is the flow rate required to drain the sink in one minute.* *Note: If drain down time is not critical, on interceptor with a lesser flow rate, up to half the calculated flow rate may be specified. zz GPM Three compartment pot sink, each compartment 12" x 12" x 15" —� 1. 12" x 12" x 15" = 2160 cu. in. x 3 comp. = 6480 cu. in. 2. 6480 cu. in. + 231 = 28 GPM. 3. 28 GPM x 0.75 = 21 GPM. A 20 GPM interceptor would permit the sink to drain in slightly more than one minute. *Discharge from spray hoods is determined by the flow rate of the hood. Sizing For Multiple Fixtures: 1. Determine the flow rate for each fixture to be serviced by the interceptor. 2. Add together 100% of the largest flow rate, 50% of the second largest, and 25% of all others. 3. Result is the recommended flow rate of the interceptor. Example: 1. Fixture A: 35 GPM Flow Rate Fixture B: 26 GPM Flow Rate Fixture C: 18 GPM Flow Rate Fixture D: 12 GPM Flow Rate 2. 35 GPM (A) x 100% = 35 GPM 26 GPM (B) x 50% = 13 GPM 30 GPM (C + D) x 25% = 7.5 GPM Total Flow Rate = 55.5 GPM A 50 GPM interceptor is recommended for this installation. Typical Configurations AIR INTAKE SINK VENTED WASTE y FLOW CONTROL TEE ON FLOOR AIK INTAKEVENTED WASTE 7�M+ FLOW CONTROL TEE RECESSED North Andover Country Club Sinks Cutsheets United Restaurant Equipment Co. F INTAKE SINKVENTED WASTE y FLOW CONTROL TEE RECESSED WITH EXTENSION 7 Poolside menu notes: • All highlighted items are prepared and served from the snack bar • Non -highlighted items are prepared and served from the NACC main kitchen by a food runner and delivered right to the customer for consumption. • Circled items are prepared in the NACC kitchen for sale in the snack bar. These items are replaced daily sometimes hourly if needed. Breakfast 11-12pm Granola Ba eese Cup of Fruit Assorted Yogurt Single Serving Cereals Milk and Assorted Juices Snacks Assorted Lays Chips Assorted Candy Assorted Ice Creams AYurt ruit Cup *Steamed Hot Dog --1 Natural Casing Frank on a Warm Roll, Served with Potato Chips 6 Uncrus rat Peanut Butter and Jelly 5 *Chicken Fingers & French Fries Served with Duck Sauce 9 * = items not prepared in the snack bar are available only during lunch and dinner hours Tuesday through Sunday Consuming raw or undercooked meats, poultry, seafood, shellfish or eggs may increase your risk of foodborne illness. Please inform your server if you or anyone in your party has allergies or special dietary requirements. Lunch and Dinner Starters *Shrimp Cocktail (4) Cocktail Sauce and Lemon 12, Add Shrimp 3 each *Clam Chowder Local Clams, Smoked Bacon and Leeks Cup 5 / Bowl 8 *Chef's Seasonal Soup Cup 5 / Bowl 8 Salads Caesar Salad Romaine Hearts tossed w/ House Made Dressing, -Croutons and Impa armesan Sm1i House Salad Mixed Baby Greens, Cucumber, Carrots and Sliced Red Onion with choice of Dressing. Small 5 Sandwiches & Wraps *B.L.T. Smoked Bacon, Lettuce and Tomato, Choice of Bread 6 Served with Chips and a Dill Pickle Make it a Triple Decker and add: Turkey Breast 5 Scoop of Tuna Salad 4 Sliced Avocado 2 *Chicken Caesar wrap Grilled Chicken, Romaine Lettuce, Parmesan Cheese and Croutons tossed in our House Made Caesar Dressing in a White Flour Tortilla *Greek salad wrap Romaine Lettuce, Kalamata Olive, Feta Cheese, Roasted Red Peppers, Pepperoncini Tomatoes and Cucumber tossed with Greek Dressing in a Flour Tortilla �d � � ��� � �, � �� ����� .- �, o Krowne Metal 12-812L Item#:2 8" CENTER WALL MOUNT FAUCETS MODEL: PROJECT: PRODUCT IMAGE 12-812 SHOWN ALSO AVAILABLE IN LOW LEAD BY ADDING T' TO MODEL NUMBER SPECIFICATIONS 8" on center wall mount with 1/2" NPT female inlets Rough in: Two 1/8" round holes on 8" centers Flow rate: 2 GPM max o Shipping weight: 4 lbs. Quantity per case: 12 ITEM #: QTY: STANDARD FEATURES • Mounting flanges with eccentric fittings for quick installations m Heavy -Duty spout with double 0 -Ring construction and welded shoulder for durability ® High precision machining and polished nickel chromium finish ® Color -coded handles A Optional wrist blade handles available m Full replacement parts available a Low Lead Compliance T' Models meet California A13-1953 and Vermont S152 standards (Faucet models already listed with the "L" suffix (i, e. 12-806L) are only available in Low Lead Compliant model) APPROVED BY: CERTIFICATIONS: Due to our commitment to continued product improvement, specifications are subject to change without notice. Printed in the USA Krowne Metal Corporation Rev. 05/2012 100 Haul Rd. Wayne, NJ 07470 • Toll Free: (800) 631-0442 • Fax: (973) 872-1129 No. 12-8XX sales@krowne.com • www.krowne.com • www.facebook.com/KrowneMetal • www.twitter.com/KrowneMetal North Andover Country Club Sinks Cutsheets United Restaurant Equipment Co. Krowne Metal HS -21- -AN MODEL: PROJECT: HS -2 HS -2 14" 14 lbs. I`— L L 1 ,>,.: 101,I Item#:1 ITEM #: QTY: STANDARD FEATURES ® Fabrication 20 gauge stainless steel. All seams tig welded and polished • Bowl Deep drawn with stamped rim to prevent spillage ® Wall Mounting Bracket Offset design for added strength ® Faucet 4" on center wall mount faucet included on most models ® Drain Stainless Steel • Drain with Overflow Stainless Steel with plastic overflow tube and inlet • Plumbing 1/2" IPS hot and cold water. l 1/2" IPS drain outlet. Install at 36" working height. 1/2" faucet supply 12" from floor.1 1/2" drain line 23'/4" from floor. (3'/2" IPS drain on Model HS -20) o Low Lead Compliance Low Lead Compliant faucet options are available to meet California AB -1953 and Vermont S152 standards oil • H-100 Chrome Plated 1 1/2" IPS P -Trap 0 H-101 Deck Mount Soap Dispenser ® H-102 Upgrade: Low Lead Wrist Handle Faucet ® H-103 Wrist Handle Kit © H-104 Wall Mount Soap Dispenser ® H-105 Wall Mount Towel Dispenser ® H-106 One Side Splash (Specify Side) ® H-107 Two Side Splashes ® H-108 Stainless Steel Skirt ® H-109 Upgrade: Low Lead Royal Series Faucet o H-110 Side Support Brackets ® H-111 Soap & Towel Dispenser ® H-200 Upgrade: Low Lead Commercial Series Faucet APPROVED BY: CERTIFICATIONS: Due to our commitment to continued product improvement, specifications are subject to change without notice. Printed in the USA Krowne Metal Corporation Rev. 1/2013 100 Haul Rd. Wayne, NJ 07470 • Toll Free: (800) 631-0442 • Fax: (973) 872-1129 No. 2.1 sales@krowne.com • www.krowne.com • www.facebook.com/KrowneMetal • www.twifter.com/KrowneMetal North Andover Country Club Sinks Cutsheets United Restaurant Equipment Co. d Dormont Manufacturing WD -50 Item#:3 cg�� WD Series PDI Certified Grease Dormont Interceptors SPECIFICATION: Dormont WD Series PDI Certified recessed or floor mounted epoxy coated steel grease interceptor with gasketted solid steel cover, hex head center bolt(s), removable baffle assembly, deep seal trap with cleanout, no hub connections (standard), and external cast iron flow control fitting. Secured Non -slip Cover Neoprene Gasket --'� Locking Device DxE Clean-out ISO 9001:Y000 REGISTERED Interceptor Catalog flow Rate Grease CO city p A ltrlet & �� B C ID "' E F Base to One-piece Width Air Relief — Bypass Number Gp/yt j II Center Removable No -hub 4 8 2"(51) 7-3/4"(197) Baffle 10"(254) 11"(279) (N11) F Inlet & 7 Static 2"(51) 8.1/2"(216) 3-1/2"(89) 18"(457) 13"(330) 12"(305) WD -10 Outlet (*) C Water 8-1/2"(216) 3-1/2"(89) 21-3/4"(552) 14"(356) 12"(305) WD -15 Q Integral APMO TM Level Baked Epoxy, 3-1/2"(89) 22"(559) ( 14"(356) WD -20 20 40 Deep Seal Trap u p C 3-1/2"(89) 24"(610) Coated Body 15"(381) WD -25 25 50 3"(76) 12'(305) Fixed 16-1/2"(419) 16.1/2"(419) WD -35 35 70 3"(76) 14"(356) 5"(127) 30"(762) Sediment 19"(483) WD -50 50 Note: *Optional Threaded Inlet And Outlet Baffle 16"(406) 3/8"(10) 22'(559) (includes Threaded Flow Control) Air Space—_j Interceptor Catalog flow Rate Grease CO city p A ltrlet & �� B C ID "' E F Base to ;-, Top to Length , " _ Center Width Height,` Number Gp/yt ,.,. Lbs outlet Center WD -4 4 8 2"(51) 7-3/4"(197) 3.1/4"(83) 16"(406) 10"(254) 11"(279) WD -7 7 14 2"(51) 8.1/2"(216) 3-1/2"(89) 18"(457) 13"(330) 12"(305) WD -10 10 20 2"(51) 8-1/2"(216) 3-1/2"(89) 21-3/4"(552) 14"(356) 12"(305) WD -15 15 30 2"(51) 10-1/2"(267) 3-1/2"(89) 22"(559) 15"(381) 14"(356) WD -20 20 40 3"(76) 11-1/2"(292) 3-1/2"(89) 24"(610) 15-3/4"(400) 15"(381) WD -25 25 50 3"(76) 12'(305) 4-1/2"(114) 26"(660) 16-1/2"(419) 16.1/2"(419) WD -35 35 70 3"(76) 14"(356) 5"(127) 30"(762) 18"(457) 19"(483) WD -50 50 100 4"(102) 16"(406) 5-1/2'(140) 32'(813) 22'(559) 21-1/2'(546) J North Andover Country Club Sinks Cutsheets United Restaurant Equipment Co. Dormont Manufacturing WD -50 Item#:3 Sizing Chart Grease interceptors are sized according to the rate of incoming flow, in gallons per minute (GPM). Associated with the incoming flow rate is an interceptor's capacity. The rated capacity, in lbs., is listed at twice the flow rate, in GPM. For example, a 10 GPM interceptor has a rated capacity of 20 lbs General Procedure: To Determine the Flow Rate of Each Sink: 1. Calculate the capacity of the sink in cubic inches: 3X _I S(LENGTH) x -IS (WIDTH) x�4(DEPTH) _ 13 60N. 2. Convert the capacity from cubic inches to gallons per minute (GPM): CU.IN. _ 231 = 59 GPM. 3 _ Adiust for displacement: GPM x 0.75 =-+4 4 GPM. Result is the flow rate required to drain the sink in one minute.' *Note: If drain down time is not critical, an interceptor with a lesser flow rate, up to half the calculated flow rate may be specified.JL 22 GPM Three compartment pot sink, each compartment 12" x 12" x 15" —� 1. 12" x 12" x 15" = 2160 cu. in. x 3 comp. = 6480 cu. in. 2. 6480 cu. in. _ 231 = 28 GPM. 3. 28 GPM x 0.75 = 21 GPM. A 20 GPM interceptor would permit the sink to drain in slightly more than one minute. *Discharge from spray hoods is determined by the flow rate of the hood. Sizing For Multiple Fixtures: 1. Determine the flow rate for each fixture to be serviced by the interceptor. 2. Add together 100% of the largest flow rate, 50% of the second largest, and 25% of all others. 3. Result is the recommended flow rate of the interceptor. Example: 1. Fixture A: 35 GPM Flow Rate Fixture B: 26 GPM Flow Rate Fixture C: 18 GPM Flow Rate Fixture D: 12 GPM Flow Rate 2. 35 GPM (A) x 100% = 35 GPM 26 GPM (B) x 50% = 13 GPM 30 GPM (C + D) x 25% = 7.5 GPM Total Flow Rate = 55.5 GPM A 50 GPM interceptor is recommended for this installation. Typical Configurations AIR INTAKE SINK VENTED WASTE i FLOW CONTROL TEE ON FLOOR AIR INTAKE • SINK VENTED WASTE y FLOW CONTROL TEE RECESSED North Andover Country Club Sinks Cutsheets United Restaurant Equipment Co. FLOW AIR INTAKE SINK [ VENTED WASTE y RECESSED WITH EXTENSION 7 MODEL: PROJECT: PRODUCT IMAGE 18-24-7 SHOWN AVAILABLE IN 1800 or 2100 SERIES ITEM #: ICE BINS QTY: STANDARD FEATURES a Interior 20 gauge stainless steel a Cold Plate Cast aluminum post mix plate with 7 circuits. Plate is sealed into bottom. Each circuit is 5/16" OD stainless steel tubing. Two full with remainder to be half circuits. Bump and swedge fittings on ends a Front Apron 22 gauge stainless steel clad over 20 gauge galvanized steel a Backspiash 22 gauge stainless steel a Back and Bottom 20 gauge galvanized steel a Legs 1 5/6" tubular 16 gauge galvanized steel with grey plastic bullet foot ENog e:1/2" IPS drain connection. 4" tailpiece providedlate: 1" IPS drain connection OPTIONAL ACCESSORIES a C-19 Stainless Steel Divider (Specify Model) a C-21 Bottle Wells (6 pack) a C-32 Condiment Tray a C-34 Stainless Steel Perforated Bottom (24", No Cold Plate) a C-35 Stainless Steel Perforated Bottom (30"+, No Cold Plate) a C-36 Upgrade: Stainless Steel Legs a C-39 Right End Side Splash a C-40 Left End Side Splash a C-41 Partial Sliding Cover (Using Bottle Wells) a C-42 Full Sliding Cover (No Bottle Wells) a C-43 Bottle Wells (2 pack) a C-46 Upgrade: 10 Circuit Cold Plate a S -"XX" Single Speedrail ("XX" denotes 24, 30", or 36") a D -"XX" Double Speedrail ("XX" denotes 24, 30", or 36") APPROVED BY: CERTIFICATIONS: Due to our commitment to continued product improvement, specifications are subject to change without notice. Printed in the USA Krowne Metal Corporation Rev. 03/2012 100 Haul Rd. Wayne, NJ 07470 • Toll Free: (800) 631-0442 • Fax: (973) 872-1129 No. 4.2 sales@krowne.com 9 www.krowne.com 9 www.facebook.com/KrowneMetal 9 www.twitter.com/KrowneMetal r.STANDARD SERIES UNDERBARICE BINS MODEL: PROJECT: ITEM #: QTY: 1800 SERIES +D16-125 18.5' l --- __-- I ------ 6 i c 1--- ---�� to 29.5' 7--n--r `nmmlhnnlT 34" 3to E 100 SERIES �D I 16.125 21 Model Length Ice Bin Overall Left Side Inside Bin Cold Ice Leg Weight Numbers 3'-0" Depth Depth to Drain Dimensions Plate Capacity Size (lbs.) 18-24DP-7 2'-0" 15" 19'/2" 12" 15" x 22" Circuits (Ibs.) 10" 132 18-30DP-7 ® © © O 15" x 28" 7 120 O 135 18-24 2'-0" 12" 13'/2' 12" 15" x 22" N/A 80 16" 55 18-30 2'-6" 12" 131/2" 15" 15" x 28" N/A 97 16" 65 18-36 3'-0" 12" 131/2" 18" 15" x 34" N/A 115 16" 69 18-24-7 2'-0" 12" 16 1h" 12" 15"x 22" 7 80 13" 105 18-30DP 2'-6" 15" 161/2" 15" 15"x 28" N/A 120 13" 69 18-36DP 3'-0" 15" 16'/2" 18" 15" x 34" N/A 138 13" 80 18-24DP-7 2'-0" 15" 19'/2" 12" 15" x 22" 7 100 10" 132 18-30DP-7 2'-6" 15" 191/2" 15" 15" x 28" 7 120 10" 135 18-36DP-7 3'-0" 15" 191/2" 18" 15" x 34" 7 138 10" 145 MECHANICAL REQUIREMENTS: Cold Plate: 1/2" IPS drain connection No Cold Plate: l " IPS drain connection Model Length Ice Bin Overall Left Side Inside Bin Cold Ice Leg Numbers Depth Depth to Drain Dimensions Plate Capacity Si (lbs.) Circuits (Ibs. ® © © O 21-24 2'-0" 12" 131/2" 12" 15" x 22" 80 16" 55 21-30 2'-6" 12" 131/2" 15" 15" x 28" N/A 97 16" 65 21-36 3'-0" 12" 131/2" 18" 1 " N/A 115 16" 80 21-24-7 2'-0" 12" 16'/2" 12" 5" x 22" 7 80 13" 120 -7 2'-6" 12" 161/2" 15" x 28" 7 97 13" 130 t 21 36- 3'-0" 12" 16 18" 15 x 34 7 115 13" 135 21 24D 15" 6'/2" 12" 15 x 22 NIA 100 13" 65 21 30DP 2'-6" 161/2" 15" 15" x 28" N/A 120 13" 80 -'—� 21-36DP 3'- ' 1 16 1h" 18" 15" x 34" N/A 138 13" 95 21-24DP-7 0" 15" 12" 15"x 22" 7 100 10" 150 21 2'-6" 15" 191/2 15" 15" x 28" 7 120 10" 155 _r -36DP-7 3'-0" 15" 191/2" 15" x 34" 7 138 10" 160 MECHANICAL REQUIREMENTS: Cold Plate: 1/2" IPS drain con No Cold Plate: l' .............. IPS drain connection APPROVED BY: CERTIFICATIONS: Due to our commitment to continued product improvement, specifications are subject to change without notice. Printed in the USA Krowne Metal Corporation Rev. 03/2012 100 Haul Rd. Wayne, NJ 07470 • Toll Free: (800) 631-0442 • Fax: (973) 872-1129 No. 4.2 sales®krowne.com 9 www.krowne.com 9 www.facebook.com/KrowneMetal 9 www.twifter.com/KrowneMetal Food Establishment Plan Review Guide, ECEIVEa MAY 2 2 2014 J"N'T NORTH ANDOVER HEALTH DEPARTMENT 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 establishmentplanned openings. TOWN OF NORTH ANDOVER, MA Regulatory Authority 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Date:KA o LO I NEW - New construction, not yet built REMODEL - partial or major renovation of existing establishment CONVERSION — existing establishment that you are purchasing Name of Establishment:ur'Nno (){f -may C (4b Corporate Name: 411411 A AdOSI&C (tix 1 In %rtT^(.1 h ��*�n4r 1 Y Category: Restaurant , Institution , Daycare , Retail Market , Other Establishment Address: 60 �-recn � � ltri� lvnry c f Phone: (at location if available) — (G % —7y/5� E-mail Contacts: s ie -o h { 6 ac r1_12►c��VAr ('� . CO ,n. Name of Owner: IQ�Ye, 4 Zi --11 C Mailing Address: 5Z)C) l l'i'e /A li6nCif Road Telephone:i7r� - 10Y7- %�f/� Applicant's Name (if different than owner): Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 1 of 19 Title (owner, manager, architect, etc.):r;- eAPr& i A& nao P, r Mailing Address: ,Sbo &t r; J7 Telephone: J7J- - (@ S7- 7c//cf X. f i ate Received: BOH office—Us—e&'ly Date Review completed: BOH office use anlyAppraved%llend ate Revised plicat on Received BOH office use only,g ; ate Review completed: BOH of ce use,anl1) "I ed / De'nied 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 or decline (circle one) participation in the TRC process. t to,f TRC General Information Hours of Operation: Sun(p a Thurs /t4 -(pp Mon Fri/ Tues I /& - (o p Sat 11 Wed /14 4 ➢ Number of Seats for customers: M ➢ Number of Staff: Z (Maximum per shift) ➢ Total Square Feet of Facility: Z 1(6 ➢ Number of Floors on which operations are conducted j ➢ Maximum Daily Meals to be Served: (approximate number) ➢ Breakfast 0 ➢ Lunch ➢ Dinner — Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 2 of 19 Type of Service: (check all that apply) Please enclose the following documents: Sit Down .Meals Take Out Caterer Mobile Vendor Otherkt�Ceed Srw-clic—S L,,"Vioposed Menu (including seasonal, off-site and banquet menus) �/,a facturer 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: Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 3 of 19 a. Entrances, exits, loading/unloading areas and docks; b. Complete finish schedules for each room including floors, walls, ceilings and coved juncture bases; c. Plumbing schedule including location of floor drains, floor sinks, water supply lines, overhead waste -water lines, hot water generating equipment with capacity and recovery rate, backflow prevention, and wastewater line connections; d. Lighting schedule with protectors; (1) At least 110 lux (10 foot candles) at a distance of 75 cm (30 inches) above the floor, in walk-in refrigeration units and dry food storage areas and in other areas and rooms during periods of cleaning; (2) At least 220 lux (20 foot candles): (a) At a surface where food is provided for consumer self-service such as buffets and salad bars or where fresh produce or packaged foods are sold or offered for consumption; (b) Inside equipment such as reach -in and under -counter refrigerators; (c) At a distance of 75 cm (30 inches) above the floor in areas used for hand washing, ware washing, 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 Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 4 of 19 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) ( ) (14) 2. Thick meats, whole poultry (roast beef; whole turkey, chickens, hams) 3. Cold processed foods (salads, sandwiches, vegetables) N) ( ) 4. Hot processed foods (soups, stews, rice/noodles, gravy, chowders, casseroles) ( ) 00 5. Bakery goods (pies, custards, cream fillings & toppings) ( ) (X) 6. Other FOOD SUPPLIES: 1. Are all food supplies from inspected and approved sources? ES / NO 2. What are the projected frequencies (daily, weekly, etc) of deliveries for Frozen foods- , Refrigerated foods "DrA, I j and Dry goods 3. Provide information on the amount of space (in cubic feet) allocated for: Dry storage Z ae , Refrigerated Storage •'%� , and Frozen storage 19 4. How will dry goods be stored off the floor? COLD STORAGE: 1. Is adequate and approved freezer d refrigeration available to store frozen foods frozen, and refrigerated foods at 41°F (5°C) and below? E / NO 2. Will raw meats, vqWtry and seafood be stored in the same refrigerators and freezers with cooked/ready-to- eat foods? YES'6 If yes, how will cross -contamination be prevented? r.�1 fr 3. Does each refrigerator/freezer have a thermometer? YE NO Number of refrigeration units: 2_ Number of freezer units: Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 5 of 19 4. Is there a bulk ice machine available? 49 / NO Is ice packaged and sold for retail? YES, 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 *Thin/Portioned Frozen Refrigeration Running Water Less than 70°F(21°C) Microwave (as part of cooking process) Cooked from Frozen state" 44 Other (describe) t *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. i/ S/7 2. Will food employees be trained in good food sanitation practices NO Method of training: Number(s) of employees: Dates of completion: , f 20 It 3.Will ispo able gloves and/or utensils and/or food grade paper be used to prevent handling of ready -to -eat foods. Y NO Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 6 of 19 4. Is there a written policy to exclude or restrict food workers who are sick or have infected cuts and lesions? Y NO Please describe briefly: Will employees have paid sick leave? YES 0 vm lef' -a" SG f" 7 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: r} Concentration: bq h Test KiCS ANO 141 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 P/ A If not, how will ready -to -eat foods be cooled to 41'F? 7. Will all produce be washed on-site prior to us ?YES NO IC Is there a planned location sed for wasi g ro uce? YES / NO Describe l� If not, describe the procedure for cleaning and sanitizing multiple use sinks between uses. Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 7 of 19 8. Describe the procedure used for minimizing the length of time PHF's will be kept in the temperature danger zone (41T - 140T) during preparation. 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? M 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. 0 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? VIA YES / NO What type of temperature measuring device: `./ Aut� Ux w"141 ver p ;,& k A.-►% Minimum cooking time and temperatures o0roduct utilizing convection and conduction heating equipment: ➢ ➢ beef roasts 130OF(121min) ➢ 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) ➢ reheated PHF's ➢ 1657 (15 sec) Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 8 of 19 2. List types of cooking equipment. 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. MIA 2. How will cold PHF's be maintained at 41°F (5°C) or below during holding for service? Indicate type and number of cold holding units. 94 \�' COOLING: Please indicate by chec mg 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 METHOD THICK MEATS THIN MEATS V THIN SOUPS/ GRAVY � THICK SOUPS/ GRAVY RICE/ NOODLES Shallow Pans Ice Baths Reduce Volume or Size Rapid Chill Other (describe) Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 9 of 19 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. 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 (i.e. quarry tile, stainless steel, 4" plastic coved molding, etc.) will be used in the following areas. (please be specific) Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 10 of 19 FLOOR COVING ----[Kitchen WALLS CEILING Bar E" 1' Food Storage CbA% Other Storage Toilet Rooms I �I� Dressing Rooms i Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 10 of 19 Kitchen CotC"J/11N NO N/A c Garbage & Refuse Storage 2. Are screen doors provided on all entrances left open to the outside? Mop Service I Basin Area 3. Do all operable windows have a minimum #16 mesh screening? 4. Is the placement of electrocution devices identified on the plan? 5. Will all pipes & electrical conduit chases be sealed; ventilation systems Ware washing Area 4 �0�, exhaust and intakes protected? Walk-in Refrigerators and 6. Is area around building clear of unnecessary brush, litter, boxes and other Freezers �\N harborage? B. INSECT & RODENT CONTROL APPLICANT. PLEASE CHECKAPPROPRIATE BOXES. Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 11 of 19 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 operable windows have a minimum #16 mesh screening? 4. Is the placement of electrocution devices identified on the plan? 5. Will all pipes & electrical conduit chases be sealed; ventilation systems exhaust and intakes protected? 6. Is area around building clear of unnecessary brush, litter, boxes and other harborage? 7. Will air curtains be used? If yes, where? 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. M(Aq,ptir-Q f7es•I Cuttvot - r14uA,Nv04- Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 11 of 19 C. GARBAGE AND REFUSE INSIDE YES NO N/A 9. Do all containers have lids? 10. Will refuse be stored inside? If so, where? K 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: 1 b. Size of: c. Frequency of Pick -Up? Indicate days and how often 13. Will a compactor be used? K Number: �C Size: Frequency of Pick -Up �C 14. Will garbage cans be stored outside? K 15. Describe surface and location where dumpster/compactor/garbage cans are to be stored. C pp �G,.uG Svr i�ct � 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, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 12 of 19 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� Equipment Code Confirmed Describe/ Comments Requirements by Operator please initial Dish Machine Backflow prevention device Indirect Waste I Steam Jacketed Backflow prevention Kettle i device N I Indirect Waste Steamer Backflow prevention j device 1 a Indirect Waste Garbage Disposals Backflow prevention or dish table device troughs; N� Submerged inlets At all hose Backflow prevention connections I device Garbage can washer Backflow prevention device 11 Carbonated beverage Carbonated Backflow prevention device dispenser Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 13 of 19 Refrigerator Indirect Waste condensate/ drain tj� ft lines Ice storage bins Indirect Waste C`��C9✓� ✓c`'' c4e All sinks Air Gape ✓r�lfill2r� �1/ �'c%% Ice Cream dipper wells Air Gap n Other 19. Are floor drains provided & easily cleanable, if so, indicate location: A E. WATER SUPPLY 20. Is water supply public Nor 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 �Q or purchased commercially ( )? If made on premise, are specifications for the ice machine provided? YES ( ) NO ( ) s Describe provision for ice scoop storage: Provide location of ice maker or bagging operation 23. What is the capacity of the hot water generator? A6 Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 14 of 19 24. Is the hot water generator sufficient for the needs of the establishment? Provide calculations for necessary hot water 25. Is there a water treatment device? YES ( ) NO k If yes, how will the device be inspected & serviced? 26. How is backflow prevention devices inspected & serviced? F. SEWAGE DISPOSAL 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? If so - where? 0 YES hNO ( ) YES ( ) NO ( ) PENDING ( ) YES () NO 00 W'1r1 ift i A S mC4_4 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): 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 The 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). G. DRESSING ROOMS 30. Are dressing rooms provided? YES( ) NO K 31. Describe storage facilities for employees' personal belongings (i.e., purse, coats, boots, umbrellas, etc.) 04,ia Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 15 of 19 & GENERAL 32. Are insecticides/rodenticides stored separately from cleaning & sanitizing agents? YESVNO ( ) Indicate location: 33. Are all t6xics for use on the premise or for retail sale (this includes personal medications), stored away from food preparation and storage areas? YES M NO ( ) 34. Are all containers of toxics including sanitizing spray bottles clearly labeled? YES NNO ( ) 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? 35. Will linens be laundered on site? If yes, what will be laundered and where? If no, how will linens be cleaned? _�,'� ®'feud 36. Is a laundry dryer available? 37. Location of clean linen storage: 14_ 38. Location of dirty linen storage: NO YES( ) Pr:✓�C4� YES O NO (k 39. Are containers constructed of safe materials to store bulk food products? YES (ANO ( ) Y Indicate type: ja:(Z J., - CG✓ :...� �, 40. Indicate all areas where exhaust hoods are installed: N M LOCATION FILTERS WOR EXTRACTION DEVICES SQUARE FEET FIRE PROTECTION AIR CAPACITY CFM AIR MAKEUP CFM Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 16 of 19 41. How is each ventilation hood system that is listed cleaned? I. SINKS 42. Is a mop sink present? If no, please describe facility�for cleaning of other YES (V NO 43. If the menu dictates, is a foo preparation sink present? YES ( ) NO (Xdetail answer A J. DISHWASHING FACILITIES 44. Will sinks or a dishwasher be used for ware washing? 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 ( ) AI% A 47. 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 (N NO ( ) If no, what is the procedure for manual cleaning and sanitizing? 49. Are there drain boards on both ends of the pot sink? i (i Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 17 of 19 YES( )N 0 (A 50. What type of sanitizer is used? ❑Chlorine ❑Iodine Vouaternary ammonium ❑Hot Water o0ther 51. Are test papers and/or kits available for checking sanitizer concentration? YES �NO ( ) K. HANDWASHING/TOILET FACILITIES 52. Is there a hand washing sink in each food preparation, cooking and ware washing area? YES (kNO ( ) 53. Do all hand washing sinks, including those in the restrooms, have a mixing valve or combination faucet? YES k)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 hand washing sinks? YES V�,NO ( ) 56. Are hand drying facilities (paper towels, air blowers, etc.) at all hand washing sinks? YES &NO ( ) 57. Are covered waste receptacles available in each restroom? YES (' . NO ( ) 58. Is hot and cold running water under pressure available at each hand washing sink? YES (' "O ( ) 59. Are all toilet room doors self-closing? YES ( ) NO M 60. Are all toilet rooms equipped with adequate ventilation? YES N NO ( ) 61. Are hand washing signs and instructions posted in each employee restroom? YES ( ) NO Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 18 of 19 L. SMALL EQUIPMENT REQUIREMENTS 62. Please specify the number, location, and types of each of the following proposed for on site use: Slicers Oil A - 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. 1__:7 Signature (s) Print: Owner (s) or responsible representative (s) Date: 5—A -0 /f 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: 1/29/2013 Town of North Andover, Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 --Phone: 978.688.9540-- Fax: 978.688.8476 Page 19 of 19