APPENDIX I
(See Paragraph-6)
FORM 1
Note : If space provided against any parameter is inadequate, Kindly upload supporting document under 'Additional Attachments if any'  at the last part of the Form1. Please note that all such Annexures must be part of single pdf document.
(I) Basic Information
S.No.Item Details
Is your project Comes under Notified Industrial Area NA
Whether proposal involved violation of EIA notificationN/A
Weather Consent to Establishment ObtainedN/A
Upload copy of CTE N/A
1.
Name of the Project/s Different type of resin manufacturing process project.
Brief summary of projectAnnexure-Brief summary of project
Proposal Number IA/GJ/IND2/111532/2019
Project Cost 150 lacs
2.
S. No. in the schedule5(f) Synthetic organic chemicals industry (dyes & dye intermediates; bulk
Project Sector Industrial Projects - 2
3. Proposed capacity/area/length/tonnage to be handled/command area/lease area/number or wells to be drilled 1200 MT/Month ha.
4.
New/Expansion/ModernizationNew
5. Existing Capacity/Area etc. 2.4518 ha.
6. Category of project i.e. 'A' or 'B' A
7.
Does it attract the general condition? If yes, please specify No
8.
Does it attract the specific condition? If yes, please specify No
9.
Location of the projectSurvey No 1763, Village – Vadasma, Taluka : Mehsana, District Mehsana 382705, Gujarat.
Shape of the project landBlock (Polygon)
Uploaded GPS fileAnnexure-GPS file      
Uploaded copy of survey of India ToposheetAnnexure-Survey of india toposheet
Plot/Survey/Khasra No.Survey No 1763
Town / VillageVadasma
State of the projectGujarat
Details of State of the project
S.no State Name District Name Tehsil Name
(1.)GujaratMahesanaMahesana
10.
Nearest railway station along with distance in kms Dangarwa, 2.56 K.m. in WSW Direction km
Nearest airport along with distance in kms Mehsana, 24.98 K.m. in North-Northeast direction km
11. Nearest Town/City/District Headquarters along with distance in kms Kalol Town , 15.26 K.m. in S direction km
12. Village Panchayats, Zila Parishad, Muncipal Corporation, Local body (Complete postal address with telephone nos. to be given) Vadasma Grampanchayat, District : Mehsana – 382705
13. Name of the Applicant Kantibhai
14. Registered Address Survey no.1763, village- vadasma,
15.
Address for correspondance:
Name of the Company HOLZWOOD INDUSTRIES PVT LTD
Name of the Applicant Kantibhai
Designation (Owner/ Partner/ CEO) Director
Pin code 380060
E-mail holzwoodindustries2019@gmail.com
Telephone No. 079-26564545
Fax No. 079-
Copy of documents in support of the competence/authority of the person making this application to make application on behalf of the User Agency . Annexure-Uploaded Copy of documents in support of the competence/authority
16.
Details of Alternative Sites examined, if any. Location of these sites should be shown on a toposheet No
17. Whether part of Interlinked projects? No
18. Whether separate application of Interlinked project has been submitted? N/A
19.
If Yes, MoEF file numberN/A
Date of submissionN/A
20. If No, Reason N/A
21.
Whether the proposal involves Approval/ Clearance under: if yes, details of the same and their status to be given
(i) Whether the proposal involves approval/clearance under the Forest (Conservation) Act,1980?No
(ii) Whether the proposal involves approval/clearance under the wildlife (Protection) Act,1972?No
(iii) Whether the proposal involves approval/clearance under the C.R.Z notification, 2011?No
22.
Whether there is any Government Order/Policy relevant/relating to the site?No
23.
Whether any Forest Land Involved?No
Area of Forest land Involved (hectares)N/A
24.
Whether there is any litigation pending against the project and/or land in which the project is proposed to be set up?No
(a) Name of the CourtN/A
(b) Name of the Sub courtN/A
(c) Case No.N/A
(d) Orders/directions of the court, if any and relevance with the proposed projectN/A
(II) Activity
1 Construction, operation or decommissioning of the Project involving actions, which will cause physical changes in the locality (topography, land use, changes in water bodies, etc.)
S.No Information/Checklist confirmation Yes/No Details there of (with approximate quantities/rates, wherever possible) with source of information data
1.1 Permanent or temporary change in land use, land cover or topography including increase in intensity of land use (with respect to local land use plan) Yes There is minor change in land use due to construction work.
1.2 Clearance of existing land, vegetation and buildings? No Not Applicable
1.3 Creation of new land uses? No Not Applicable
1.4 Pre-construction investigations e.g. bore houses, soil testing? No Not Applicable
1.5 Construction works? Yes Existing Structure available.
1.6 Demolition works? No Not Applicable
1.7 Temporary sites used for construction works or housing of construction workers? No No temporary sites or housing facilities will be provided since local contractors/ workers will be given preference for various construction activities.
1.8 Above ground buildings, structures or earthworks including linear structures, cut and fill or excavations and fill or excavations Yes Detailed plant lay-out is attached as Annexure –2.
1.9 Underground works including mining or tunnelling? No Not Applicable
1.10 Reclamation works? No Not Applicable
1.11 Dredging? No Not Applicable
1.12 Offshore structures? No Not Applicable
1.13 Production and manufacturing processes? Yes All the steps for the control of air pollution, water pollution and safe handling and disposal of all types of hazardous wastes will be considered in our Environmental Management Plan. Manufacturing process along with flow diagram is attached as Annexure – 4
1.14 Facilities for storage of goods or materials? Yes Covered shed will be provided for storage of goods & materials.
1.15 Facilities for treatment or disposal of solid waste or liquid effluents? Yes A detail of solid/hazardous waste is attached as Annexure – 5. A detail of ETP is attached as Annexure – 7
1.16 Facilities for long term housing of operational workers? Yes Labor quarter will be provided for permanent` worker.
1.17 New road, rail or sea traffic during construction or operation? No During operation phase, traffic will be momentary increased. However; existing transport routes are adequate for the proposed momentary increase in traffic.
1.18 New road, rail, air water borne or other transport infrastructure including new or altered routes and stations, ports, airports etc? No No new roads and rails are envisaged. Existing transportation facilities will be used for the proposed project.
1.19 Closure or diversion of existing transport routes or infrastructure leading to changes in traffic movements? No Not Applicable
1.20 New or diverted transmission lines or pipelines? No Not Applicable
1.21 Impoundment, damming, culverting, realignment or other changes to the hydrology of watercourses or aquifers? No Not Applicable
1.22 Stream crossings? No Not Applicable
1.23 Abstraction or transfers of water from ground or surface waters? Yes Abstraction of ground water through Borewell.
1.24 Changes in water bodies or the land surface affecting drainage or run-off? No Not Applicable
1.25 Transport of personnel or materials for construction, operation or decommissioning? No Transport of personnel or materials for construction or operation will not bring change to topography, land use, water bodies etc. Also to be noted that local personnel will be employed for the operation work, hence no such impact due to transport of personnel or material is envisaged.
1.26 Long-term dismantling or decommissioning or restoration works? No Not Applicable
1.27 Ongoing activity during decommissioning which could have an impact on the environment? No Not Applicable
1.28 Influx of people to an area in either temporarily or permanently? No Local people will be given preference for almost all the temporary as well as permanent jobs. Therefore, no such impact due to influx of people to an area in either temporarily or permanently is envisaged.
1.29 Introduction of alien species? No Not Applicable
1.30 Loss of native species or genetic diversity? No Not Applicable
1.31 Any other actions? No No additional actions will be implemented that would cause physical changes in land use, topography or water bodies.
2 Use of Natural resources for construction or operation of the Project (such as land, water, materials or energy, especially any resources which are non-renewable or in short supply):
S.No Information/Checklist confirmation Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of information data
2.1 Land especially undeveloped or agricultural land (ha) Yes The proposed unit will be set-up on 24,518 m2 of total land area. NA permission is already taken.
2.2 Water (expected source & competing users) unit: KLD Yes Total consumption of water during the plant operation will be 25.5 kl/day. Water balance diagram is attached as Annexure – 6.
2.3 Minerals (MT) No Not Applicable
2.4 Construction material – stone, aggregates, sand / soil (expected source – MT) Yes Locally available construction materials will be utilized for the construction work.
2.5 Forests and timber (source – MT) Yes A small amount of timber will be utilized for office building. The same will be purchased from open market.
2.6 Energy including electricity and fuels (source, competing users) Unit: fuel (MT),energy (MW) Yes Total demand load: 450 KVA from Uttar Gujarat Vij Corporation Ltd. Coal/ Briquettes – 4.5 MT/day
2.7 Any other natural resources (use appropriate standard units) No Not Applicable
3 Use, storage, transport, handling or production of substances or materials, which could be harmful to human health or the environment or raise concerns about actual or perceived risks to human health
S.No Information/Checklist confirmation Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of information data
3.1 Use of substances or materials, which are hazardous (as per MSIHC rules) to human health or the environment (flora, fauna, and water supplies Yes Raw material which are hazardous as per MSIHC rules are Phenol, Formaldehyde (37%), Acetic Acid. Note - Adequate measures will be taken as per the Manufacture, Storage & Import of Hazardous Chemicals Rules, 1989 and subsequent amendments for handling, storage and use of the hazardous materials. However, Risk Assessment Study will be carried out and based on the same On-site Emergency Plan will be prepared.
3.2 Changes in occurrence of disease or affect disease vectors (e.g. insect or water borne diseases) No Not Applicable
3.3 Affect the welfare of people e.g. by changing living conditions? No Not Applicable
3.4 Vulnerable groups of people who could be affected by the project e.g. hospital patients, children, the elderly etc. No Not applicable due to the fact that our unit is to be set-up on an open land area, this is away from residential area. Thus, there will not be any adverse effect occurred on vulnerable groups of people.
3.5 Any other causes No Not Applicable
4 Production of solid wastes during construction or operation or decommissioning (MT/month)
S.No Information/Checklist confirmation Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of information data
4.1 Spoil, overburden or mine wastes No Not Applicable
4.2 Municipal waste (domestic and or commercial wastes) Yes A details of solid/hazardous waste is attached as Annexure – 5.
4.3 Hazardous wastes (as per Hazardous Waste Management Rules) Yes A details of solid/hazardous waste is attached as Annexure – 5.
4.4 Other industrial process wastes Yes A details of solid/hazardous waste is attached as Annexure – 5.
4.5 Surplus product No Not Applicable
4.6 Sewage sludge or other sludge from effluent treatment Yes A details of solid/hazardous waste is attached as Annexure – 5.
4.7 Construction or demolition wastes No Construction wastes will be inert in nature and will be collected and utilized in filling of low-lying areas within the unit. Since the quantity of the construction material is not available, quantity of construction waste can not be estimated. No demolition work will be carried out for the proposed manufacturing unit. Therefore, no demolition waste will be generated.
4.8 Redundant machinery or equipment No Not Applicable
4.9 Contaminated soils or other materials No Not Applicable
4.10 Agricultural wastes No Not Applicable
4.11 Other solid wastes No Not Applicable
5 Release of pollutants or any hazardous, toxic or noxious substances to air(Kg/hr)
S.No Information/Checklist confirmation Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of information data
5.1 Emissions from combustion of fossil fuels from stationary or mobile sources Yes Details of flue gas stack are shown in the Annexure - 8.
5.2 Emissions from production processes No Not Applicable
5.3 Emissions from materials handling including storage or transport Yes There will be minor fugitive emissions due to handling & storage of materials for which proper control measures will be adopted.
5.4 Emissions from construction activities including plant and equipment Yes - Due to construction activities there may be chances of fugitive emission. - To avoid fugitive emission, proper control measures will be adopted.
5.5 Dust or odours from handling of materials including construction materials, sewage and waste No Due to handling of construction materials, concentration of particulate matter in ambient air will slightly increase for that particular time. Nevertheless, water sprinkling will be carried out during construction activity to nullify the effects of such dusting. There will not be any odour problem during the handling of construction materials. During construction and operation phase adequate sanitary facilities will be provided for the workers.
5.6 Emissions from incineration of waste No Not Applicable
5.7 Emissions from burning of waste in open air (e.g. slash materials, construction debris) No Not Applicable
5.8 Emissions from any other sources No Not Applicable
6 Generation of Noise and Vibration, and Emissions of Light and Heat:
S.No Information/Checklist confirmation Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of information data
6.1 From operation of equipment e.g. engines, ventilation plant, crushers Yes Source of noise pollution will be boiler, D.G. set, air compressor etc. As far as noise is concerned adequate sound enclosures will be provided to all the equipments & machineries generating high noise. However, ear protecting devices will be provided to all workers who working in such areas where noise levels will high. Increase in greenbelt development will help to abate noise levels.
6.2 From industrial or similar processes Yes Sources of noise pollution from the plant are pumps and motors, machineries, cooling tower etc. All the equipment in the unit will be designed and operated to have the noise level not exceeding 75-80 dB (A) at a distance of 1.5 m. from the equipment. Also, all the measures will be taken to limit the noise level at the plant boundary within the stipulated limits.
6.3 From construction or demolition Yes Ambient noise level will slightly increase during construction phase. However, effect of such noise would be temporary and negligible.
6.4 From blasting or piling No Not Applicable
6.5 From construction or operational traffic Yes Ambient noise level will slightly increase due to construction and operational traffic. However, effect of such noise would be temporary and negligible.
6.6 From lighting or cooling systems No Not Applicable
6.7 From any other sources No Not Applicable
7 Risks of contamination of land or water from releases of pollutants into the ground or into sewers, surface waters, groundwater, coastal waters or the sea:
S.No Information/Checklist confirmation Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of information data
7.1 From handling, storage, use or spillage of hazardous materials No Concrete flooring will be provided and spilled materials will be collected and treated in ETP.
7.2 From discharge of sewage or other effluents to water or the land (expected mode and place of discharge) No The details of Effluent Treatment Plant are attached as Annexure – 7.
7.3 By deposition of pollutants emitted to air into the land or into water No No major impact is anticipated by deposition of pollutants emitted to air into the land or into water, due to all the necessary Air Pollution Control measures to be adopted for controlling the air pollution within the norms specified by Central/State Pollution Control Board.
7.4 From any other sources No Not Applicable
7.5 Is there a risk of long term build up of pollutants in the environment from these sources? No Not Applicable
8 Risk of accidents during construction or operation of the Project, which could affect human health or the environment
S.No Information/Checklist confirmation Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of information data
8.1 From explosions, spillages, fires etc from storage, handling, use or production of hazardous substances Yes Risk Assessment study will be carried out to minimize any possible causes that would lead to an accident. Based on the same, the industry will prepare an onsite emergency plan highlighting the steps to be taken at the time of emergency. Adequate storage facilities will be provided and special care will be taken for storage, handling, use and transport of hazardous materials.
8.2 From any other causes No Not Applicable
8.3 Could the project be affected by natural disasters causing environmental damage (e.g. floods, earthquakes, landslides, cloudburst etc)? No Floods are not likely to occur as water body are away. It may be noted that seismic forces will be considered for the construction of proposed structures/buildings as the project site falls under the Sesmic Zone - IV.
9 Factors which should be considered (such as consequential development) which could lead to environmental effects or the potential for cumulative impacts with other existing or planned activities in the locality
S.No Information/Checklist confirmation Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of information data
9.1 Lead to development of supporting utilities, ancillary development or development stimulated   by the project which could have impact on the environment e.g.:
  • Supporting infrastructure (roads, power supply,waste or waste water treatment, etc.)
  • housing development
  • extractive industries
  • supply industries
  • Other
No Not Applicable
9.2 Lead to after-use of the site, which could have an impact on the environment No There will no major impact on the environment due to industry will take the steps for the control of air pollution, water pollution and safe handling and disposal of all types of hazardous wastes through Environmental Management Plan.
9.3 Set a precedent for later developments No Not Applicable
9.4 Have cumulative effects due to proximity to other existing or planned projects with similar effects No Not Applicable
(III) Environmental Sensitivity
S.No Areas Name/Identity Aerial distance (within 15km.) Proposed project location boundary
1 Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
No Not Applicable
2 Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Yes Vadasama village lake is approx. 2.92 km away in NE direction from project site.
3 Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Yes Nalsarovar Bird Sanctuary 72.21 km in SW direction
4 Inland, coastal, marine or underground waters Yes Vadasama village lake is approx. 2.92 km away in NE direction from project site.
5 State, National boundaries No Not Applicable
6 Routes or facilities used by the public for access to recreation or other tourist, pilgrim areas No Not Applicable
7 Defence installations No Not Applicable
8 Densely populated or built-up area Yes Nearest Mehsana City total population is around 20,27,727. 462 persons per sq. km.
9 Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship, community facilities) Yes Govindpura Veda Hospital is approx. 8.16 Km in E direction from project site.
10 Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) No Not Applicable
11 Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) No Not Applicable
12 Areas susceptible to natural hazard which could cause the project to present environmental problems (earthquakes, subsidence, landslides, erosion, flooding or extreme or adverse climatic conditions) similar effects No Not Applicable
(IV) Proposed Terms of Reference for EIA studies
1 Uploaded Proposed TOR File Annexure-TOR file
2 Uploaded scanned copy of covering letter Annexure-scanned copy of covering letter
3 Uploaded Pre-Feasibility report(PFR) Annexure-PFR
4 Uploaded additional attachments(only single pdf file) Annexure-Additional attachments
Additional Attachments, if any
Attached File
EDS Reply
            Essential Detail Sought:
Sno. EDS Letter Remarks Date of EDS
1.NAThe correction have been made as per the instruction received 23 Jul 2019
2.NAPlease inform whether the project falls in the category of 'small unit' as per the water/power requirement. Please provide details of land available and permission for its industrial use. Please provide project name (not PPs or company name) in S.NO. 1 of Form1 22 Jul 2019
      Additional Detail Sought : NIL
(V) Undertaking
I hereby give undertaking that the data and information given in the application and enclosures are true to be best of my knowledge and belief and I am aware that if any part of the data and information found to be false or misleading at any stage, the project will be rejected and clearance given, if any to the project will be revoked at our risk and cost.
V.(i)
Name of ApplicantKantibhai
DesignationDirector
Name of Company (Applicant Name should not be given here)HOLZWOOD INDUSTRIES PVT LTD
AddressSurvey no.1763, village- vadasma,
Print