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 Pondicherry Port under “Sagarmala” Scheme to carry out Capital dredging and construction of a barrier between drainage channel and navigation channel as part of phase I works
Brief summary of projectAnnexure-Brief summary of project
Proposal Number IA/PY/MIS/87021/2018
Project Cost 4440 lacs
2.
S. No. in the schedule7(e) Ports, Harbours
Project Sector INFRA-2
3. Proposed capacity/area/length/tonnage to be handled/command area/lease area/number or wells to be drilled 60.70 Ha ha.
4.
New/Expansion/ModernizationNew
5. Existing Capacity/Area etc. 60.70 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 projectThengaithittu, Pondicherry
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.'1', '2'
Town / Village'Thengaithittu', 'Ariyankuppam Communue'
State of the projectPuducherry
Details of State of the project
S.no State Name District Name Tehsil Name
(1.)PuducherryPondicherryAriankuppam Commune Panchayat
10.
Nearest railway station along with distance in kms Pondicherry, 1 km
Nearest airport along with distance in kms Pondicherry, 6 km
11. Nearest Town/City/District Headquarters along with distance in kms Pondicherry , 2 km
12. Village Panchayats, Zila Parishad, Muncipal Corporation, Local body (Complete postal address with telephone nos. to be given) Near Thengaithittu Ariyankuppam Commune Pondicherry - 605004 +91-413-2344800
13. Name of the Applicant Shanmugasundaram
14. Registered Address No.1, Rue Dumas Puducherry
15.
Address for correspondance:
Name of the Company PORT DEPARTMENT
Name of the Applicant Shanmugasundaram
Designation (Owner/ Partner/ CEO) Director
Pin code 605001
E-mail portpondicheery@gmail.com
Telephone No. 0413-2337114
Fax No. 0413-2338092
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?Yes
22.
Whether there is any Government Order/Policy relevant/relating to the site?Yes
Uploaded Order/PolicyAnnexure-Uploaded order/policy
23.
Whether any Forest Land Involved?No
Area of Forest land Involved (hectares)N/A
24.
Whether there is any litigation pending against the project and/or land in which the project is proposed to be set up?No
(a) Name of the CourtN/A
(b) Name of the Sub courtN/A
(c) Case No.N/A
(d) Orders/directions of the court, if any and relevance with the proposed projectN/A
(II) Activity
1 Construction, operation or decommissioning of the Project involving actions, which will cause physical changes in the locality (topography, land use, changes in water bodies, etc.)
S.No Information/Checklist confirmation Yes/No Details there of (with approximate quantities/rates, wherever possible) with source of information data
1.1 Permanent or temporary change in land use, land cover or topography including increase in intensity of land use (with respect to local land use plan) No No land side activity
1.2 Clearance of existing land, vegetation and buildings? No Not Required
1.3 Creation of new land uses? No Not Applicable
1.4 Pre-construction investigations e.g. bore houses, soil testing? No Nil No Bore well investigations. Soil sampling and testing were not required for the proposed dredged activity. However, it will be carried out and the Report of Analysis will be presented in the EIA report
1.5 Construction works? No Nil
1.6 Demolition works? No Nil
1.7 Temporary sites used for construction works or housing of construction workers? No Not applicable
1.8 Above ground buildings, structures or earthworks including linear structures, cut and fill or excavations and fill or excavations No Nil
1.9 Underground works including mining or tunnelling? No Nil
1.10 Reclamation works? No Nil
1.11 Dredging? Yes Capital Dredging 0.73 million cubic meter Maintenance Dredging: 0.15 mcm per annum
1.12 Offshore structures? No Nil
1.13 Production and manufacturing processes? No Nil
1.14 Facilities for storage of goods or materials? No Nil
1.15 Facilities for treatment or disposal of solid waste or liquid effluents? No Nil
1.16 Facilities for long term housing of operational workers? No Nil
1.17 New road, rail or sea traffic during construction or operation? No Nil
1.18 New road, rail, air water borne or other transport infrastructure including new or altered routes and stations, ports, airports etc? No Nil
1.19 Closure or diversion of existing transport routes or infrastructure leading to changes in traffic movements? No Nil
1.20 New or diverted transmission lines or pipelines? No Nil
1.21 Impoundment, damming, culverting, realignment or other changes to the hydrology of watercourses or aquifers? No Nil
1.22 Stream crossings? No Nil
1.23 Abstraction or transfers of water from ground or surface waters? No Nil
1.24 Changes in water bodies or the land surface affecting drainage or run-off? No Nil
1.25 Transport of personnel or materials for construction, operation or decommissioning? Yes For the operation of Dredgers
1.26 Long-term dismantling or decommissioning or restoration works? No Nil
1.27 Ongoing activity during decommissioning which could have an impact on the environment? No Nil
1.28 Influx of people to an area in either temporarily or permanently? No Nil
1.29 Introduction of alien species? No Nil
1.30 Loss of native species or genetic diversity? No Nil
1.31 Any other actions? No Nil
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 Not Applicable
2.2 Water (expected source & competing users) unit: KLD No Not Applicable
2.3 Minerals (MT) No Nil
2.4 Construction material – stone, aggregates, sand / soil (expected source – MT) No Ready mix concrete
2.5 Forests and timber (source – MT) No Nil
2.6 Energy including electricity and fuels (source, competing users) Unit: fuel (MT),energy (MW) Yes Fuel/Energy required for Dredger operation. Existing Port and hence, required energy is readily available
2.7 Any other natural resources (use appropriate standard units) No Nil
3 Use, storage, transport, handling or production of substances or materials, which could be harmful to human health or the environment or raise concerns about actual or perceived risks to human health
S.No Information/Checklist confirmation Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of information data
3.1 Use of substances or materials, which are hazardous (as per MSIHC rules) to human health or the environment (flora, fauna, and water supplies No Nil
3.2 Changes in occurrence of disease or affect disease vectors (e.g. insect or water borne diseases) No Nil
3.3 Affect the welfare of people e.g. by changing living conditions? No Nil
3.4 Vulnerable groups of people who could be affected by the project e.g. hospital patients, children, the elderly etc. No Nil
3.5 Any other causes Yes Disposal of the dredged Spoil 0.73 mcm
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 Dredged Spoil 0.73 mcm
4.2 Municipal waste (domestic and or commercial wastes) No Nil
4.3 Hazardous wastes (as per Hazardous Waste Management Rules) No Nil
4.4 Other industrial process wastes No Nil
4.5 Surplus product No Nil
4.6 Sewage sludge or other sludge from effluent treatment No Nil
4.7 Construction or demolition wastes No Nil
4.8 Redundant machinery or equipment No Nil
4.9 Contaminated soils or other materials No Nil
4.10 Agricultural wastes No Nil
4.11 Other solid wastes No Nil
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 No Nil
5.2 Emissions from production processes No Nil
5.3 Emissions from materials handling including storage or transport No Nil
5.4 Emissions from construction activities including plant and equipment No Nil
5.5 Dust or odours from handling of materials including construction materials, sewage and waste No Nil
5.6 Emissions from incineration of waste No No Incinerator
5.7 Emissions from burning of waste in open air (e.g. slash materials, construction debris) No Nil
5.8 Emissions from any other sources No Nil
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 Operation of Dredgers
6.2 From industrial or similar processes No Nil
6.3 From construction or demolition No Nil
6.4 From blasting or piling No Nil
6.5 From construction or operational traffic Yes Operation of Dredgers
6.6 From lighting or cooling systems No Nil
6.7 From any other sources No Nil
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 Nil
7.2 From discharge of sewage or other effluents to water or the land (expected mode and place of discharge) No No Discharge or Disposal of sewage
7.3 By deposition of pollutants emitted to air into the land or into water No Nil
7.4 From any other sources No Nil
7.5 Is there a risk of long term build up of pollutants in the environment from these sources? No Nil
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 Nil
8.2 From any other causes No Nil
8.3 Could the project be affected by natural disasters causing environmental damage (e.g. floods, earthquakes, landslides, cloudburst etc)? No Nil
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
No Nil
9.2 Lead to after-use of the site, which could have an impact on the environment No Nil
9.3 Set a precedent for later developments No Nil
9.4 Have cumulative effects due to proximity to other existing or planned projects with similar effects No Nil
(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 Nil
2 Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests No Nil
3 Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration No Nil
4 Inland, coastal, marine or underground waters No Nil
5 State, National boundaries No Nil
6 Routes or facilities used by the public for access to recreation or other tourist, pilgrim areas No Nil
7 Defence installations No Nil
8 Densely populated or built-up area No Nil
9 Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship, community facilities) No Nil
10 Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) No Nil
11 Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) No Nil
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 Nil
(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 ApplicantShanmugasundaram
DesignationDirector
Name of Company (Applicant Name should not be given here)PORT DEPARTMENT
AddressNo.1, Rue Dumas Puducherry
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