EmailMe Form - Food Service Plan Application

NEW FOOD SERVICE OPERATORS
This office has been notified of your intent to open a new food service facility in Rowan County. Please be advised that North Carolina General Statutes 130A-248(b) states that "No facility shall commence or continue operation that does not have a permit issued by the Department. The permit shall be issued to the owner or operator of the facility and shall not be transferable. A permit shall be issued only when the facility satisfies all of the requirements of the rules ... ".
To insure that modern standards of sanitation are included in new and remodeled food handling establishments, the Rules Governing the Sanitation of Restaurants and Other Food handling Establishments ISA NCAC 18A. 2658 (2) requires that "Plans, drawn to scale, and specifications, for new food service establishments shall be submitted for review and approval to the local health agency prior to initiating construction ... ". The entire rules can be reviewed at http://www.rowancountync.gov/GOVERNMENT /Departments/ HealthDepartment/Environmental Health.aspx.
You will need to submit to this office a completed food service plan review application, a complete set of floor plans, drawn to scale (l/4" = 1' minimum) along with a floor, wall and ceiling fmish schedule, an equipment schedule that identifies each piece of equipment by common name, manufacturer's name and model number, a plumbing diagram, and a proposed menu as soon as possible. Any construction that has been initiated should be stopped until the fmal plan approval has been issued. Any construction that has been done, which does not meet the rules will have to be redone in an approved manner before an operations permit will be issued.
If you have any questions about this matter or if this office can be of assistance to you in any way, please feel free to call at 704 216-8530 or email Greg.McNeely@rowancountync.gov.
FOOD SERVICE PLAN REVIEW APPLICATION
Prototype "franchised" or "chain" food service facilities shall submit plans for review to: NCDHHS Division of Public Health: Food Service Plan Review, 1632 Mail Service Center, Raleigh NC 27699-1632. Phone 888-251-5543.
Date of Application
MM / DD / YYYY
NEW
REMODEL
Name of Establishment
Establishment Type
Restaurant
Institution
Day Care
Meat Market
Other
Physical Location
Name of Owner
First MI Last
Phone
### - ### - ####
Owner Mailing Address (Street, City, Zip Code)
Applicant's Name
First MI Last
Phone
### - ### - ####
Applicant Mailing Address (Street, City, Zip Code)
Title
Owner
Manager
Architect
Other
Email Address
Enter Days of Week & Hours that Establishment of open for Business (Sat 9am-9pm, Sun-Closed, etc)
Number of Seats Available Inside
Number of Seats Available Outside
Type of Service Available (Check All That Apply)
Sit Down Meals
Buffet
Take Out
Caterer
Mobile Vendor
PLEASE ENCLOSE THE FOLLOWING DOCUMENTS:
Proposed Menu (including seasonal, off-site and banquet menus) Menu must include disclaimer and consumer advisory for foods served raw or undercooked. Reference rule 3-603.11 of NC Food Code Manual
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; and location of any outside equipment (dumpsters, well, septic system, can wash - if applicable)
Plan drawn to scale (1/4" = 1' minimum) of food establishment showing location of equipment, plumbing, services
Describe lighting (recessed fixtures-bulb shields-shatter shield bulbs)
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 heating equipment with capacity and recovery rate or on demand heaters
Number of food deliveries (from vendors) per week
Manager's training certificate; 210 days after permit issued.
FOOD PREPARATION REVIEW

	Yes	No
Thin meats, poultry, fish, eggs
Thick meats, whole poultry
Sandwich meats sliced on site.
Hot processed foods
Bakery goods (made on site)
Are slaws or salads (Ex: potato, pasta, etc.) made on site

PLEASE ANSWER THE FOLLOWING QUESTIONS RELATED TO FOOD SUPPLIES:
How will dry goods be stored off the floor?
Where will damaged food items be stored?
Yes No

Will raw meats, poultry and seafood be stored in the same refrigerators and freezers with cooked/ready-to-eat foods?
If yes, how will cross-contamination be prevented?
Yes No

Will any seafood and/or meats be washed

Or thawed on-site prior to use?
Describe where/how:
Describe where/how produce will be washed prior to use (If applicable).
Describe where/how raw meats are processed on site; cutting meats, making burgers, etc. (if applicable).
Describe where/how raw meats are stored on ice (If applicable).
Describe how sushi rice will be handled: 135 or above, written procedures for time hold, or apply for variance (If applicable).
Provide a list of all food items that will be cooked, cooled, and reheated for service at a later time.
FINISH SCHEDULE:
Applicant must indicate which materials (quany tile, stainless steel, 4" plastic coved molding, etc.) will be used in the following areas.

	Yes	No
Will raw meats, poultry and seafood be stored in the same refrigerators and freezers with cooked/ready-to-eat foods?

	Floor	Coving	Walls	Ceiling
Kitchen
Bar (if applicable
Food Storage
Other Storage
Toilet Rooms
Garbage & Refuse Storage
Mop Service Basin Area
Ware washing Area

INSECT AND RODENT CONTROL: Please check appropriate boxes.

Yes No

Will all outside doors be self-closing and rodent proof?

Will air curtains be used?
Garbage and Refuse: INSIDE

Yes No

Is there area for washing trash cans?

Is there area for mop/broom storage?
Garbage and Refuse: OUTSIDE

Yes No

Will garbage cans be stored outside?

Will there be area for recyclables?

Will a dumpster be used?
Number of Dumpsters Size Frequency of Pickup Contractor

Will a Dumpster Be Used?
Describe surface and location where dumpster/compactor/garbage cans are to be stored
Will the dumpster be cleaned? If cleaned off site provide copy of cleaning contract (select below)
Describe location of grease storage receptacle
What type metal stem thermometer(s) will be used; must be capable of checking temperature of thin foods such as
lettuce and thin meats?
Is Water Supply (select below)
Private water supplies must be listed with the Public Water Supply Section of DEH Mooresville Regional Office 704-663-1699) and comply with Section .1700 of the NCAC
If private, has source been approved under 15A NCAC I SA . I 700. (select below).
Provide spec's for backflow prevention devices.
Where is Ice made?
Is building connected to a municipal sewer?
If no, is private disposal system approved?
Please attach copy of written approval and/or permit.
Describe storage facilities for employees' personal belongings (i.e., purse, coats, boots, umbrellas, etc.)
Will linens be laundered on site?
If yes, what will be laundered and where/how?
If no, how will linens be cleaned?
Is a laundry dryer available?
Location of clean linen storage:
Location of dirty linen storage:
Name of linen service if laundered off site:
DISHWASHING FACILITIES:
Answer the below questions
Utensils:
Will sinks or a dishwasher be used for warewashing?
Dishwasher
Two-Compartment Sink (Will require detergent sanitizer or variance.)
Three compartment sink
6 KW booster heater
Dishwasher (If applicable)
Type of sanitization used:
Hot water (temp. provided)
Chemical type
Adequate prewash facilities
Does the largest pot and pan fit into each compartment of the pot sink?
If no, what is the procedure for manual washing, rinsing, and sanitizing utensils?
Select types of sanitizers to be used (must have correct test strips for each)
Chlorine
Iodine
Quaternary ammonium
Hot Water
Other
THE ROWAN COUNTY HEALTH DEPARTMENT MUST APPROVE ANY CHANGES MADE TO PLANS.
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. Food service permits issued by this department are required to be issued before an establishment can operate or have food and supplies delivered.
The scheduling of the preopening inspection should be discussed with the Environmental Health Specialist as far in advance as possible. The Environmental Health Specialist that has been working on this project will be the one that issues the food service permit unless other arrangements are made in advance.
Submittal of Forms
I have submitted plans/application to the following contacts in Rowan County Zoning & Planning and Building Inspections
Zoning/Planning Point of Contact:
Building Inspections Point of Contact:
Signature of individual submitting this Application:
Clear
Date Application Signed
MM / DD / YYYY

	Yes	No
Will any seafood and/or meats be washed
Or thawed on-site prior to use?

	Yes	No
Will all outside doors be self-closing and rodent proof?
Will air curtains be used?

	Yes	No
Is there area for washing trash cans?
Is there area for mop/broom storage?

	Yes	No
Will garbage cans be stored outside?
Will there be area for recyclables?
Will a dumpster be used?

	Number of Dumpsters	Size	Frequency of Pickup	Contractor
Will a Dumpster Be Used?