Wake County Environmental Food Service Plan Review Application/City of Raleigh

Food Service Establishment Plan Review Application

NC Food Code Manualand Rules Governing the Sanitation of Food Service Establishmentsrequire that plans be submitted to the local health department (Wake County Environmental Services) for approval prior to construction, renovation, modification or change of ownership of a food service establishment.

Wake County Environmental Services (WCES) charges a $200 plan review and a $100 re review fee. Franchise or chain establishments that pay NCDHHS plan review fee are exempt from WCES plan review fee, but may be subject to a re review fee.

Franchise or chain establishments must also submit planstoNC DHHS Environmental Health Services, Plan Review Unit prior to submitting to Wake County Environmental Services. An approval letter from NC DHHS, Plan Review Unit must be included with franchise/chain plan review applications that are submitted to WCES. State submittal information can be found at www..

Plan Review Submittal Checklist:

_____ Complete set of plans drawn to scale showing the placement of each piece of food service equipment, storage areas, and trash can wash facilities. Plans must include general plumbing, electrical, mechanical and lighting drawings and room finish schedules.

_____ A site plan locating exterior equipment, such as dumpsters and walk-ins

_____ Manufacturer specification sheets for each piece of new equipment

_____ Completed Food Service Plan Review Application

_____ Proposed menu

_____ State approval letter if this is a franchise or chain

If you have questions, contact one of the Plan Review staff listed below:

Terry Chappell, REHS, Section ChiefChristina Sancha, REHS

Plan Review/Recreational Sanitation SectionEnvironmental Health Specialist

Environmental Health Specialist(919) 868-2559

(919) 856-7437

Jessica Sanders, REHS

Rob Richardson, REHS, Team LeaderEnvironmental Health Specialist

Environmental Health Specialist(919) 856-7417

(919) 857-9356

Rebecca Robbins, REHS

Laura Lerch, REHS Environmental Health Specialist

Environmental Health Specialist (919) 856-7419

(919)856-6609

Food Service Establishment Plan Review Application

Type of Construction:NEW ______REMODEL ______

Name of Establishment: ______

Address: ______

City: ______Zip Code: ______County: ______

Phone (if available):_____ - _____ - ______Fax: _____ - _____ - ______

Owner or Owner’s Representative:______

Address: ______

City & State: ______Zip Code: ______

Telephone _____ - _____ - ______Fax: _____ - _____ - ______

E-mail Address: ______

Applicant: ______

Address: ______

City & State : ______Zip Code: ______

Telephone: _____ - _____ - ______Fax: _____ - _____ - ______

E-mail Address: ______

Title (owner, manager, architect, etc.______

Projected start date of construction: ______Projected completion date: ______

I certify that the information in this application is correct, and I understand that any deviation without prior approval from Wake County Environmental Services may nullify plan approval.

Signature: Date:

(Owner or Responsible Representative)

Hours of Operation:

Sun______Mon______Tue______Wed______Thu______Fri______Sat______

Number of seats: ______Facility total square feet: ______

Projected number of meals served between product deliveries:

Breakfast: ______Lunch: ______Dinner: ______

TYPE OF FOOD SERVICE:CHECK ALL THAT APPLY

_____ Restaurant_____ Sit-down meals

_____ Food Stand_____ Take-out meals

_____ Drink Stand_____ Catering

_____ CommissarySingle-service (disposable):

____Plates ____Glassware ____Silverware

_____ Meat Market

Multi-use (reusable):

_____ Other (explain): ______Plates ____Glassware ____Silverware

Whatspecialized processes will be used?___Curing___Acidification (sushi, etc.)

___Smoking ___Reduced Oxygen Packaging(vacuum packaging, sous vide, cook-chill, etc.)

Explain checked processes: ______

______

Specialized process may need a state or local approved variance or HACCP plan.

A variance application can be found at

Indicate any of the following highly susceptible populations that will be catered to or served:

___Nursing Home___Child Care Center

___Health Care Facility___Assisted Living Center

___School with pre-school aged children or an immuno-compromised population

Will managers or supervisors have current Food Protection Certification (such as ServSafe) as required byNC Food Code Manual? ___Yes ___No

Does your food establishment have an Employee Health Policy? ___Yes ___No

Example of an Employee Health Policy can be found at

Will under cooked or raw beef, eggs, fish, lamb, milk, pork, poultry or shellfish be served?

___Yes___No If yes, where will the Consumer Advisory be posted? ______

Examples of a Consumer Health Advisory can be found at

COLD STORAGE

Cubic-feet of reach-in cold storage: Cubic-feet of walk-in cold storage:

Reach-in refrigerator storage: ______ft³Walk-in refrigerator storage: ______ft³

Reach-in freezer storage: ______ft³ Walk-in freezer storage: ______ft³

Number of reach-in refrigerators: ______

Number of reach-in freezers: ______

HOT HOLDINGList food that will be heldhot: ______

______

COLD HOLDINGList food that will be held cold: ______

______

COOLING

Indicate by checking the appropriate boxes how cooked food will be cooled to 410F (70C) within 6 hours. If “Other” is checked indicate type of food: ______

Cooling Process / Meat / Seafood / Poultry / Other
Shallow Pans
Ice Baths
Rapid Chill

THAWING

Indicate by checking the appropriate boxes how food in each category will be thawed.

If “Other” is checked indicate type of food: ______

Thawing Process / Meat / Seafood / Poultry / Other
Refrigeration
Running Water less than 700 F (210 C)
Cooked Frozen
Microwave

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 review process.

Explain the handling procedures for the following categories of food. Describe the process from receiving to ready-to-eat form, including:

How the food will arrive (frozen, fresh, packaged, etc.)
Where the food will be stored
Where (prep table, sink, counter, etc.) the food will be handled (washed, cut, marinated,
When (time of day and frequency/day) food will be handled

1. READY-TO-EAT FOOD HANDLING (Edible without additional preparation: sandwiches, salads, etc…)

______

2. PRODUCE HANDLING

______

3.POULTRY HANDLING

______

4. MEAT HANDLING

______

5. SEAFOOD HANDLING

______

6. SUSHI PREPARATION

______

DRY STORAGE

Provide information on the frequency of deliveries. ______

Square feet of dry storage shelf space: ______ft²

Where will dry goods be stored? ______

______

FINISH SCHEDULE

Indicate floor, wall and ceiling finishes (i.e., quarry tile, stainless steel, vinyl coated acoustic tile)

Area / Floor / Base / Walls / Ceiling
Kitchen
Bar
Walk-in Cooler
Walk-in Freezer
Dry Storage
Toilet Rooms
Dressing Rooms
Garbage & Refuse Storage
Can Wash Area
Other
Other

WATER SUPPLY – SEWAGE DISPOSAL

1. Is water supply: ___Municipal ___Well

Is sewer: ___Municipal ___On Site

2.Will ice be made on premises or purchased? ______

3.Grease trap/interceptor provided: _____ Yes_____ No

Location: ______

4.Water heater Information

Tank type:

Manufacturer and model: ______
Storage capacity: ______gallons

Electric water heater: ______kilowatts (kW)
Gas water heater: ______BTU’s

Water heater recovery rate (gallons per hour at 100ºF temperature rise): ______GPH

(See Water Heater Calculator on page 11 to calculate recovery rate needed)

Tankless:

a.Manufacturer and model: ______

b.Number of tankless water heaters: ______

Electric water heater: ______kilowatts (kW)
Gas water heater: ______BTU’s

Water heater recovery rate (gallons per hour at 100ºF temperature rise): ______GPM

(See Water Heater Calculator on page 12 to calculate recovery rate needed)

5.Check the appropriate box indicating equipment drains:

Indirect Waste / Direct Waste
Plumbing Fixtures / Floor sink / Hub Drain / Floor Drain
Utensil Washing Sink
Prep Sinks
Hand Sinks
Dish machine
Food Prep Sinks
Ice Machine
Garbage Disposal
Dipper Well
Refrigeration
Steam Table
Other

DISHWASHING FACILITIES

a. Hand Dishwashing

1.Number of sink compartments: ______

Size of sink compartments (inches): Length: ______Width: ______Depth: ______

Length of drain boards (inches): Right: ______Left: ______

2. What type of sanitizer will be used?

Chlorine: ____ Iodine: ____ Quaternary Ammonium: ____ Hot Water: ____

Other (specify): ____

b.Mechanical Dishwashing

1. Will a Dishmachine be used? Yes_____ No_____

Dishmachine manufacturer and model:______

2. Type of sanitization: Hot water (180F) _____ Chemical _____

c.General

1.Describe how cooking equipment, cutting boards, slicers, counter tops and other food contact surfaces that cannot be submerged in sinks or put through a dishwasher will be cleaned and sanitized:

______

2. Describe location and type (drainboards, wall-mounted or overhead shelves, stationary or portable racks) of air drying space:

______

Square feet of air drying space: ______ft²

HANDWASHING

Indicate number and location of kitchen hand sinks:

______

EMPLOYEE AREA

Indicate location for storing employees’ personal items:

______

GARBAGE AND REFUSE

1.Will refuse be stored inside? Yes______No ______

If yes, where______

______

2. Provision for garbage disposal: Dumpster ______Compactor ______

3.Provision for cleaning dumpster/compactor: On-site ______Off-site ______

If off-site cleaning, provide name of cleaning contractor: ______

______

4.Describe location for storage of recyclables: (cooking grease, cardboard, glass, etc.) ______

______

CLEANING FACILITIES

1.Location and size of can wash/mop storage area: ______

______

2.Location of chemical storage: ______

______

INSECT AND RODENT

1.How is fly protection provided on all outside doors?

Self-closing door ____ Fly Fan ____ Screen Door ____

2.How is fly protection provided on windows?

Self-closing ______Fly Fan ____ Screening ____

3.Location of insecticide/rodenticide storage: ______

______

Location of clean linen storage: ______

______

5.Location of dirty linen storage: ______

TANK WATER HEATER SIZING

TANK Water Heater Calculation Worksheet
Equipment / Quantity / Times / Size / GPH
Dish Sink 3 Comp. (See Note below) / 3 comp / X / ____ x ____ x ____x.00325 / =
Dish Sink 4 Comp. (See Note below) / 4 comp / X / ____ x ____ x ____x.00325 / =
Bar Sink 3 Comp. (See Note) / 3 comp / X / ____ x ____ x ____x.00325 / =
Prep sink with 1 compartment / X / 5 GPH
Prep sink with 2 Compartments / X / 10 GPH
Hand Sink / X / 5 GPH / =
Can Wash / X / 5 GPHH
Dish Machine / X / GPH = 70% of “Final Rinse Usage”
Dish Machine prewash / X / 45 GPH / =
Bar Glass Machine / X / GPH = 70% of “Final Rinse Usage”
Cloth Washer / X / 15 GPH / =
Hose Reel / X / 5 GPH / =
Other Equipment / X / =
Other Equipment / X / =
A gallon per hour (GPH) Recovery Rate needed is based on 700 to 1000 F temperature rise and depends on the dish machine temperature requirements. / Total

NOTES

Dish Sink Calculation / GPH = (# compartments) x (Sink size in cu. in.) x (.003255/cu. in.)
Example: (3 compartments) x (24” x 24” x 14”) x (.00325) = 79 GPH

TANKLESS WATER HEATER SIZING

TANKLESS Water Heater Calculation Worksheet
Equipment / Quantity / Times / GPM / GPM
Utensil Sink / X / 2 / =
Prep Sink / X / 1 / =
Hand Sink / X / 0.5 / =
Can Wash / Mop Sink / X / 1 / =
Cloth Washer / X / See Manufacture Spec Sheet / =
Dish Machine / X / See Manufacture Spec
Sheet / =
Pre-Rinse / X / 2 / =
Gallons per Minute (GPM) Recovery Rate needed at 100 degrees rise / Total

List the Make and Model of the dish machines and glass washers to be installed:

MakeModel

______

Please note that some dish machines are not compatible with tankless water heaters.

Dish machine and clothes washer GPM cannot be converted to GPH.

S:\Plan Review\Plan Review Application

Wake County Environmental Food Service Plan Review Application/City of Raleigh

Signature: ______Date: ______

COLD STORAGE

HOT HOLDINGList food that will be heldhot: ______

FOOD HANDLING PROCEDURES

1. READY-TO-EAT FOOD HANDLING (Edible without additional preparation: sandwiches, salads, etc…)

2. PRODUCE HANDLING

4. MEAT HANDLING

5. SEAFOOD HANDLING

6. SUSHI PREPARATION

DRY STORAGE

FINISH SCHEDULE

Dishmachine manufacturer and model:______

HANDWASHING

EMPLOYEE AREA

Signature: Date: