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 Construction of 4/6 lane road from Rasisar (Bikaner) to Deogarh (Jodhpur) in the state of Rajasthan from CH-0.000 km to 180.000 km. This is a part of Amritsar to Kandla Express Way under Bharatmala Pariyojana.
Brief summary of projectAnnexure-Brief summary of project
Proposal Number IA/RJ/MIS/75735/2018
Project Cost 450000 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 1775 Ha area required 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 projectRajasthan
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.various
Town / VillageRasisar Purohitan, Rasisar Bas Bada, Parva, Jegla Panna, Manyana, Desalsar Purohitanoga, Kisanasar, Udasar, Panchu, Bhadla, Tardo ki Basti, Boogdi, Rohni, Shyam Nagar, Mata ji ki Doli, Champasar, Ridm
State of the projectRajasthan
Details of State of the project
S.no State Name District Name Tehsil Name
(1.)RajasthanBikanerNokha
(2.)RajasthanJodhpurPhalodi
(3.)RajasthanJodhpurOsian
(4.)RajasthanJodhpurShergarh
10.
Nearest railway station along with distance in kms Deshnok Railway Station, 4.5 km
Nearest airport along with distance in kms Bikaner Airport, 30 km
11. Nearest Town/City/District Headquarters along with distance in kms Bikaner , 30 km
12. Village Panchayats, Zila Parishad, Muncipal Corporation, Local body (Complete postal address with telephone nos. to be given) Jodhpur and Bikaner, Rajasthan
13. Name of the Applicant Shailendra
14. Registered Address NHAI, PIU 188 Umaid Heritage, Ratnada, Jodhpur (Rajasthan)
15.
Address for correspondance:
Name of the Company NATIONAL HIGHWAY AUTHORITY OF INDIA PIU JODHPUR
Name of the Applicant Shailendra
Designation (Owner/ Partner/ CEO) PD
Pin code 342001
E-mail jodhpurpiu3@gmail.com
Telephone No. 291-2510065
Fax No. 291-
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?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) Yes 94% of agricultural land, 4% Government Land and approx. 1% barren land will be used for road construction. However, the surrounding land will be used at some places for facilities like Highway Village leading to growth in employment at locality Total Land -1775 Ha.
1.2 Clearance of existing land, vegetation and buildings? Yes The alignment will require cutting of approximately 7767 no. of trees.
1.3 Creation of new land uses? Yes New road will be constructed
1.4 Pre-construction investigations e.g. bore houses, soil testing? Yes Pre-construction alignment survey is in progress & geo-technical investigations would be undertaken shortly.
1.5 Construction works? Yes The project will consist of the following key components: i. Length in Km – 180.000 kms approx. ii. ROBs - 1 iii. Major Bridges – N/A iv. Minor Bridge over Minor canal / Nallah - 2 v. Culverts – N/A vi. Vehicular underpass - 15 vii. LVUP – N/A viii. SVUP – 345 ix. Bridges for utility crossings – N/A x. Flyovers – N/A xi. Intersections - 4 (Grade separated Interchanges)
1.6 Demolition works? Yes 396 no. of structure (out of which 80 are partially affected and 316 are completely affected)
1.7 Temporary sites used for construction works or housing of construction workers? Yes Temporary sites will be used for construction yards, labour camps, and construction camps.
1.8 Above ground buildings, structures or earthworks including linear structures, cut and fill or excavations and fill or excavations Yes The above ground structure includes bridges, flyovers, ROBs. Truck lay bays and Bus –Bays and wayside amenities and Toll Plazas.
1.9 Underground works including mining or tunnelling? No NA
1.10 Reclamation works? No NA
1.11 Dredging? No NA
1.12 Offshore structures? No NA
1.13 Production and manufacturing processes? No NA
1.14 Facilities for storage of goods or materials? Yes Materials for construction such as bitumen cement, paints, steel etc. will be stored in the construction shed/storage tanks.
1.15 Facilities for treatment or disposal of solid waste or liquid effluents? Yes The liquid effluent generates from labour /construction camps will be treated in septic /sedimentation tank before diverting it to soak pit. The solid waste will be disposed as per Solid Waste Management rules, 2016
1.16 Facilities for long term housing of operational workers? No NA
1.17 New road, rail or sea traffic during construction or operation? No NA
1.18 New road, rail, air water borne or other transport infrastructure including new or altered routes and stations, ports, airports etc? No NA
1.19 Closure or diversion of existing transport routes or infrastructure leading to changes in traffic movements? No This is a greenfield alignment
1.20 New or diverted transmission lines or pipelines? Yes Will be diverted as per utility shifting plan
1.21 Impoundment, damming, culverting, realignment or other changes to the hydrology of watercourses or aquifers? No Cross drainage works shall be constructed in order to maintain the natural hydrology of the area.
1.22 Stream crossings? Yes 1 canal
1.23 Abstraction or transfers of water from ground or surface waters? Yes Water will be extracted from suitable sources (canals, rivers and ponds) after obtaining necessary permissions from the competent authority.
1.24 Changes in water bodies or the land surface affecting drainage or run-off? No NA
1.25 Transport of personnel or materials for construction, operation or decommissioning? Yes The Construction materials will be transported during construction from different sources, construction labour will be transported from labour camp.
1.26 Long-term dismantling or decommissioning or restoration works? No NA
1.27 Ongoing activity during decommissioning which could have an impact on the environment? No No ongoing activity will be affected during Decommissioning.
1.28 Influx of people to an area in either temporarily or permanently? Yes During the construction of the road project around 980 persons would be employed temporarily for a period of 3 years. However due to construction of toll plazas approx. 150 persons will be employed on permanent basis. Preference will be given to local people for employment.
1.29 Introduction of alien species? No Only indigenous species shall be planted
1.30 Loss of native species or genetic diversity? No NA
1.31 Any other actions? No NA
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 94% of agricultural land, 4% Government Land and approx. 1% barren land will be used for road construction. However, the surrounding land will be used at some places for facilities like Highway Village leading to growth in employment at locality Total Land -1775 Ha.
2.2 Water (expected source & competing users) unit: KLD Yes 720 KLD Water will be extracted from suitable water sources after obtaining necessary permissions. Approx. 70% of water form surface and 30% from ground water is envisaged
2.3 Minerals (MT) Yes Minor minerals use in construction:- Coarse sand- 111024 Cum Coarse Aggregate- 1893806 MT Fine Aggregate- 825799 MT Borrow Earth- 2000000 cum
2.4 Construction material – stone, aggregates, sand / soil (expected source – MT) Yes (a) Cement: 76266.88 MT (b) Course Aggregate: 1893805.76 MT (c) Fine Aggregate: 825798.88 MT (d) Steel: 207668.73 MT (e) Bitumen: 37422 MT. (f) Emulsion: 850.5 MT (g) Earthwork in embankment: i. Borrowing: 2000000 cum ii. Roadway Excavation: 6000000 cum (h) Earthwork in Cutting: 6000000 cum
2.5 Forests and timber (source – MT) No The conventional use of fuel wood by the labour and staff shall be totally banned and it will be substituted through use of LPG/Suitable clean cooking fuel.
2.6 Energy including electricity and fuels (source, competing users) Unit: fuel (MT),energy (MW) Yes Temporary electricity connection will be taken from State Electricity Board for construction camp and Diesel generator will provide electricity required for construction equipment and power backup. Labour camps will be provided with LPG as fuel sourced from Authorized Supplier.
2.7 Any other natural resources (use appropriate standard units) No NA
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 and Bitumen. Contractor will store fuel oil for DG sets and for construction plant and machinery. Bitumen will be stored for road construction. The respective contractors will obtain necessary License / NOC. The hazardous waste (management, handling & transboundary movement) rules, 2008 and its amendments till date will be followed
3.2 Changes in occurrence of disease or affect disease vectors (e.g. insect or water borne diseases) No Adequate precautions shall be taken to prevent stagnation of sewage and grey water from labour camp. Routine inspection and spray of disinfectants shall be made to prevent outbreak of water borne disease
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 agricultural developments as a result of fast connectivity to these facilities. Overall 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. No There will positive impact due to faster connectivity to hospitals & schools. No adverse impact is envisaged to vulnerable groups of people due to the project.
3.5 Any other causes No NA
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 NA
4.2 Municipal waste (domestic and or commercial wastes) Yes Construction Phase Domestic waste shall be generated from temporary construction camps @ 500 grams per head per day. The solid waste will be disposed as per Solid Waste Management rules, 2016. Operation Phase Domestic waste to be produced from commercial establishment will be disposed off at municipal waste disposal site. Solid waste will be generated during operation phase from way side amenities and will be handled as per established rules.
4.3 Hazardous wastes (as per Hazardous Waste Management Rules) Yes Used / Waste oil and lubricants will be utilized in oiling shuttering and remaining balance will be sold to authorized recyclers. The hazardous waste (management, handling & transboundary movement) rules, 2008 and its amendments till date will be followed.
4.4 Other industrial process wastes No No other industrial process wastes will be generated during construction and operational stages.
4.5 Surplus product No No surplus product will be produced
4.6 Sewage sludge or other sludge from effluent treatment Yes The solid waste will be disposed as per Solid Waste Management Rules ,2016
4.7 Construction or demolition wastes Yes The resulting scarified bitumen waste / oil spill from various machineries may contaminate soil. Required precautions including routine checks and maintenance of machinery and equipment will be taken to avoid or minimize contamination of soils. C & D rules, 2016 will be followed.
4.8 Redundant machinery or equipment No NA
4.9 Contaminated soils or other materials No NA
4.10 Agricultural wastes No NA
4.11 Other solid wastes No NA
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 Emissions from Diesel Generator (DG) sets, hot mix plants and construction machineries. Emission norms of CPCB & SPCB for DG set and HM plant will be followed as per MoEF&CC notification no. 595 dated December, 2013 for DG sets.
5.2 Emissions from production processes No No production process is contemplated in the project.
5.3 Emissions from materials handling including storage or transport Yes The use of transport vehicle for carriage of material shall lead to emission. However, there will be no emission during material handling except for the dust pollutants during handling of cement bags, which will be controlled.
5.4 Emissions from construction activities including plant and equipment Yes Fugitive emissions such as gases & fumes are emitted from construction equipment and transportation vehicles, batching & mixing plants of Bitumen is generated. Hot mix plant shall be located at least 500 m down windward direction and away from nearest human habitations. Also the machineries and equipment shall be fitted with suitable dust catching
5.5 Dust or odours from handling of materials including construction materials, sewage and waste Yes Dust will be generated from earth mixing sites, asphalt mixing site and crushers. Water will be sprayed regularly to prevent dust generation from these areas.
5.6 Emissions from incineration of waste No NA
5.7 Emissions from burning of waste in open air (e.g. slash materials, construction debris) No No burning of waste is proposed.
5.8 Emissions from any other sources Yes Emissions of Particulate Matter, CO, SO2 and NOx from vehicles used for transportation of construction Materials. However all the vehicles would comply as per standard emission norms.
6 Generation of Noise and Vibration, and Emissions of Light and Heat:
S.No Information/Checklist confirmation Yes/No Details thereof (with approximate quantities/rates, wherever possible) with source of information data
6.1 From operation of equipment e.g. engines, ventilation plant, crushers Yes Noise will be generated from operation of construction equipment. Use of protective equipment, scheduling of activities, maintenance and isolation of equipment will be practiced.
6.2 From industrial or similar processes No No industrial process is involved in the project.
6.3 From construction or demolition Yes Noise and vibration will be generated due to construction activity. Ambient air Quality standards with respect to noise, 2000 MoEF&CC
6.4 From blasting or piling No There shall be no piling or blasting activity.
6.5 From construction or operational traffic Yes During construction, noise will be generated from trucks for transportation of material.
6.6 From lighting or cooling systems No NA
6.7 From any other sources No NA
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 Short term accidental spills may happen during construction. To avoid contamination of soil and Ground/surface water from fuel and lubricants, the vehicles and equipment shall be properly maintained and repaired. The hazardous waste (management, handling & transboundary movement) rules, 2008 and its amendments till date will be followed.
7.2 From discharge of sewage or other effluents to water or the land (expected mode and place of discharge) Yes There shall not be direct discharge of sewage in to water or on land. Septic tank, soak pit is prepared for canteen/kitchen waste in construction camp and toilet waste liquids are discharge to septic/soak pit. Other liquid waste treated at sites by using storage and sedimentation tank. The effluent of the sedimentation tank is discharge within permissible limits of respective parameters. The sewage system shall be properly designed and built so that no water pollution takes place.
7.3 By deposition of pollutants emitted to air into the land or into water Yes Water spraying during loading and unloading of raw materials, earth work, construction machinery shall be operated using controlled devices meeting permissible emission norms. Liquid effluent generated from labour/construction camps will be treated in septic /sedimentation tank before diverting it to soak pit. The solid waste will be disposed as per SWM rules, 2016.Water spraying for dust suppression during construction stage. Avenue plantation along the project road.
7.4 From any other sources No NA
7.5 Is there a risk of long term build up of pollutants in the environment from these sources? No NA
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 is a possibility of risks from handling of petrochemical and other chemical substances. Fire safety equipment and first aid kit will be provided at such locations. To avoid accident due to handling of explosives, proper precautionary and safety measures as suggested in relevant Act and codes shall be adopted. Handling of explosives/chemicals would be governed as per the PESO guidelines. Fire Prevention and Life Safety Measures Act, Rules and Regulation.
8.2 From any other causes No NA
8.3 Could the project be affected by natural disasters causing environmental damage (e.g. floods, earthquakes, landslides, cloudburst etc)? No The design of the road and structures would be made following all the relevant codes and guidelines to take care for these natural disasters.
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 road project under Bharatmala Scheme envisages development of the area through which the road passes hence ancillary development of housing, industries is possible.
9.2 Lead to after-use of the site, which could have an impact on the environment Yes Beyond our RoW, no role of NHAI/MoRTH, the remaining surrounding development generally starts during operational phase under the statue of local law.
9.3 Set a precedent for later developments Yes The proposed expressway is a part of an exclusive transport corridor planned between Rasisar in Bikaner Districts and Deogarh in Jodhpur Districts in the state of Rajasthan. The project shall Result in shorter distance to travel, development of area, development of industrial corridor and economic development of the state and the country.
9.4 Have cumulative effects due to proximity to other existing or planned projects with similar effects No NA
(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 NA
2 Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests No NA
3 Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration No NA
4 Inland, coastal, marine or underground waters No NA
5 State, National boundaries No NA
6 Routes or facilities used by the public for access to recreation or other tourist, pilgrim areas Yes There are many Religious & Historical places in Deshnok, Bhikamkhor, Osian, Bikaner & Jodhpur etc.
7 Defence installations No NA
8 Densely populated or built-up area Yes Bikaner- 30.0 Km Panchu in Nokha, Bikaner. Jodhpur – 60 Km
9 Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship, community facilities) No NA
10 Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) No NA
11 Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) No NA
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 NA
(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 24 Aug 2018
2.NAPlease provide information/clarification on following: i. The covering letter and document in support of competence/authority are same. Please explain how a covering letter would serve as document of competence/authority. Or provide the adequate document of competence/authority. 11 Aug 2018
3.NAThe correction have been made as per the instruction received 19 Jul 2018
4.NAPlease mention whether the express way is National high or state highway 09 Jul 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 ApplicantShailendra
DesignationPD
Name of Company (Applicant Name should not be given here)NATIONAL HIGHWAY AUTHORITY OF INDIA PIU JODHPUR
AddressNHAI, PIU 188 Umaid Heritage, Ratnada, Jodhpur (Rajasthan)
Print