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 Common Effluent Treatment Plant (Phase -I) Kala Amb proposed by KalaAmb Infrastructure Development Company
Brief summary of projectAnnexure-Brief summary of project
Proposal Number IA/HP/MIS/113394/2019
Project Cost 2641 lacs
2.
S. No. in the schedule7(h) Common Effluent Treatment Plants (CETPs)
Project Sector INFRA-2
3. Proposed capacity/area/length/tonnage to be handled/command area/lease area/number or wells to be drilled 5 MLD(Phase-I 2.5 MLD & Phase-II 2.5 MLD) ha.
4.
New/Expansion/ModernizationNew
5. Existing Capacity/Area etc. 1.65 ha.
6. Category of project i.e. 'A' or 'B' A
7.
Does it attract the general condition? If yes, please specify Yes
d) Inter-State boundaries and international boundaries
8.
Does it attract the specific condition? If yes, please specify No
9.
Location of the projectKhasra No. 1075/456/175/5 & 1075/456/175/4, village ogly, Kala Amb, Distt.Sirmaur
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.1075/456/175/5 & 1075/456/175/4
Town / Villagevillage ogli
State of the projectHimachal Pradesh
Details of State of the project
S.no State Name District Name Tehsil Name
(1.)Himachal PradeshSirmaurNahan(T)
10.
Nearest railway station along with distance in kms Ghagghar Railway Station, 38.8 km
Nearest airport along with distance in kms Chandigarh Airport, 45 km
11. Nearest Town/City/District Headquarters along with distance in kms Kala Amb , 1 km
12. Village Panchayats, Zila Parishad, Muncipal Corporation, Local body (Complete postal address with telephone nos. to be given) Tehsil: Nahan
13. Name of the Applicant Shekhar
14. Registered Address Khasra Nos. 1075/456/175/5 & 1075/456/175/4,village ogly, District Sirmour, Himachal Pradesh
15.
Address for correspondance:
Name of the Company KALA AMB INFRASTRUCTURE DEVELOPMENT
Name of the Applicant Shekhar
Designation (Owner/ Partner/ CEO) MD
Pin code 134203
E-mail cetpkalamb@gmail.com
Telephone No. 99-96628586
Fax No. 99-
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?Yes
Uploaded Order/PolicyAnnexure-Uploaded order/policy
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) No Proposed CETP project is in Mauza Ogly, Khasra No. 1075/456/175/5 & 1075/456/175/4, allotted by District Industries Centre (DIC)
1.2 Clearance of existing land, vegetation and buildings? No The allotted plot is vacant.
1.3 Creation of new land uses? No Proposed CETP project is in Mauza Ogly, barren land allotted by District Industries Centre (DIC)
1.4 Pre-construction investigations e.g. bore houses, soil testing? Yes Soil test done and soil load bearing capacity established
1.5 Construction works? Yes Construction of CETP as per proposed design.
1.6 Demolition works? No None
1.7 Temporary sites used for construction works or housing of construction workers? No Local workers will be involved in the construction, only temporary rest shelters will be provided.
1.8 Above ground buildings, structures or earthworks including linear structures, cut and fill or excavations and fill or excavations Yes Excavation of soil and refilling of soil is required for construction of CETP Plant.
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? No Not applicable
1.14 Facilities for storage of goods or materials? Yes Storage for construction materials will be under temporary shed.
1.15 Facilities for treatment or disposal of solid waste or liquid effluents? Yes Proposed project is of CETP in which combined stream of Industrial Effluent & Domestic Sewage from Industrial units and sewage from municipal areas of Kala Amb shall be treated. The solid waste generated in the form of ETP sludge will be sent to authorized TSDF facility.
1.16 Facilities for long term housing of operational workers? No Local workers will be employed for the construction work; hence no long-term housing is proposed.
1.17 New road, rail or sea traffic during construction or operation? No Existing infrastructure facility will be used.
1.18 New road, rail, air water borne or other transport infrastructure including new or altered routes and stations, ports, airports etc? No Existing infrastructure facility will be used.
1.19 Closure or diversion of existing transport routes or infrastructure leading to changes in traffic movements? No None
1.20 New or diverted transmission lines or pipelines? No Effluent collection from member units will be carried through tankers.
1.21 Impoundment, damming, culverting, realignment or other changes to the hydrology of watercourses or aquifers? No Construction of CETP on allotted land.
1.22 Stream crossings? No Not applicable
1.23 Abstraction or transfers of water from ground or surface waters? Yes Water for construction and domestic purposes, would be taken from DIC supply.
1.24 Changes in water bodies or the land surface affecting drainage or run-off? No There will no change in the water bodies or the land surface that will affect drainage or runoff.
1.25 Transport of personnel or materials for construction, operation or decommissioning? Yes The construction material shall be drawn from local sources. There is no transport of personnel, as the construction workers will be hired from nearby villages.
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 Only local workers will be involved.
1.29 Introduction of alien species? No Not applicable
1.30 Loss of native species or genetic diversity? No There is no vegetation.
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 Industrial plot measuring about 16545 Sq. Mtr. has been allotted to CETP Plant.
2.2 Water (expected source & competing users) unit: KLD Yes Approximately 4.5 KLD will be required during operation period shall be met from Tube well to be installed
2.3 Minerals (MT) No Not applicable
2.4 Construction material – stone, aggregates, sand / soil (expected source – MT) Yes Reinforced cement concrete (RCC) of different grades and steel will be used. The construction materials will be supplied from local/approved sources.
2.5 Forests and timber (source – MT) No Not applicable
2.6 Energy including electricity and fuels (source, competing users) Unit: fuel (MT),energy (MW) Yes The electricity would be required for construction as well as operational phase. Power Source- HPSEB In case of power failure D.G. Set will be used as standby.
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 No No hazardous substance (as per MSIHC rules) shall be used in operation CETP.
3.2 Changes in occurrence of disease or affect disease vectors (e.g. insect or water borne diseases) Yes Suitable drainage and waste management measures will be adopted in both the construction and operational 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? Yes Operation of CETP shall lead treatment of industrial effluent & better environment conditions Increase the employment potential for locals.
3.4 Vulnerable groups of people who could be affected by the project e.g. hospital patients, children, the elderly etc. No The proposed project shall not affect any vulnerable groups of people in the near vicinity.
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 Yes There will be generation of excavated soil and construction debris during construction phase, which will be utilized as per guidelines.
4.2 Municipal waste (domestic and or commercial wastes) Yes Municipal waste would be generated and same would be done as per MSW 2000 rule & amended thereof.
4.3 Hazardous wastes (as per Hazardous Waste Management Rules) Yes Hazardous waste in the form of Used oil from DG set will be stored and transported to registered recycler as per Hazardous Waste Management Rules.
4.4 Other industrial process wastes Yes ETP Sludge generated from CETP categorized as hazardous waste will be stored and transported to authorized TSDF site as per Hazardous Waste Management Rules.
4.5 Surplus product No Not applicable
4.6 Sewage sludge or other sludge from effluent treatment Yes ETP Sludge will be properly collected and transported to authorized TSDF Site.
4.7 Construction or demolition wastes Yes Construction waste will consist of excavated earth and construction debris along with cement bags, scraps, insulating and packing materials etc. Recyclable waste will be sold to authorized recyclers.
4.8 Redundant machinery or equipment No Not applicable
4.9 Contaminated soils or other materials No None
4.10 Agricultural wastes No None
4.11 Other solid wastes No None
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 Emissions from D.G. sets will be through adequate stack height as per SPCB/CPCB norms.
5.2 Emissions from production processes No Not Applicable
5.3 Emissions from materials handling including storage or transport No Transfer of materials will be through closed pipeline systems.
5.4 Emissions from construction activities including plant and equipment Yes Dust generation arises due to material handling during the construction phase and construction site.
5.5 Dust or odours from handling of materials including construction materials, sewage and waste Yes Dust is likely to be generated during construction phase, Water sprinkling will be done. Tarpaulin cover will be provided over stored raw material to reduce dust emission. Green belt development would be done along with the plant boundary
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 DG set shall be installed & run as per PCB norms Noise levels are expected at area due to use of pumps and motors, necessary maintenance and PPEs (ear muffs, closed chamber) will be provided for the personnel’s working in this area.
6.2 From industrial or similar processes Yes None, the available source of noise as given in above (6.1)
6.3 From construction or demolition Yes Noise during construction shall be due to construction equipment and standby DG sets. Construction during day time. Regular maintenance of all the machinery.
6.4 From blasting or piling No Not applicable
6.5 From construction or operational traffic Yes Noise from traffic movements is expected from the proposed facility during the construction and operational phase.
6.6 From lighting or cooling systems Yes Light emissions and Heat emission are not envisaged in the project.
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 Yes Used oil from standby DG set shall be sent to registered recycler. Sludge generated from CETP categorized as hazardous waste will be stored and transported to authorized TSDF as per HWM rules.
7.2 From discharge of sewage or other effluents to water or the land (expected mode and place of discharge) Yes The treated wastewater from CETP will be used for horticulture development in the industrial area and balance water is disposed to Markanda River.
7.3 By deposition of pollutants emitted to air into the land or into water No Air Pollutants generated from DG set shall be as per prescribed standards.
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 Treated effluent shall recycled and used for irrigation as per prescribed norms.
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 Chances of spillage of hazardous chemical, fires are very low. To deal with any accident; fire fighting facility, fire extinguishers, shall be provided in the complex as per guidelines. PPEs will be provided to the worker during construction & operation activity.
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)? Yes The Project area fall in seismic Zone-IV. Construction of CETP shall conform to norms to minimize the damage from earthquake & flood.
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
Yes There will be cumulative positive impact on the environment in terms of better waste management. The project shall enhance the socio-economic status of the area as more employment opportunities will be created and aesthetics of the area will be improved. Due to the proposed facility impact may be felt on local infrastructure. Demand for housing will increase There are no major support industries required for this plant.
9.2 Lead to after-use of the site, which could have an impact on the environment No No negative impact on the environment is envisaged.
9.3 Set a precedent for later developments Yes As more industries will be setup in the area, there will certainly be a need to treat effluent from the industries. The project aims at providing high quality effluent treatment facility and thus more safe industrial practices may be promoted in the area.
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 Markanda River: Adjacent to the site. Trilokpur Nadi: At a distance of 5Km in NW direction. Run Nadi: At a distance of 4.8 in West direction Kardiwala ki Nadi: At a distance of 8.61 km in North direction Salauni ki Nadi: At a distance of 3.65 Km in NE direction
3 Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Yes Kala Amb RF: At a distance of 1.5 km. Lal Devi RF: At a distance of 2.5 km. Trilokpur RF: At a distance of 7.2 km. Maindhar RF: At a distance of 9.7 km. Banswala RF: At a distance of 8.8 km. Jirha RF: At a distance of 9.8 km. Kangniwala Rf: At a distance of km. Jabal Rf: At a distance of 7.0 km. Ambwala RF: At a distance of 6.2 km. Pairiwala RF: At a distance of 9.1km. Bikrambag RF: At a distance of 9.5 km. Siketi RF: At a distance of 1 km.
4 Inland, coastal, marine or underground waters No Not applicable
5 State, National boundaries No Interstate boundary with Haryana at a distance of 1.06 km in South direction.
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 Kala Amb: Approx. 1 km in West direction
9 Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship, community facilities) Yes • Govt. Senior Secondary school, Kala Amb, approx 0.17 km in West direction. • IITT college of Engineering, Kala Amb: Approx. 0.67 km in WNW direction. • Sneh Hospital, Kala Amb: Approx. 0.20 km, in West direction • Shiv Mandir, Kala Amb: Approx. 0.24 km, in West direction
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 Yes The area lies in Seismic Zone IV which is prone to earthquakes. However, there is no history of damages due to earthquake in the area.
(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
      Essential Detail Sought : NIL
      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 ApplicantShekhar
DesignationMD
Name of Company (Applicant Name should not be given here)KALA AMB INFRASTRUCTURE DEVELOPMENT
AddressKhasra Nos. 1075/456/175/5 & 1075/456/175/4,village ogly, District Sirmour, Himachal Pradesh
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