Form-4

APPLICATION FOR AMENDMENT IN ENVIRONMENTAL CLEARANCE

(To be filled up by User Agency)
1. Details of Project
 
 Proposal No. : SIA/OR/MIN/300358/2023  
 (a) Name of the project : Proposal for ammendment of EC of Brahmani River Sand, Sahupada over an area of 2.00 Acres or 0.81 Ha at village Sahupada of Bari Tahasil, Dist-Jajpur, Odisha  
 (b) Name of Company / Organisation. : RAJANI DHAL  
 (c) Registered Address. : AT-SAHUPADA, P.O-BARI, DIST-JAJPUR, ODISHA Orissa 755003  
 (d) Legal Status of the Company. : Individual  
 (e) Joint Venture (Yes/No) : No
2. Address for the Correspondence
 
 (a) Name of the Applicant. : RAJANI DHAL  
 (b) Designation (Owner/Partner/CEO) : No  
 (c) Address :-  
        State : Orissa  
        District : Jajpur  
        Town / Village : No  
 (d) Pin Code : 755003  
 (e) Email : rkdhal2022@gmail.com  
 (f) Telephone no : No  
 (g) Fax no : No  
 (h) Mobile no : 7008470867  
 (i) Contact Person. : RAJANI DHAL  
 (j) Website (if any) : No
3. Category of the Project/Activity as per Schedule of EIA Notification,2006
 
 (a). Major Activity. : 1(a) Mining of minerals
                                 
       Minor Activity : 1(a) Mining of minerals
                                 
       Major Sub Activity. : No  
       Minor Sub Activity : Open Cast Mining  
 (b). Category : B2  
       Reason for applicant at central level/state level(in case of B1 and B2 ): No  
 (c). Reason : No  
       EAC Concerned (for category A Projects Only ): No
4. Location of the Project
 
 (a) Plot No/Survey No/Khasra No : Khata No-189, Plot-2141  
 (b) Village : village-Sahupada, Tahasil-Bari  
 (c) Tehsil : Jajapur  
 (d) District : Jajpur  
 (e) State : Orissa  
 (f) Pin Code : 755003  
 (g) Bounded Latitudes (North) : Yes  
         From : Degree:20, Minutes : 42, Seconds :9  
         To    : Degree:20, Minutes : 42, Seconds :14  
 (h) Bounded Longitudes (East) : Yes  
         From : Degree:86, Minutes : 19, Seconds :49  
         To    : Degree:86, Minutes : 19, Seconds :55  
 (i) Survey of India Topo Sheet No : 73L/6
5 Details of Environmental Clearance
 
 (a) Project Name : Proposal for ammendment of EC of Brahmani River Sand, Sahupada over an area of 2.00 Acres or 0.81 Ha at village Sahupada of Bari Tahasil, Dist-Jajpur, Odisha  
 (b) MoEF&CC / SEIAA File No : SEIAA-1077/12-2020  
 (c) Date of issue of EC : 26/03/2021   (d) Uploaded EC letter :
6 Details of Consent to Operate
 
 (i) Whether Consent to operate obtained (Yes/No) ? : Yes   (ii) Uploaded copies of all Consent to operate obtained since inception:  
 (iii)Date of issue : 15/04/2021  
 (iv)Valid Upto: 14/04/2026  
 (v)File No : 1194/KNG/SQ/67  
 (vi)Application No : 3587575   (vii)Uploaded copy of Consent to operate valid as on Date:
7 Amendment Sought for
 
 Amendment in Configuration/ Amendments in Clearance condition/ Other (specify) : EC may be allowed as per the Repleinshment Survey Report and also to obtain necessary orders from th
8 Details of Product (as per the approved EC)
Details of Products
S.no Product / Activity (Capacity/ Area). Quantity Unit Mode of Transport/ Transmission of Product
1River Sand of 2970 Cu.m is allowed from 0.81 Ha area of Brahmani River Sand, Sahupada2970 cu.m per annumOthersRoad
9 Details of Configuration (Multiple Entries Allowed)
Details of Configurations
S.no Plant/ Equipment/ Facility Existing Configuration Proposed Configuration Final configuration after Amendment Remarks if Any
1Sand production will be done2970cu.m2564.02 cu.m2564.02 cu.mAs per Replenishment Study Report
10 Reasons for Amendment
 
 Reasons for Amendment : This application is submitted in compliance to the EC stipulated conditions point no. 9.1 and also to obtain necessary order from the concerned Board
11 Any Other Amendment required
Any Other Amendment Required
S.no Reference of Approved EC Description as per Approved EC Description as per Proposal. Remarks
1EC Letter no-1051/SEIAA of dated 26.03.2021MAximum 2970 cu.m of sand will be extracted.2564.02 cu.m per annum sand may be allowed.As per Replenishment Study Report
12 Details of EIA Consultant
 
 Have you hired Consultant for preparing document (Yes/No) ? : No  
 (i)Reason for not engaging the Consultant : This is a B2 Category Project.
13. Documents to be Attached
  (a) Uploaded addendum to EIA/EMP Report:  
 (b) Uploaded Copy of revised -Feasibility Report /Detailed Project Report (DPR) / Detailed Engineering Report / Detailed Conceptual Plan / Approved Mining Plan (in case of mining proposals) : No Data   (c) Uploaded Copy of final Layout Plan:   (d)Uploaded Cover Letter duly signed by the project proponent or authorized person:   (e)Uploaded a copy of authorization duly signed by the project proponent in support of the person making this application on behalf of the User Agency:  
 (f)Uploaded Additional File, If any : No Data
Essential Details Sought
Essential Details Sought
S.no. EDS Sought Date EDS Sought Letter
1.11/06/2023The PP ask to submit the replenishment study report with signature of Tahasildar, lessee and consultant and mentioning the next year production quantity.
 
Additional Detail Sought:   NIL
14. Undertaking
(a): 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. In addition to above, I hereby give undertaking that no activity / construction / expansion has since been taken up. (b)Name : RAJANI DHAL (c)Designation: No (d)Company: RAJANI DHAL (e)Address: AT-SAHUPADA, P.O-BARI, DIST-JAJPUR, ODISHA Orissa 755003