HS REVIEW •
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Y A T ES # C 11 R E I T Z R E R C # 1-1 U 6 H E s y �
ARCH ITECTS
September 7, 2010
Mrs. Jamie Turlington
Harnett County Environmental Health
307 W. Cornelius Harnett Blvd.
Lillington, NC 27546
Reference: Food Lion Store #2594 — Spring Lake, NC Renovation
3260 Ray Road
Spring Lake N.C.
Architect's Comm. No. 10015.00
Subject: Food Establishment Plan Review Application
Dear Mrs. Turlington:
Per our previous discussions this is one of several Food Lion stores that we will be submitting for review. This is an
existing facility and the size of any space for coolers /freezers will not change. Prep areas will have minor changes if
any per the drawings and listing below. Handling of food product and disposal of wastes will continue per health
department guidelines as facility is currently permitted. Finishes in any prep area that will be remodeled will have like
finishes added or put new back in place. See the finish schedule for finishes. Below is an outline of the work to be
performed in the listed area.
Deli /Bakery
Deli /Bakery to be remodeled according to construction documents to accommodate new layout. Some work will
involve the removal of the existing slab /tile in order to install drains and waterlines. The wall tile will be completely
replaced.
• New /Existing front line -up for Deli /Bakery
• New cake merchandiser
• New bread station
• Existing cold deli service .
• New self service cold deli (2 cases)
• Existing slicers on existing stands
• New 4 door frozen bakery case
• Replace all wall tile
• New eye wash station
Produce Prep
• New eye wash station
• Replaced swing door into sales area
•
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Meat Prep
• New eye wash station
• Replaced swing door into sales area
• Removed existing window
Please review and let me know when project is approved.
If you have any questions or comments to the above information, please let me know.
Sincerely,
� AT��EI = ERG -. U'• HE • 1:1• ITECTS
C. Eric Bollenbecker
Project Manager
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HARNETT COUNTY PLAN REVIEW APPLICATION COVER LETTER
FOOD SERVICE ESTABLISHMENTS
Review for Compliance with NC Rules Governing the Sanitation of Food Service
Establishments (15A NCAC 18A .2600)
All items are to be submitted through the Central Permitting Office at 108 East Front St.,
Lillington, NC 27546 or by mail to PO Box 65, Lillington, NC 27546. You may contact the
Central Permitting Office at 910- 893 -7525, Ext. 2. However, please contact our office with
questions regarding the contents of this application.
The North Carolina Rules Governing the Sanitation of Food Service Establishments require that
plans be submitted for approval prior to construction / renovation 1 modification / change of
ownership of such facilities by the local H Department.
Plans are reviewed using North Carolina's "Rules Governing the Sanitation of Food Service
Establishments," 15A NCAC 18A .2600. You may view these rules at
www. deh .enr.state.nc.us/ehs/rules.htm or obtain a copy from our office at 307 Cornelius Harnett
Boulevard, Lillington, NC 27546. For additional information regarding facility design and
layout, you can access the "Guidelines for the design, installation and construction of food
establishments in North Carolina" by going to the web page:
http: / /www. deb. a nr .state.nc.us /ehs /food/olan
Plans for franchised, chain, and prototyped facilities are required to be submitted to the North
Carolina Department of Environment and Natural Resources, Division of Environmental Health,
Facility and Plan Review Unit, Room 1A109, 2728 Capital Blvd., Raleigh, NC 27604. Checks
must be made payable to DENR/EHSS.
If you have questions, contact one of the following Food and Lodging staff listed below at 910-
893 -7547:
Gale Violette Greene, RS Jamie Turlington, RS
Food and Lodging Program Specialist Environmental Health Specialist
Cindy Pierce, RS
Environmental Health Specialist
Plans must be submitted with the following supporting documentation:
✓ Complete set of plans drawn to scale showing the placement of each piece of food
service equipment, storage areas, trash can wash facilities, etc. along with general
plumbing, electrical, mechanical, and lighting drawings
✓ Pfans must include a site plan locating exterior equipment such as dumpsters or
walk ins
✓A complete equipment list and corresponding manufacturer specification sheets
�A proposed menu
✓,A completed Food Service Plan Review Application
✓ $200 Plan Review Fee
8/09
gg
Page 1 of 11
Food Service Plan Review Application
Type of plan: New Remodel ,� Change of Ownership
Name of Establishment: r 0e � Law., STA$F. ' 4.5 9y
Physical Address: 326o RAY ROAD
City: 51."N4_ I-Fk3 State: tie .Zip: .28390—
Phone (if available): _ ! i 0. '136. 6 031 Fax:
Website: 4,a l,ts.t. (pA.f
Applicant: _fiergillessisslif Mei oa tOn".
Address: 2116 ncE a nVE pp.
City: SaL,Mbfrek State: f.JC Zip: 2. V195
Phone: 7oN •3SWO Fax 7a r r f 951
Email: CC Mr. L n.c e& Q�rooe0L1n•I • COnN
$U+ LDWb e.owtr
Owner (if different from Applicant): WS`AC. 1 1-LC.
Address: �i 1.2-1 f MI trrMy ROAD CO OFF
City: WiLausle,To d State: NG Zip: 28405'
Phone: "TM 256 22!( Fax:
Email:
I certify that the information in this application is correct, and I understand that any deviation
without prior approval from this Department may nullify plan approval.
Signature: C___S Date: S 1 311
(Applicant or Responsible Representative)
Page 2 of 1 I
Hours of Operation:
Mon Wues ]=11._ Wed _- t!_Thurs ) - Fri 1:t Sat 7 -ft Sun 7 -1
Number of Seats: 0
Facility total square feet: 33, S ¥6 SgPr
Protected start date of construction 1 change of ownership: 1 -1 4.o11
Food Safety Knowledge:
Do any members of management have current ScrvSafe at equivalent food service
certification?
Type of Food Service: Check all that apply
Restaurant _ Sit down meals
_ Food Stand X Take -out meals
Drink Stand Catering
_ Commissary
X Meat Market
Other (explain): L IASNKAey
Utensils:
Multi -use (reusable): Single -use (disposable): X
Food delivery schedule (per week): VA¢t ES
Indicate any specialized process that will take place: Neat!
Curing _Acidification (sushi, etc.) , Smoking
Reduced Oxygen Packaging (e.g. vacuum packaging, sous vide, cook -chill, etc.)
Explain checked processes:
Indicate any of the following highly susceptible populations that will be catered to or served: PLoME
_ Nursing/Rest Home Child Care Center _Health Care Facility
Assisted Living Center _ School with pre - school aged children or an immuno-
compromised population
Page 3 of 11
Water Supply:
Type of water supply: (check one)
❑ Non - public
Community/Municipal
❑ Non - transient, non- community
❑ Transient, non - community
Is an annual water sample required of your establishment? (check one)
❑ Yes
No
Wastewater System:
Type of wastewater system: (check one)
Public sewer
❑ On -site septic system
Number of current seats: 0
Number of seats applying for: 0
Water Heater:
Manufacturer and Model: sEE SEib& - Wm-n_ !4 'oz
Storage Capacity: gallons
• Electric water heater: kilowatts (kW)
• Gas water heater: BTU's
Water heater recovery rate (gallons per hour at 100F rise): GPH
If tankless, GPM ; Number of heaters:
*Water heater calculator on the Plan Review Unit web page at
www. deh. enr. state.nc.us /ehs /food/plan3.httn
Service Area: Restroom Water Heater
Manufacturer and Model: Rheem Rudd 81VP10S — Existing to Remain
Storage Capacity: 10 Gal
Electric Water Heater: 2.0 KW
Service Area: Deli
Manufacturer and Model: Rheem Rudd ES85 -18 -G - Existing to Remain
Storage Capacity: 85 Gal
Electric Water Heater: 18.0 KW
Service Area: Meat Prep, Produce Prep, & supplies preheated water to Deli Water Heater
Manufacturer and Model: Therma -Stor TS III-1 — Existing Reclaim Water Heaters in parallel to remain
Storage Capacity: 119 Gal (each)
Electric Water Heater: 6.0 KW (each)
Rarnvary 1 d7 11rr.,ti „1(U ' Apr. / ,,k1 Pa_ le N ,ejFII
HOT HOLDING
Foods that will be held hot before serving: SEE MaJJU A'ITr¢r 41>
COLD HOLDING
Foods that will be held cold before serving: SEE M ENO ►4 Mrifirtj
DRY STORAGE
y
Frequency of deliveries per week: (/a u/M& Square feet shelf space: e. 6 o ft
Ls a separate room designated for dry storage? . E fl arts
FINISH SCHEDULE
Floor, wall and ceiling finishes (vinyl tile, acoustic tile, vinyl baseboards, FRP, etc.)
AREA FLOOR BASE WALLS CE
C IL ^ ING (�
.
T IK @ T 4 TLe ltRAwa r�tE WWI- A
44keNen L 14
tier P clomt . T� ctttaty.liYe- FR? tc f4sts
nova dear Fit q.,,tr� d Qv a l++�'r�t t tas.4 tcata+ w (A-n e
Food Storage 6444d toile 1.s,.t.;n(Lesker oasts a+l�
orolgt pr.ett via% s" a
Dry Storage tt?kat�' T�" "r Tart. t A.ols
Toilet Rooms W tE Thf�tal -me ibrceleknLE ug
Garbage & Can ch 7 a P@uatly 71 War r tt EPP! P MT D
Wash Areas PLY w•Mx
Other
Other
Page 5 of 11
FOOD PREPARATION FACILITIES
Number of food prep sinks:., Are separate sinks provided for vegetables and meats? ye$
Size of sink drainboards (inches): /L"
How will sinks be sanitized after use or between meat species? SE'E / rI7A E1J
DISHWASHING FACILITIES
Hand Dishwashing
Number of sink compartments: 3
Size of sink compartments (inches): Length Width Depth
Length of drainboards (inches): Right ZY Left W
Are the basins large enough to immerse your largest utensil? it's
What type of sanitizer will be used? % EC ATIPICOED
Chlorine _ Quaternary ammonium _ Hot water _ Other (specify)
Mechanical Dishwashing
Will a disbmachine be used? Yes __ No X
Dishmachine manufacturer and model:
Hot water sanitizing? or chemical sanitizing? X
How will large utensils such as prep tables, dough mixing bowls, slicers, and other food contact
surfaces that cannot Oe submerged in sinks or put through a dishwasher be cleaned and sanitized?
Se r. te't.k
How many air drying shelves will you have?
Calculate the square feet of total air drying space: (h ft
HANDWASHING
Indicate number and locations of hand sinks in the establishment:
-
1- Pin - tr. �. ptip
Z - Meer rasp
ort. se r9se...
Page 6 of I I
EMPLOYEE AREA
Indicate location for storing employees' personal items: &Xi 5'Ti r i 4 L.e a/Y
GARBAGE, REFUSE AND OTHER
Will trash be stored in the restaurant overnight? Yes _ No % If so, how will it be stored
to prevent contamination?
a
i.ocation and size of can wash facility: 30 SC214A46 I SAsrPTas. Llacer
Are hot and cold water provided as well as a threaded nozzle? y ES
Will a dumpster be provided? yes Do you have a contract with the dumpster provider
for cleaning? fG>
How will used grease be handled? EX TERNt4L 6, IZE794i: gee-1
Is there a contract for grease trap cleaning? yE S
Are doors self-closing'? )IS Fly fans provided? yes
Where will chemicals be stored? E$a577JA 5Awit7DR,s clouT
Where will clean linen be stored? Meer egatt / DaU BAkwy Weser
Where will dirty linen be stored? e ua Lit7 1 N Mt.T'rAa- of 1),- 1)Ll -k! Ls
Page 7 of 11
ti
FOOD HANDLING PROCEDURES
Explain the following with as much detail as possible. Complete descriptions including specific
areas of the kitchen and corresponding items on the plan where food is handled will expedite the
plan review process.
Explain the entire food handling procedure for each food item on the proposed menu. Including:
• How the food will arrive (frozen, fresh, packaged, etc.)
• Where the food will be stored
• Where and how the food will be thawed
• Where (prep tables, sink, counter, etc.) the food will be handled (washed, cut,
marinated, breaded, cooked, etc.)
• When (time of day and frequency /day) food will be handled
• Whether or not the food or any part of the food will be used as leftovers or as any
ingredient in a future dish
• How the food will be cooled if applicable
FOOD PRODUCT SEE DUD M 6ry t 1 f ncu FFAap gs is
ittE Arrn>f l
FOOD PRODUCT
Page 8 of 11
FOOD PRODUCT
FOOD PRODUCT
FOOD PRODUCT
***ADDITIONAL SHEETS ARE AVAILABLE
Page 9 of 11
The following questions will test how much you already know about food safety. Please answer
to the best of your ability and as clearly as possible in order that the EHS understands what you
are eying to say.
1. What are the final cook temperatures ( °P) for the following foods?
a. Chicken PC he /s
b. Hamburger /Sr far ISM.
c. Ground Sausage ISS 4r /SSrc..
d. Pork 15f5 /Sec..
e. Eggs Pic or /SS
f. Steaks Per fir /S
2. In the following list, place in order from top to bottom, how the following will be
stored in a cooler and/or freezer: raw chicken, raw eggs, vegetables, foods that are
cooling, raw pork, raw hamburger, beef steak.
Top V e arie" -M S
au) e
beef S fr1./c'
2a.4,4.) raex
AAA) cete4,-
Bottom
3. Describe how you would cool hot foods for the next day's usage. Explain specific
examples. stating temps, time of cooling process, and size of containers.
Pte su. 4. ,..mot " M t c/tz jc q Ati2 ut; •
4. What minimum temperature ( °F) must leftovers be reheated to? /(PS fer
5. Describe your sanitizing procedures for your pots, pans and other utensils. Be
specific.
Page 10 of 11
6. Describe how you will sanitize the cutting boards, prep area tables, prep sinks, and
knives when switching from one food to another. Describe what products will be
used to clean this area and the contact time for the sanitizing chemicals used.
7. Please list the hot holding and cold holding temperatures of foods that are held on a
buffet bar or held in the walk -in cooler.
ire
Hot Holding /3S r h (
Cold Holding +O! * ! 4 " — "
8. Describe when you and your employees are required to wash your hands.
Ste-- al
9. Describe your sick employee policy.
�� Q44-C.
10. Explain how to use and calibrate a thermometer. �J
cc,
11. Explain the policy if there are cuts or burns on the hands of an employee.
alt
12. Explain the procedure for making up a sanitizing solution.
5 a Nitthe £
13. Will staff be allowed to smoke? Where will they be allowed to smoke?
c-Ae aC
14. What distributors will be used to purchase the food being sold?
%ppro tee repvf 4. 42A_ s„ pfret&es
15. Where will personal drinks be stored and how will they be stored?
c 5a-- 144 o--Ic c
These questions must be answered correctly to demonstrate whether the restaurant owner or
operator is knowledgeable enough to receive a Permitaransitional Permit from this office.
Page 1 1 of 11