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 Four laning of Kothi – Satna - Mahiar Section of NH 135BG from km 55.000 to km 76.960 (Package-II) and km 80.800 to km 119.535 (Package-III) under Bharatmala Pariyojana in the State of Madhya Pradesh
Brief summary of projectAnnexure-Brief summary of project
Proposal Number IA/MP/MIS/83186/2018
Project Cost 159319 lacs
2.
S. No. in the schedule7(f) Highways
Project Sector INFRA-2
3. Proposed capacity/area/length/tonnage to be handled/command area/lease area/number or wells to be drilled Length of proposed project road is 60.695 km 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 projectMadhya Pradesh
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.Will be provided in the EIA Report
Town / VillageList of Villages will be provided in the EIA Report
State of the projectMadhya Pradesh
Details of State of the project
S.no State Name District Name Tehsil Name
(1.)Madhya PradeshSatnaMaihar
10.
Nearest railway station along with distance in kms Satna Railway Station, 6 km
Nearest airport along with distance in kms Jabalpur Airport, 159 km
11. Nearest Town/City/District Headquarters along with distance in kms Satna , 5 km
12. Village Panchayats, Zila Parishad, Muncipal Corporation, Local body (Complete postal address with telephone nos. to be given) Office of The Municipal Corporation MP Nagar Satna – 485001 Madhya Pradesh Phone: 076725 04152 Office of the Municipal Council Devi Ji Temple Road Maihar District: Satna, Madhya Pradesh Phone: 07674-232054
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?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 There will be permanent change of land use due to the proposed development
1.2 Clearance of existing land, vegetation and buildings? Yes The land and building falling in proposed right of way will be cleared after acquisition of land. Only those trees which will directly come in the way of the work will be cleared.
1.3 Creation of new land uses? Yes New land use of road will be created within the proposed Right of Way
1.4 Pre-construction investigations e.g. bore houses, soil testing? Yes Soil testing, hydro-geological studies are to be carried out
1.5 Construction works? Yes Development of carriageway, Tunnel, road side drain, Bridges, Culverts, Toll Plaza, Way Side Amenity, Bus Bays, Truck Lay Byes, Toilet facilities etc.
1.6 Demolition works? Yes Structures falling in the alignment shall be demolished after paying due compensation as applicable under law.
1.7 Temporary sites used for construction works or housing of construction workers? Yes Around 2 Labor / construction camps will be established during construction phase. Land will be leased temporarily for establishment of labour camps during construction period. All establishment i.e., labour camp, construction camp, Hot mix Plant, crusher plant etc. will be located away from the Forest area / Sensitive Receptors.
1.8 Above ground buildings, structures or earthworks including linear structures, cut and fill or excavations and fill or excavations Yes The construction of temporary structures for staff, cross-drainage structures and cutting/ filling/ excavation of earth etc. are involved in proposed project. The above ground structure includes construction of Bridges, Toll Plaza, Way side Amenities, Truck lay bye etc.
1.9 Underground works including mining or tunnelling? No
1.10 Reclamation works? No
1.11 Dredging? No
1.12 Offshore structures? No
1.13 Production and manufacturing processes? Yes Hot bitumen mix, wet mix macadam etc. required for road construction will be produced at specified locations, outside the forest areas
1.14 Facilities for storage of goods or materials? Yes Temporary storage facilities during construction period
1.15 Facilities for treatment or disposal of solid waste or liquid effluents? Yes Construction Stage The liquid effluent generated from labor and construction camps will be treated in Septic Tank before diverting it to soak pit. Mobile toilets, if required, will also be provided. Solid waste will be generated from labor and construction camps. Organic Waste will be treated at site and inorganic waste will be disposed as per guidelines. The recyclable waste will be sold to recycler only
1.16 Facilities for long term housing of operational workers? No
1.17 New road, rail or sea traffic during construction or operation? Yes During construction, haulage road may be required to be developed for transportation of construction material from borrow pits. During operation, this will be an upgraded facility for long distance traffic movement
1.18 New road, rail, air water borne or other transport infrastructure including new or altered routes and stations, ports, airports etc? No
1.19 Closure or diversion of existing transport routes or infrastructure leading to changes in traffic movements? Yes During construction, traffic diversion shall take place where proposed Project Road crosses the existing road
1.20 New or diverted transmission lines or pipelines? Yes Overhead high tension line crossing, overhead electric line, Electric Poles and Telephone Poles within ROW. All utility coming under proposed ROW will be shifted and such shifting requirement will be detailed out in DPR
1.21 Impoundment, damming, culverting, realignment or other changes to the hydrology of watercourses or aquifers? No No changes in the hydrology of area are anticipated. Following cross drainage structures will be provided to maintain the natural water flow and drainage: New Major Bridge: 3 nos. New Minor Bridge: 12 nos. Widening of existing culverts: 8 Replacement of existing culverts: 10 Construction of new culvert: 92
1.22 Stream crossings? Yes The proposed alignment is crossing Satna River at Ch. 85+550, Barua Nala at Ch. 106+750 and streams at number of locations
1.23 Abstraction or transfers of water from ground or surface waters? Yes Both
1.24 Changes in water bodies or the land surface affecting drainage or run-off? No Proposed project will not cause any changes in water bodies nor will affect the land surface affecting drainage of the area
1.25 Transport of personnel or materials for construction, operation or decommissioning? Yes During construction phase, local labor shall be transported to the site and migrant labor shall be transported from labor camps to the site
1.26 Long-term dismantling or decommissioning or restoration works? No
1.27 Ongoing activity during decommissioning which could have an impact on the environment? No
1.28 Influx of people to an area in either temporarily or permanently? Yes There will be temporary influx of labours during construction phase. However preference will be given to hire local labours
1.29 Introduction of alien species? No
1.30 Loss of native species or genetic diversity? No
1.31 Any other actions? No
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 land to be acquired is 406.513 Ha
2.2 Water (expected source & competing users) unit: KLD Yes Consumption: Approx. 2,542 KL per day Source: both ground and surface water
2.3 Minerals (MT) Yes Only minor minerals such as sand and ordinary earth will be used
2.4 Construction material – stone, aggregates, sand / soil (expected source – MT) Yes Cement : 3.77 lakh MT Aggregate : 15,77,000 cum Sand : 10,50,000 cum Bitumen : 7,000 MT Diesel : 10,800 KL Flyash : 20,81,656 cum Earthwork in cut : 7,80,000 cum Earthwork in fill : 45,50,000 cum
2.5 Forests and timber (source – MT) No
2.6 Energy including electricity and fuels (source, competing users) Unit: fuel (MT),energy (MW) Yes Power supply will be met through State Electricity Department along with stand by DG sets. Fuel requirement during the construction phase- 10,800 KL
2.7 Any other natural resources (use appropriate standard units) No
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 Bitumen : 7,000 MT Diesel : 10,800 KL
3.2 Changes in occurrence of disease or affect disease vectors (e.g. insect or water borne diseases) No The construction waste will be cleared regularly from the road sites to avoid blockage of drainage near habitations along project road. Construction camp sites will be provided with soak pits and septic tanks. At regular intervals disinfectants will be applied to such habitation so that vector growth is restricted. Suitable drainage and waste management measures will be adopted during construction phase, which will restrict stagnation of water or accumulation of waste within the project site.
3.3 Affect the welfare of people e.g. by changing living conditions? Yes The project on completion will provide better access to market, public places, schools and emergency facilities like dispensaries and hospitals. The project will also lead to establishment of other small and large scale industries in the vicinity due to improved access, reduced traveling time, improved safety and low vehicle operating cost
3.4 Vulnerable groups of people who could be affected by the project e.g. hospital patients, children, the elderly etc. Yes There will be positive impact on Vulnerable Group due to improved connectivity as travelling to educational institutions and health care
3.5 Any other causes No
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 Construction Phase: Domestic waste will be produced from labour camps which will be disposed as per Solid Waste Management Rules, 2016 Operation Phase: The domestic / commercial waste will be generated during operation phase from way side amenities, Toll Plazas, which will be handled as per Solid Waste Management Rules, 2016
4.3 Hazardous wastes (as per Hazardous Waste Management Rules) Yes Used oil and lubricants will be produced which will be temporarily stored and sold to the recycler
4.4 Other industrial process wastes No
4.5 Surplus product No
4.6 Sewage sludge or other sludge from effluent treatment Yes Construction camp sites will be provided with soak pits and septic tanks. Provision of Packaged Treatment Plant may be explored for Construction Camp
4.7 Construction or demolition wastes Yes Structures falling on proposed alignment shall be demolished
4.8 Redundant machinery or equipment No
4.9 Contaminated soils or other materials Yes Maintenance of machinery and operation of diesel generator sets, oil spill from the operation of the mechanical workshops, diesel storage, storage of bitumen and emulsion, improper disposal of construction wastes and spoils may result in contamination of soil if not handled carefully or in the absence of proper arrangements and awareness. Required precaution shall be taken to avoid or minimize contamination of soils
4.10 Agricultural wastes No
4.11 Other solid wastes No
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 During Construction emissions will be generated from the Vehicles transporting Construction Materials, Machineries involved in the construction. DG Sets which will be used as power back up. During Operations the emissions will be from the mobile sources as vehicles running on Road and from DG sets to be used as power back up at toll plazas
5.2 Emissions from production processes No
5.3 Emissions from materials handling including storage or transport Yes During Construction emissions may result from transportation, loading and unloading and Storage of construction material. Construction material will be transported in covered trucks
5.4 Emissions from construction activities including plant and equipment Yes There will be emissions from Crusher Plant, Hot Mix Plant, Batching Plant and other Machineries installed for production of aggregate, bitumen, concrete etc. The movement of construction vehicles, clearing and grubbing of ground, earth work and other related activities will also result in emissions
5.5 Dust or odours from handling of materials including construction materials, sewage and waste Yes There will be dust generation during different construction activities particularly earthwork, loading and unloading of construction materials and disposal of construction waste
5.6 Emissions from incineration of waste No
5.7 Emissions from burning of waste in open air (e.g. slash materials, construction debris) No
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 During Construction Period noise will be generated from equipment, machinery and, crushers plants
6.2 From industrial or similar processes No
6.3 From construction or demolition Yes During Pre-Construction and Construction Period only. Low noise construction equipment will be used. Wherever required the workers will be provided with personal protective equipment. The machinery will be properly maintained to minimize the noise pollution.
6.4 From blasting or piling No
6.5 From construction or operational traffic Yes The heavy vehicles engaged in construction work and slow movement of traffic may increase noise during construction phase. However, due to smooth running of vehicles on widened and improved road in operation phase, the ambient noise levels and emissions are expected to come down
6.6 From lighting or cooling systems No
6.7 From any other sources No
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 Oils and lubricants will be stored for the construction activities with all the prescribed anti-spill measures. Vehicles will be serviced and refueled at designated areas on paved surface. Oil traps will be provided to intercept oil / grease /asphalt etc. to prevent pollution from run -off entering into any water body.
7.2 From discharge of sewage or other effluents to water or the land (expected mode and place of discharge) No
7.3 By deposition of pollutants emitted to air into the land or into water No
7.4 From any other sources No
7.5 Is there a risk of long term build up of pollutants in the environment from these sources? No
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 There may be accidental spillage. Required Precaution will be taken in Storage, Handling of Hazardous Materials and accidental spillage of hazardous materials
8.2 From any other causes No
8.3 Could the project be affected by natural disasters causing environmental damage (e.g. floods, earthquakes, landslides, cloudburst etc)? No As per Seismic Map of India (as per IS: 1893, Part I, 2002); proposed project road is situated in the Zone II (having low seismic intensity) and has a low risk of potential damage due to earthquake. However required precautions have been taken in design
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 - Improved access will lead to development of other industries and business enterprises in the area; - During construction, construction material will be supplied from nearby vendors; - The project will also result in development of supporting infrastructures like shops, community facility in the vicinity of the project; - Such induced development is not likely to cause any adverse impact on environment
9.2 Lead to after-use of the site, which could have an impact on the environment No Temporary land-use sites like borrow areas, labour camps, construction camp sites etc. will be redeveloped in consultation with owner / community
9.3 Set a precedent for later developments No
9.4 Have cumulative effects due to proximity to other existing or planned projects with similar effects No
(III) Environmental Sensitivity
S.No Areas Name/Identity Aerial distance (within 15km.) Proposed project location boundary
1 Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
 Yes There are no Wildlife Sanctuary, National Park, Tiger Reserve, Biosphere Reserved etc. within 15 km radius of the of the project road. However, Eco-Sensitive Zone boundary of Ranipur Wildlife Sanctuary is located at a distance of approx. 14.3 km from the start point of the proposed project road. Alignment of proposed project road and 15 km radius has been shown on Survey of India Toposheet.
2 Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Yes Reserved Forest within 15 km radius; however, the proposed project road does not pass through the forest area
3 Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration No
4 Inland, coastal, marine or underground waters No
5 State, National boundaries Yes
6 Routes or facilities used by the public for access to recreation or other tourist, pilgrim areas Yes The project road is used by the people to visit tourist places in Satna, Maihar and surrounding areas
7 Defence installations No
8 Densely populated or built-up area Yes The project road is passing through densely populated or built-up area such as Kothi, Satna, Piprikala, Unchehara, Ichol and Maihar
9 Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship, community facilities) Yes Along the proposed project road, there are 9 educational institutions, 8 religious places and 1 Primary Health Center.
10 Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) No Proposed project road does not pass through any forest area
11 Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) No No such environmental resources have been noted
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 No such environmental resources have been noted
(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
            Essential Detail Sought:
Sno. EDS Letter Remarks Date of EDS
1.NAThe correction have been made as per the instruction received 25 Feb 2019
2.NAPlease provide following information/documents: 1. Tree cutting details including no. of trees to be cut along the proposed alignment. 2. Certificate from Chief Wildlife Warden of the state about distance of proposed alignment from nearest Protected Area (PA), i.e., Ranipur Wildlife Sanctuary or any other PA, if applicable. 26 Nov 2018
      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
Print