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 The Project is “up gradation of Baindur to Ranebennur Section of “NH- 766 C in the state of Karnataka to two / four lane with paved shoulder configuration (Package no- NH/IAHE/24)” with a total length of 198.5 km”.
Brief summary of projectAnnexure-Brief summary of project
Proposal Number IA/KA/MIS/30301/2015
Project Cost 200000 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 Up gradation of Baindur to Ranebennur Section of NH- 766 C with a total length of 198.5 km. ha.
4.
New/Expansion/ModernizationNew
5. Existing Capacity/Area etc. -1 ha.
6. Category of project i.e. 'A' or 'B' A
7.
Does it attract the general condition? If yes, please specify Yes
c) Notified Eco-sensitive areas
8.
Does it attract the specific condition? If yes, please specify No
9.
Location of the projectNH-66 near Baindur starting chainage : 0+000 ends at NH-48 near Ranebennur, end chainage : 198+500 with a total length of 198.5 km
Shape of the project landStrip
Uploaded GPS fileAnnexure-GPS file      
Uploaded copy of survey of India ToposheetAnnexure-Survey of india toposheet
Plot/Survey/Khasra No.Baindur & Rannebennur area details are being carried out
Town / VillageBaindur & Ranibennur
State of the projectKarnataka
Details of State of the project
S.no State Name District Name Tehsil Name
(1.)KarnatakaHaveriRanibennur
(2.)KarnatakaShimogaShikaripura
(3.)KarnatakaUdupiUdupi
10.
Nearest railway station along with distance in kms Mukambika, 2 km
Nearest airport along with distance in kms Hubli, 100 km
11. Nearest Town/City/District Headquarters along with distance in kms Ranibennur , 35 km
12. Village Panchayats, Zila Parishad, Muncipal Corporation, Local body (Complete postal address with telephone nos. to be given)
13. Name of the Applicant Sh NRavishankar
14. Registered Address NH DIVISION, JCR EXTENSION, NEAR PWD QUARTERS, CHITRADURGA, KARNATAKA
15.
Address for correspondance:
Name of the Company MINISTRY OF ROAD TRANSPORT AND HIGHWAYS
Name of the Applicant Sh NRavishankar
Designation (Owner/ Partner/ CEO) Executive Engineer
Pin code 577501
E-mail kkvcplnh766c@gmail.com
Telephone No. 040-66667926
Fax No. 040-
Copy of documents in support of the competence/authority of the person making this application to make application on behalf of the User Agency . NIL
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?Yes
StatusApplication for Forest Clearance yet to be submitted
(ii) Whether the proposal involves approval/clearance under the wildlife (Protection) Act,1972?Yes
StatusApplication for Wildlife Clearance yet to be submitted
(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?
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 Since the project is an up gradation of Baindur to RanebennurSection of NH- 766C in the state of Karnataka, the change in land use is anticipated to a certain extent.
1.2 Clearance of existing land, vegetation and buildings? Yes Clearance of existing land, vegetation is anticipated.
1.3 Creation of new land uses? Yes As mentioned in S.No.1.1 as major realignment is foreseen through the forest area.
1.4 Pre-construction investigations e.g. bore houses, soil testing? Yes Pre-construction investigations ex: Soil testing will be carried out during the detailed engineering phase of the project.
1.5 Construction works? Yes Since all construction activities will be confined within the project premises, there will be no physical changes outside the project boundary.
1.6 Demolition works? Yes Structures within the ROW will be demolished. Suitable compensation will be given to PAP’s as per the norms.
1.7 Temporary sites used for construction works or housing of construction workers? Yes Since all construction activities will be confined within the project premises, there will be no physical changes outside the project boundary.
1.8 Above ground buildings, structures or earthworks including linear structures, cut and fill or excavations and fill or excavations Yes Only top soil will be excavated and the excavated soil will be filled in designated places in tune with the local norms.
1.9 Underground works including mining or tunnelling? No Not applicable
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 construction of road and bridges.
1.14 Facilities for storage of goods or materials? Yes Separate raw material storage yard will be made. 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. The storage yard will be located within the project site.
1.15 Facilities for treatment or disposal of solid waste or liquid effluents? Yes Solid Waste During construction phase, recyclable waste construction materials will be sold to recyclers. Unusable, excess construction debris will be disposed at designated places in tune with the local norms.
1.16 Facilities for long term housing of operational workers? No Not applicable
1.17 New road, rail or sea traffic during construction or operation? No The road will be upgraded and the same will be used for vehicular movement during operation. No rail or sea traffic is envisaged.
1.18 New road, rail, air water borne or other transport infrastructure including new or altered routes and stations, ports, airports etc? Yes The road will be upgraded as per the design criteria and development of the highway as per norms laid down vide IRC 73 and IRC 86 for urban and non urban areas. The issue of realignment and provision of bypasses at Kollur, Hosanagara, Shikaripur, Masur and Halagiri have been duly considered.
1.19 Closure or diversion of existing transport routes or infrastructure leading to changes in traffic movements? Yes The possibility of traffic diversion to the Project Road from/to other road routes including bypasses is envisaged.
1.20 New or diverted transmission lines or pipelines? No There may be shifting of transmission line, which will be carried out with necessary approvals
1.21 Impoundment, damming, culverting, realignment or other changes to the hydrology of watercourses or aquifers? No Wherever crossing the waterways, bridges /culverts are proposed. Size of vent will be as per the hydrological requirements and necessary clearances will be obtained from concerned departments.
1.22 Stream crossings? Yes Bridges/culverts are proposed at stream crossings as per the hydrological requirements and necessary clearances will be obtained from concerned departments.
1.23 Abstraction or transfers of water from ground or surface waters? No No abstraction or transfers of water from ground or surface waters is anticipated in this project.
1.24 Changes in water bodies or the land surface affecting drainage or run-off? No Not making any changes in water bodies and surface drainage/run-off ensured by providing adequate number of cross drainage structures.
1.25 Transport of personnel or materials for construction, operation or decommissioning? Yes Construction workers will be hired from local area. Movements of trucks / vehicles are envisaged for transporting materials during construction. As the project is upgradation of road, transport of personnel and materials is expected during operation period.
1.26 Long-term dismantling or decommissioning or restoration works? No Not Applicable
1.27 Ongoing activity during decommissioning which could have an impact on the environment? No Not Applicable
1.28 Influx of people to an area in either temporarily or permanently? No Not Applicable
1.29 Introduction of alien species? No Not Applicable
1.30 Loss of native species or genetic diversity? No Not Applicable
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) Yes The project requires undeveloped/agricultural land. The extent of land is being studied.
2.2 Water (expected source & competing users) unit: KLD Yes Water is required during construction phase only and no water is required during operation phase. Contractor shall provide independent sources of water supply through water tankers for use in the works and for associated storage, work shop and work force compounds. Prior approval shall be obtained from the relevant State authorities and all installations shall be in compliance with local regulations.
2.3 Minerals (MT) No There will be no usage of minerals
2.4 Construction material – stone, aggregates, sand / soil (expected source – MT) Yes Construction materials required as follows: S. No. Material 1 Steel (T) 2 Cement (bags) 3 Stone Aggregate (m3) 4 Sand (m3) Steel, cement and bitumen etc., will be procured from authorized vendors. Sand & aggregate will be procured from local material suppliers.
2.5 Forests and timber (source – MT) No There is no usage of timber
2.6 Energy including electricity and fuels (source, competing users) Unit: fuel (MT),energy (MW) No During construction phase of Road, temporary measures will be taken for electricity supply. While, during operation phase, electricity is required only for Street lighting purpose, which will be met from nearby grid.
2.7 Any other natural resources (use appropriate standard units) No There is no need for other natural resources
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 The project is a road project, hence no storage of hazardous chemicals (as per MSIHC rules) will be done, except HSD required to run standby DG sets, whenever necessary, for which the quantity stored will be below the threshold limit specified in the MSIHC rules.
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 construction phase, which will restrict 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? No No adverse impacts on human health and their living conditions due to proposed project are envisaged. Moreover this project will provide employment to local labours during construction phase.
3.4 Vulnerable groups of people who could be affected by the project e.g. hospital patients, children, the elderly etc. No As such no Vulnerable groups of people will be affected due to the project. However, the details will be collected during detailed design stage.
3.5 Any other causes No Nil
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) No Not applicable
4.3 Hazardous wastes (as per Hazardous Waste Management Rules) No No Hazardous waste will be produced
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 No Not applicable
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 & packaging materials etc. Recyclable waste construction materials sold to recyclers. Unusable and excess construction debris will be disposed at designated places in tune with local norms.
4.8 Redundant machinery or equipment No Not applicable
4.9 Contaminated soils or other materials No Not applicable
4.10 Agricultural wastes No Not applicable
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 No The operation of proposed project does not envisage any major air pollution sources like Particulate matter (PM), SO2, Nox. The gaseous emissions are expected from transport vehicles moving in the project road.
5.2 Emissions from production processes No Not Applicable
5.3 Emissions from materials handling including storage or transport No Construction material storage yards will be always covered to reduce emission. Dust will arise during the transportation of materials and the dust will be controlled by slow movement of vehicles, covering the materials properly and by water spraying.
5.4 Emissions from construction activities including plant and equipment Yes Some emissions are envisaged from machinery and equipment engaged during construction phase. They will be fitted with dust extraction units.
5.5 Dust or odours from handling of materials including construction materials, sewage and waste Yes Dust is likely to be generated during construction which will be controlled by water-sprinkle and tarpaulin cover will be provided on stored raw material to reduce dust emission
5.6 Emissions from incineration of waste No There will be no incineration activities
5.7 Emissions from burning of waste in open air (e.g. slash materials, construction debris) No No such activities will be carried out
5.8 Emissions from any other sources No No emissions from any other sources
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 The machinery/ equipment, will be properly maintained as per the norms and workers will be given ear plugs to protect themselves against noise that is generated.
6.2 From industrial or similar processes No Not Applicable
6.3 From construction or demolition Yes During construction work noise will be generated from construction machinery, however, adequate precautions have taken to reduce the noise generation.
6.4 From blasting or piling No No blasting or mechanized piling will be used.
6.5 From construction or operational traffic Yes There will be slight increase in noise levels due to traffic movement during construction & operational phase.
6.6 From lighting or cooling systems No Not applicable
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 No Hazardous material will be used on the site
7.2 From discharge of sewage or other effluents to water or the land (expected mode and place of discharge) No Suitable measures will be taken during construction phase for disposal of sewage which will be considered in Environmental Management Plan.
7.3 By deposition of pollutants emitted to air into the land or into water No Negligible
7.4 From any other sources No No other polluting sources exist.
7.5 Is there a risk of long term build up of pollutants in the environment from these sources? No There will not be any long term build up of pollutants in the environment from these sources.
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 This is road project and does not involve use or production of hazardous substances. So the chances of explosions, spillages, and fires are not anticipated in this project.
8.2 From any other causes No Training and awareness about the safety norms will be provided to all supervisors and labours involved in construction activities. All the labours will be provided with suitable personal protective equipment (PPE).
8.3 Could the project be affected by natural disasters causing environmental damage (e.g. floods, earthquakes, landslides, cloudburst etc)? Yes The project area may be prone to floods as it is running parallel to Tungabhadra river.
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 The project will have positive impact on the ancillary infrastructure like roads, markets, public health amenities, conveyance facilities in the area. Moreover this project will provide employment to local labours in the construction phase. Thus, the project is supposed to have major beneficial impacts.
9.2 Lead to after-use of the site, which could have an impact on the environment No No impact will be seen due to the proposed activity
9.3 Set a precedent for later developments No No impact is seen
9.4 Have cumulative effects due to proximity to other existing or planned projects with similar effects No Does not arise
(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 The existing alignment passes through reserve forest of length of about 109.6 km and as also through a wildlife sanctuary. More details are being studied.
2 Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Yes The alignment is passing through the reserved forest & wild life sanctuary, which needs acquisition as per the procedures. Also the project requires tree cutting. Necessary permissions will be obtained from Forest Department in this regard.
3 Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration No Not located.
4 Inland, coastal, marine or underground waters No Not applicable
5 State, National boundaries Yes Not applicable
6 Routes or facilities used by the public for access to recreation or other tourist, pilgrim areas No Not applicable
7 Defence installations No Not applicable
8 Densely populated or built-up area Yes Project is passing through residential and commercial developments also at the towns of Kollur at chainage 25+500, Hosanagara at chainage 87+400, Anandapur at chainage 114+100, Shikaripur at chainage 148+900 and Masur at chainage 166+500.
9 Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship, community facilities) Yes Number of hospitals, schools and community facilities are available within 15km buffer.
10 Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Yes The alignment is passing through the reserved forest & wild life sanctuary, which needs acquisition as per the procedures.
11 Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) No Not located.
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 According to the Indian Standard Seismic Zoning Map, the project is located in the Zone III of seismic intensity and therefore will have minimum risk of damage from earthquake.
(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 : 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 ApplicantSh NRavishankar
DesignationExecutive Engineer
Name of Company (Applicant Name should not be given here)MINISTRY OF ROAD TRANSPORT AND HIGHWAYS
AddressNH DIVISION, JCR EXTENSION, NEAR PWD QUARTERS, CHITRADURGA, KARNATAKA
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