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Home My WebLink AboutApplication 1750 Ellington Road (2) Town of South Windsor - Health Department 1540 Sullivan Ave., South Windsor, CT 06074—Mailing Address 1530 Sullivan Avenue, South Windsor, CT 06074—Office Address Phone Number: (860) 337-6173 Fax: (860) 644-1930 FOOD ESTABLIS I I N I ENT PLAN REV I I'M APPLICATION NEW REMODEL V ALTERATIO�N'' CHANGE OF OWNERSHIP Name of EstaNislunent: 100,444 ZI '� Establishment's Address: l //a � �d. 61V o� Phone(if available): Name of Owner OR Owner's Representative: 6111z/1-zz Mailing Address: �i..n ,f cf/,�, "�T� J•h �o'' �f �� — Telephone: kS , Applicant's Name and Relationship to Owner(self,manager, architect,etc): Mailing Ad(lress: I cI: I,I;i m": Hours of 0i)eration: Mon // 2 Tues / Wed /�Thurs 4/-!� Fri A-$ Sat /!S_Sun ��— Number of Seats: �2 Number of Staff: (Maximum per shift) Total Square Feet of Facility: a U Number of Floors on which operations are cond»cted Maximum Meals to be Served:(approx. #) Breakfast Lunch �� Dinner 5� COOKING TECHNIQUES check all that apply): Steaming_Blanchi _Roastin Broiling _ moki Stewin _ Bar-B-Que �/Grilling B�oilin Sauteing Bake Deep Fryin _Brazing Pan Frying — Roasting — —_____ '1'v e of Service check all that apply): Hot Foods Only _Co! o(k Only Hot & Cold Foos Commercially Pre-packaged Foods it Down Meals Take Out V Off-Site Catering Mobile Food Unit Push Cart Customer Self Service Other(Please Describe) The following documents must be submitted for review: Plan of facility that are a minimum of 11 x 14 inches in size including the layout of tl It i Io-I plan accurately drawn to a minimum scale of 1/4 inch= 1 foot showing locat o�n of eqti 1{ nient,pl m 10), electrical services and mechanical ventilation and equipment schedule Proposed Menu(including seasonal,off-site and banquet menus) Qualified Food Operator Certificate(s)and Designated Alternate Form(Class 3 and 4) 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, driveways, and location of any outside equipment(dumpsters,walk-ins, we,-septic"ein-i applicable) Other Items Required for Review and Construction: _ Show the location and when requested,elevated drawings of all food equipment. Each piece of equipment must be clearly labeled on the plan with its common name. Submit drawings of self-service hot and cold holding units with sneeze guards. Designate clearly on the plan equipment for adequate rapid cooling,including ice baths and refrigeration, and for hot-holding potentially hazardous foods. Label and locate separate food preparation sinks when the menu dictates to preclude contamination and cross-contamination of raw and ready-to-eat foods. Clearly designate adequate handwashing lavatories for each toilet fixture and in the immediate area of food preparation. Provide the room size, aisle space,space between and behind equipment and the placement of the equipment on the floor plan. On the plan represent auxiliary areas such as storage rooms, garbage rooms,toilets,basements and/or cellars used for storage or food preparation. Show all features of these rooms as required by this guidance manual. _Include and provide specifications for: Entrances,exits,loading/unloading areas and docks; Complete finish schedules for each room including floors, walls,ceilings and coved juncture bases; 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; Lighting schedule with protectors; 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). 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; Ventilation schedule for each room; _A mop sink or curbed cleaning facility with facilities for hanging wet mops; _Garbage can washing area/facility; Cabinets for storing toxic chemicals; Dressing rooms, locker areas,employee rest areas, and/or coat rack as required Identify which type and how many food product thermometers (0°F-212°F) will be available and be used -17easure final cooking/reheating temperatures of PHF: Identify how and where will hot PHF be maintained at 140°F or above during holding for service. Indicate type and number of hot holding units. / ,.� `-LOl�7� /�O�Gc Lr4..t��r ��" �oli/`/4� ✓�4�t �t�� COOLING Please indicate by checking the appropriate box(es) how PHF will be cooled from 140°F to 70°F in 2 hours and from 70°F to 45°F in an additional 4 hours. Cooling Thick Thin Fish Poultry Hot Baked Process Meats Meats Seafood Products Foods Goods Shallow _ Pans in (/ Refrigerators Ice Baths Stirring with Iced Chill Sticks Mechanical Rapid Chill Equipment FOOD PREPARATION Please list all food items prepared more than 12 hours in advance of service. Food Preparation Review FOOD SUPPLIES. All Food must be from inspected and approved sources. Identify the food supplier(s) and the frequency of deliveries: /JJ COLD STORAGE Will raw meats,poultry and seafood be stored in the same refrigerators and freezers with cooked/ready-to-eat foods? 0 Yes =No If yes,how will cross-contamination be prevented? Will each refrigerator have a thermometer? 10 Yes No Number of refrigeration units: Number of freezer units: 3 THAWING Please indicate by checking the appropriate box(es) ho potentially hazardous foods (PHF) in each category will be thawed. More than one method may appi . Thawing Thick Thin Fish Poultry Cold Baked Process Meats Meats Seafood Produc_W Foods Goods In a refri erator Submerged in Running Water less than 70'F Cooked from a Frozen State Microwave as part of the cooking process How will ingredients for cold ready-to-eat foods such as tuna, mayonnaise and eggs for salads and sandwiches be pre-chilled before mixing and assembly? Produce Will produce be washed or rinsed prior to use? Yes Ll No Is there a designated location that will be used for washing or rinsingproduce? Yes No Will this area be used for other operations (i.e. / utensil washing?) Yes No kl Seafood Will raw seafood be washed or rinsed prior to Yes No use? Is there a designated location that will be used for (/�J -washing, rinsing, or thawingraw seafood? Yes No /I W Will this are be used for other operations (i.e. utensil or produce washing?) Yes No Poultry Will poultry be washed or rinsed prior to use? Yes No Is there an approved location that will be used for washing, rinsing, or thawing poultry? Yes No Will this area be used for other operations (i.e. produce or utensil washing?) Yes No DRY GOODS STORAGE/STORAGE OF SINGLE SERVICE ITEMS (PAPER CUPS, PLATES, STRAWS,ETC.) Is ;appropriate dry good storage space provide or based upon the menu, meals offered, frequency of deliveries, and item~being stored? Yes No Where will single service items be stored in the service location(s)? Will all hand-washing sinks have mixing valves or combination faucets? Yes y No Will self-closing metering faucets provide a flow of water for at least 15 seconds without the need to reactivate the faucet? Yes No ,l/ Will soap dispensers be available at all hand washing sinks? Y,,.s_ No Will hand drying facilities (paper towels, air hloer, etc.) and waste receptacles be available at all hand washing sinks and in each restroom? Yes N Will toilet room doors be self-closing? Yeti No /Will unise and/o omen's restrooms have covered receptacles? Yesr No SEWAGE DISPOSAL Will the building be connected to a municipal sewer? Yes No DRESSING ROOMS Will separate dressing rooms be provided? Yes No Describe the storage facilities for employees' personal belongings (i.e., purses, coats, phones, etc.) CHEMICAL STORAGE Will all cjocrfiing materials and toxic items be stored away from food prep and storage areas? Yes No Will insecticides/rodenticides (if used) be stored separately from cleaning and sanitizing agents? Yes No P I c i •;� describe the location of all toxic items storage-including areas in the food prep areas where "in- use" chemicals will be stored: Will all c amers of toxic/cleaning material, including sanitizing spray bottles, be clearly labeled? Yes No LINENS Will a laundry washer and dryer be available on the premises? Yes No GARBAGE AND REFUSE Inside Will all garbage containers have lids? Yes �//_ No Will refuse be stored inside? Where? Outside Will the area around premises be maintained clear of unnecessary brush, litter, boxes and other vermin harborage? Yes No Will a dumpster be used? Yes v No Where will the dumpster be located? ol" - Identify the Waste Hauler to be utied: // JW Will a compacter be used? Yes No y �b Where will the compacter be located? Describe the surface and location where the dumpster/compactor/barrels will be stored: Specify the type and location of cooking grease waste storage receptacles: Cte"*-I' C&,,-�a,. a# Jr-e2Heo Identify the location(s) and size(s) of the grease trap(s): Will there be an area to store recycled containers?Describe. MOP CLEANING FACILITIES / Will a separate mop basin be provided: Yes. -_ No v If Yes, please describe the facility for cleaning mops and other maintenance equipment: HANDWASHING/TOILET FACILITIES Will the e hand-washing sinks in the food preparation, food dispensing, and ware washing areas? Yes No DISHWASING FACI I.ITES A three-compartment sink shall be provided and used whenever washing, rinsing, and sanitization of equipment and utensils are conducted. Does the large pot, pan, utensil, or container fit into each compartment of the three-compartment sink? Yes No What type of sanitizer will be used?More than one may apply. 1 f- Chlorine __ Quaternary Ammonium _ Iodine Hot Water Other Chemical Test Kits/Pa ers available for checking sanitizer co entrations: Yes l/ No P g Will ventilation be provided over the dishwasher? Yes No All dish machines must have accurate temperature and pressure gauges. Is appropriate air drying space available for the air drying of all washed ensils with the use of drain boards, wall or overhead shelves, stationary or portable racks? Yes No 'Please describe the type and location of the air-drying space for the cleaned items: l WATER SUPPLY Will ice be made on premises or purchased commercially? Please specify: Describe provision for ice scoop storage: ��G�Gin � /rd Comet 5�c(mot ey INSECT AND RODENT CONTROL Please check appropriate boxes. YES NO N/A { ill all outside doors be self-closing and have rodent proof flashing/weather stripping? �• Screen Doors (minimum#16 Mesh screen) Air Curtain Other / Will all pipe penetrations, beverage chases & ectrical conduit chases be sealed; ventilation systems, exhaust and intakes protected? Yes. No PL I N 1 DING Applicants must identify the type of plumbing connections that will be used on the drains for the fixtures listed below: Plumbing Indirect Indirect Other Direct Waste Fixture Floor Sink Floor Drain Connection Dishwasher -- Ice Machine Ice Storage Bins Food Prep Sinks Utensil/Pot wash / Sinks Steam Tables Dipper Wells Refrigeration Other Other Other Applicants must identify the type of backflow prevention to be used for the water supply to each l u m N n!, fixture listed below: Plumbing Fixture Backflow Prevention Device Air Gap Hose Connections Soda Carbonation System Water Supply for Garbage Grinders Water Fill for Soda Guns Dipper Wells Other Other FINISH SC 6 i FDULE Applicants must indicate the materials (i.e., quarry tile, stainless steel, 6"plastic cove molding, etc.) to be used in each area listed below: BASE AREA FLOOR (FLOORIWALL WALLS CEILING JUNCTURE) Kitchen/Cooking Area Bar Food S orage ell,I, Other Storage Toilet Rooms Ae � %ll� Dressing Rooms (` Garbage &Refuse Storage Mop Service Area Basement Other Other Other Other Identify the finishes of the counters, cabinets, storage shelves, tables, etc.: Will approved food storage containers be used to store bulk food products? Describe. PERSONNEL Will disposable gloves and/or ute ils and/or food grade paper be used to minimize direct hand contact of ready-to-eat foods? Yes_ 1 No- Your food establishment must have a policy to exclude or restrict food workers who are ill with symptoms compatible with food borne illness (vomiting, diarrhea, nausea, stomach cramps, high fever, jaundice) or have infected cuts and lesions. Describe your policy to restrict food workers with these symptoms. V. /tV Class III and IV food establishments are required to have a Qualified Food Operator employed in a full-time supervisory position at the establishment. It is recommended that Class I and Class II food operators consider becoming QFO's as well. List the names of the QFO's: List the names of the Alternate QFO's: C00el Describe the training that the QFO will provide to the food workers and how written records of training will be maintained: Can!/ �5��1.,� /J ito c e d�itr.L____� ��a !� /` �•ca�'.r C � / 60 x Y rW 4L If Yes, what items will be laundered? Identify the location of dirty linen storage: oLyre' STATEMENT: I hereby certify that the above information is correct. I fully understand that any deviation from the above with Sul prior app oval from the Town of South Windsor Health Department is prohibited. Signature(s) 6-- Owner(s) or Responsible Representatives Date: -' .Z? //2 Approval of these plans and specifications by the Town of South Windsor Health Department 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 pre-opening- inspection of the establishment with equipment in place and operational will be necessary to determine if it complies with the local and state laws zoverninp. food service establishments. E