HomeMy WebLinkAbout466 Evergreen Way n'' "•° - 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 ESTABLISIiMENT PLAN REVIEW AI'I'LICATION
/NEWREMODEL ALTERATION CHANGE OF OWNERSHIP
Nameof F,,tahli,,hment: ��C-_d ",< /; V,-r;r)
Establishment's Address: ybl) gycr- r Y-. W,�N L; �ry� ✓� W'^'a3� � '0 I
Phone(if available): ,/
Name of Owner OR Owner's Representitive: t C�a e, /�1 t!C.
Mailing Address: 300 5V',k /0-3 Ii Al d v<l / I q
Telephone:-
Applicant's Name and Relationship to Owner(self,manager,architect,etc):
Mailing Address:
Telephone:
Hours of Operation:
Mon t ••10' "Tues -41rl"Wed 3—' b' tI'hurs Fri&IL- Sat Alf Sun / W''
Number of Seats: A?
Number of Staff: (Maximum per shift)
Total Square Feet of Facility: `17 y Number of Floors on which operations are conducted
Maximum Meals to be Served:(approx. #) Breakfast �_ Lunch P** • Dinner
OFFICE USE ONLY l/
Inspector Name:
(Please Print):
Inspector Date:
Signature:
Food Class: 1❑ 2❑3❑4❑ PLAN REVIEW FEE: $150, Nonprofits exempt
Notes: Date Received:
COOKING TECHNIQUES (check all that analv):V Steaming Blanching Roasting
7Bro'l'ng Smoking Stewin Bar-B-Que Grilling Boiling Sauteing Baking
eep Frying_✓Brazing Pan Frying_Roasting
Tvve of Service check all that apply): Hot Foods Only Col Foods Only
I�ot&Cold Foos Commercially Pre-packaged Foods Sit Down Meals
Take Out vI 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 the floor plan
accurately drawn to a minimum scale of 1/4 inch= 1 foot showing location of equipment,plumbing,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
v 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,well,septic system-if applicable)
Payment
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
Food Preparation Review
FOOD SUPPLIES.
All Food must be from inspected and approved sources. Identify the food supplier(s)and the frequency of
deliveries: J
6s h ����iL j L.A/1'►,ArI,.'�c. Jf�Cn �,�i�_
COLD STORAGE
Will raw meats,poultry and seafood be stored in the same refrigerators and freezers with cooked/ready-to-eat
foods?CR Yes No If yes,how will cross-contamination be prevented?
IN
Will each refrigerator have a thermometer? Yes =No
Number of refrigeration units: Number of freezer units: S
THAWING
Please indicate by checking the appropriate box(es)ho potentially hazardous foods (PRF) in each
ate gory will be thawed. More than one method inay appl .
Thawing Thick Thin Fish Poultry Cold Baked
Process Mea Meats Seafood Products Foods Goods,
In a
refrigerator
Submerged
in Running
Water less
than 70'F
Cooked from
a Frozen V,
State
Microwave
as part of the
cooking
process
Identify which type and how many food product thermometers (0°F-212°F)will be available and be
used to measure final cooking/reheating temperatures of PHF:
Lj
lip T
Identify how and where will hot PHF be maintained at A0V or above during holding for service.
Indicate type and number of hot holding units.
.) por silk, rJ wok Jl,vy-.)
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 j
Pans in \ _
Refrigerators V V
Ice Baths
a
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.
}G�i.S 5d147K W� �P1Lt'��5'f "�"l/✓f��1 IJ,`2stc3T j lya.nR�e�lS fi° G/OIi,
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 No
Is there a designated location that will be used /
for washing or rinsing produce? Yes V No
Will this area be used for other operations (i.e.
utensil washing?) Yes No
Seafood
Will raw seafood be washed or rinsed prior to Yes No
use?
Is there a designated location that will be used for
Washing, nnsin(, or tha%!i raw seafood? Yes No
Will this are be used for other operations (i.e.
utensil or produce washing?) Yes No
I'>>ultr
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? YesA No
`.Will this area be used for other operations (i.e.
produ e or lit�nsil washing?) Ye. �� No
DRY GOODS STORAGE/STORAGE OF SINGLE SERVICE ITEMS (PAPER CUPS,
PLATES, STRAWS, ETC.)
Is appr.)priate dry good storage space Pr d for based upon the menu, meals offered, frequency of
deliver cs and items being stored? Yes No
Where will single service items be stored in the service locations ?
Will approved food storage containers be used to store bulk food products?Describe.
PERSONNEL
Will disposable gloves an r tensils and/or food grade paper be used to minimize direct hand contact
of ready foods? Y_ 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. � �
C ass Ill and IV food esuiblishments are required to have a Qualified Food Operator employed in a
It 11-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:
Describe the training that the QFO will provide to the food workers and how written records of
training will be maintained:
r
FINISH SC 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:
I BASE
AREA FLOOR (FLOOR/WALL WALLS CEILING
JUNCTURE)
Kitchen/Cooking r,
Area , ,
!q SQ�r?-J,r_e. �r�, o �USGa•r�2r.
Bar
Food Storage t
Other Storage
Toilet Rooms
Dressing Rooms
Garbage&Refuse
Storage
Mop Service Area
Basement
Other
Other
Other
Other
Identify the finishes of the counters, cabinets,storage shelves, tables,etc.:
Ci
1 =n, o inn
2018-01-23
PLUMBING IBLW Engineers, Inc.
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 X
Ice Machine Floor Trough
Ice Storage Bins J X
Food Prep Sinks J X
Utensil/Pot wash
Sinks
J X
Steam Tables N/A
Dipper Wells ,/ X
Refrigeration j X
Other - - -- --- — — —
Other
Other
Applicants must identify the type of backflow prevention to be used for the water supply to each
pf
hinibing fixture listed below:
Plumbing Fixture Backflow Prevention Device Air Gap
Hose Connections X
Soda Carbonation System Integral with equipment from Vendor
Water Supply for Garbage
Grinders X
Water Fill for Soda Guns Integral with equipment from Vendor
Dipper Wells J X
Other
Other
ES-007
Job Name Red Heat Tavern Contractor
Job Location South Windsor CT Approval
Engineer BLW Engineers, Inc. Contractor's P.O. No.
Approval Representative
Series 007
Double Check Valve Assemblies
Sizes: 1/2" -2" 4,—
Series 007 Double Check Valve Assemblies are designed to
protect drinking water supplies from dangerous cross-connec-
tions in accordance with national plumbing codes and water
authority requirements for non-potable service applications 1"007M1QT
such as irrigation,fireline,or industrial processing.Only those
cross-connections identified by local inspection authorities as
non-health hazard shall be allowed the use of an approved
double check valve assembly.
Check with local authority having jurisdiction regarding vertical 1*
orientation,frequency of testing or other installation requirements. t `
The valve shall meet the requirements of ASSE Std. 1015 and
AWWA Std.C510.Approved by the Foundation for Cross- '�„
"7
Connection Control and Hydraulic Research at the University of
Southern California.
1'007M1QT-S
Features
• Ease of maintenance —only one cover
• Top entry Test Cocks
• Replaceable seats and seat discs
• Modular construction n U
• Compact design
• Cast bronze body construction — 1h"-2"
• Top mounted ball valve test cocks
• Low pressure drop r —
• No special tools required for servicing '
• 1h'-1"have tee handles
First Check Second Check
Specifications Module Assembly Module Assembly
A Double Check Valve Assembly shall be installed at each The 007 Series features a modular design concept which facilitates
noted location.The assembly shall consist of two positive complete maintenance and assembly by retaining the spring load.
seating check modules with captured springs and rubber
seat discs.The check module seats and seat discs shall be Now Available
replaceable.Service of all internal components shall be through WattsBox Insulated Enclosures.
a single bronze or stainless steel access cover secured with For more information,send for literature ES-WB.
stainless steel bolts.The assembly shall also include two resil-
ient seated isolation valves;four top mounted,resilient seated
test cocks.The assembly shall meet the requirements of ASSE
Std. 1015 and AWWA Std.C510.Approved by the Foundation owl if)
for Cross-Connection Control and Hydraulic Research at the Inquire with governing authorities for local installation
University of Southern California.Assembly shall be a Wafts requirements
Series 007.
Watts product spattfi echm a U.S.a�rra is roils and metric are apprige or and are provided for reference only.For fical ,or materials
please oahiac Watts Techrrical Service.Watts rh�rves the right to change or modify product design,construction,specficatlorhs,or rrelerials wing
out prior nofice and wltlhout incurring any obligation 10 make such changes and modifications on Watts products ReAousy or subsequently sold.
Pressure — Temperature Suffix:
1/211-211 S-bronze strainer
Temperature Range:33°F-180*F(0.5°C-82°C). LF-without shutoff valves
Maximum Working Pressure: 175psi(12.1 bar). SH-stainless steel ball valve handles
HC-21h'inlet/outlet fire hydrant fittings(2"valve)
Standards Prefix:
ASSE Std. 1015,AWWA Std.C510 U-Union connections
IAPMO PS31, CSA B64.5
Approvals
t ASSE,AWWA, IAPMO,CSA, UPC
A Approved by the Foundation for Cross-Connection Control
and Hydraulic Research at the University of Southern
California.
• Models LF and S are not listed,
♦ UL Classified(LF models only)3/4"-2"
(except 007M3LF)
* Horizontal and vertical"flow up"approval on all sizes
Dimensions-Weights
Models
Sizes:1h"—2"
_...—..__...._ A. _... —_.____.._.............
A
CB11 Al,
y ,
D '�
....... F - R - T
*Subscript'S'=strainer model
MODEL SIZE DIMENSIONS WEIGHT
A B C D F G R T
in. in. mm M. mm in. mm in. mm in. mm in. mm in. mm in. mm lbs. kos.
♦0070T 'h 10 254 46k 117 2'/6 62 5 127 3% 85 25A6 59 21/+6 52 4.5 2
♦007M30T 3/4 11'/6 282 4 102 TA 79 - - 63AG 157 37/6 87 21h 54 'V,6 33 5 2.3
♦ 007110110T 1 13'/4 337 5% 130 4 102 714 191 3% 85 111A6 43 111/16 43 12 5.4
♦007M20T 1%4 163h 416 5 127 1 3%6 84 - - 91h 241 1 5 127 3 76 2 50 1 15 6.8
♦007M20T 1'h 163/4 425 47A 124 Th 89 - - 93/4 248 513A6 148 3'k 79 TIN 68 15.9 72
tA 00710110T 2 191h 495 61/4 159 4 102 - 133A 340 61A 156 37/4 87 211H6 68 25.7 11.7
• 0070T-S 'h 13 330 6 152 27H6 62 3 76 5 127 3% 85 21/+6 59 2'/+6 52 5.5 2.5
• 007M30T-S Y4 141h 368 61A 156 Th 79 3 76 636 157 31A6 87 2'1A 54 'Yi6 33 6.7 3.1
• 007M10T-S 1 1715/i6 157 73/4 197 4 102 31/4 83 Th 191 3% 85 111h6 43 111A6 43 14 6.4
• 007M20T-S 1'/4 211/z 546 71/4 179 3V16 84 Th 83 91h 241 5 127 3 76 2 50 19 8.6
• 007M20T-S 11h 251/+6 637 1 7'hs 179 3'h 89 33/4 95 1 93/4 248 57% 148 Th 79 211ti6 68 19.6 8.9
•007M10T-S 2 27'/4 692 83/4 222 4 102 4 102 133A 340 61A 156 37/i6 87 211/i6 68 33.5 15.2
Suffix HC -Fire Hydrant Fittings dimension"A"=231h'(594mm)
Dimensions-Weights
1'0007M1QT
Union Tailpiece------- ......•• Union Tailpiece
Union Nut ........ ------ Union Nut
A ......
Sizes: 1hn-2"
A
In. In. nun
00070T 'h 121% 326
0007M20T ?4 1313/+s 350
0007M2QT 1 16% 422
0007M2QT 203/a 527
0007M2QT 1'fi 211h 546
0007MiQT 2 241h 622
Capacity
As compiled from documented Foundation for Cross-Connection Control and
Hydraulic Research at the University of Southern California lab testa
"Typical maximum system flow rate(7.5 feet/sec.,2.3 meters/sec.)
UL rated flow
'k"(15mm) 1'k"(40mm)
bas psi * bars Psi
.8 12 sa.8 12
.7 10
Q .7 10
5 8 C 5 8
LD .4 6 .4 6
.3 4 3 4
.1 2 .1 2
a 0 0 0 0
0 2 4 6 8 10 12 gpn 0 10 20 30 40 50 60 70 80 90 100 110 120 gpm
0 7.6 152 22.8 30.4 38 45.6 Ipm 0 36 76 114 152 190 228 66 304 342 390 418 456 W
5 7.5 10 Ips 5 7.5 10 15 fps
15 25 3.0 mpg 15 2.5 30 4.5 mpa
Flow Row
bars fd 3/4"(20mm) 2"(50mm)
15 22 bas psi
.8 12
1.2 18 7 10
Q.96 14 LD 4 6
.69 10 3 2
d .41 6 0 00 25 50 75 100 125 150 175 200 gpm
.14 2 0 95 190 285 380 475 570 665 760 Ipin
5 75 10 15 fps
0 5 10 15 20 25 30 35 40 45 50 gpn 1.5 2.3 3.0 4.6 mils
0 19 38 57 76 95 114 133 152 171 190 Ipm Raw
75 15 4X
2.3 4.6 mils
Row
1"(25mm)
bars psi
1.1 16
8. 12
.7 10
.5 8
.4 6
.3 4
a .1 2
0 5 10 15 20 25 30 35 40 45 50 55 60 gpm
0 19 38 57 76 95 114 133 152 171 190 209 228 1pn
5 7.5 10 15 0
1.5 2.3 3.0 4.6 mils
Flow
1'/4"(32mm)
baFS pW
1 14
B 12
.7 t0
5 8
.4 6
.3 4
d .1 2
0 0
0 10 20 30 40 50 60 70 80 90 100 110 120 gpm
0 38 76 114 152 190 228 266 304 342 380 418 456 IM
5 75 10 15 fps
15 2.3 3.0 4.6 mils
Flow
IVWATTS® 191M_28
CERTIFIED
A Watts Water Technologies Company USA:Tel:(978)688-1811 •Fax:(978)794-1848•www.watts.com
Canada:Tel:(905)332-4090•Fax:(905)332-7068•www.watts.ca
ES-007 1319 0 2013 Watts
ES-009
Job Name Red Heat Tavern Contractor
Job Location South Windsor CT Approval
Engineer BLW Engineers,Inc. Contractor's P.O.No.
Approval Representative
Series 009
Reduced Pressure Zone
Assemblies
wAn N- EA0
Sizes: '/4"-2"
Series 009 Reduced Pressure Zone Assemblies are designed
to protect potable water supplies in accordance with national 009QT-S
plumbing codes and water authority requirements.This series
is designed to protect drinking water supplies from dangerous
cross-connections in accordance with national plumbing codesj �
and water authority requirements for non-potable service appli-
cations such as irrigation,fireline,or industrial processing. "T - >
This series features two in-line, independent check valves,cap- o
tured springs and replaceable check seats with an intermediate
relief valve. Its compact modular design facilitates easy main-
tenance and assembly access.Sizes 1/4"-1"shutoffs have tee
handles. 009M2QT
Features Test Cock No.3
•Single access cover and modular check construction gall ryh.: Test Cock No.4
for ease of maintenance Test i:(`i kf,
•Top entry-all internals immediately accessible Test Cock
•Captured springs for safe maintenance No.2
•Interval relief valve for reduced installation clearances - Second
•Replaceable seats for economical repair First Check - >: _• ` Check
•Bronze bodyconstruction for durability 1/4"-2" Module ! Module
�Y Assembly u �; — Assembly
•Ball valve test cocks—screwdriver slotted Ya'—2" -- ' r
•Large body passages provides low pressure drop
•Compact,space saving design R.P.Zone
•No special tools required for servicing Water Outlet
SpecitiCatioris Relief Valve Assembly
—
A Reduced Pressure Zone Assembly shall be installed at each
potential health hazard location to prevent backflow due to
backsiphonage and/or backpressure.The assembly shall Now Available
consist of an internal pressure differential relief valve located WattsBOX Insulated Enclosures.
in a zone between two positive seating check modules with For more information,send for literature ES-WB.
captured springs and silicone seat discs.Seats and seat discs
shall be replaceable in both check modules and the relief valve.
There shall be no threads or screws in the waterway exposed
to line fluids.Service of all internal components shall be through Inquire with goveming authorities for local installation
a single access bronze cover secured with stainless steel bolts. requirements
The assembly shall also include two resilient seated isolation
valves,four resilient seated test cocks and an air gap drain fit-
ting.The assembly shall meet the requirements of: t1SC;ASSE
Std. 1013;AWWA Std.C511-92;CSA B64.4.Shall be a Watts
Series 009.
tDoes not indicate approval status.Refer to Page 2 for
approved sizes&models.
Watts product spedfipbas in U.S.aislonVtiy units and metric are appnvdmate and are provided for reference only.For precise merit wnmt,
pl�e fact Watts Technical Service.Watts reserves the right to change or rnodffy product design,carsbuchon,specifications,or materials with- WATM
out prior notice and Wthout Incurring any obligation to make such changes and modifigtlons on Watts products previously or subsequently sold.
Available Models: '/4" -2" Pressure/Temperature
Suffix: Series 009'/4"-2"Suitable for supply pressure up to 175psi
QT - quarter-tum ball valves (12.1 bar).Water temperature:33°F-180°F
S - bronze strainer (0.5"C-75°C).
LF - without shutoff valves Standards
AQT - elbow fittings for 3600 rotation USC
%"-2"only ASSE No. 1013
PC - internal Polymer Coating AWWA C511-92
SH - stainless steel ball valve handles 64.4
B
HC - 2'/Z"inlet/outlet fire hydrant fitting(2"valve) CSA CSAIAPIV File No. 1563.
Prefix:
C - clean and check strainer tDoes not indicate approval status.See below for approved
models.
3/a'-1'only
U - union connections(see ES-0009)
Materials: 1/4"-2" O & Ca® N®
Bronze body construction,silicone rubber disc material in the
first and second check plus the relief valve. Replaceable poly- Approvals
mer check seats for first and second checks. Removable stain- ASSE,AWWA,CSA, IAPMO
less steel relief valve seat.Stainless steel cover bolts. Approved by the Foundation for Cross-Connection Control and
Standardly furnished with NPT body connections. For optional Hydraulic Research at the University of Southern California.
bronze union inlet and outlet connections,specify prefix U 3
('fi"-2').Series 0090T furnished with quarter turn,full port, UL Classified /a"-2"
resilient seated,bronze ball valve shutoffs. (LF models only except 009M3LF)
Air Gaps and Elbows
A
for 909,009 and 993 sizes A B
In. mm in. mm in. mm lbs. kp- _T
909AGA '/"-''/z"009, '/2 13 23/0 60 3'/ 79 0.625 0.28
W 009M2/M3
909AGC 3/"-1"009/909, 1 25 3'/4 83 4% 124 1.5 0.68 B
1"-1'/z"0091Y12
909AGF 1'/"-2"0091VI1, 2 51 43/e 111 63/a 171 3.25 1.47
1'/a"-3"009/9%
2"0091V12.4"-6"993
909AGK 4"-6"909, 3 76 6% 162 95/s 244 6.25 2.83
8"-10"909M1
909AGM 8"-10"909 4 102 73/e 187 li'/ 286 15.5 7.03 A
909ELA '/"-'/z'009 %"0091V12/M3 - - - - - - - -
909ELC Y4"-1"009/909 - - 23/e 60 2% 60 0.38 0.17
*909ELF 1'/+"-2"0091VI1, - - 3% 92 3% 92 2 0.91
1'/"-2"009/909, B
2"009M2,4"-6"993
' 909ELH 21/"-3"009/909 - - - - - - - -
Verfical I U
Epoxy coated
Dimensions and Weight: 1/4" -2" 009
c
T —� B
N J D
L
M A
0091/a"-2"
A B c D L M N
In. b. mm in. mm h. mm in. inn in. M in. mm in. mm !t kgs.
1/4 10 250 45A 117 33A 86 11/4 32 51h 140 2% 60 2% 64 5 2
'A 10 250 45A 117 33A 86 11/4 32 51h 140 23A 60 21h 64 5 2
1h 10 250 45A 117 33A 86 11/4 32 51h 140 23/4 70 21/4 57 5 2
3/4 103/4 273 5 127 31h 89 11h 38 63/ 171 33/16 81 23/4 70 6 3
1 141h 368 51h 140 3 76 21h 64 91h 241 33/4 95 3 76 12 5
11/4 173A 441 6 150 31h 89 21h 64 113h 289 47/16 113 31h 89 15 6
1'h 177A 454 6 150 31h 89 2% 64 11'A 283 47h 124 4 102 16 7
2 213A 543 73/4 197 41h 114 31/4 83 131h 343 515/16 151 5 127 30 13
Suffix HC-Fire Hydrant Fittings dimension'A'=25'
Capacity
Performance as established by an independent testing laboratory.*Typical maximum system flow rate(7.5 feet/sec.,2.3 meters/sec.)
kPa psi VI"009QT kPa psi
138 138 20 172 25
117 17 138 20
96 14 103 15
76 1
55 8 69 10 -02
35 5 35 5
AP 0 25 60 75 1 1.17 gpm 0 0
0 .95 1.9 2.9 3.8 4.5 Ipm AP 0 10 20 30 40 50 60 70 80 gpm
0 38 76 114 152 190 228 266 304 Ipm
5 7.5 10 15 fps
1.5 2.3 3.0 4.6 mps
kPa psiU"0109QT kPa psi1 "U09M2QT
138 20 207 30
117 17 172 25
96 14 138 20
76 11 103 15
55 8 69 10
35 5 35 5
APO 25 50 75 1 1.25 1.50 2.5 3.1 gpm 0 0
0 95 1.9 2.9 3.8 4.8 5.7 9.4 11.8 Ipm APO 10 20 30 40 50 60 70 80 90 100 110120 gpm
0 38 76 114 152 190 228 266 304 342 380 418 456 Ipm
5 7.5 10 15 fps
1.5 2.3 3.0 4.6 mps
kPa psi !6"009QT 2"W9M2QT
psi
172 25 207 30
138 20 172 25
138 20
103 15 103 15
69 10 69 10
35 5 35 5
AP 0 1 2.5 5 7.5 10 12.5 15 gpm
0 3.8 9.5 19 28.5 38 47.5 57 Ipm AP 0 20 40 60 80 100 120 140 160 180 200 gpm
5 7.5 15 fps 0 76 152 228 304 380 456 532 608 684 760 Ipm
1.5 2.3 4.6 mps 5 7.5 10 15 fps
1.5 2.3 3.0 4.6 mps
kPa psi 314 009M30T
207 30
165 24 00
124 18 ILL I
83 12
41 6
0 0
ffig-
APO 2 6 10 14 18 22 26 30 34 38 42 46 gpm
07.6 23 38 53 68 84 99 114 129 144 160175 Ipm
7.5 15 fps
2.3 4.6 mps
kPa psi * 1"009M2QT
207 30
172 25
138 20
103 15
69 10
35 5 ---------j--------�-I
0 0
AP 0 5 10 20 30 40 50 60 70 80 gpm
0 19 38 76 114 152 190 228 266 304 Ipm
7.5 15 fps
2.3 4.6 mps
IMWArM 191
CERTIFIED
A Watts Water Technologies Company USA Tel:(978)688-1811 -Fax:(978)794-1848-www.watts com
Canada:Tel:(905)332-4090-Fax:(905)332-7068-www,watts.ca
ES-009 1318 0 2013 Watts
DISHWASING FACILITES
A three-compartment sink shall be provided and used whenever washing, rinsing, and sanitization of
ec uipnient .anal wen;il, are conducted.
v
Dees the lare_ Nc-
Whatot, pan, utensil, or container fit into each compartment of the three-compartment
sink? Yes type of sanitizer will jbnd9 More than one may apply.
Chlorine uaternary Ammonium Iodine 11,,t Water
Other ��
Chemical Test Kits/Pa ers available for h p checking sanitize r con ntrattons: Yes No
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 n s I I s 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:
WATER SUPPLY
Will ice be made on remises or purchased commercially? Please specify:
Describe provision for ice scoop storage:
Idtr
INSECT AND RODENT CONTROL
Please check appropriate boxes.
YES NO N/A
Will all outside doors be self-closing and have rodent proof
flashin weather stripping?
Screen Doors (minimum#16 Mesh screen)
Air Curtain /
Other
Will all pipe penetrations, beverage chases lectrical conduit chases be sealed; ventilation systems,
exhaust and intakes protected? Yes_ No
GARBAGE AND REFUSE
Inside /
Will all garbage containers have lids? Yes No r
Will refuse be stored inside? Where?
N()
Outside
W ill the area around premises be maintained clear of unnecessary brush,litter, boxes and other vermin
harborage? Yes V Now
Will a dumpster be used?Yes '� No
Where will the dumpster be located.
�n_��
Identify the Waste Hauler to be used: 7` 7
Will a compacter be used?Yes ✓ No
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:
Identify the location(s) and size(s)of the grease trap(s):
o
Will there be an area to store recycled containers?Describe.
I ' JAM "
MOP CLEANING FACILITIES
Will a separate mop basin be provided: Yes._/o
If Yes,please describe the facility for cleaning mops and other maintenance equipment:
HANDWASHING/TOILET FACILITIES
Will there be hand-washing sinks in the food preparation,food dispensing, and ware washing areas?
Yes ✓ No
Will all hand-washing sinks have mixing valves or combination faucets? Yeti ✓ No
Will self-cl,ring metering faucets provide a flow of%\<itei for at least 15 seconds without the need to
reactivate [hc faucet? YesIM No
Will soap dispensers be available at all hand washing pinks? Yes V No
Will hand drying facilities (paper towels, air b er, etc.) and waste receptacles be available at all hand
washing sinks and in each restroom? ) es No
Will toilet room doors be self-closing? Yes No
Will unisex and/or women's restrooms have covered receptacles? Yeti" 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 cl e n ma�erials and toxic items be stored away from food prep and storage areas?
Yes No
Will in. rides/rodenticides (if used) be stored separately from cleaning and sanitizing agents?
Yes No
Please describe the location of all toxic items storage-including areas in the food prep areas where "in-
use" chemicals will be stored:
Will all r:: i i iers of toxic/cleaning material, including sanitizing spray bottles,be clearly labeled?
Y.s No
LINENS
Will a laundry washer and dryer be available on the premises?Yes No
If Yes,what items will be laundered?
Identify the location of dirty linen storage: bG cl-- do-Of- S�-✓ �' -
STATEMENT: I hereby certify that the above information is correct. I fully understand that any
deviation from the above without prior approval from the Town of South Windsor Health Department
is prohibited.
Signature(s)
Owner(s)or Responsible Representatives
Date:
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
governing food service establishments.
Employee Health Policy Agreement
Reporting: Symptoms of Illness
I agree to report to the manager when I have:
1. Diarrhea
2. Vomiting
3. Jaundice (yellowing of the skin and/or eyes)
4. Sore throat with fever
5. Infected cuts or wounds, or lesions containing pus on the hand, wrist, an exposed
body part (such as boils and infected wounds, however small).
Reporting: Diagnosed Illnesses
I agree to report to the manager when I have:
1. Norovirus
2. Salmonella Typhi (typhoid fever)
3. Shigella spp. infection
4. E. coil infection (Escherichia coil 0157:1-17 or other EHEC/STEC infection)
5. Hepatitis A
Note: The manager must report to the Health Department when an employee has one
of these illnesses.
Reporting: Exposure of Illness
I agree to report to the manager when I have been exposed to any of the illnesses listed
above through:
1. An outbreak of Norovirus, typhoid fever, Shigella spp. infection, E. coil infection, or
Hepatitis A.
2. A household member with Norovirus, typhoid fever, Shigella spp. infection, E. coil
infection, or hepatitis A.
3. A household member attending or working in a setting with an outbreak of Norovirus,
typhoid fever, Shigella spp. infection, E. coil infection, or Hepatitis A.
Exclusion and Restriction from Work
If you have any of the symptoms or illnesses listed above, you may be excluded* or
restricted** from work.
*If you are excluded from work you are not allowed to come to work.
**If you are restricted from work you are allowed to come to work, but your duties
may be limited.
Returning to Work
If you are excluded from work for having diarrhea and/or vomiting, you will not be able to
return to work until more than 24 hours have passed since your last symptoms of diarrhea
and/or vomiting.
If you are excluded from work for exhibiting symptoms of a sore throat with fever or for
having jaundice (yellowing of the skin and/or eyes), Norovirus, Salmonella Typhii (typhoid
fever), Shigella spp. infection, E. coil infection, and/or Hepatitis A, you will not be able to
return to work until Health Department approval is granted.
Agreement
I understand that I must:
1. Report when I have or have been exposed to any of the symptoms or illnesses listed
above; and
2. Comply with work restrictions and/or exclusions that are given to me.
I understand that if I do not comply with this agreement, it may put my job at risk.
Food Employee Name (please print)
Signature of Employee Date
Manager(Person-in-Charge) Name (please print)
Signature of Manager(Person-in-Charge) Date
Courtesy of the Alexandria Health Department, 4480 King Street,Alexandria, Virginia 22302
More information can be found at:
www.alexandriava.oov/En vironmentalHealth