QUESTIONNAIRE FOR ENVIRONMENTAL APPRAISAL

(FOR ROAD/HIGHWAY PROJECTS)

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 :

 

 

 
 


B.           Length (in kilo metres)

 

C. Location

 

Stretch of the

Road/Alignment

Village

 

Tehsil

District

State

 

 

 

 

 

 

 

 

 

 

 

 

D. Geographical information

 

 

 

 

 

 

 
1. Latitude From To

 

 
 


2. Longitude From To

 

 
 


3. G.T. Sheet No. (Survey of India Map No.).

 

4. Elevation above Mean Sea Level (metres)

 

 

 

 

Min. Max.

 

5.                 

 

 
Total Area proposed for the Project (in ha.)

 

 

6. Nature of Terrain

 

 

 

 
7. Nature of Soil

(Clayey, Sandy, silty, loam etc)

 

8.                 

 

 
Permeability along the route

in various Sections

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

 

 

 

 
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. National Park/Sanctuary

 

 

 
Total

III. Alternate Routes/Alignments considered

A. ___________________________________________________

B. ___________________________________________________

C. ___________________________________________________

D. ___________________________________________________

IV.              Reason for selecting the proposed Route/Alignment:

V.                 Land use plan

A. Does the proposed project conform to the approved land use all along the route/alignment? (To be certified by the concerned Department of State Government).

 

 

 

 

Yes No

 

B.                 If not, clearly indicated, which of the stretches are not as per approved land use.

C.      Does it conform to the Regional Development Plan?

 

 

 

 
Yes No

VI. Site Preparation

A. Is the proposed route/alignment 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 required

 

Quantity of Fill Material required (in cu.m)

Source

 

 

 

 

E. Gradient details

             

F. Would the above filling result in complete/partial filling of water

Bodies ?

 

 
G. Does the site involve stripping?

 

 
Yes No

 

If yes, provide the following details:

1. Size of the area to be stripped.

2. Location

3. Soil type

4. Volume and quantity of earth to be removed

5. Location of dump site

6. Proposal for utilisation of removed topsoil.

H. Does it involve cutting?

 

 

 

 
Yes No

If yes, please furnish the following details:

1.      Size of the area to be cut.

2.      Depth of cut

3.      Location

4.      Soil type

5.      Volume and quantity of earth and other material to be removed

6.      Location of dump site.

I. Does it involve tunneling?

 

 

 

 
Yes No.

 

If yes, please furnish the following details:

1. Lithology

2. Geological structural fraction

3. Diameter (meters.)

4. Length (kilometer.)

5. Location

J. Does the site preparation require cutting of trees?

 

 

 

 
Yes No

If yes, please furnish the following details:

 

 
1. How many trees are proposed to be cut?

            2. Species of the above trees

            3. Are there any protected/endangered species?

 

 

 

 
Yes No.

 

            If yes, provide details

 

VII. In case the route/alignment falls totally or partially in the CRZ area

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

 

 

 

 

 

 
CRZ-I C CRZ-II CRZ-III

 

 
 


CRZ-IV

 

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

 

 

 

 
Yes No

 

C. If yes, under what provision is it permitted?

Sl. No.

Provision No.

 

 

D. In case the road passes through a flood plain of a river, please

furnish:

1. Detailed micro-drainage

2. Flood passages
3.      Flood periodicity in the area

 

E. Does the proposed project involve construction on any sandy stretch?

 

 

 

 
Yes No

 

If yes, please furnish detail

 

 

 
F. Height (above MSL in metres.)

G. 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. Stretch

 

 
 


            2. Area (sq. metre)

 

H. Does the project involve any dredging?

 

 

 

 
Yes No

 

If yes, please provide the following details (capital/maintenance):

Extent of dredging, disposal of dredged material etc)

 

 

 

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

Yes No

J. Does the project involve cutting/destroying of mangroves?

 

 

 
Yes No

 

If yes, give detail

1.     

 

 
Area

2.      Species

3.     

 

 
Existing health

 

VIII. Details of the location:

 

Sea

Other Water Bodies River/Creek/Lake ,etc (Please specify)

Distance of seaward boundary from the edge of the alignment (in m.)

 

 

Distance of seaward boundary of construction (in m.)

 

 

 

IX. 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

D.     Independent report of biohabitat study may be furnished.

X. Does the project have any adverse effect on biodiversity?

If so, details of flora and fauna so affected:

XI. Does the project involve any land reclamation?

 

 

 

 
Yes No

 

 

 
If yes, please provide the following details

A. Activity for which land to be reclaimed

 

 
B. Area of land to be reclaimed (Hectares)

 

XII. Whether there will be any change in the drainage pattern after the

proposed activity?

 

 

 

 
Yes No

 

If yes, what are the changes?

 

 

 
A. What is the maximum extent

 

 

 
B. Is any additional area to be flooded

 

 

 

 

 
XIII. Does the proposed alignment/route involve migratory path of animals?

Yes No

 

If yes, please provide the following:

A. Name of fauna

B. Habitat

C. Period of the year in which activity take place

XIV. Project Details (A summary of project proposal shall be enclosed).

 

 

 

 
A. Length of New alignment proposed (kms)

B.       Width of the new alignment (metres)

C.     

 

 
Length of existing alignment proposed to be

Strengthened/widened (kilometers.)

D.     

 

 
Width of the existing alignment (metres)

E.      

 

 
Width of the existing alignment after

widening (metres)

 

 
F. Total length of the alignment (kilometres)

 

 
G. No. of Bridges Major

 

 
Minor

 

 
H. Length of Bridges (metres)

 

 

 
I. Width of Bridges (metres)

 

 

 
J. No.of Culverts

 

 
 


K. Length of Culverts (metres)

 

 
L. Number and distance (metres) between

underpasses

 

 
M. No.of intersections

 

 
N. Length of Intersection (metres)

 

 
O. No. of Railway crossings

P.           

 

 
Length of Railway crossings (metres)

Q.         

 

 
No.of Villages through which

Alignment passes through

 

 
R. Population of the villages

 


XV. Raw material required during construction

S.No
Item
Quantity

(Tonnes)

Mode of Transport
Source
1
Bluemetal
 
 
 
2
Bricks
 
 
 
3
Sand
 
 
 
4
Cement
 
 
 
5
Bitumen
 
 
 
6
Diesel
 
 
 
7
Others(Please specify)
 
 
 

 

XVI. Water required during construction:

A. Water Requirements (cu.m./day)

S.No

Purpose

 

Average Demand

Peak Demand

Source

Type Treated/ Untreated/Fresh/Recycled

Remarks

1

Road making

 

 

 

 

 

2

Dust Suppression

 

 

 

 

 

3

Drinking

 

 

 

 

 

4

Others (Please specify)

 

 

 

 

 

TOTAL

 

 

 

 

 


B. Source of Raw Water Supply (Net)

S.No

Source

Cu.m/hr

Cu.m./day

1

Sea

 

 

2

River

 

 

3

Groundwater

 

 

4

Rainwater harvesting

 

 

5

Municipal water supply

 

 

6

Others (Please specify)

 

 

 

XVII. Whether there will be any ingress of saline water into ground water

due to project?

 

 

 

 
Yes No

 

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

S.No

Item

Name

Aerial Distance (in km)

1

National Park

 

 

2

Marine Park

 

 

3

Sanctuary/Tiger Reserve/Elephant Reserve/Turtle westing 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

 

 

 

XIX. Ambient Air Quality (for RPM, SPM, SO2, NOX, CO)

Procedures adopted should be as per guidelines of CPCB and should cover

one full season (Locations should be so selected to represent the varying

geographical locations and sensitive receptors)

 

S.No

Stretch of the road

Date, Time & Location

Concentration as monitored (in ug/m3)

SPM, SO2, NOX, CO

Permissible Standard (As per SPCB guidelines

Remarks (Name of the instrument and sensitivity)

 

 

 

 

 

 

 

 

 

XX.           Solid Waste

A.                 Solid Waste generated during Road Construction (Tonnes/Day)

1.     

 

 
Top Soil

 

2.     

 

 
Overburden

3.     

 

 
Others (Please specify)

 

 
 


Total

B. Possible users of Solid Waste

 

C. Method of disposal of solid waste

Method Quantity (TPM)

1.     

 

 
Landfill

2.     

 

 
Others(Please specify)

3.      In case of landfill

 

 

 

 
a) Is solid suitable for landfill Yes No

 

 
b) Dimensions

 

 
 


            c) Life of landfill

 

d) Proposed precautionary and mitigation measures

e)                  Other alternative proposed along with details

 

 

 

 

 

 

XXI.         Noise level (dB)

S.No

Stretch of the Road (Locations Should be so selected to represent the varying geographical locations and sensitive receptors)

Noise before Construction

Noise after Construction

 

Abatement Measures

1

 

 

 

 

2

 

 

 

 

3

 

 

 

 

             

             

   XXII. Projected Air Quality (taking into account the traffic projections on this road).

(SPM, SO2, NOX, CO in ug/m3)

S.No

Pollutant

Before Constructions

After Construction

1

SPM

 

 

2

SO2

 

 

3

NOX

 

 

4

CO

 

 

 

XXIII. Storage (of inflammable/explosive/hazardous/toxic substances)

S.No

Name

Consumption

(in TPD)

Maximum Quantity at any point of time

(tonnes)

Means of transportation

1

Bitumen

 

 

 

2

Diesel

 

 

 

3

Others (please specify)

 

 

 

 

XXIV.     Occupational Health

A.                 What are the major occupation health and safety hazards anticipated including due to use of explosives, if any?

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

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

XXV.       

 

 
Green Belt

A.                 Total area of project (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.) along the alignment

E.                  Trees planted and proposed

 

 
Nos.

1. Planted

2.                 

 

 
Proposed

3.                  List of species

F. Proposal for maintenance of plantation

XXVI.     Construction Phase

A.                 Estimated duration of construction

B.                 Number of persons to be employed for construction

 

 
1. Peak

 

 
2. Average

 

C. Proposal for employment of local people.

D. What provision has been made for the sanitation for the construction workers ?
E. How the fuel (kerosene/wood, etc) requirement of labour force will be met to avoid cutting of trees from the adjoining areas.

F.       Measures for Health care with emphasis on protection from endemic diseases.

XXVII. Socio-economic profile

A.                 Human Settlement

 

 

Aerial distance from the periphery of the site

 

Upto 500 m From the Periphery

500 m to 3000 m From the Periphery

3000 m to 7000 m From the periphery

Population

 

 

 

Of which

SC/ST

 

 

 

Number of Houses

 

 

 

Present Occupational Pattern

 

 

 

B.                 Economic activity

S No.

Population

Occupation(Agriculture/Horticulture/Fishing/Tourism/Transport/construction)

Average Income per annum

 

 

 

 

 

 

 

 

 

 

XXVIII. Rehabilitation & Resettlement Plan including vocational training and other avenues of employment

A.                 Population to be displaced

S.No

Name of Village

Population

 

Land oustees only

Homestead Oustees only

Land + Homestead Oustees

1

 

 

 

 

2

 

 

 

 

3

 

 

 

 

 

B.                 Rehabilitation Plan for Oustees

C.                 Site where the people are proposed to be resettled

D.                 Compensation package

E.                  Agency/Authority responsible for their resettlement.

XXIX.     Does it involve displacement of ethnic minority

 

 

 

 
Yes No

 

If yes, please furnish details

S.No

Name of the community

Number of Males

Number of Females

Total

 

 

 

 

 

 

A.                 Please specify any special measures for their rehabilitation.

 

 

 

XXX.        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

B. Protection of Forest/National Park./Sanctuary/Mangroves

1.      Agricultural land

2.      Grazing land

3.      Top soil

4.      Natural resources

5.      Sand dunes and mudflats

6.      Hill feature

7.      Reclaiming borrow areas

8.      Low-lying areas

9.      Soil and slope stabilization

10.  Preventing siltation

11.  Archaeological and other Heritage sites

XXXI.     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

Green Belt

 

 

5

Others (Please Specify)

 

 

Total

 

 

XXXII. 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

S.No

Summary/details of public hearing Issues raised

Recommendation of panel

Response of Project Proponents

1

 

 

 

2

 

 

 

3

 

 

 

4.

 

 

 

 

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.