(FORM-1) Submitted by Rajiv Gandhi Government General Hospital

APPLICATION FOR PRIOR ENVIRONMENTAL CLEARANCE (FORM-1)

APPENDIX-I FORM-1

(I) Basic Information

Sr. No. Item Details 1 Name of the Project/s The Proposed Construction of Outpatient Block and Other Departments by M/s. Rajiv Gandhi Government General Hospital. 2 S. No. in the Schedule 8(a) 3 Proposed Capacity/area/length/tonnage Plot area: 8215.62 sq.m to be handled/command area/lease Built-up area: 23,429 sq.m area/number of wells to be drilled 4 New/ Expansion/ Modernization New 5 Existing Capacity/ Area etc., Not applicable. 6 Category of Project i.e. 'A' or 'B' Category “B2” 7 Does it attract the general condition? If No yes, please specify 8 Does it attract the specific condition? If No yes, please specify 9 Location Plot/ Survey/ Khasra No. S. F. Nos. 37/1 Village Vepery Tehsil Tondiarpet District Chennai State Tamil Nadu 10 Nearest Railway Station/ Airport along Adjacent to Park town railway station, South with distance in kms Chennai Central Railway Station - 0.1 km, NW 11 Nearest Town, City, District Headquarters Vepery – 1.9 Km along with distance in kms 12 Village Panchayats, Zilla Parishad, Greater Chennai Corporation, Municipal Corporation, Local body Ripon Building, (Complete Postal address with Chennai-600003 Telephone) 13 Name of the Applicant The Dean, Madras Medical College 14 Registered Address Rajiv Gandhi Government General Hospital, E.V.R Salai, Park Town, Chennai – 600003 Telephone: 044-25305112 Mobile: 944108579 15 Address for Correspondence Name Dr. R. Vimala Designation (Owner/ Partner/CEO) The Dean Address Rajiv Gandhi Government General Hospital, E.V.R Salai, Park Town, Chennai Pin Code 600 003 Email ----- Telephone No. 044-25305112 Fax No. --- 16 Details of Alternative Sites examined, if No alternative site examined. any location of these sites should be

Submitted by Rajiv Gandhi Government General Hospital, Chennai 1

APPLICATION FOR PRIOR ENVIRONMENTAL CLEARANCE (FORM-1)

shown on a TOPO Sheet 17 Interlinked Projects Nil 18 Whether separate application of Not applicable interlinked project has been submitted? 19 If yes, date of submission - 20 If no. reason - 21 Whether the proposal involves No approval/clearance under: If yes, details of the same and their status to be given:

(a) The Forest (conservation) Act, 1980 (b) The Wildlife (Protection) Act, 1972 (c) The C.R.Z. Notification, 1991? 22 Whether there is any Government Order G.O.(Ms). No.75 Health and Family Welfare / Policy relevant/relating to the site (EI) Department- Dated 12.03.2015 23 Forest Land involved (in hectares) No 24 Whether there is any litigation pending No against the project and/or land in which the project is propose to be setup? (a) Name of the Court (b) Case No. (c) Orders/ Directions of the Court, if any and its relevance with the proposed project

(II) Activity

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.):

Details thereof (with approximate quantities/ Sr. Information/ Checklist Yes/ rates, wherever possible) with source of No. Confirmation No information data Permanent or temporary Yes The present land use of the proposed project site is change in land use, land Primary Residential Land use by CMDA. The land cover or topography including area will be converted into buildings for hospital 1.1 increase in intensity of land purpose. use (with respect to local land use plan) Clearance of existing land, No No major clearing of vegetation or buildings is 1.2 vegetation and buildings? envisaged. 1.3 Creation of new land uses? No -- Pre- construction Yes Soil Investigation Report is attached as Annexure-I 1.4 investigations e.g. bore holes, soil testing? Construction Works? Yes The project will involve the construction of 1.5 outpatient block for public. 1.6 Demolition Works? No -- 1.7 Temporary sites used for No The construction materials will be brought to the construction works or housing project site as and when the need arises. Hence, no of construction workers? bulk storage is envisaged. Further, the construction workers will be sourced from the surrounding areas,

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APPLICATION FOR PRIOR ENVIRONMENTAL CLEARANCE (FORM-1)

so there will not be any requirement for housing of construction workers. 1.8 Above ground buildings, Yes Excavation will be carried out for the construction structures or earthworks of basements and civil structures. The excavated including linear structures, soil will be used for the leveling of site and cut and fill or excavations greenbelt development. 1.9 Underground works including No Not applicable mining or tunneling? 1.10 Reclamation Works? No Not applicable 1.11 Dredging? No Not applicable 1.12 Offshore Structures? No Not applicable 1.13 Production and Manufacturing No The project involves only construction of buildings processes?

1.14 Facilities for storage of goods Yes No bulk storage of materials is envisaged during the or materials? construction phase, as the materials required will be procured as and when required. 1.15 Facilities for treatment or No No facilities for treatment and disposal of solid disposal of solid waste or waste are envisaged. liquid effluents? 1.16 Facilities for long term No - housing of operational workers? New road, rail or sea traffic No - 1.17 during construction or operation? New road, rail, air waterborne No There will not be any new road, rail, air, waterborne or other transport or other transport infrastructure. 1.18 infrastructure including new or altered routes and stations, ports, airports etc? 1.19 Closure or diversion of No Not envisaged. existing transport routes or infrastructure leading to changes in traffic movements? 1.20 New or diverted transmission No Not envisaged. lines or pipelines? 1.21 Impoundment, damming, No Not applicable. culverting, realignment or other changes to the hydrology of watercourses or aquifers? 1.22 Stream crossings? No -- 1.23 Abstraction or transfers of The water requirement for the proposed project will water from ground or surface be met from Chennai Metropolitan Water Supply & waters? Sewerage Board (CMWSSB). The copy of the water No supply request letter obtained from Chennai Metropolitan Water Supply & Sewerage Board (CMWSSB) is attached as Annexure-II 1.24 Changes in water bodies or No There will not be any change in the drainage the land surface affecting pattern. drainage or run- off?

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APPLICATION FOR PRIOR ENVIRONMENTAL CLEARANCE (FORM-1)

1.25 Transport of personnel or Yes The transport of personnel and construction materials for construction, materials, during the construction phase, will be operation or made through the existing road network. decommissioning? 1.26 Long- term dismantling or No Not applicable. decommissioning or restoration works? 1.27 Ongoing activity during No Not applicable. decommissioning which could have an impact on the environment? 1.28 Influx of people to an area Yes During operation phase, there will be influx of direct either temporarily or employees and public from the surrounding areas. permanently? 1.29 Introduction of alien species? No Not envisaged. Loss of native species or No Not envisaged. 1.30 genetic diversity? Any other actions? Yes Greenbelt will be developed in an area of 334.35 1.31 Sq.m. of the total project area.

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):

Details thereof (with approximate quantities/ Sr. Information/ Checklist Yes/ rates, wherever possible) with source of No. Confirmation No information data 2.1 Land especially No The total land area of 8215.62 sq.m required for undeveloped or agricultural the proposed project has been categorized as land (ha) Primary residential land by CMDA. 2.2 Water (expected source & Yes Water requirement – 243 KLD competing users) unit: KLD Source: Chennai Metropolitan Water Supply & Sewerage Board (CMWSSB)) 2.3 Minerals (MT) No ---- 2.4 Construction Material- Yes Building materials will be sourced from indigenous Cement, Steel, Sand, Blue supply. metal and bricks 2.5 Forests and Timber Not applicable. No (Source- MT) 2.6 Energy including Electricity Yes Required power of 500 KVA will be sourced from and fuels (source, Tamil Nadu Generation & Distribution Corporation competing users) (TANGEDCO).

To meet the emergency requirement during power failure, 2 DG Sets of 250 KVA will be used as back- up power. The DG sets are equipped with In-built fuel storage, acoustic enclosures and silencers 2.7 Any other natural No Not envisaged. resources (use appropriate

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APPLICATION FOR PRIOR ENVIRONMENTAL CLEARANCE (FORM-1)

standard units)

3. Use, storage, transport and 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:

Sr. Details thereof (with approximate quantities/ Information/ Checklist Yes/ No. rates, wherever possible) with source of Confirmation No information data 3.1 Use of substances or Yes Biomedical wastes generated from the outpatients materials, which are block will be segregated, collected and disposed to hazardous (as per MSIHC authorized recyclers/processors. rules) to human health or the environment (flora, fauna and water supplies) 3.2 Changes in occurrence of No Not envisaged. disease or affect disease vectors (e.g. insect or water borne diseases) 3.3 Affect the welfare of Yes The direct and indirect employment opportunities people e.g. by changing created during construction and operation phase of living conditions the project will help in ensuring better livelihood of the people and also the medical facilities will be provided for the public. 3.4 Vulnerable groups of No Not envisaged. people who could be affected by the project e.g. hospital patients, children, the elderly etc., 3.5 Any other causes No --

4. Production of Solid wastes during construction or operation or decommissioning (MT/month):

Details thereof (with approximate quantities/ Sr. Information/ Checklist Yes/ rates, wherever possible) with source of No. Confirmation No information data Spoil, overburden or mine No Not applicable 4.1 wastes Municipal waste (domestic Yes The municipal solid waste generated during the and/or commercial waste) construction and operation phase of the project will be properly collected, segregated and disposed in an efficient manner.

4.2 Construction phase: Domestic biodegradable waste: 0.15 TPD Domestic non-biodegradable waste: 0.1 TPD

Operation phase: Domestic biodegradable waste: 1.02 TPD Submitted by Rajiv Gandhi Government General Hospital, Chennai 5

APPLICATION FOR PRIOR ENVIRONMENTAL CLEARANCE (FORM-1)

Domestic non-biodegradable waste: 0.68 TPD Biomedical waste: 0.1 TPD Hazardous Wastes (as per No Spent oil generated from DG sets will be disposed to 4.3 Hazardous Waste authorized recyclers Management Rules) Other industrial process No --- 4.4 wastes 4.5 Surplus product No Not applicable. 4.6 Sewage sludge or other No Sewage generated will be pumped to the CMWSSB sludge from effluent pumping station. Hence, no STP is proposed. treatment Construction or demolition Yes Construction waste will be properly collected and 4.7 wastes disposed. Redundant machinery or No Not applicable. 4.8 equipment Contaminated Soils or other Not applicable. 4.9 No materials 4.10 Agricultural Wastes No Not applicable 4.11 Other Solid Wastes No Not applicable

5. Release of Pollutants or any hazardous, toxic or noxic substances to air (kg/hr):

Details thereof (with approximate quantities/ Sr. Information/ Checklist Yes/ rates, wherever possible) with source of No. Confirmation No information data 5.1 Emissions from Yes During power failure, DG sets will be operated. This Combustion of fossil fuels will generate particulate and gaseous emissions of from stationary or mobile SO2 and NOx. Adequate stack height above ground source level) will be provided as per CPCB norms, for each DG set. 5.2 Emissions from production No` Not envisaged. processes 5.3 Emissions from materials Yes Fugitive dust will be generated during the transport handling including storage of construction materials to the project site. It will be or transport minimized by water sprinkling.

All roads will be paved and adequate greenbelt will be developed. 5.4 Emissions from Yes The gaseous emissions from the transportation of construction activities vehicles will be of short duration. The fugitive dust including plant and will be controlled by sprinkling water and the equipment vehicles complying with Bharat Stage-III & IV will be used. 5.5 Dust or odours from Yes Construction activities may lead to temporary handling of materials increase in particulates. The trucks carrying including construction construction material will be covered with tarpaulin materials, sewage and covers & sheets. waste 5.6 Emissions from No Not applicable. incineration of waste Submitted by Rajiv Gandhi Government General Hospital, Chennai 6

APPLICATION FOR PRIOR ENVIRONMENTAL CLEARANCE (FORM-1)

5.7 Emissions from burning of No Not applicable. waste in open air (e.g. slash materials, construction debris) 5.8 Emissions from any other No Not envisaged. sources

6. Generation of Noise and Vibration and Emissions of Light and Heat:

Details thereof (with approximate quantities/ Sr. Information/ Checklist Yes/ rates, wherever possible) with source of No. Confirmation No information data 6.1 From operation of No Noise and vibration from the vibrators used during equipment e.g. Engines, construction will be temporary and restricted to Ventilation plant, crushers project site. The personnel working near the equipment will be provided with protective devices like ear plugs, ear muffs etc.

During operation phase, there won't be increase in the ambient noise levels as all DG sets will be provided with acoustic enclosures. 6.2 From industrial or similar No Not applicable. processes 6.3 From construction or Yes The noise generated during construction activities demolition will be of short duration. 6.4 From blasting or piling No Not envisaged. 6.5 From construction or Yes The noise levels will be less than 85 dB (A) and operational traffic these will be from non-point sources. However, the workers will be provided with protective equipment such as ear plugs etc. 6.6 From lighting or cooling No – systems 6.7 From any other sources No --

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:

Details thereof (with approximate quantities/ Sr. Information/ Checklist Yes/ rates, wherever possible) with source of No. Confirmation No information data From handling, storage, use Yes The spent oil from the DG sets and used oil from 7.1 or spillage of hazardous machineries during the operation phase will be materials disposed off through authorized recyclers. 7.2 From discharge of sewage No The sewage generated from the proposed project will or other effluents to water be pumped to the Chennai Metropolitan Water Supply or the land (expected mode and Sewerage Board (CMWSSB) and place of discharge) 7.3 By deposition of pollutants No Not envisaged. emitted to air into the land

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APPLICATION FOR PRIOR ENVIRONMENTAL CLEARANCE (FORM-1)

or water 7.4 From any other sources No Not envisaged. 7.5 Is there a risk of long term No The chief sources of emissions will be from the DG build up of pollutants in the sets. No long term build-up of pollutants is envisaged. environment from these sources?

8. Risk of accidents during construction or operation of the Project, which could affect human health or the environment:

Details thereof (with approximate quantities/ Sr. Information/ Checklist Yes/ rates, wherever possible) with source of No. Confirmation No information data 8.1 From explosions, spillages, No Not envisaged. fires etc from storage, handling, use or production of hazardous substances 8.2 From any other causes No Not envisaged. 8.3 Could the project be No The project site falls under seismic zone- III as per affected by natural IS 1893 (Part-1)-2002. Further, it is not flood prone disasters causing or landslide prone zone. Hence, there will not be environmental damage any risks due to natural disasters. (e.g. floods, earthquakes, landslides, cloudburst etc)

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:

Details thereof (with approximate quantities/ Sr. Information/ Checklist Yes/ rates, wherever possible) with source of No. Confirmation No information data 9.1 Lead to development of Yes Supporting infrastructure will be developed in the supporting facilities, surrounding areas which will aid in infrastructural ancillary development or development of the region. development stimulated by the project which could have impact on the environment e.g., Supporting Yes These facilities will be developed. infrastructure (roads, power supply, waste or wastewater treatment, etc.,) Housing No development – Extractive industries No - Supply industries No - Others No

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APPLICATION FOR PRIOR ENVIRONMENTAL CLEARANCE (FORM-1)

9.2 Lead to after-use of the No Not envisaged. site, which could have an impact on the environment 9.3 Set a precedent for later No Not envisaged. developments 9.4 Have cumulative effects No Not envisaged. due to proximity to other existing or planned projects with similar effects

(III) Environmental Sensitivity

Sr. Aerial distance (within 15 km) Areas Name/ Identity No. Proposed Project location boundary 1 Areas protected under ------international conventions, national or local legislation for their ecological, landscape, cultural or other related value 2 Areas which are important Guindy National Park 9.0 km, SW or sensitive for ecological reasons- wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests 3 Areas used by protected, Guindy National Park 9.0 km, SW important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration

4 Inland Coastal, marine or Couum river 0.05 km, South underground waters Chetpet Lake 3.53 km, West Semmozhi poonga 4.0 km, SW Adyar River 7.0 km, SSW Madhavaram Eri 9.5 km, NNW Kortalaiyar river 11.0 km, North 5 State, National boundaries --- Nil 6 Routes or facilities used by --- Nil the public for access to recreation or other tourist, pilgrim areas 7 Defense installation Defense Academy 11 km, SW 8 Densely populated area Triplicane 1.7 km, South

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APPLICATION FOR PRIOR ENVIRONMENTAL CLEARANCE (FORM-1)

Vepery 1.7 km, West Egmore 1.6 km, SW George town 1.4 km, NE 9 Areas occupied by St. Mary's church 0.9 km, ESE sensitive man-made land Fort. St.George 0.8 km, East uses (hospitals, schools, places of worship, community facilities) 10 Areas containing - - important, high quality or scarce resources- groundwater resources, surface resources, forestry, agriculture, fisheries, tourism, minerals 11 Areas already subjected to Kodungaiyur Landfill 5.3 km, North pollution or environmental site damage. (those where existing legal environmental standards are exceeded) 12 Areas susceptible to Yes, Earthquake The area falls under Seismic Zone III as natural hazard which could per IS 1893(Part 1)-2002. The cause the project to structural design shall confirm to IS present environmental 875-1987 and IS: 1893-2002. problems (earthquakes, subsidence, landslides, erosion, flooding for extreme or adverse climatic conditions

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APPLICATION FOR PRIOR ENVIRONMENTAL CLEARANCE (FORM-1)

(IV) Proposed Terms of Reference for EIA Studies:

The proposed project involves construction of factory units, common amenities and infrastructure with a total build-up area of 23,429 sq.m. which comes under item 8(a) of the schedule of the “EIA Notification” dated 14.09.2006. No terms of reference is proposed for this project since it will not require any scoping exercise or EIA Report.

I hereby give undertaking that the data and information given in the application and enclosures are true to the best of my knowledge and belief and I am aware that if any part of the data and information submitted is 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.

Date: 16th March, 2017 Place: Chennai

Dr. R. Vimala The Dean Rajiv Gandhi Government General Hospital, E.V.R Salai, Park Town, Chennai – 600003

NOTE:

1.The project involving clearance under Coastal Regulation Zone Notification, 1991 shall submit with the application a C.R.Z. map duly demarcated by one of the authorized agencies, showing the project activities, w.r.t. C.R.Z (at the stage of TOR) and the recommendations of the State Coastal Zone Management Authority (at the stage of EC). Simultaneous action shall also be taken to obtain the requisite clearance under the provisions of the C.R.Z Notification, 1991 for the activities to be located in the CRZ.

2. The projects to be located within 10 km of the National Parks, Sanctuaries, Biosphere Reserve, Migratory Corridors of wild Animals, the project proponent small submit the duly authenticated by Chief Wildlife Warden showing there features vis-à-vis the project location and the recommendations or comments of the Chief Wildlife Warden thereon (at the stage of EC).

3. All correspondence with the Ministry of Environment & Forests including submission of application for TOR/Environmental Clearance, subsequent clarifications, as may be required from time to time, participation in the EAC Meeting on behalf of the project proponent shall be made by the authorized signatory only. The authorized signatory should also submit a document in support of his claim of being an authorized signatory for the specific project.

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