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HomeMy WebLinkAboutFood Service Establishment Inspection Town of South Windsor — Health Department 1640 Sullivan Avenue, South Windsor, CT 06074 Phone: 860-644-2511 ext. 248 Fax: 860-644-7280 FOOD ESTABLISHMENT PLAN REVIEW APPLICATION NEW REMODEL CONVERSION CHANGE OF OWNERSHIP Name of Establishment: Alp p*&I 's 0,6 U f 61 ()-r-r IF Category: Restaurant ,Institution ,Daycare ,Retail Market ,Other (Jh,E 5WL-f- Address: f � Phone(if available):_��� Name of Owner: G L !M Mailing Address: r— /Coyiut/L do c/ Telephoner n �k &(3`s6o1-- n a Applicant's Name: Title(owner,manager, architect,etc.): "rxu ✓-� Mailing Address:) Telephone: Hours of O eration: Mon M Z/ es Wed Thurs Fri Sat Sun Number of Seats: Number of Staff: (Maximum per shift) Total Square Feet of Facility: r 200 Number of Floors on w ich operations are conducted Maximum Meals to be Served:(approx. #) Breakfast Lunch Dinner Projected Start Date of Project: _ Projected Completion Date of Project: T Z Type of Service: Sit Down Meals Take Out Caterer Mobile Vendor Other W44 1 FOOD PREPARATION REVIEW Check categories of Potentially Hazardous Foods(PHF's)to be handled,prepared and served. CATEGORY* (YES)0 O 1. Thin meats,poultry, fish, eggs (hamburger; sliced meats; fillets) 2_ Thick meatc�whn1P poetry(roastbeef;-whole-turkeS,chickens, (� F•� 3. Cold processed foods(salads, sandwiches,vegetables) 4.Hot processed foods(soups, stews,rice/noodles,gravy,chowders, casseroles) 5. Bakery goods (pies, custards, cream fillings &toppings)` . 6. Other *A generic HACCP plan for each category of food may be available from the regulatory authority for reference. PLEASE CIRCLE/ANSWER THE FOLLOWING QUESTIONS: FOOD SUPPLIES: 1.Are all food supplies from inspected and approved sources63/NO 2.What are the projected frequencies of deliveries for Frozen foods- Z11A - Refrigerated foods ,and Dry goods t! 1� ,� - 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 approv ezer and refrigeration available to store frozen foods' and refrigerated foods at 45°F and below?YESAV Provide the method use o calculate cold storage requirements. 2. Will raw meats oultry and seafood be stored in the same refrigerators and freezers with cooked/ready-to-eat foods?YES If yes,how will cross-contamination be prevented? 3.Does each refrigerator/freezer have a thermometer?YES A0 4. #of refrigeration units: #of freezer units: Bulk Ice Machine?YES/ - 2 - THAWING FROZEN POTENTIALLY HAZARDOUS FOOD: Please indicate By-checking a 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. .• o Thawing Method *THICK FROZEN FOODS *THIN FROZEN FOODS I Refrigeration Y`1" 1 Running Water Less than 70OF , Microwave(as part of cooking process) Cooked from Frozen state ✓Y Other(describe) *Frozen foods: approximately one inch or less=thin, and more than an inch=thick. COOKING: 3 1.Will food thermometers be used to measure final cooking/reheating temperatures of PHF's?YES/E� What type"of temperature measuring,devise�R 2.List types of cooking equipment. 9 , HOT/COLD HOLDING: 1.How will hot PHF's be maintained at 140T or above during holding for service?Indicate type and number of hot holding units. 2.How will cold PHF's be maintained at 45T or below during holding for service?Indicate type and number of cold holding units. •S: - 3 - COOLING: Please indicate by checking the appropriate boxes how PHF's will be cooled to 45°F within 6 hours(140°F to in 2 hours,wrd 7011F to 45OF in 4 hom).Also, ftrdicate whue the couling Will take place. COOLING THICK THIN THIN 'THICK RICE/ �'FIiO M�rTS NfK�rT� —SOUPS/ SO PS/---- NOODLES GRAVY GRAVY Shallow Pans N Ice Baths Reduce Volume or Size Rapid Chill / Other(describe) ry a 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 temperatlye off at least 165T for 15 seconds.Indicate type and number of units used for reheating foods. 2.How will rehe in food to 165T for hot holding be done rapidly and within 2 hours? /V -4- PREPARATION: 1.Please list cateWries of bad- more than 12-bours in-advance of sen.dee. 4zl- 2.Will food employees be trained in good food sanitation practices?&�D/NO Method of training: Number(s)of employees: 2' Dates of completion: 12gA&C- 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: Will employees have paid sick leave?YES 5.How will cooking equipment,cutting boards,counter tops and other food contact surfaces which cannot be submerged in sinks or ut through a dishwasher be sanitized? Chemical Type: /V Concentration: Test Kit:-YES(/NO 6.Will ingredients for cold ready-to-eat foods such as 5Aia,mayonnaise and eggs for salads and sandwiches be pre-chilled before being mixed and/or assembled?YEEY If not,how will ready-to-eat foods be cooled to 41°F? 1 � _ 3 7.Will all produce be washed on-site prior to use?YES Is there a planned location/designated sink used for washing produc Y Describe - 5 - If not,describe the procedure for cleaning and sanitizing multiple use sinks between uses. 51 8.Describe the procedure used for minimizing the length of time PHF's will be kept in the temperature danger zone(45°F-140-F)du—n g prepara io . 9.Provide a HACCP plan for specialized processing method such as vacuum packaged food items prepared on- site or otherwise required by the regulatory authority. 10.Will the facility be serving food to a highly susceptible population?YES,!NO � (� r If yes,how will the temperature of foods be maintained while being transferred between the kitchen and service area? A.FINISH SCHEDULE Applicant must indicate which materials(quarry tile,stainless steel,4"plastic coved molding, etc.).will be used in the followi4g areas. Kitchen FLOOR COVING WALLS CEILING Bar Food Storage Other Storage Toilet Rooms - 6 - Dressing Rooms AA Garbage& RefuseStorage - ( - Y1 Mop Service Basin Area Warewashing Area d, Walk-in Refrigerators . 3 and Freezers ; ---- YES NO NA B.INSECT AND RODENT CONTROL (Please check appropriate boxes) 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 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? C. GARBAGE AND REFUSE Inside 8. Do all containers have lids? 9. Will refuse be stored inside? If so, where? 10. Is there an area designated for'garbage can or floor mat cleaning? - 7- Outside 11. Will a dumpster be used? �NO Number Size �� Contractor VJ* Frequency of pickup 12. Will a compactor be used? YES Number Size Frequency of pick up IA116 Contractor 13. Will garbage cans be stored outside? YES 14. Describe surfa a and location where dumpster/compactor/garbage cans are to be stored 15. Describe location of grease storage receptacle f 16. Is there an area to store recycled containers? Y (list location) Indicate what materials are required to be recycled; ( ) Glass ( )Metal ( )Paper (Cardboard ( ) Plastic 17. Is there any area to store returnable damaged goods? YES ` D.PLUMBING CONNECTIONS AIR AIR *INTEGRAL *"P" VACUUM CONDENSATE GAP BREAK TRAP TRAP BREAKER PUMP 18. Toilet 19. Urinals _ r - 8 - f• 20• Dishwasher 21. Garbage Grinder 22..Ice machines 23..Ice storage bin 24. Sinks a.Mop b.Janitor (D c.Handwash d.3Compartment e.2 Compartment L 1Compartment g.Water Station F25. Steam bles 26.Dipper wells 27. Refrigeration condensate/ N drain lines 28. Hose connection / 29.Potato peeler ,v - 9 - 30. Beverage Dispenser 31. Other 32.Are floor drains provided&easily cleanable,if so,indicate location: E.WATER SUPPLY 33.Is water supply public( or private( )? 34.If private,has source been approved?YES ( )NO( )PENDING( ) Please attach copy of written approval and/or permit. 35.Is ice made on premises( )or purchased commercially( ) ? 1" If made on premise,are specifications for the ice machine provided?YES( )NO( ) Describe provision for ice scoop storage: Provide location of ice maker or bagging operation fN 36.What is the capacity of the hot water generator?164 37.Is the hot water generator sufficient for the needs of the establishment?YES ("NO( ) 38.Is there a water treatment device?YES O NO If yes,how will the device be inspected&serviced? 39.How are backflow prevention devices inspected&serviced? zz F.SEWAGE DI POSAL 40.Is building connected to a municipal sewer?YES (-NO( ) - 10 - 41.If no,is private disposal system approved?YES ONO( )PENDING( ) *Please attach copy of written approval andJ/or-pertntt 42.Are grease traps provided?YES(/NO( ) If so,where? Provide schedule for cleaning&maintenance G.DRESSING ROOMS 43.Are dressing rooms provided?YES O NO 44.Describe storage facilities for employees'personal belongings(i.e.,purse,coats,boots,umbrellas,etc.) H.GENERAL 45.Are insecticides/rodenticides stored separately from cleaning&sanitizing agents?YES j-40( ) Indicate location: 46.Are all toxics for use on the premise or fo'r retails a(this includes personal medications), stored away from food preparation and storage areas?YES( )NO( 47.Are all containers of toxics including sanitizing spray bottles clearly labeled?YES( )NO( ) 48.Will linens be laundered on site?YES O NO(� If yes,what will be laundered and where? f/- /40 4 If no,how will linens be cleaned? 49.Is a laundry dryer available?YES O NO(� s 50.Location of clean linen storage: 1 Lo 51.Location of dirty linen storage: 52.Are containers constructed of safe materials to store bulk food products?YES tIONO� ) Indicate type: - 11 - 53.Indicate all areas where exhaust hoods are installed: AIR -AIR 'LOCATION FILTERS SQUARE WOR FEET PROTECTION CAPACITY MAKEUP EXTRACTION CFM CFM DEVICES 54.How is each listed ventilation hood system cleaned? I. SINKS 55.Is a mop sink present?YES (-1,40( ) w If no,please describe facility for cleaning of mops and other equipment: 56. If the menu dictates,is a food preparation sink present?YES( )NO( ) J.DISHWASHING FACILITIES I 57.Will sinks or a dishwasher be used for warewashing? IV Dishwasher( )Two compartment sink( )Three compartment sink( ) 58.Dishwasher: Type of sanitization used: Hot water(temp. provided) Booster heater Chemical type Is ventilation provided?YES( )NO( ) - 12 - 59. Do all dish machines have templates with operating instructions?YES( )NO( ) 60. Do all dish machines have temperature/pressure gauges as required that are accurately YES NO ( ) 61.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? •6 62.Are there drain boards on both ends of the pot sink? YES�el)NO( ) 63.What type of sanitizer is used?(circle one) Chlorine Quaternary Ammoni of W er Iodine 64.Are test papers and/or kits available for checking sanitizer concentration?YES qlJ NO( ) K.HANDWASHING/TOILET FACILITIES 65.Is there a handwashing sink in each food preparation and warewashing area?YES "'NO( ) 66.Do all handwashing sinks I I d' g those in the restrooms,have a mixing valve or combination faucet? YES ( )NO( 67.Do self-closing metering fauce s provide a flow of water for at least 15 seconds without the need to reactivate the faucet?YES(&WO( ) 68.Is hand cleanser available at all handwashing sinks?YES(✓)PTO( ) 69.Are hand drying facilities(paper towel dispensers,etc.)available at all handwashing sinks?YES (AI-100( ) 70.Are covered waste receptacles available in each restroom?YES( )NO 71.Is hot and cold running water under pressure available at each handwashing sink?YES(•-J'NO( ) 72.Are all toilet room doors self-closing?YES�JINO( ) 73.Are all toilet rooms equipped with adequate ventilation?YES t<NO( ) 74.If required,is a handwashing sign posted in each employee restroom?YES (91'NO{ ) L.SMALL EQUIPMENT REQUIREMENTS` 75. Please specify the number,location, and types of each of the following: /'�t Slicers (/� /'- Cutting boards Can openers ki /A- Mixers Floor mats //U I��' Other - 13 - a - 1ti�C*7/tl�7TC�C7�C7IC IC7Y�c' STATEMENT:I hereby certify that the abovelnformation 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: (Owner or responsible r resentative) Print G v Date: � / 2 Name: Approval of these plans and specifications by this Regulatory Authority does not indicate compliance with any other code,law or regulation that may be required--federal,state,or local.It further does not constitute endorsement or acceptance of the completed establishment(structure or equipment).A preopening inspection of the establishment with equipment in place&operational will be necessary to determine if it complies with the local and state laws governing food service establishments. - 14 - •• � VR• •1111 i NAME OF UIVATJ Q DATE OF • .+- :Ott •� �� I � _ .� � •.. _ � L �J .� * ML- ampzwww-�, •• y i A . . ! t �A* { r Paged of INSPECTION FOOD SERVICE ESTABLISHMENTS DEPARTMENT OF PUBLIC HEALTH CONTINUATION SHEET NAME OF ESTABLISHMENT TOWN DATE OF INSPECTION `S v�• "S L� ti 0 2 O: - - INSPECTIO REMARKS FORM# S � INITIAL(INSPECTOR) INITIAL(PERSON IN CHARGE) Distribution: 1 st-White-Health Department 2nd-Yellow-Owner/Manager CP-17 Rev.10/85 STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION STATE OFFICE BUILDING HARTFORD, CT INSPECTION REPORT V&0yy Name: G.4w s - b r Township �1 : LVtHD t,L Date: .� .... Z s 1 Manag r: .....F�/&45— .................. P.O.Address: yf ......1. :.E.... ......................... f Title of person Kind of Business: Y�.Q.! 1�t:.T...l.../L.00.>✓s��. interviewed: ........... � v':................................. Make report on one person or firm on each sheet REMARKS: 7NV s ;etePo&-T 1s iN TZ� ✓C� 7a 11" u' 11G�'�lrCl � 7AeT4-,,-'-1 c 1 TY eS 4 i Wet #&Me' 415?M �-S- �g'Z- rests slre - l S -/a /&WwA&,,74n y Ae c. Ow,.,tA-... 4/�G ��,o/4�-d`7/�t�-s✓�"" �!Z- �''+J/�t.� � /�i�B�✓1�&'L_ ���it�G/� jzs 'v2�c,�,z,,v gzf!L C Report received b • ............ .......... .. ........ Inspector: ..... dzl�c..�/�-�C� August 23, 2012 Certified Mail Return Receipt# Hand Delivered by Deputy Fire Marshal To: Mr. Eric Slocum Megan's Donuts LLC 565 Talcottville Road, Apt 2C Vernon, CT 06066 CONNECTICUT STATE FIRE SAFETY CODE ABATEMENT ORDER OF FIRE/LIFE SAFETY HAZARDS Dear Mr. Slocum: On August 23, 2012, at approximately 11:15 hours, an inspection was conducted of the premises located at 400 Chapel Road, Unit 1-K; South Windsor, Connecticut for the purposes of determining compliance with the Connecticut State Fire Safety Code and the applicable referenced standards, adopted pursuant to Connecticut General Statutes §29-292 and §29-293. The Code and said standards are available for your inspection at this Office. The violations of the code found on the date of inspection are listed on the attached inspection report. You are hereby ordered to take the proper corrective action to remove or remedy all listed violations within thirty (30)days from the day that this notice is received, unless otherwise noted on the attached inspection report. If you believe that compliance with the Code will impose an unreasonable hardship, and that alternative methods of achieving an equivalent level of life safety could be attained, you may request, in writing, a modification of the requirements of said Code as outlined in Connecticut General Statute §29-296. If you believe compliance will take more time than that specified, you may request an extension of time prior to the expiration of the thirty (30) day period, unless otherwise noted on the attached inspection report. Sample forms for application for modification and extension of time for compliance are available from this office. In addition you have the right to appeal this order pursuant to Connecticut General Statutes §29-309 for a period of not more than thirty(30)days from receipt. Plans/specifications for work to be done shall be submitted to this office prior to the commencement of any construction. This review of all plans/specifications would avoid unnecessary expense that could result from non- complying changes. Please note that the correction of certain violations may require proper permits and approval from the building official and other local agencies prior to any construction. This is the only order you will receive. This Office will conduct a re-inspection of the premises to determine compliance with this order after the expiration of the thirty-day (30) or the time period noted on the inspection report. Your failure to comply with this order within the time period specified as determined by said re-inspection constitutes your failure to comply with the Connecticut State Fire Safety Code which may subject you to criminal prosecution as prescribed by Connecticut General Statute §29-306 with penalties of a fine not less than two hundred dollars ($200) nor more than one thousand dollars ($1,000) or imprisonment of up to six months, or both, as prescribed in Connecticut General Statute §29-295. Non-compliance may also result in a civil proceeding against you as authorized in Connecticut General Statute§29-306. This Office is looking forward to working with you in the interest of fire and life safety for the community and awaits your timely response regarding this matter. Sincerely, David S. Mauldin Deputy Fire Marshal Town of South Windsor e � � �' 3 '} `� � � sa ��� = �, �r � �� � "�� � ' �r �� � r t� � � � ��� � �� r r r� r� ���� '£ ' � y �. C 4.�. b 4rn'�FS� �k� .� �4 _ ,,s,�Y 1 - K �t�.�„d � �� �a's�t �, � ��" i�Xfp�cRl" r � �'—: ,$ � �� -'� s _ f .�� t.. � 4 `fit+ �s �_ �, ',,. t ` z t_,. 1 i r l k 1� l `� �:,� 9 t <3 _ � (8' ta'Y s r i �, �� & � y s 1t {3 3 � f 4 .. � � c , ' // � �s•� � `T h' 1. ' � 3 F �`. �, � a �r. '� f���> � '�s+���s�r"t���}fit'. 4s �gy�ys 2, :f �r,3'� I 1 i t 1 t ;ttt I » ns`3s � r i �k { 4 S a SAI'li n_ l4l _ —.�.. ooz 4 ;y �a 3� 1 AUG 23 a4I PAEL £ 3 0 s T A.; i - O S Oo T Ab - f�l �L�CtRICA�.. I< SCALE: " f! 7. G ir i v g — t 's 3 i s rl 9 I i, o co �� a 40 -- s-5~0 i I � J it ty � � E aust Only Backshelf Kitchen Hood Typical Specifications for Mo... Page 1 of 1 g ; '- 400 South Industrial Drive,PO BOX 327 Elkhart Lake,WI 53020-0327 Phone:(920)876.3391 Fax:(920)876-3065 Email Us Q Home About Us i Our Products I p Contact Us t-4 Find a Re � Rep Login � I EXHAUST ONLY BACKSHELF KITCHEN HOOD TYPICAL SPECIFICATIONS: MODELS KC, KD ND KE Provide KEES Model KC or KD( )( r KE)exhaust only backsheif(or backshelf/counter)(or broiler/oven or pizza)type hood(s)constructed on 18 gauge type 304(type 430) inless steel wh h#3 polish of sizes as indicated.All exterior seams shall be continuously welded,liquid tight,and ground and polished to match the origin)]finish of thematerial.The filter housing and full length pitched grease trough shall be of 18 gauge type 304 steel with removable stainless st el grease container.Filters shall be U.L Classified,2"thick baffle g (type 430)#3 polish stainless type constructed of aluminum(or stainless steel)and shall be of full hc od length and o height to assure optimal performance as specified by the filter manufacturer.Hood(s)shall be fabricated in accordance with National Fire Protection Association(NFPA)Bulletin#96,and shall be National Sanitation Foundation(NSF)Listed and bear the NSF seal.For more details,refer to KEES catalog KCC E. Back to: -Hoods Home I About Us 1 Our Products I Find a Rep I Contact Us I Rep Login Website 2011 Kees,Inc.I 400 South Industrial Drive,PO Box 327,Elkhart Lake,WI 53020-0327 f Phone:(920)876-3391 1 Fax:(920)876-3065 f Email ,+ 1 f © w 40 y bd � AIM Restaurant Equipment ** REP ** Paradise Inc. r4 465 Park Avenue - QUOTE East Hartford, CT 06108 ' / picket#: 8-500012 Ticket date: 7/30/12 Page: 1 Sold to: Ship to: Customer#: ASH Ship date: Shia code Sales Rep: ARJ Location: MAIN Terms: ;Qty _ Itertt# iecripti�a'n 7111 . Uniti Ext-prc 1 U-H600-1 Mixer, 60 Quart, Single phase $4,200.00 Each 4,200.00 1 U-313AYSINK Used 3bay sink $400.00 EACH 400.00 1 U-966 Used Blodgett Baking Oven $1,800.00 EACH 1,800.00 1 W-200-IS Grease separator 20 GPM $2,900.00 Each 2,900.00 1 - 8 ft Hood and Fan Combo $950.00 EACH 950.00 c Ir User: ARJ Total line items: 5 Sale subtotal: 10,250.00 Tax: 466.73 Total: 10,716.73 Special Orders are Non-Refundable,-A 50% Deposit is Required,-Returns Approved Subject to a Minimum 20%Restocking Fee.-Store Credits Only for Approved Returns-No Cash Back QUOTE NOTES: 7,/ --- _.- Z'7­7i- 1j, Commercial Recording Division Page 1 of 1 Business Inquiry HOME OHELP Business Inquiry Details Business Name: MEGANS DOUGHNUTS LLC Business Id: 1079848 Business Address: 400 CHAPEL RD UNIT 1-K,S Mailing Address: NONE WINDSOR,CT, 06074 Citizenship/State Inc: Domestic/CT Last Report Year: Business Type: Domestic Limited Liability Business Status: Active Company Date Inc/Register: Aug 07,2012 Principals Name/Title: Business Address: Residence Address: JUDITH SLOCUM 400 CHAPEL RD, S WINDSOR, 2 PEPPER BUSH WAY, S WINDSOR, CT MEMBER CT Business Summary Agent Name: JUDITH SLOCUM Agent Business 400 CHAPEL RD UNIT 1-K, S WINDSOR, CT Address: Agent Residence 2 PEPPER BUSH WAY,S WINDSOR, CT Address: View Filing History View Name History View Shares Back http://www.concord-sots.ct.gov/CONCORD/Publiclnquiry?eid=9744&businessID=l079848 8/27/2012