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
Whether it is a violation case and application is being submitted under Notification No. S.O.804(E) dated 14.03.2017 ? No
1.
Name of the Project/s Consultancy Services for Project Management Phase-I including Preparation of Detailed Project Report for Upgradation of Junction with NH-53 near Songudh-Ahwa, in the state of Gujarat, Saputra, Sarad, Vani - Pimpalgaon Baswant in the state of Maharashtra section of NH-953 to Two / Four Lane with Paved Shoulder Configuration (Package No: NH/IAHE/17)
Brief summary of projectAnnexure-Brief summary of project
Proposal Number IA/GJ/MIS/38627/2016
Project Cost (in lacs) 60000
2.
S. No. in the schedule7(f) Highways
Project Sector Infrastructure and Miscellaneous Projects  +  CRZ
3. Proposed capacity/area/length/tonnage to be handled/command area/lease area/number or wells to be drilled Two / Four Lane with Paved Shoulder Configuration (Package No: NH/IAHE/17) Total length of 150 Km approx ha.
4.
New/Expansion/ModernizationNew
5. Existing Capacity/Area etc.  ha.
6. Category of project i.e. 'A' or 'B' A
7.
Does it attract the general condition? If yes, please specify Yes
a) Protected areas notified under the wildlife (Protection) Act, 1972
c) Notified Eco-sensitive areas
d) Inter-State boundaries and international boundaries
8.
Does it attract the specific condition? If yes, please specify No
9.
Location of the projectSection I:- Songudh-Ahwa, in the state of Gujarat, Section II :- National Highway 953, from Saputra, Sarad, Vani - Pimpalgaon Baswant in the state of Maharashtra.
Shape of the project landStrip
Uploaded GPS fileAnnexure-GPS file      
Uploaded copy of survey of India ToposheetAnnexure-Survey of india toposheet
Plot/Survey/Khasra No.The project corridor connects two Major National highways in the region as well as it connects two big industrial states of country. The project corridor is divided in two Sections as follows: Section I:-Songudh to Ahwa, NH 953 in the State of Gujarat for a length of 65 kms. National Highway 953, Starts from its junction with NH 53, near Songudh in Navagam Main road and terminates at its junction with SH 174 near Mission Pada, in Ahwa via Temka, Baopada, Modla, Tarpada, Bardipada, Mahal, Jamlapada, Garvi, Piaplyamal, Laskariya Amba, Borkhet, mission Pada in the State of Gujarat, the project corridor is part of NH 953, which starts from Songudh and end at Ahwa having a total length of around 64 kms located entirely in the State of Gujarat. The project highway passes through two districts i.e. Tapi and Dang District in the State of Gujarat. Section II :- National Highway 953, from Sarad , Vani to Pimpalgaon Baswant in the state of Maharashtra for a length of 58 Km. National Highway 953
Town / VillageThe project corridor connects two Major National highways in the region as well as it connects two big industrial states of country. The project corridor is divided in two Sections as follows: Section
State of the projectGujarat
Details of State of the project
S.no State Name District Name Tehsil Name
(1.)GujaratTapiSongadh
10.
Nearest railway station along with distance in kms Ukai Songudh Railway station, 2.2 km
Nearest airport along with distance in kms Surat Airport, 86 km
11. Nearest Town/City/District Headquarters along with distance in kms Songudh , 0.0 km
12. Village Panchayats, Zila Parishad, Muncipal Corporation, Local body (Complete postal address with telephone nos. to be given)
13. Name of the Applicant Ratilal
14. Registered Address Indian Academy of Highway Engineers ( MORTH) A-5, Sector 62, Institutional Area, NH 24 Bypass, Noida-201301
15.
Address for correspondance:
Name of the Company IAHE
Name of the Applicant Ratilal
Designation (Owner/ Partner/ CEO) Executive Engineer (Authorized
Pin code 422001
E-mail nasiknh@gmail.com
Telephone No. 120-2400085
Fax No. 120-2400085
Copy of documents in support of the competence/authority of the person making this application to make application on behalf of the User Agency . NIL
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?Yes
StatusApplication for Forest Clearance yet to be submitted
(ii) Whether the proposal involves approval/clearance under the wildlife (Protection) Act,1972?Yes
StatusApplication for Wildlife Clearance yet to be submitted
(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?
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 Since the project is Upgradation of Songudh-Ahwa, in the state of Gujarat and Saputara (Gujarat border), Sarad, Vani - Pimpalgoan Basant in the state of Maharashtra section of NH-953 to Two / Four Lane with Paved Shoulder Configuration, there may be change in land use is anticipated.
1.2 Clearance of existing land, vegetation and buildings? Yes Clearance of existing land is anticipated.
1.3 Creation of new land uses? Yes As mentioned in S. No. 1.1
1.4 Pre-construction investigations e.g. bore houses, soil testing? Yes For the upgradation of existing road within the ROW, the Consultants shall test at least three sub-grade soil samples for each homogenous road segment or three samples for each soil type encountered, whichever is more. For the roads along new alignments, the test pits for sub grade soil shall be at 5km or for each soil type, whichever is more. A minimum of three samples should be tested corresponding to each homogenous segment.
1.5 Construction works? Yes The Highway will be constructed which will include Sub grades, Bituminous Surfaces, Bridges, Drains, Culverts, ROB, underpasses, flyovers, interchanges, and grade-separated intersections along the project road alignment.
1.6 Demolition works? Yes Structures to be affected needs to be demolished. Suitable compensation will be given to PAP’s as per the norms.
1.7 Temporary sites used for construction works or housing of construction workers? Yes A small area will be utilized temporarily for construction of sheds for the workers and materials. Water supply and sanitation facilities will be provided for them. Mostly workers will be deployed from local area only. All the construction activities including temporary storage of raw materials will be confined within the project site.
1.8 Above ground buildings, structures or earthworks including linear structures, cut and fill or excavations and fill or excavations No None.
1.9 Underground works including mining or tunnelling? No Not Applicable.
1.10 Reclamation works? No No reclamation work required.
1.11 Dredging? No No dredging work required.
1.12 Offshore structures? No No offshore structure.
1.13 Production and manufacturing processes? No No production/ manufacturing process involved as the project is construction and upgradation of road.
1.14 Facilities for storage of goods or materials? Yes Separate raw material storage yard will be made. Cement will be separately stored under cover in bales. Sand will be stacked neatly under tarpaulin cover. Bricks and steel will be laid in open. The storage yard will be located within the project site.
1.15 Facilities for treatment or disposal of solid waste or liquid effluents? Yes Solid Waste during construction phase, waste recyclable construction materials will be sold to recyclers. Unusable, excess construction debris will be disposed at designated places in tune with the local norms.
1.16 Facilities for long term housing of operational workers? No Not Applicable
1.17 New road, rail or sea traffic during construction or operation? Yes The road will be upgraded and the same will be used for vehicular movement during operation. No rail or sea traffic is envisaged.
1.18 New road, rail, air water borne or other transport infrastructure including new or altered routes and stations, ports, airports etc? Yes The road will be upgraded as per the design requirement to serve as an important connectivity
1.19 Closure or diversion of existing transport routes or infrastructure leading to changes in traffic movements? Yes The present existing alignment of NH-953 passes through many small villages/ towns where the present road becomes narrower and there is no space for further improvement. To reduce the demolition of built-up structures, to avoid the problem of traffic congestion and safe movement of vehicle, alternative routes have been proposed in terms of bypasses to divert the traffic from town areas.
1.20 New or diverted transmission lines or pipelines? No None
1.21 Impoundment, damming, culverting, realignment or other changes to the hydrology of watercourses or aquifers? No None
1.22 Stream crossings? Yes Bridges/culverts are proposed at stream crossings as per the hydrological requirements and necessary clearances will be obtained from concerned departments.
1.23 Abstraction or transfers of water from ground or surface waters? No No abstraction or transfers of water from ground or surface waters is anticipated in this project.
1.24 Changes in water bodies or the land surface affecting drainage or run-off? No None
1.25 Transport of personnel or materials for construction, operation or decommissioning? Yes Construction workers will be hired from local area. Movements of trucks / vehicles are envisaged for transporting materials during construction. As the project is upgradation of road, transport of personnel and materials is expected during operation period.
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 Not Applicable.
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 Not Applicable.
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 project requires undeveloped/agricultural land and the identification of land to be acquired is under progress.
2.2 Water (expected source & competing users) unit: KLD Yes Water is required during construction phase only and no water is required during operation phase. Contractor shall provide independent sources of water supply through water tankers for use in the works and for associated storage, work shop and work force compounds. Prior approval shall be obtained from the relevant State authorities and all installations shall be in compliance with local regulations.
2.3 Minerals (MT) No There will be no mineral requirement.
2.4 Construction material – stone, aggregates, sand / soil (expected source – MT) Yes Sources of all materials (including use of fly-ash/ slag), quarry sites and borrow areas shall be identified and field and laboratory testing of the materials to determine their suitability for various components of the work and establish quality and quantity of various construction materials shall be undertaken and their use on the basis of techno-economic principles shall be recommended.
2.5 Forests and timber (source – MT) No There is no use of Timber.
2.6 Energy including electricity and fuels (source, competing users) Unit: fuel (MT),energy (MW) Yes During construction phase of Road, temporary measures will be taken for electricity supply. While, during operation phase, electricity is required only for Street lighting purpose, which will be met from 12/12/2015 nearby grid.
2.7 Any other natural resources (use appropriate standard units) No There is no need for other natural resources.
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 No The project is a road project, hence no storage of hazardous chemicals (as per MSIHC rules) will be done, except HSD required to run standby DG sets, whenever necessary, for which the quantity stored will be below the threshold limit specified in the MSIHC 2000 rules.
3.2 Changes in occurrence of disease or affect disease vectors (e.g. insect or water borne diseases) No Suitable drainage and waste management measures will be adopted in construction phase, which will restrict stagnation of water or accumulation of waste. This will effectively restrict the reproduction and growth of disease vectors.
3.3 Affect the welfare of people e.g. by changing living conditions? No No adverse impacts on human health and their living conditions due to proposed project are envisaged. Moreover this project will provide employment to local labours during construction phase.
3.4 Vulnerable groups of people who could be affected by the project e.g. hospital patients, children, the elderly etc. No As such no Vulnerable groups of people will be affected due to the project. However, the details will be collected during detailed design stage.
3.5 Any other causes No Nil.
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 No such spoil, overburden or mine wastes is produced.
4.2 Municipal waste (domestic and or commercial wastes) No Not Applicable.
4.3 Hazardous wastes (as per Hazardous Waste Management Rules) No No hazardous waste will be produced.
4.4 Other industrial process wastes No Not Applicable.
4.5 Surplus product No Not Applicable.
4.6 Sewage sludge or other sludge from effluent treatment No Not Applicable.
4.7 Construction or demolition wastes Yes The construction waste will consist of excess earth and construction debris along with cement bags, steel in bits and pieces, insulating & packaging materials etc. Recyclable waste construction materials sold to recyclers. Unusable and excess construction debris will be disposed at designated places in tune with local norms.
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 No The operation of proposed project does not envisage any major air pollution sources like Particulate matter (PM), SO2, Nox. The gaseous emissions are expected from transport vehicles moving in the project road.
5.2 Emissions from production processes No Not Applicable.
5.3 Emissions from materials handling including storage or transport No Construction material storage yards will be always covered to reduce emission. Dust will arise during the transportation of materials and the dust will be controlled by slow movement of vehicles, covering the materials properly and by water spraying.
5.4 Emissions from construction activities including plant and equipment Yes Some emissions are envisaged from machinery and equipment engaged during construction phase. They will be fitted with dust extraction units.
5.5 Dust or odours from handling of materials including construction materials, sewage and waste Yes Dust is likely to be generated during construction which will be controlled by water sprinkle and tarpaulin cover will be provided on stored raw material to reduce dust emission
5.6 Emissions from incineration of waste No There will be no incineration activities.
5.7 Emissions from burning of waste in open air (e.g. slash materials, construction debris) No No such activities will be carried out.
5.8 Emissions from any other sources No No emissions from any other Sources.
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 No Ready Mix Concrete will be used at site. In case of any usage of machinery/ equipment, will be properly covered and workers will be given ear plugs to protect against noise.
6.2 From industrial or similar processes No Not Applicable
6.3 From construction or demolition Yes During construction work noise will be generated from construction machinery, however, adequate precautions will be taken to reduce the noise generation.
6.4 From blasting or piling No Not Applicable.
6.5 From construction or operational traffic Yes During construction work noise will be generated from construction machinery, however, adequate precautions will be taken to reduce the noise generation.
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 No handling, storage, use or spillage of hazardous materials will be done.
7.2 From discharge of sewage or other effluents to water or the land (expected mode and place of discharge) No Suitable measures will be taken during construction phase for disposal of sewage which will be considered in Environmental Management Plan.
7.3 By deposition of pollutants emitted to air into the land or into water No Negligible
7.4 From any other sources No No other polluting sources exist.
7.5 Is there a risk of long term build up of pollutants in the environment from these sources? No There will not be any long term build up of pollutants in the environment from these sources.
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 No This is road project and does not involve use or production of hazardous substances. So the chances of explosions, spillages, and fires are not anticipated in this project.
8.2 From any other causes No Training and awareness about the safety norms will be provided to all supervisors and labours involved in construction activities. All the labours will be provided with suitable personal protective equipment (PPE)
8.3 Could the project be affected by natural disasters causing environmental damage (e.g. floods, earthquakes, landslides, cloudburst etc)? No The area under study falls in Zone III, according to the Indian Standard Seismic Zoning Map. The structure has been designed with adequate Seismic safety factors.
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 The project will have positive impact on the ancillary infrastructure like roads, markets, public health amenities, conveyance facilities in the area. Moreover this project will provide employment to local labours in the construction phase. Thus, the project is supposed to have major beneficial impacts.
9.2 Lead to after-use of the site, which could have an impact on the environment No No impact will be seen due to the proposed activity
9.3 Set a precedent for later developments No No impact is seen
9.4 Have cumulative effects due to proximity to other existing or planned projects with similar effects No Does not arise.
(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
Yes The section Badripada to Ahwa passes through the forest/Purna wild life area. Vansda National Park at a distance of 4.5 Km approx. in South-west.
2 Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests No Not identified yet.
3 Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Yes The section Badripada to Ahwa passes through the forest/Purna wild life area. Vansda National Park at a distance of 4.5 Km approx. in South-west.
4 Inland, coastal, marine or underground waters Yes • Zhakri (11.485 Km from the origin of Road Corridor). • Gira (17.48 Km from the origin of Road Corridor). • Purna Rivers (30.15 Km from the origin of Road Corridor).
5 State, National boundaries Yes Interstate boundary of Gujrat and Maharashtra at 19.20 Km from Section 1 (Songudh to Ahwa) and at <1 Km from Section 2 (Sarad to Vani).
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 located.
8 Densely populated or built-up area Yes National Highway 953, Starts from its junction with NH 53, near Songudh in Navagam Main road and terminates at its junction with SH 174 near Mission Pada, in Ahwa via Temka, Baopada, Modla, Tarpada, Bardipada, Mahal, Jamlapada, Garvi, Piaplyamal, Laskariya Amba, Borkhet, mission Pada in the State of Gujarat, the project corridor is part of NH 953, which starts from Saputara (Gujarat border), Songudh and end at Ahwa having a total length of around 64 kms located entirely in the State of Gujarat.
9 Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship, community facilities) Yes Along the Highway.
10 Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Yes The alignment is passing through the reserved forest & protected forest area, which needs acquisition as per the procedures.
11 Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) No Not located.
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 Yes The road stretch is located in Seismic Zone-III as per the revised seismic map of India (IS: 1893-2002).
(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
(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 ApplicantRatilal
DesignationExecutive Engineer (Authorized
Name of Company (Applicant Name should not be given here)IAHE
AddressIndian Academy of Highway Engineers ( MORTH) A-5, Sector 62, Institutional Area, NH 24 Bypass, Noida-201301
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