QUESTIONNAIRE FOR ENVIRONMENTAL APPRAISAL

     (FOR HOTELS/BEACH RESORTS AND OTHER PROJECTS

LOCATED IN CRZ EXCEPT PORTS & HARBOURS)

Note 1 :      All information given in the form of annexures should be part of this      file itself.  Annexures as separate files will not be accepted.

Note2 :       Please enter x in appropriate box where answer is Yes/No

 

 

 
 

 

 

 


I.  General Information

 

A.              Name of the Project

 

1.                Existing project/proposed project/

expansion project/modernization project :

2.                If Existing/expansion/

modernization project, whether

 environmental clearance

 has been obtained                                      :

                       

                                                                                                 Square Metres

B.             

 

 
Size. (Plinth Area)

 

C.              Location

         
Village
Tehsil
District
State
 

 

 
 
 

      

           D.     Geographical Information 

 

 
 


1.            Survey no.

 

 
 


2.            Latitude                                                             

 

 

 

 

 

 
 


3.            Longitude        

                                                        

4.            Elevation above Mean                               

 

 
         Sea Level (Metres)                                                      

 

5.           

 

 
Total Area envisaged for

         setting up of project (in ha.)

 

6.            Nature of terrain    

 

7.            Nature of Soil (permeability)

 

        

8.            Stability Status of the Coast ,i.e.

 

 

 

 
 


                   (i)  Is it stable?                                 Yes                No    No

 

 

 

 
 


                   (ii) Is it accreding?                          Yes                         No

 

 

 

 
 


                  (iii) Is it eroding?                             Yes                         No 

 

 

 

 
 


                  (iv) Is it prone to flooding?             Yes                         No

 

9.            Nature of Coast, i.e.,

 

 
                  (i) Rocky                                              

 

 
                  (ii) Sandy                                                                                                            

 

 
                  (iii) Others (Please specify)                                 

 

II.                Current land use of the proposed project site  Area (in hectares)

 

A.                

 

 
Agricultural

1.      Irrigated

2.     

 

 
Unirrigated

B.                

 

 
Homestead

 

 
 


C.                 Forest                                                             

 

 
 


D.                 Notified Industrial Area/Estate

 

 
 


E.                  Grazing

 

F.                 

 

 
Fallow 

 

 
 


G.                 Mangroves

 

 
 


H.                 Orchards

 

 
 


I.                    Sand    dunes

 

 
 


J.                   No development zone

 

K.               

 

 
Marshes

 

L.                 

 

 
Others(Please specify)

 

 

 
Total                                                                                               

 

III.             Alternate sites considered from environmental consideration

A.                 ___________________________________________________________

B.                 ___________________________________________________________

C.                 ___________________________________________________________

D.                 ___________________________________________________________

IV.   Reason for selecting the proposed site from environmental consideration.

V.           Does the proposed project site conform to the stipulated land use as per the     local  land use plan ?

 

 

 

 
Yes                                                       No                  

VI.    What is the categorization of the area (as per approved CZMP)?

 

 

 

 

 

 
CRZ-I                                        CRZ-II                                               CRZ-III          

                        CRZ-IV

VII.  Does the proposed activity qualify under the category of permissible activity ?

 

 

 

 

 
Yes                                                      No                                                      

            If yes, under  what provision   is it permitted ?

           

S.No.

Provision No.

 

 

 

 

 

VIII.        Does the  proposed  project site involve  any  breeding  or nesting  ground ?

                                                                                                           

                               Yes

 

 

 

 
                                             No

If  yes, provide the following  details:

           

A.                 Name of the aquatic organism

 

B.                 Type of habitat

 

C.                 Period of year in which activity takes place

 

         

IX.     Site preparation.

 

A.                 Is the proposed  site located in low-lying area ?

 

 

 

 

 
Yes                                                         No

 

 
    

B.                 Level  before filling (above MSL, in m)

C.                

 

 
Level after filling (above MSL, in m)

D.      Details of fill material

Quantity of Fill Material required (in cu. m.)

Source

 

 

 

 

E.                  Does the site preparation require cutting of trees ?

 

 

 

 
Yes                              No

 

 

 

F.                 

 

 
If yes, how many trees are proposed to be cut ?

1.      Does it include any protected/endangered

     species (as per BSI list) ?

 

 

 

 
Yes                              No

 

2.      If  yes, provide detail.

 

G.                 Does the project involve  construction  on any sandy stretch ?                           

 

 

 

 
                                  Yes                                 No  

                          If  yes, please  furnish detail.

 

H.                

 

 
Height (above MSL in m.)                   

I.                    Does the project  involve extraction of sand, leveling or digging of sandy      stretches within 500 mts of  high tide line

 

 

 

 
Yes                                                  No

  

            If  yes, mention the activity involved and area.

 

 
                       1.   Activity

 

 
                       2.   Area (sq. metre)

J.                   Does the project involve any land reclamation ?

 

 

 

 
           Yes                                           No

 

             If  yes, pl. provide the following details.

1.        

 

 
Activity for which land to be reclaimed

2.        

 

 
Area of land to be reclaimed (ha)

K.                Does  the project  involve any dredging ?

 

 

 

 
Yes                                             No

           

                        If  yes, provide details (capital/maintenance,

Extent of dredging, disposal of dredged material etc)

 

L.                  Is any sand proposed to be removed from sand dunes?            

 

 

 

 
            Yes                              No

           

M.               Whether there will be any change in the drainage pattern after the proposed activity ?

 

 

 

 
            Yes                              No

           

If  yes, what are the changes ?

 

N.                Does the project  involve cutting/clearing of  mangroves ?  

 

 

 

 
            Yes                              No

           

                        If yes, give detail

 

 
                        Area (ha)

 

 
                        Species

 

 
                        Existing health

 

 

O.                Whether there will be any  ingress  of  saline water  into ground/surface water/soil due to project ?

 

 

 

 
            Yes                              No

 

 

X.     Please indicate area earmarked for each of the following (in Square meters)

S.No.

 

0-200 mt

200-500 mt

Beyond 500 mt

1

Area of all buildings

 

 

 

2

Courts

 

 

 

3

Playground

 

 

 

4

Swimming pool

 

 

 

5

Lawns

 

 

 

6

Amusement park

 

 

 

7

Landscaping

 

 

 

8

Approach Road

 

 

 

9

Tree plantation

 

 

 

10

Waste water treatment

 

 

 

11

Solid waste disposal

 

 

 

12

Others (Please specify)

 

 

 

TOTAL

 

 

 

 

XI.    Project  Details.

A.                 Total Area of  the plot (in square metres)

1.      Area within 200 mts of  HTL 

2.     

 

 
Area between 200-500 mts of HTL

3.     

 

 
Area beyond 500 mts of HTL

 

B.                

 

 
Width of the plot along the coastline (in metres)

 

C.                 Width of access road to the beach through the property

on  either side of he Hotel/Beach Resort left for public access (in metres )         

1.     

 

 
Left side

2.     

 

 
Right side  

D.                 If  the width of the plot along the coast is more than 500 metres , whether additional public access to the beach has been provided through the property  ?

 

 

 

 
            Yes                              No

                        If yes,

1.     

 

 
Width of  public access road (in metres)

2.     

 

 
Area of public access road (in metres)

3.     

 

 
Distance along the coastline between two public

      access roads to the beach(in metres)

E.                  Details of Buildings to be constructed (layout to be provided)

No. of buildings

Area of each building    (Sq.metres)

Distance from HTL (metres)

 

Height of each building (metres)

 

 

 

 

 

F.                 

 

 
Floor space index / Floor space area.                                     In metres

1.      Ground coverage between 200-500 metres

of HTL

2.     

 

 
Coverage of first floor

3.     

 

 
Total floor area (1+2)

4.     

 

 
50% of plot area within 200 metres of HTL

5.     

 

 
Plot area between 200-500 metres of HTL

6.     

 

 
Total  (4+5)

7.     

 

 
 Floor space index (3/6)

G.                 Is it proposed to construct any basement ?

 

 

 

 
                            Yes                               No

                         If  yes,

1.     

 

 
Depth of Basement (meters)              

2.     

 

 
Area of basement (Sq. meters)

3.     

 

 
Activity/Purpose

4.     

 

 
Maximum Ground water

       Table (metres)

5.     

 

 

 

 
Has the approval of Ground                    Yes                            No

                          Water Board  been obtained?           

 

H.                 Whether construction would be consistent with the surrounding landscape and local architecture ?

 

 

 

 
                                                                       Yes                             No

           

            If  no, reason for adopting different architectural style may be specified.

 I.         Number of  rooms to be constructed

1.     

 

 
Ground floor

                                               

2.     

 

 
First  floor

 

 

 

 

 

 

 

XII.     Details of the location:

 

Sea*

Other Water bodies

Rivers/creek/lake etc*.

(Please specify)

Distance of seaward boundary of the plot (in m)

 

 

Distance of seaward boundary of construction (in m.)

 

 

 

            *   From high tide line

 

XIII.  Surroundings.

A.      Whether there are any  structures existing within 1 km of the periphery

          along shore of the proposed site ?

 

 

 

 
            Yes                              No

           

B.      If yes, please provide details along with a layout plan:

1.      Distance of each structure from the boundary of the

   proposed site

2.     

 

 

 

 
Distance of each structure from the HTL

3.     

 

 
CRZ classification as per approved CZMP


 

XIV.    Whether any of the following exist within 7 km. of the periphery of the project site. If so, please   indicate aerial distance and the name of the site.

 

S.No.

 

Name

Aerial Distance (in km)

1

National Park

 

 

2

Marine Park

 

 

3

Sanctuary/Tiger Reserve/Elephant Reserve/ Turtle Nesting Ground

 

 

4

Core Zone of Biosphere Reserve

 

 

5

Reserved Forest

 

 

6

Wildlife Habitat

 

 

7

Habitat of endangered/exotic species

 

 

8

Coral Reef

 

 

9

Mangroves

 

 

10

Lakes/Reservoirs/Dams

 

 

11

Breeding Site

 

 

12

Nesting Site

 

 

 

 

 

 

XV.      Transportation system

          Type

            Transportation System                   Road                  Rail                Airport

A.     Existing

B.     After the proposed activity

C. Whether existing  network is adequate        

 

 

 

 
       Yes                        No

D.                 If not, provide details of alternative proposal

 

XVI.            Raw  material transportation to the site , (Quantity in tonnes per day)

A.  During construction

S.No.

Item

Quantity

Mode of Transportation

1

Brick

 

 

2

Sand

 

 

3

Steel

 

 

4

Others (Please Specify)

 

 

 

B. After construction

                                                            No of trips/day Mode

 

 

 

 
                        Material

 

 

 

 
                        Manpower      


 

XVII.         Whether the area is affected by cyclone

 

 

           

 
         Yes                                        No

     If  yes provide

            A.   Maximum  wind speed reached

B.   Frequency of cyclone

C.   Distance affected from high tide line

 

XVIII.  Ambient Air Quality (for RPM,SPM, SO2, NOx, CO)

Procedures adopted should be as per guidelines of CPCB and should cover one full season excluding monsoon.

Date, Time & Location

Concentration as monitored  (in g/cu.m.)

SPM,SO2,Nox,CO

Permissible Standard(As per SPCB guidelines)

Remarks (Name of the instrument and sensitivity)

 

 

 

 

 

XIX.    Water Requirements (cum./day)

Purpose

Avg. Demand

Peak Demand

Source

Type Treated / untreated/Fresh/Recycled

Remarks

 A) Project  Area

1. Washing

    2.  Dust        suppression

    3. Drinking

      4.  Green Belt

      5.  Fire Service

   6.  Others (Pl. Specify)

B) Township Area

    1. Green Belt

    2. Drinking

    3. Other(Please Specify)

              TOTAL

              

 

 

 

 

 

XX.      Source of Raw Water Supply (Net)

S.No.

Source

Cu.m./hr

Cu.m./day

1

Sea

 

 

2

River

 

 

3

Groundwater

 

 

4

Rain water harvesting

 

 

5

Municipal water supply

 

 

6

Others (Pl. specify)

 

 

 

XXI.  In case of groundwater from Dug wells in the CRZ area

 

A.   No. of wells(existing) within            No.                  Yield (kl/day) 

1.                 

 

 

 

 
0-200 metres

 

 

 

 
                    

2.                  200-500 metres

 

 

 

 

 

 
B.   New wells (proposed) within

a)                  0-200 metres

b)                 

 

 

 

 
200-500 metres

 

 

 

 

 
XXII.   Lean Season flow in case of surface water (cum./sec) 

 

XXIII. Groundwater                          A.     Recharge Rate (cubic meters)

 

 

 

 
B.    Withdrawal rate (cubic meters)

 

 

 

 
          Groundwater Table:                    A.      Pre monsoon (metres BGL)

            B.     Post monsoon (meters BGL)

 

XXIV.   Competing Users of the Water Source

 

S.No.

Usage

Present Consumption (cu.m/day)

Addition Proposed as per local plan

Total

 

 

Surface

Ground

Surface

Ground

Surface

Ground

1

Irrigation

 

 

 

2

Industry

 

 

 

3

Drinking

 

 

 

4

Others (Please specify)

 

 

 

Total

 

 

 

 

XXV.   Physico chemical analysis of Raw Water at intake point

 

XXVI.  Physico chemical analysis of  treated  water to be used  in the Project/Township (Envisaged Standards).

 

 

XXVII. Waste Water Management

A.  Waste water and /or sewage treatment plan

 B.  Composition/characteristics of discharge before and after treatment

Item

Characteristics

Before

After

 

 

 

      C.   Daily discharge (cu.m./day) from different sources

1.  

 

 
Toilet/sewage  

2.   

 

 
kitchen

3.   

 

 
Workshop

4.   

 

 
Other

 

 
                        Total

 

 
D.    Quantity of water recycled

1.   (in  %)

2.  

 

 
(in cu.m/day)

            E.       Details of recycling mechanism

                        1.  During monsoon season

             

                  2. Other than monsoon season

            F.    Mode of final discharge/disposal

S.No.

Mode

Length (in m.)

Quantity(in cu.m./day)

1

Open Channel

 

 

2

Pipeline

 

 

3

Others (Please specify)

 

 

 

G.                 Point of final discharge :

 

S.No.

Final Point (please specify the location)

Quantity discharged (in cum.)/day

1

Agricultural land

 

2

Fallow Land

 

3

Forest Land

 

4

Green Belt

 

5

River

 

6

Lake

 

7

Estuary

 

8

Sea                      

 

Total

 

 

H.                

 

 
Lean season flow rate in case of

                        river/stream/creek (cumecs)  

                     I. Downstream users of water (cusecs/cumecs)

1.                       

 

 

 

 
Domestic    

2.                        Irrigation

3.                       

 

 
Fisheries

4.                        Others (Please specify)

                                                         Total

J.                   Analysis of river water 100 metres upstream of discharge point and 100

                        metres downstream of discharge point and details of aquatic life in case of

                        discharge into water bodies.

                         

                        XXVIII.   Solid Waste

A.        Details

S.No.

Source

Qty (TPM)

Form

Composition

1

Raw Water treatment

 

 

 

2

ETP

 

 

 

3

Others

 

 

 

 

B.         What are the possibilities of recovery and recycling of wastes?

C.      Possible users of Solid Waste.

D.                 Method of disposal of solid waste

 

 
            Method                                                            Qty (TPM)

E.                  Landfill            

F.                 

 

 
Incineration

G.                

 

 
Other (pl. specify)

H.                

 

 
In case of landfill

1.     

 

 
Is solid suitable for landfill               Yes                   No           No

2.     

 

 
Dimensions

3.     

 

 
Life of landfill (years)

4.      Proposed precautionary and mitigation measures

         I.                 In case of incineration:

                                              Details of incinerator

1.        

 

 
Size           

2.        

 

 
Capacity

3.        

 

 
Fuel

 

J.                   Likely composition and quantum of emissions

S.No.

Components

Quantity (in cu.m/hr)

 

 

 

 

 
            K.    Frequency of incineration/annum

 

 
            L.     Others alternative proposed along with details

XXIX.  Noise level (dB)

A.                

 

 
Source                                                                                    

B.

 

 
Level at Source (db)

C.                

 

 
Level at project boundary (dB)

D.                 Abatement measures

XXX.    Fuel/Energy Requirements

 

            A. Total Power Requirement (MW)

 

S.No.

 

Project

Other(please specify)

 

 

Present (in existing)

 

 

 

 

Proposed

 

 

 

 

Total

 

 

 

 

          B.  Source of Power (MW)

S.No.

 

SEB/Grid

Captive power plant

DG Sets

1

 

Present

 

 

 

2

 

Proposed

 

 

 

 

 

Total

 

 

 

 

 

 

 

 

 

 

C.     Details of Fuel used

 

S.No.

Fuel

Daily Consumption (TPD)

Calorific value (Kcals/kg)

% Ash

% Sulphur

Existing

Proposed

1

 

2

 

3

 

4

 

5

 

6

 

7

 

Naphtha

 

HSD

 

LSHS

 

Furnace Oil

 

Coal

 

Lignite

 

Other (Please specify)

 

 

 

 

 

 

XXXI. Occupational Health

 

A.                 What are the major occupational health and safety hazards anticipated

 

 

B.                 What provisions have been made/propose to be made to conform to health/safety requirements.

 

C.                 Details of personal protective equipment provided/to be provided to the workers

 

XXXII.  Green Belt

 

 
 


A.                 Total area of project / township (in ha.)

 

 

B.                

 

 
Area already afforested (for existing projects), in ha.

 

 

C.                

 

 
Area proposed to be afforested (in ha.)

 

 

 
 


D.                 Width of green belt (minimum, in m.)

 

 

 

 

 

 

E.                  Trees planted & proposed

             Nos.              Survival Rate     Species

 

 

 

 

 
Planted            

 

 
                                   

Proposed

 

 
 


                        Major species          

 

 

XXXIII.          Construction Phase

 

A.                 Estimated duration of construction

B.                 Number of persons to be employed for construction

 

 
 


a)                  Peak

 

 
 


b)                  Average

 

C.                 What provision has been made for the sewage treatment for the construction workers?

 

D.                 How the fuel (kerosene/wood, etc.) requirement of labour force will be met to avoid cutting of trees from the adjoining areas

 

E.        Measure for Health care with emphasis on protection from endemic       diseases.

 

 

XXXIV.   Socio economic profile

 

A.     Human Settlement

S.No.

 

 

Aerial distance from the periphery of the site

 

 

 

Upto 500m from periphery

500m to 3000 m from the periphery

3000m to 7000m from the periphery

1.

Population

 

 

 

 

2.

Number of Houses

 

 

 

 

3.

Present Occupational Pattern

 

 

 


 

            B.         Economic activity

 

S. No.

Population

Occupation

(Agriculture/horticulture/

fishing/ tourism/transport/ construction)

Average Income per annum

 

 

 

 

 

 

 

 

 

 

 

 

 

 

XXXV.       Rehabilitation & Resettlement plan

 

A.  Population to be displaced

 

S.No.

Name of Village

Population

Land oustees only

Homestead

Oustees only

Land and Homestead                                           Oustees

1

 

 

 

 

2

 

 

 

 

3

 

 

 

 

 

            B. Rehabilitation Plan for oustees

 

 

            C. Site where the people are proposed to be resettled

                and the facilities to be provided at the new site

            

D. Compensation package

 

            E. Agency/Authority responsible for their resettlement.

 

            F. Approval/comments of competent authority

 

 

XXXVI.      Pollution Control

 

          A.     Details of Pollution Control Measures/Environmental safeguards:

 

S.No.

Existing

Proposed to be Installed

1.

Air

 

2.

Water

 

3.

Noise

 

4.

Solid Waste

 

 

C.     Protection of

 

1.      Forest

2.      Agricultural land

3.      Grazing land

4.      Top soil

5.      Natural  resources

6.      Sand dune             

7.      Hill feature

8.      Reclaiming borrow lists

9.      Low lying list

10.  Soil and slope stabilization

 

D.                 Preventing siltation

 

            D.        For Existing Units Only

 

                    1.  Difficulties encountered in implementing pollution control measures.

             

                          2.  Efficiency of each pollution control equipment/system installed. 

             

S.No.

Name of the System Equipment

Design Efficiency %

Present Working efficiency %

1

 

 

 

2

 

 

 

3

 

 

 

 

 

                  Proposed Units

 

S.No.

Name of the System Equipment

Design Efficiency %

Present Working efficiency %

 

 

 

 

 

 

 

 

 

 

 

 

 

 

XXXVII.     Expenditure on Environmental Measures

 

         A.           Capital cost of the project (as proposed to the funding agency/financial              institutions

 

 
                                                 (Rs. Lakhs)

 

 

 

 

B.                 Cost of environmental protection measures (Rs. Lakhs)

 

S.No.

 

Recurring Cost  per annum

Capital Cost

1

Pollution Control

 

 

2

Pollution Monitoring

 

 

3

Solid Waste Management

 

 

4

Occupational Health

 

 

5

Green Belt

 

 

6

Others ( Pl. Specify)

 

 

Total

 

 

 

 
XXXVIII.        Public Hearing

 

 

 
A. Date of Advertisement:                                

 

 
           

B. Newspapers in which the advertisement appeared

 

 
        

C. Date of Hearing

 

D. Panel Present

E. List of Public present along with addresses and occupation

F. Summary/details of public hearing

 

 

 Issues raised

Recommendation of panel

Response of Project Proponents

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The data and information given in this Performa are true to the best of my knowledge and belief:

 

Date:                                                                            Signature of the Applicant with

                                                                                                   full name & address.

             Place:

                                                                                      Given under the seal of organisation

                                                                                      on behalf of whom the applicant

                                                  is signing.

 

 

 

 

 

 

 

 

LIST OF DOCUMENTS TO BE ATTACHED IN RESPECT OF PROJECTS FALLING WITHIN COASTAL REGULATION ZONE

 

 

S. No

Document to be attached

1

Location Map delineating  LTL HTL,200 metre line, 500 metre line, and extent of Coastal Regulation Zone as per Naval Hydrographer Chart / Chief Hydrographer demarcation duly certified by the competent authority

2

Topographic map of the site (1:2500 scale) indicating contours sand dunes and ecologically sensitive features.

3

Confirmation from the Department of Environment of the State Government/ Union Territory Administration indicating the classification of the area, their observation/ recommendation  on the proposal and confirmation that the proposal is as per the approved Coastal Zone Management Plan

4

Topographic map covering 10 kilometres radius from the periphery of the site indicating mangroves, mudflats, nesting grounds for aquatic animals, migration path of turtles and other ecologically sensitive areas.

5

General Lay out of the site  (1:2500 Scale) showing installations already developed, approach roads and other infrastructure facilities constructed/Planned for the project, location of dug wells, sand dunes, effluent treatment facilities/Septic tank, courts, Lawns, tree plantation, Swimming pool etc and their distance from High Tide Line.

6

Comments/observation of the Chief Wildlife Warden

7

Plan of the area showing existing structure within one kilometre

8

Plan /Elevation of the buildings proposed clearly demarcating the access road to the public on either side of the proposed construction if it is a beach resort/ hotel in accordance with the provisions of the guidelines given in CRZ notification.

9

Approval of Electricity connection and certificate of supply of electricity

10

Lay out of green belt clearly indicating the width on all side’s trees, lawns, bushes etc.

11

Approval of Tourism Department

12

No objection certificate from the State Pollution Control Board

13

No objection certificate from the State Ground water Board

14

A certificate from water supplies authority regarding its availability in case water from other sources is to be obtained.