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 Residential Plotted Colony
Brief summary of projectAnnexure-Brief summary of project
Proposal Number IA/HR/NCP/80326/2018
Project Cost 3500 lacs
2.
S. No. in the schedule8(b) Townships and Area Development projects.
Project Sector INFRA-1
3. Proposed capacity/area/length/tonnage to be handled/command area/lease area/number or wells to be drilled 4,07,495.432 sq.m. ha.
4.
New/Expansion/ModernizationNew
5. Existing Capacity/Area etc. 0 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 projectSouthern Side of Railway Line, Mandi Township, Ellenabad
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.Southern side of Railway Line, Mandi Township, Ellenabad
Town / VillageEllenabad
State of the projectHaryana
Details of State of the project
S.no State Name District Name Tehsil Name
(1.)HaryanaSirsaEllenabad
10.
Nearest railway station along with distance in kms Ellenabad Railway Station, 0.6 km
Nearest airport along with distance in kms Sirsa Air Force Station, 36.6 km
11. Nearest Town/City/District Headquarters along with distance in kms Ellenabad , 0 km
12. Village Panchayats, Zila Parishad, Muncipal Corporation, Local body (Complete postal address with telephone nos. to be given) Ellenabad
13. Name of the Applicant Pawan
14. Registered Address Southern side of Railway Line, Mandi Township, Ellenabad
15.
Address for correspondance:
Name of the Company HSVP HISAR
Name of the Applicant Pawan
Designation (Owner/ Partner/ CEO) ExecutiveEngineer
Pin code 125005
E-mail hsvppawan@gmail.com
Telephone No. 0120-4044630
Fax No. 0120-
Copy of documents in support of the competence/authority of the person making this application to make application on behalf of the User Agency . Annexure-Uploaded Copy of documents in support of the competence/authority
16.
Details of Alternative Sites examined, if any. Location of these sites should be shown on a toposheet No
17. Whether part of Interlinked projects? No
18. Whether separate application of Interlinked project has been submitted? N/A
19.
If Yes, MoEF file numberN/A
Date of submissionN/A
20. If No, Reason N/A
21.
Whether the proposal involves Approval/ Clearance under: if yes, details of the same and their status to be given
(i) Whether the proposal involves approval/clearance under the Forest (Conservation) Act,1980?No
(ii) Whether the proposal involves approval/clearance under the wildlife (Protection) Act,1972?No
(iii) Whether the proposal involves approval/clearance under the C.R.Z notification, 2011?No
22.
Whether there is any Government Order/Policy relevant/relating to the site?No
23.
Whether any Forest Land Involved?No
Area of Forest land Involved (hectares)N/A
24.
Whether there is any litigation pending against the project and/or land in which the project is proposed to be set up?No
(a) Name of the CourtN/A
(b) Name of the Sub courtN/A
(c) Case No.N/A
(d) Orders/directions of the court, if any and relevance with the proposed projectN/A
(II) Activity
1 Construction, operation or decommissioning of the Project involving actions, which will cause physical changes in the locality (topography, land use, changes in water bodies, etc.)
S.No Information/Checklist confirmation Yes/No Details there of (with approximate quantities/rates, wherever possible) with source of information data
1.1 Permanent or temporary change in land use, land cover or topography including increase in intensity of land use (with respect to local land use plan) No Land has been embarked by HSVP (state agency for Urban Development) to develop a residential plotted colony.
1.2 Clearance of existing land, vegetation and buildings? No The construction of project does not require any clearance of existing Land, Vegetation.
1.3 Creation of new land uses? No Land has been embarked by HSVP (state agency for Urban Development) to develop a residential plotted colony.
1.4 Pre-construction investigations e.g. bore houses, soil testing? Yes Soil testing will be done during detailed EIA/EMP study.
1.5 Construction works? No As it is a residential plotted colony, so there will be no construction work required except the sector roads developments.
1.6 Demolition works? No Demolition is not required.
1.7 Temporary sites used for construction works or housing of construction workers? Yes Only sector roads will be developed by HSVP, so less construction works will be occurred for which local labours from nearby area will be hired. Sanitation facilities will be developed at site.
1.8 Above ground buildings, structures or earthworks including linear structures, cut and fill or excavations and fill or excavations Yes Very less quantity of soil will be excavated during the development of residential plotted colony which will be used for backfilling.
1.9 Underground works including mining or tunnelling? Yes No underground works including mining/ tunneling is required except excavation of earth.
1.10 Reclamation works? No No reclamation work required.
1.11 Dredging? No No dredging required.
1.12 Offshore structures? No No offshore structures required.
1.13 Production and manufacturing processes? No No production/manufacturing process involved as the project is a Residential Plotted Colony.
1.14 Facilities for storage of goods or materials? Yes Raw material will be stored at site in a covered area. 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.
1.15 Facilities for treatment or disposal of solid waste or liquid effluents? Yes Solid Waste: The solid waste generated from the project will be in the form of: Construction Waste: Left over cement and mortars, cement concrete blocks, aggregate, sand and other inorganic material will be recycled and reused as granular subbase (GSB) layer of pavement. Operational Phase: The solid waste generated from project will be mainly domestic in nature, and the quantity of the waste will be 13,805 kg/day. Solid wastes generated will be segregated into biodegradable (waste vegetabl
1.16 Facilities for long term housing of operational workers? No Local labourers will be hired from nearby areas during construction phase. So, there will be no facilities for long-term housing of operational workers.
1.17 New road, rail or sea traffic during construction or operation? No The project site is adjacent to Ellenabad to Sirsa road. The nearest highway is SH-23 which is 1.06 km away from project site in NE. The nearest railway station is Ellenabad railway station, which is approx. 600 km away from the project site towards NW. The nearest airport is Sirsa Airforce station, which is approx. 36.60 km away from the project site towards ENE. Only internal roads, paths will be developed for vehicular movements for transportation of construction material during construction
1.18 New road, rail, air water borne or other transport infrastructure including new or altered routes and stations, ports, airports etc? No The project site is adjacent to Ellenabad to Sirsa road. The nearest highway is SH-23 which is 1.06 km away from project site in NE. The nearest railway station is Ellenabad railway station, which is approx. 600 km away from the project site towards NW. The nearest airport is Sirsa Airforce station, which is approx. 36.60 km away from the project site towards ENE.
1.19 Closure or diversion of existing transport routes or infrastructure leading to changes in traffic movements? No The project site is adjacent to Ellenabad to Sirsa road which has low traffic density; there will be no need for diversion or closure of existing traffic routes.
1.20 New or diverted transmission lines or pipelines? No There will not be any new/diverted transmission lines or pipelines around the project.
1.21 Impoundment, damming, culverting, realignment or other changes to the hydrology of watercourses or aquifers? No No impoundment, damming, culverting, realignment or other changes to the hydrology of surface water courses is proposed.
1.22 Stream crossings? No There are no streams running across the site.
1.23 Abstraction or transfers of water from ground or surface waters? Yes About 2,616 KLD of water will be required during operation phase of the project which will be supplied by municipal water supply.
1.24 Changes in water bodies or the land surface affecting drainage or run-off? Yes Runoff will increase due to increased paved surface. However, increased runoff will be managed by well-designed rainwater harvesting system and storm water management plan.
1.25 Transport of personnel or materials for construction, operation or decommissioning? Yes During the construction phase, about 15-20 trucks are estimated per week. Adequate parking space within the project site for loading and unloading of materials will be provided. Adequate parking space will be provided for operational phase to the residents and commercial occupants of the premises. For plotted development, individuals plot owner will be responsible for providing parking within their plots itself.
1.26 Long-term dismantling or decommissioning or restoration works? No No Long term dismantling or decommissioning or restoration works will be involved.
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 Local laborers from nearby area will be employed during the construction phase. In the operation phase, most of the expected occupants will be from the surrounding areas. Hence, the project will lead to a redistribution of occupants within the city. Thus, no significant influx of people is envisaged.
1.29 Introduction of alien species? Yes The landscaping will be carried out with mainly local species with a few ornamental varieties of flora that are well suited to the local conditions like Azadirachta indica, Delonix regia, Jacaranda mimosifolia, etc.
1.30 Loss of native species or genetic diversity? Yes There will be no significant impact on the native species or 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) No Land has been embarked by HSVP (state agency for Urban Development) to develop a residential plotted colony.
2.2 Water (expected source & competing users) unit: KLD Yes During operation phase, water supply will be provided through the municipal supply (HUDA). About 2,616 KLD of water will be required during operation phase of the project.
2.3 Minerals (MT) Yes Minerals such as sand and aggregates will be required during the construction phase.
2.4 Construction material – stone, aggregates, sand / soil (expected source – MT) Yes All materials for construction will be arranged through select suppliers.
2.5 Forests and timber (source – MT) No All material forests and timber will be provided by selected suppliers. However steel frames etc shall be used to minimize the use of timber.
2.6 Energy including electricity and fuels (source, competing users) Unit: fuel (MT),energy (MW) Yes The total demand load of the project is estimated 4,723.5 KW. Power will be supplied by Dakshin Haryana Bijli Vitran Nigam (DHBVN).
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 Diesel for DG sets will be stored in drums in earmarked locations. It shall also be handled as per The Manufacture, Storage and Import of Hazardous Chemical Rules, 2000.
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 both the construction and operational phase such that there will be no 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 Socio-economic standard of people will increase due to increased employment opportunities provided by this project. This will lead to better quality of life and will also set a standard for future developments in the area.
3.4 Vulnerable groups of people who could be affected by the project e.g. hospital patients, children, the elderly etc. No Impacts of this type are not expected.
3.5 Any other causes No Not Applicable.
4 Production of solid wastes during construction or operation or decommissioning (MT/month)
S.No Information/Checklist confirmation Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of information data
4.1 Spoil, overburden or mine wastes No No such spoil, overburden or mine wastes will be generated.
4.2 Municipal waste (domestic and or commercial wastes) Yes The total municipal (domestic) solid waste to be generated is approx. 13,805 kg/day. Biodegradable waste(60% of Domestic Waste) 8,283 kg/day (Waste vegetables and foods etc.) Recyclable waste(30% of Domestic Waste) 4,141.5 kg/day (Papers, cartons, thermocol, plastics, glass etc.) Inert waste(10% of Domestic Waste) 1,380.5kg/day Total 12,648.60 kg/day
4.3 Hazardous wastes (as per Hazardous Waste Management Rules) No Biomedical waste will be produced from the project site will be disposed through govt. approved vendors.
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 Yes The sullage will be discharged to sewer line.
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 and packaging materials etc. Recyclable waste construction materials will be sold to recyclers. Unusable and excess construction debris will be disposed at designated places in tune with the local norms.
4.8 Redundant machinery or equipment No Redundant machinery will not be generated.
4.9 Contaminated soils or other materials No Contaminated soils or other materials will not be generated.
4.10 Agricultural wastes Yes Landscape waste of 7.8 kg/day will be generated according to @0.20 kg/acre/day
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 The project does not envisage any major air pollution sources except vehicular traffic.
5.2 Emissions from production processes No No production processes involved. Hence, there will be no such emissions.
5.3 Emissions from materials handling including storage or transport Yes Small quantities of fugitive emissions are envisaged during transport and handling of construction materials. Such emissions will be temporary and controlled by the use of sprinkling and other viable techniques.
5.4 Emissions from construction activities including plant and equipment Yes This will be restricted to the construction phase and the construction site only.
5.5 Dust or odours from handling of materials including construction materials, sewage and waste Yes Dust is anticipated during loading and unloading of construction material and excavation of upper earth surface. These will however be temporary in nature, which will be controlled by providing water sprinklers. Tarpaulin cover will be provided on stored loose materials to reduce the dust emission.
5.6 Emissions from incineration of waste No No incineration of wastes is proposed.
5.7 Emissions from burning of waste in open air (e.g. slash materials, construction debris) No Open burning of biomass/other material will be prohibited on site.
5.8 Emissions from any other sources No Not Applicable
6 Generation of Noise and Vibration, and Emissions of Light and Heat:
S.No Information/Checklist confirmation Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of information data
6.1 From operation of equipment e.g. engines, ventilation plant, crushers Yes Source of noise in the operational phase will be from vehicular movement.
6.2 From industrial or similar processes No No industrial processes will be carried out in the project.
6.3 From construction or demolition Yes Due to various construction activities, there will be short-term noise impacts in the immediate vicinity of the project site. The construction activities will include the following noise generating activities: • Concreting, mixing • Construction plant and heavy vehicle movement.
6.4 From blasting or piling No No blasting or mechanized piling will be done.
6.5 From construction or operational traffic Yes Some noise will be generated from vehicular movement in the construction and operational phase but that will be mitigated with green belt.
6.6 From lighting or cooling systems No No significant noise impact will result from lighting or cooling systems.
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 None
7.2 From discharge of sewage or other effluents to water or the land (expected mode and place of discharge) No The sullage will be discharged to sewer line. External facility will be provided to discharge the sullage as per The Water (Prevention and Control of Pollution) Act, 1974.
7.3 By deposition of pollutants emitted to air into the land or into water No The DG Sets will be provided with stacks of adequate height. Hence dispersion will be achieved and avoid deposition of pollutants in significant concentrations at any single location.
7.4 From any other sources No Not Applicable.
7.5 Is there a risk of long term build up of pollutants in the environment from these sources? No Not Applicable
8 Risk of accidents during construction or operation of the Project, which could affect human health or the environment
S.No Information/Checklist confirmation Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of information data
8.1 From explosions, spillages, fires etc from storage, handling, use or production of hazardous substances Yes To deal with any fire related accident, fire fighting facility of single handed hydrant valve, long hose reel, and portable fire extinguisher shall be provided.
8.2 From any other causes No Not Applicable
8.3 Could the project be affected by natural disasters causing environmental damage (e.g. floods, earthquakes, landslides, cloudburst etc)? No The site falls under the Zone-II as per the Seismic Zone Map of India and is thus prone to the least active Risk 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 Appropriate infrastructure like roads, power supply, waste management and sullage treatment will be developed within the project site. The Haryana Govt. through its town and country planning Department has prepared a Draft Master Plan for the development of this area. Not yet. Not Applicable Not Applicable Not Applicable
9.2 Lead to after-use of the site, which could have an impact on the environment No Not Anticipated
9.3 Set a precedent for later developments Yes The project will provide good infrastructure and better life style and will set an example for later developments in the areas.
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, there is no area protected under international conventions, national or local legislation for their ecological, landscape, cultural or other related value within 15 km.
2 Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests No There is no such area which is ecological sensitive.
3 Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration No No, there are no such areas under protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration value within 15 km.
4 Inland, coastal, marine or underground waters Yes Ground Water The ground water table of the district ranges between 10-20 mbgl.
5 State, National boundaries No Haryana-Rajasthan Border Approx. 7.72 km; WNW
6 Routes or facilities used by the public for access to recreation or other tourist, pilgrim areas Yes SH-23 Approx. 1.06 km in NE from the project site.
7 Defence installations Yes Sirsa Airforce station Approx. 3.60 km in ENE from the project site.
8 Densely populated or built-up area Yes Ellenabad City Adjacent to the project site.
9 Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship, community facilities) Yes Janta Hospital Govt. Civil Hospital Approx. 0.41 km; NE Approx. 0.50 km; NNE Govt. Girls Senior Secondary School Sarvodaya Shiksha Sadan Approx. 1.00 km; NE 1.50 km; ESE Durga Mandir Hanuman Mandir Approx. 0.19 km in WSW from the project site. Approx. 2.07 km in NNW from the project site. Vishal mega mart Approx. 3.30 km in NNW from the project site.
10 Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Yes Chilli Lake Approx. 3.75 km in North from the project site.
11 Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) No There are no areas within 15 km which are subjected to pollution or environmental damage.
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 Earthquakes The site falls under the Zone-II as per the Seismic Zone Map of India and is thus prone to the least active 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) 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 ApplicantPawan
DesignationExecutiveEngineer
Name of Company (Applicant Name should not be given here)HSVP HISAR
AddressSouthern side of Railway Line, Mandi Township, Ellenabad
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