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 Proposed Common Effluent Treatment Plant of 10 MLD capacity at village and Tehsil Bhahadurgarh, District Jhajjar, Haryana
Brief summary of projectAnnexure-Brief summary of project
Proposal Number IA/HR/MIS/75611/2018
Project Cost 4515 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 10 MLD ha.
4.
New/Expansion/ModernizationNew
5. Existing Capacity/Area etc. 1.41 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 projectOpposite Plot No. 2065, MIE, Sec-21 & 22, Bahadurgarh
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.Opposite Plot No. 2065, MIE, Sec-21 & 22
Town / VillageBahadurgarh
State of the projectHaryana
Details of State of the project
S.no State Name District Name Tehsil Name
(1.)HaryanaJhajjarBahadurgarh
10.
Nearest railway station along with distance in kms Bahadurgarh Railway Station, 2.8 km
Nearest airport along with distance in kms IGI Airport, 22.5 km
11. Nearest Town/City/District Headquarters along with distance in kms Bahadurgarh , 6 km
12. Village Panchayats, Zila Parishad, Muncipal Corporation, Local body (Complete postal address with telephone nos. to be given) Municipal Council, Bahadurgarh, City Police Station, N-10, Bahadurgarh, Dist. – Jhajjar. Ph. No.- 01276-230544, 230204 E-mail- mcbgarh2016@gmail.com
13. Name of the Applicant Rajiv
14. Registered Address HSIIDC Industrial Estate, Sector 17, PO Jakhoda, Bahadurgarh, District Jhajjar, Haryana, India
15.
Address for correspondance:
Name of the Company HSIIDC BAHADURGARH
Name of the Applicant Rajiv
Designation (Owner/ Partner/ CEO) Manager
Pin code 124505
E-mail hsiidc.bahadurgarh2018@gmail.com
Telephone No. 01276-297030
Fax No. 01276-
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?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 The proposed project shall be executed on non agricultural land it is within industrial estate. Leveling of the site for construction work shall be done. However, top soil shall be stored at separate place and reused for gardening purposes.
1.2 Clearance of existing land, vegetation and buildings? No Vegetation The site is devoid of any significant vegetation. However, there will be some clearing of site during the construction phase. Building There are some existing structure at the site. The proposed project shall be executed after dismantling the structure on non agricultural land.
1.3 Creation of new land uses? No The entire MIE area alongwith proposed CETP site is already ear marked as Industrial Zone.
1.4 Pre-construction investigations e.g. bore houses, soil testing? No There will be no impacts which will cause changes physical changes in the locality due to the soil testing or other pre-construction investigations.
1.5 Construction works? Yes The construction activities will have insignificant impact on environment confined to site only. During construction work for foundations and any other structures for proposed CETP units will be done.
1.6 Demolition works? No Not envisaged
1.7 Temporary sites used for construction works or housing of construction workers? No Workers will be hired from nearby villages so no housing facility is required. However, temporary rest shelters will be provided at the site.
1.8 Above ground buildings, structures or earthworks including linear structures, cut and fill or excavations and fill or excavations Yes During construction work for foundations and any other structures for proposed CETP units will be done.
1.9 Underground works including mining or tunnelling? No Not envisaged
1.10 Reclamation works? No Not envisaged
1.11 Dredging? No Not envisaged
1.12 Offshore structures? No Not envisaged
1.13 Production and manufacturing processes? Yes Detailed process description for proposed facility of CETP is given in the pre feasibility report.
1.14 Facilities for storage of goods or materials? Yes Temporary store rooms for the storage of construction materials will be built at the site, which will be removed later. Thus the impact on physical environment will be temporary. During the operation; phase, There will be well-designated confined storage areas within the project premises, which will not have an impact on the physical environment.
1.15 Facilities for treatment or disposal of solid waste or liquid effluents? Yes The CETP itself is a treatment facility for effluent generated from the member industries of MIE area. It is proposed to provide Disposal works Common Effluent Treat Plant & Disposal of Treated Effluent. The CETP is to be provided for treating the sewage of Industrial Estate to desired level of treatment as required by Haryana Pollution Control Board. The treated effluent after tertiary treatment shall be recycled for industrial use.
1.16 Facilities for long term housing of operational workers? No Workers will be hired from nearby villages so no housing facility is required. However, temporary rest shelters will be provided at the site.
1.17 New road, rail or sea traffic during construction or operation? Yes There will be increase in road traffic for transportation of construction material during construction phase. There will be no increase in rail and sea traffic.
1.18 New road, rail, air water borne or other transport infrastructure including new or altered routes and stations, ports, airports etc? No There is no new rail, air borne transport infrastructure required for the project.
1.19 Closure or diversion of existing transport routes or infrastructure leading to changes in traffic movements? No Due to upcoming CETP project, there will be no closure or diversion of existing transport routes or infrastructures leading to changes in traffic movements.
1.20 New or diverted transmission lines or pipelines? No Not envisaged
1.21 Impoundment, damming, culverting, realignment or other changes to the hydrology of watercourses or aquifers? No Not envisaged
1.22 Stream crossings? No There is no stream existing within the site.
1.23 Abstraction or transfers of water from ground or surface waters? Yes The proposed unit required 5KLD water. Water supply for drinking, for chemical solution in solution tanks, office, toilet and Laboratory shall be made available by HSVP.
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 Labor and raw material for construction will be transported via the existing infrastructure.
1.26 Long-term dismantling or decommissioning or restoration works? No Restoration works for the project on long-term will be an ongoing activity which will not have any impact on physical environment.
1.27 Ongoing activity during decommissioning which could have an impact on the environment? No None
1.28 Influx of people to an area in either temporarily or permanently? No Priority will be given to local area people for preconstruction and post construction of the plant.
1.29 Introduction of alien species? No Only local plant species will be planted for the green belt/ landscaping.
1.30 Loss of native species or genetic diversity? No Nill
1.31 Any other actions? No None
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 Total plot area of 3.5 acres has been earmarked for the project.
2.2 Water (expected source & competing users) unit: KLD Yes Total water demand 5 KLD Source: HSVP
2.3 Minerals (MT) No None
2.4 Construction material – stone, aggregates, sand / soil (expected source – MT) Yes Construction material like steel, cement, crushed stones, sand, rubble etc required for the project shall be procured from the local market of the region.
2.5 Forests and timber (source – MT) No None
2.6 Energy including electricity and fuels (source, competing users) Unit: fuel (MT),energy (MW) Yes Power Requirement for the project will be 12 MW. Source: UHBVN D.G sets in no. 1 and capacity 1000 KVA will be installed for power backup. Fuel used: HSD; Quantity used : 140L/hr
2.7 Any other natural resources (use appropriate standard units) No No other natural resource will be involved in the proposed project.
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 The dry sludge shall be transported to final sludge disposal site as earmarked by State Pollution Control Board (HSPCB). Hazardous waste will be disposed off as HWMR 2016. Necessary precautions will be under taken to ensure safety of human health and environment (flora, fauna, and Water supplies)
3.2 Changes in occurrence of disease or affect disease vectors (e.g. insect or water borne diseases) No None
3.3 Affect the welfare of people e.g. by changing living conditions? Yes Local people will be employed during construction and operational work, which will lead to change in their life style.
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 Nothing significant
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
4.2 Municipal waste (domestic and or commercial wastes) Yes During construction & operational phase domestic waste will be generated which will be handled by the local body.
4.3 Hazardous wastes (as per Hazardous Waste Management Rules) Yes Spent oil from DG Set, Sludge from CETP will be generated during the operation phase and same will be disposed off properly as Hazardous and Other Waste Management Rules 2016.
4.4 Other industrial process wastes No Other than ETP sludge, there is no other industrial process waste.
4.5 Surplus product No None
4.6 Sewage sludge or other sludge from effluent treatment Yes The dry sludge generated shall be transported to final sludge disposal site as earmarked by The State Pollution Control Board (HSPCB).
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 recycler.
4.8 Redundant machinery or equipment No None
4.9 Contaminated soils or other materials No Proper care will be taken to avoid contaminating soil and if oil spilled soil will be found, the same will be scrapped off and stored at earmarked places and sent to disposal sites.
4.10 Agricultural wastes No There will be no agricultural waste.
4.11 Other solid wastes No There will not be other solid waste.
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 There will be emission from D.G. set, transportation, etc. DG Sets Stack of suitable height will be provided. Transportation PUC certified vehicles will be used; Plantation will be done at the periphery of the proposed project and local species will be planted. 33% area will be under green cover.
5.2 Emissions from production processes No The unit is Common effluent treatment plant. Thus, there is no emission from process except from running of D.G. set
5.3 Emissions from materials handling including storage or transport Yes The emission expected from construction phase will be dust arising from material handling and vehicular emission from transport vehicles. These include the emissions due to idling of the vehicles during loading and unloading activities. Management: Construction waste will reutilizes within the site itself to the extent possible to reduce the emissions during transportation. Further, idling of vehicle will be reduced to the extent possible.
5.4 Emissions from construction activities including plant and equipment Yes During construction activities, emissions will be in the form of dust. Suitable dust suppression techniques such as waster sprinkling will be taken at these times as relevant. These emissions will be temporary and will be controlled.
5.5 Dust or odours from handling of materials including construction materials, sewage and waste Yes The important dust suppression measures proposed will be regular water sprinkling on main haul roads in the project area, this activity will be carried out at least twice a day. Latest technologies will be utilized to control odours from CETP.
5.6 Emissions from incineration of waste No There will be no incineration of waste.
5.7 Emissions from burning of waste in open air (e.g. slash materials, construction debris) No The construction waste generated will be reused back for construction of road and paved areas within the project area.
5.8 Emissions from any other sources No No common burning will be allowed at site.
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 Noise will be generated during operation of various equipments/machineries of CETP units as well as DG Sets etc. Necessary PPEs (ear muffs, closed chamber) will be provided for the personnel’s Working in this area. Most of the equipment structures are static, vibration effect of these will be only local, design of support and foundation will nullify the intensity of vibrations. Proper mitigation Measures will be adopted.
6.2 From industrial or similar processes No During post construction phase noise may be generated due to various CETP processes. Following measures will be adopted to control the noise and vibration: Optimum selection of machinery tools or equipment reduces excess noise levels. Vibrations will be monitored and will be controlled appropriately.
6.3 From construction or demolition Yes During construction: During construction work D.G. sets, pumps, trucks, vibrators, drilling machine, etc will be the tentative sources of noise.
6.4 From blasting or piling No Blasting/piling operations are not envisaged in the proposed project.
6.5 From construction or operational traffic Yes There may be increase in the noise levels due to constructional/ operational traffic arising due to the project, which will be minimized by: Effective traffic management including sufficient width of driveways to avoid traffic congestions especially during the peak hours. Use of mass transportation facilities. Effective green will help in reducing the noise propagation.
6.6 From lighting or cooling systems No None
6.7 From any other sources No None
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, Sludge generated from CETP and discarded containers are the only hazardous materials that will be generated on site and Handling and storage of hazardous materials will be strictly followed as per Hazardous and Other Wastes (Management and Transboundary Movement) Rules, 2016 and amended thereafter. Impermeable surface will be made in areas that will be used to store hazardous material along with controlled access in the area
7.2 From discharge of sewage or other effluents to water or the land (expected mode and place of discharge) No The CETP itself is a treatment facility for effluent generated from the member industries. It is proposed to provide Disposal works Common Effluent Treatment Plant & Disposal of Treated Effluent. The CETP is to be provided for treating the sewage of Industrial Estate to desired level of treatment as required by Haryana Pollution Control Board. The treated effluent after tertiary treatment shall be re-circulated to industrial use.
7.3 By deposition of pollutants emitted to air into the land or into water No Construction Phase:- During construction phase, fugitive emissions will be generated from material transfer, construction operations, finishing operations, road construction, exhaust from vehicles, stationary sources etc. It is a short term source and impact will be temporary. However, proper management will be adopted to avoid any kind of emission into air.
7.4 From any other sources No There will not be any other sources, which will contaminate land & water resources.
7.5 Is there a risk of long term build up of pollutants in the environment from these sources? No None
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 Handling and storage of hazardous materials will be strictly followed as per Hazardous and Other Wastes (Management and Transboundary Movement) Rules, 2016
8.2 From any other causes No The major risks involved in the project would be mishaps due to human errors, bad construction practices and associated electric hazards. All safety measures will be in place prior to commencement of operations so as to avoid any risk of human life and as per the prevailing local by laws.
8.3 Could the project be affected by natural disasters causing environmental damage (e.g. floods, earthquakes, landslides, cloudburst etc)? No No such event reported so far. The area falls under Seismic 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
 Yes Proposed project will result in considerable growth of the surrounding areas by increased direct and indirect employment opportunities in the region including ancillary development and supporting infrastructure. The CETP unit will help in managing the industrial effluent of the area.
9.2 Lead to after-use of the site, which could have an impact on the environment No None
9.3 Set a precedent for later developments No Not envisaged
9.4 Have cumulative effects due to proximity to other existing or planned projects with similar effects No Not envisaged
(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 None
2 Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests No None
3 Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration No None
4 Inland, coastal, marine or underground waters Yes Mungashpur Drain just adjacent to project site • Mangolpur drain 1.9 Km, NNW • Kultana Chhudani Bupani Drain 2.5 Km, S • Madanpur Drain 3.7 Km, SE • West Juan Drain, 5.5 Km, NW • Kasar Drain, 6.5 Km, W • Bazidpur Drain, 8.2 Km, NE • Najaggarh Drain, 8.6 Km, SE • Drain 11.9 Km S • Gurgaon Water supply Channel, 12.0 Km, NW • Ganda Nala, 13.5 KM, SE
5 State, National boundaries No NH-10
6 Routes or facilities used by the public for access to recreation or other tourist, pilgrim areas Yes NH-10
7 Defence installations No None
8 Densely populated or built-up area Yes Bahadurgarh
9 Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship, community facilities) Yes • Educational Institutions: Government College: 1.8 Km, W Vaish Mahila Mahavidhlaya: 2.8 Km, NNW Sunshine Public School: 5.0 Km, NW Delhi Technical Campus: 5.5 Km, SW DM College of Pharmacy: 5.8 Km, W Chhotu Ram Rural Institute of Technology: 5.6 Km, NE • Worship Places: St. Gregorius Church: 9.45 Km, ESE New Vision Colony Church: 6.6 Km, SSE
10 Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) No None
11 Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) No
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 Area falls in Zone IV
(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) NIL
Additional Attachments, if any
Attached File
ADS Letter
      Essential Detail Sought : NIL
            Additional Detail Sought:
Sno. ADS Letter Remarks Date of ADS
1. ADS Reply LetterRevised Form-1 & PFR is attached with correction. 04 Jan 2019
2.NAThe proposal listed in the 33rd EAC Infra-2 meeting held on 09-10 August, 2018, but PP did not attend the said meeting, As per your request vide letter dated 15.12.2018 for ADS re-uploding the application with correction. Kindly upload as required. 12 Dec 2018
(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 ApplicantRajiv
DesignationManager
Name of Company (Applicant Name should not be given here)HSIIDC BAHADURGARH
AddressHSIIDC Industrial Estate, Sector 17, PO Jakhoda, Bahadurgarh, District Jhajjar, Haryana, India
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