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 Development of Haryana Section from Km 0+000 to Km 135+056 of Delhi–Amritsar-Katra Expressway
Brief summary of projectAnnexure-Brief summary of project
Proposal Number IA/HR/NCP/141416/2020
Project Cost 373700 lacs
2.
S. No. in the schedule7(f) Highways
Project Sector INFRA-1
3. Proposed capacity/area/length/tonnage to be handled/command area/lease area/number or wells to be drilled 135.056 km 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 No
8.
Does it attract the specific condition? If yes, please specify No
9.
Location of the projectHaryana State
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.List shall be provided in EIA Report
Town / VillageVillage List attached as additional Document
State of the projectHaryana
Details of State of the project
S.no State Name District Name Tehsil Name
(1.)HaryanaKaithalKaithal
(2.)HaryanaKarnalAssandh
(3.)HaryanaSonipatGohana
(4.)HaryanaSonipatKharkhoda
(5.)HaryanaJindNarwana
(6.)HaryanaJindSafidon
(7.)HaryanaRohtakRohtak
10.
Nearest railway station along with distance in kms Bhainswan Station, 1.2 km
Nearest airport along with distance in kms Delhi, 35 km
11. Nearest Town/City/District Headquarters along with distance in kms Bahadurgarh , 6.8 km
12. Village Panchayats, Zila Parishad, Muncipal Corporation, Local body (Complete postal address with telephone nos. to be given) Municipal Committee, Jhajjar Address: - Near Old Tehsil, Jhajjar Contact No. with STD Code: 01251-252009 Municipal Council, Kaithal Address: - Committee Chowke, Kaithal Contact No.with STD Code: 01746-232987,232513
13. Name of the Applicant Dr Biswajit
14. Registered Address G-5 & 6, Sector-10, Dwarka, New DElhi-110075
15.
Address for correspondance:
Name of the Company DR.B.Mukhopadhyay
Name of the Applicant Dr Biswajit
Designation (Owner/ Partner/ CEO) General Manager
Pin code 110075
E-mail biswajit@nhai.org
Telephone No. 11-25074200
Fax No. 11-25093543
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 Yes
Uploaded detailsAnnexure-Uploaded details
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?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?Yes
Area of Forest land Involved (hectares)48 ha.
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 greenfield alignment of expressway passes through agricultural, barren, plantation and settlements. Thus, the land-use within the proposed RoW shall undergo a change due to proposed development. Mitigation measures shall be taken in order to neutralize the impacts on land use.
1.2 Clearance of existing land, vegetation and buildings? Yes Trees and existing structures along the proposed RoW shall be removed in order to construct the road
1.3 Creation of new land uses? Yes Land-use within the proposed RoW shall undergo a change due to proposed development. The agricultural lands, Forest area, Settlements will be developed into paved area. Greenbelt development as part of avenue and median plantation shall be done along both sides of the road and at the median of highway as per provision of IRC SP21:2009.
1.4 Pre-construction investigations e.g. bore houses, soil testing? Yes Geotechnical investigation, Topographical & CPR survey, LA survey, Tree enumeration, soil testing etc. shall be conducted as a part of pre-construction investigation.
1.5 Construction works? Yes Project pertains to construction of highways
1.6 Demolition works? Yes Some structures falling in the proposed RoW shall be demolished
1.7 Temporary sites used for construction works or housing of construction workers? Yes Local labour camp shall be established after taking consent from concerned State Pollution Control Board and district administration. Minimum 500m distance shall be maintained from water body, settlement area, forest area, etc.
1.8 Above ground buildings, structures or earthworks including linear structures, cut and fill or excavations and fill or excavations Yes RoB and bridge shall be constructed. However, exact quantification of cut & fill material shall be assessed during EIA Stage.
1.9 Underground works including mining or tunnelling? Yes There will be no mining or tunnelling works for construction of Highway. The Mining activities shall be limited for borrow area and minor minerals. Separate environment clearance shall be applied based on merit of the project
1.10 Reclamation works? Yes The excavation of borrow area shall form pits which shall be reclaimed by borrow area management plan.
1.11 Dredging? No No dredging is required
1.12 Offshore structures? No No offshore structure in proposed project
1.13 Production and manufacturing processes? No This is a highway project. No production or manufacturing processes are involved.
1.14 Facilities for storage of goods or materials? Yes The construction materials shall be stored at designated places after taking consent from SPCB and district administration
1.15 Facilities for treatment or disposal of solid waste or liquid effluents? Yes Municipal Solid waste shall be stored in colored bins for segregation at site itself and shall be disposed at government approved sites only as per Solid Waste Management Rules, 2016. Sewage generated in construction camps shall be routed to septic tanks with soak pit or bio-toilets. Construction wastes will be managed as per Construction and Demolition Wastes Management Rules, 2016.
1.16 Facilities for long term housing of operational workers? No Work force during operation shall be limited for very few nos. and thus any permanent housing is not required.
1.17 New road, rail or sea traffic during construction or operation? No The proposed project shall itself act as a mode of transportation and the existing road and rail routes are enough for transport of construction materials. Hence, any new mode of transportation is not required.
1.18 New road, rail, air water borne or other transport infrastructure including new or altered routes and stations, ports, airports etc? No Not required
1.19 Closure or diversion of existing transport routes or infrastructure leading to changes in traffic movements? Yes The proposed project highway crossing some existing roads. Thus, diversion of traffic shall be planned before commencement of construction in consultation with local traffic police and shall be duly implemented.
1.20 New or diverted transmission lines or pipelines? Yes Transmission lines crossed by the proposed alignment shall be shifted with the consent of electricity dept.
1.21 Impoundment, damming, culverting, realignment or other changes to the hydrology of watercourses or aquifers? Yes The excavation required for construction of the highway shall be minimal and in no way shall intersect the groundwater table. Adequate cross drainage structures shall be provided to maintain the hydrology of the area. Hence any significant impact is not envisaged.
1.22 Stream crossings? Yes The Proposed alignment is crossing rivers and other small nallahs & canals. The complete details shall be provided in the EIA report.
1.23 Abstraction or transfers of water from ground or surface waters? Yes Water requirement for construction activities shall be sourced from surface water bodies through Tanker after necessary approval.
1.24 Changes in water bodies or the land surface affecting drainage or run-off? Yes Temporary change is expected during construction. However, adequate nos. of cross drainage structures shall be provided to maintain the natural water flow (hydrology) of the area.
1.25 Transport of personnel or materials for construction, operation or decommissioning? Yes Covered Tippers & trolleys shall be utilised for transportation of construction materials.
1.26 Long-term dismantling or decommissioning or restoration works? No Not required.
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? Yes Temporary influx of people shall occur in form of workers, labours and engineers during construction phase.
1.29 Introduction of alien species? No No alien species shall be introduced. The avenue and median shall only involve plantation of native species after consultation with forest department.
1.30 Loss of native species or genetic diversity? Yes Trees coming within proposed ROW will be felled for construction of highways. However, compensatory and avenue plantation will be done using native plant species to maintain genetic diversity.
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 About 2,040 ha are is required for this project. The proposed alignment majorly comprise of agricultural land with patches of forest and settlement area.
2.2 Water (expected source & competing users) unit: KLD Yes About 79,67,889 KL Water will be required during construction phase which will be sourced by approved sources through Tankers
2.3 Minerals (MT) No -
2.4 Construction material – stone, aggregates, sand / soil (expected source – MT) Yes 2,22,62,045 Cum of Earthwork, 13,51,688 cum of GSB, 96,402 MT of Bitumen, 5,412 MT of Emulsion, 3,47,228 MT of Cement, 6,61,441 Cum of stone dust, 3,54,899 Cum of Sand, 61,711 MT of Steel and 78,59,185 cum of Fly Ash
2.5 Forests and timber (source – MT) No -
2.6 Energy including electricity and fuels (source, competing users) Unit: fuel (MT),energy (MW) Yes The Energy required during Construction phase shall be taken from local electricity distribution company. DG sets shall also be set-up as a source of alternative power.
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 Adequate safety measures will be taken during construction phase. Hazardous substance like bitumen and waste oil from machineries will be stored at designated place and will be handled as per MSIHC rules.
3.2 Changes in occurrence of disease or affect disease vectors (e.g. insect or water borne diseases) No Construction camp sites will be provided with septic tanks with soak pit / bio-toilet / portable STP facility. At regular intervals disinfectants will be applied to restrict vector growth. Suitable drainage and waste management measures will be adopted, which will prevent stagnation of water or accumulation of waste.
3.3 Affect the welfare of people e.g. by changing living conditions? Yes The proposed project will result in appreciable welfare of the people with respect to health care, educational, employment and agriculture developments as a result of fast connectivity of these facilities. Over all there will be improvement in quality of life of people.
3.4 Vulnerable groups of people who could be affected by the project e.g. hospital patients, children, the elderly etc. Yes Schools, hospitals and other sensitive receptors along the proposed alignment shall be affected due to proposed development. Measures will be adopted based on consultation with the affected population. Due to better connectivity of Hospitals after construction of highway, the patients will be able to reach hospital quickly and get treatment on time.
3.5 Any other causes No No such other causes
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 During construction, excavated materials, Spoil, overburden or mine waste is likely to be generated. All these materials will be consumed for rehabilitation of borrow and mining areas. Remaining wastes will be managed as per Construction and Demolition Waste Management Rules 2016.
4.2 Municipal waste (domestic and or commercial wastes) Yes Municipal solid waste shall be generated from the labour camps. The solid waste will be collected & disposed suitably in compost pit and / or transported in covered trucks at approved municipal disposal sites through Contractors. These wastes will be managed as per Solid Waste Management Rules, 2016.
4.3 Hazardous wastes (as per Hazardous Waste Management Rules) Yes Spent oil from construction equipment / vehicles and DG sets generated during construction phase will be appropriately stored, handled and properly disposed off through authorized recyclers.
4.4 Other industrial process wastes Yes Insignificant amount of processing waste may be generated from Hot mix / batch mix plant which will be collected and utilized towards strengthening internal road in the campsite or other haulage roads.
4.5 Surplus product No Not Applicable
4.6 Sewage sludge or other sludge from effluent treatment Yes Sanitary toilets shall be provided with septic tank followed by soak pits, bio toilets or Portable STP in the labour camps. The sludge will be used as manure in greenbelt development.
4.7 Construction or demolition wastes Yes Demolition wastes will be generated from abandoned structures in the project RoW. Construction wastes will be generated from time to time during construction of road which will be used for levelling of road alignment. These wastes will be managed as per Construction and Demolition Waste Management Rules, 2016.
4.8 Redundant machinery or equipment Yes Some redundant machinery or equipment will be stored at construction camp in pre-designated space to avoid any contamination of soil.
4.9 Contaminated soils or other materials No No contaminated soil or material is anticipated to be generated.
4.10 Agricultural wastes No No agricultural waste is anticipated at the project site
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 Point source emissions are anticipated from the Mixing Plants, operation of DG sets, etc. Vehicles transporting construction materials, construction equipment and machinery will be another source of emissions. During Operational phase, the emissions will be from vehicles running on the highway.
5.2 Emissions from production processes No The Proposed Project is for construction of expressway. Hence, no production process is involved in the project.
5.3 Emissions from materials handling including storage or transport Yes Fugitive emission is envisaged during handling, transport, loading and unloading of construction materials.
5.4 Emissions from construction activities including plant and equipment Yes During Construction phase, the emissions will be from Mixing Plant and other Machineries. Movement of construction vehicles and other related activities will also generate emissions.
5.5 Dust or odours from handling of materials including construction materials, sewage and waste Yes Dust emission is envisaged during handling, transport, loading and unloading of construction materials.
5.6 Emissions from incineration of waste No No incineration of waste is proposed
5.7 Emissions from burning of waste in open air (e.g. slash materials, construction debris) No No burning of waste will be undertaken at the project highway
5.8 Emissions from any other sources No -
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 From construction equipment (like Excavator, Dumper, etc.) noise level in the tune of 85 to 110 dB (A) may be generated. However, adequate mitigation measures will be taken to control the noise levels and reduce the noise level till it reaches to receptor.
6.2 From industrial or similar processes No The Proposed Project is for construction of highways. Hence, no industrial process is involved.
6.3 From construction or demolition Yes Temporary Noise pollution in the tune of approx. 85 to 110 dB (A) is expected due to construction activities. Demolition of structures falling within ROW will also generate certain noise.
6.4 From blasting or piling No There will be no blasting required at the project highway.
6.5 From construction or operational traffic Yes Approximately 65 to 75 dB (A) noise may be generated from the vehicles approaching the site. During operation of road, noise generation will be mainly due to vehicles on road.
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 Yes Hazardous materials like bitumen and waste oil shall be stored and handled, thus some risk may involve. However adequate construction safety measures will be taken.
7.2 From discharge of sewage or other effluents to water or the land (expected mode and place of discharge) No Labour camps shall be provided with sanitary toilets with soak pits or portable STP or bio-toilets
7.3 By deposition of pollutants emitted to air into the land or into water Yes Surface run-off from construction area shall be protected by providing silt fencing along the nearby water body.
7.4 From any other sources No No such any other sources.
7.5 Is there a risk of long term build up of pollutants in the environment from these sources? No No Such risk.
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 Flammable and hazardous substance like bitumen and diesel will be handled, stored at designated place. Adequate construction safety measures will be taken.
8.2 From any other causes No No such impact is anticipated
8.3 Could the project be affected by natural disasters causing environmental damage (e.g. floods, earthquakes, landslides, cloudburst etc)? No Alignment of proposed expressway is found in Seismic Zone III (Moderate Damage Risk Zone) and Zone IV (High Damage Risk Zone). RoB, bridges or any other above ground structures shall be designed as per risk factor of respective seismic zone.
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 The proposed project is an infrastructure development project and doesn’t require any support infrastructure. Ribbon development as likely with highway development may have certain impact on Social setup of the area.
9.2 Lead to after-use of the site, which could have an impact on the environment No The proposed highway shall help in development of the project region.
9.3 Set a precedent for later developments Yes Better connectivity will further improve the socioeconomic growth of the region. Project shall make way for many other developmental projects in the vicinity.
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 No such area
2 Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests No No such area
3 Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration No No such area
4 Inland, coastal, marine or underground waters No -
5 State, National boundaries No Project section ends at interstate Haryana-Punjab State Border
6 Routes or facilities used by the public for access to recreation or other tourist, pilgrim areas Yes KMP, NH334B, SH18, NH709, SH16A, SH10, SH14, SH12, SH11A and NH152
7 Defence installations No -
8 Densely populated or built-up area Yes Bahadurgarh about 6.5km Rohtak about 11 km Kaithal about 15 km
9 Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship, community facilities) Yes The alignment shall pass through from the vicinity of many such areas including places of worship, hospitals, schools and Community facilities etc. The details shall be provided in the EIA report.
10 Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Yes The project doesn’t pass through any such area.
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 Yes Alignment of proposed expressway is found in Seismic Zone III (Moderate Damage Risk Zone) and Zone IV (High Damage Risk Zone).
(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
Village List
Govt Order for Delhi-Katra Expressway Page No-38
            Essential Detail Sought:
Sno. EDS Letter Remarks Date of EDS
1.NAThe correction have been made as per the instruction received 12 Feb 2020
2.NAPlease provide copy of NH notification 12 Feb 2020
      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 ApplicantDr Biswajit
DesignationGeneral Manager
Name of Company (Applicant Name should not be given here)DR.B.Mukhopadhyay
AddressG-5 & 6, Sector-10, Dwarka, New DElhi-110075
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