APPENDIX I (See Paragraph – 6) FORM 1

APPENDIX I (See paragraph – 6) FORM 1

(I) Basic Information

Sr. Item Details No. 1 Name of the Project “ GAJANANA ” 2 S. number in schedule 8 (a)

3 Proposed 2 Total Plot Area – 90,340.00 m capacity/area/length/tonnage to be 2 Net plot Area – 54,204.00 m handled/command area/lease 2 Built-up Area – 35,948.20 m area/number of well to be drilled 4 New/expansion/modernization New 5 Existing capacity/area etc. New Construction Area – 34,665.14 m2 (F.S.I) 6 Category of project i.e. “A” or “B” “B” 7 Does it attract the general No condition? If yes please specify 8 Does it attract the specific No condition? If yes please specify 9 Survey No.: 587/3/A, Ajwa-Nimeta Road, Moje: Kumetha, Location Dist: Vadodara. Survey No.: 587/3/A, Ajwa-Nimeta Road, Moje: Kumetha, Plot/Survey/Khasra No Dist: Vadodara. Village Kumetha Tehsil Vadodara District Vadodara State Gujarat 10 Nearest railway station/airport along Vadodara Railway Station is located 11.89 km in SW direction and with distance in Kms. Airport is located 7.45 km in SWW direction. 11 Nearest town, city, district Project falls in Vadodara Urban Development Authority(VUDA) headquarter along with distance in (Sayajipura) Kms. 12 Village Panchayat, Zila Parishad, Municipal Corporation, local body Project falls in Vadodara Urban Development Authority(VUDA) (Complete postal address with telephone nos. to be given) 13 Name of the applicant Rahul Mansukhbhai Raiyani (Authorized Person) 14 M/s. Mahalaxmi Associates Registered address “GAJANANA”, Near Nimeta Garden, Vadodara-Ajwa Road Vadodara-390 019. 15 Address for correspondence As below. Name Rahul Mansukhbhai Raiyani Designation Authorized Person

S-8, Pruthvi Apartment, 46-Purshottam Nagar, Address Near Urmi Char Rasta, BPC Road, Akota, Vadodara.

Pin code 390 019 E-mail [email protected], [email protected] Tele phone 9979526000 / 9825125122 Fax No 0261-2630782

16 Details of alternative sites examined, if any. Location of these Location of Site shown on Topo sheet is given in sites should be shown on a topo Annexure – 1 sheet 17 Interlinked Project No 18 Whether separate application for interlinked project has been No submitted? 19 If yes date of submission - 20 If no, reason Individual project 21 Whether the proposal involves approval/ clearance under: if yes, details of the same and their status to be given No The Forest (Conservation) Act, 1980 The Wildlife (Protection) Act, 1972 The CRZ Notification 1991 22 Whether there is any Government No order/policy relevant/ relating to site 23 Forest Land involved? No 24 Whether there is any litigation pending against the project and / or land in which the project is propose to be set up Name of court No litigation pending Case no Order/directions of the court, if any and its relevance with the proposed project.

• Capacity corresponding to sectoral activity (such as production capacity for manufacturing, mining lease area and production capacity for mineral production, area for mineral exploration, length for linear transport infrastructure, generation capacity for power generation etc.,)

(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.)

Sr. Information/Checklist Yes/ Details thereof (with approximate quantities /rates, No. confirmation No wherever possible) with source of information data 1.1 Permanent or temporary change in No The project will not cause any permanent or land use, land cover or topography temporary change to land use, land cover or including increase in intensity of topography including increase in intensity of land use land use (with respect to local land (with respect to local land use plan). use plan) The project will be developed as “GAJANANA”, (199 Nos. of Residential Raw Houses) 1.2 Clearance of existing land, No Not applicable vegetation and buildings? 1.3 Creation of new land uses? Yes The project will be developed as a Residential Raw Houses named “GAJANANA”. The development will be in accordance with local development plan. 1.4 Pre-construction investigations e.g. Yes Soil sample was collected and analyzed from the site bore houses, soil testing? and result is attached vide Annexure – 7

Sr. Information/Checklist Yes/ Details thereof (with approximate quantities /rates, No. confirmation No wherever possible) with source of information data 1.5 Construction works? Yes There will be construction of “GAJANANA”, (199 Nos. of Residential Raw Houses) 1.6 Demolition works? No Not Applicable 1.7 Temporary sites used for Yes Workers numbering 70 will be working at the site. The construction works or housing of workers will be hired from local population. Hence construction workers? temporary housing is not required. 1.8 Above ground buildings, structures Yes There will be construction of G+1 floor in all raw or earthworks including linear houses. structures, cut and fill or excavations 1.9 Underground works including Yes No Basement will be constructed. 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 Not applicable. processes? 1.14 Facilities for storage of goods or Yes Construction Phase: materials? Minimum bulk material for construction will be bought as and when required and will be temporarily stored at site with proper arrangement of storage and under proper cover. 1.15 Facilities for treatment or disposal Yes Solid Wastes: of solid waste or liquid effluents? Solid waste generated in Project area will be mainly of domestic nature. The solid wastes generated will 0.60 t/d and will be segregated into biodegradable and non-biodegradable wastes and collected in separate bins. The non-biodegradable wastes will be sold to recyclers and the biodegradable wastes will be collected and disposed into nearby municipal bin. Requested to Vadodara Urban Development Authority for disposal. An application is attached vide Annexure – 9(C).

Liquid Effluent: On site sanitation facilities will be provided for proper disposal and treatment during the construction phase. It is estimated that about 112.00 m3/d of wastewater will be treated in Sewage Treatment Plant. We also requested to Vadodara Urban Development Authority for drainage permission. An application is attached vide Annexure – 9(B).

1.16 Facilities for long term housing of No Not applicable. operational workers? 1.17 New road, rail or sea traffic during No Not applicable. construction or operation? 1.18 New road, rail, air, waterborne or No Not applicable. other transport infrastructure including new or altered routes and stations, ports, airports etc?

Sr. Information/Checklist Yes/ Details thereof (with approximate quantities /rates, No. confirmation No wherever possible) with source of information data 1.19 Closure or diversion of existing No Not applicable. transport routes or infrastructure leading to changes in traffic movements? 1.20 New or diverted transmission lines No Not applicable. or pipelines? 1.21 Impoundment, damming, culverting, No Not applicable. realignment or other changes to the hydrology of watercourses or aquifers? 1.22 Stream crossings? No Not applicable. 1.23 Abstraction or transfers of water Yes • Construction Phase: from ground or surface waters? During construction phase water requirement 16.00 m3/d will be met by tanker within premises.

• Operation Phase: During operational phase fresh water requirement of 92.00 m3/d will be met by Borewell. We also requested to Vadodara Urban Development Authority for getting fresh water permission. An application is attached vide Annexure – 9(A) 1.24 Changes in water bodies or the No Not applicable. land surface affecting drainage or run-off? 1.25 Transport of personnel or materials Yes Transport of personnel and materials will be required for construction, operation or for both construction and operation phases. 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 in either Yes During construction phase, 70 workers will be temporarily or permanently? employed temporarily and hired from local area. During the operational phase, there will be influx of more than 1195 (995 permanent residential and 200 visitors) people. 1.29 Introduction of alien species? No Not applicable. 1.30 Loss of native species or genetic No Not applicable. diversity? 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):

Sr. Information/checklist Yes/ Details thereof (with approximate quantities /rates, No. confirmation No wherever possible) with source of information data 2.1 Land especially undeveloped or No Not applicable. agricultural land (ha)

Sr. Information/checklist Yes/ Details thereof (with approximate quantities /rates, No. confirmation No wherever possible) with source of information data 2.2 Water (expected source & Yes Water demand will be as follows: competing users) unit: kld Construction phase: Maximum Quantity: (16.00 m3/d) Source: Tanker

Operation phase: Maximum Quantity: (92.00 m3/d) Source: Borewell & Requested to Vadodara Urban Development Authority 2.3 Minerals (MT) No Not applicable.

2.4 Construction material – stone, Yes Construction materials such as stone, cement, sand, aggregates, sand / soil (expected bricks, marble, paints, tiles, electric ware, sanitary ware, source – MT) glass will be used. All the above materials will be purchased from the local market and from nearest approved quarries, as and when required. It will be stored temporarily at the site. Approximate quantity are as follows: Sr. Material Quantity No. 1 Steel (t) 1766 2. Cement (bags) 11040 3. Stone Aggregate (m3) 10426 4. Sand (m3) 1276 5. Bricks (m3) 638 6. Glass (m2) 2821 3

7. Fly Ash Based Products (m ) 1840

2.5 Forests and timber (source – MT) No Not applicable

2.6 Energy including electricity and Yes Source: M.G.V.C.L. fuels (source, competing users) Expected Demand: 1500 KVA Unit: fuel (MT), energy (MW)

2.7 Any other natural resources (use No Not applicable appropriate standard units)

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.

Sr. Information/Checklist Yes/ Details thereof (with approximate quantities/rates, No. confirmation No wherever possible) with source of information data 3.1 Use of substances or materials, Yes There will be no storage of hazardous chemicals (as per which are hazardous (as per MSIHC rules). MSIHC rules) to human health or the environment (flora, fauna, and water supplies) 3.2 Changes in occurrence of disease No Suitable drainage and waste management measures will or affect disease vectors (e.g. be adopted in both construction and operational phase, insect or water borne diseases) 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 Yes It is expected that 70 workers will be employed changing living conditions? temporarily and hired from local area. During the operational phase, there will be influx of more than 1195 (995 permanent residential and 200 visitors) people.

Sr. Information/Checklist Yes/ Details thereof (with approximate quantities/rates, No. confirmation No wherever possible) with source of information data 3.4 Vulnerable groups of people who No Not applicable. could be affected by the project e.g. hospital patients, children, the elderly etc., 3.5 Any other causes No Not applicable.

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

SR. Information/Checklist Yes/ Details thereof (with approximate quantities/ rates, No. confirmation No wherever possible) with source of information data 4.1 Soil, overburden or mine wastes Yes Excavated surplus earth will be refilled at low lying areas in the project premises and development of greenbelt.

4.2 Municipal waste (domestic and or Yes The municipal solid wastes generated during commercial wastes) operation phase will consist of:

Organic waste Waste vegetables and foods

Inorganic waste Papers, cartons, Thermocol, plastics, polythene bags, Glass, etc.

Solid waste storage location will be incorporated in the design itself.

Adequate number of collection bins, separately for biodegradable and non-biodegradable waste will be provided as per Municipal Solid Waste (Management and Handling) Rule, 2000. Waste from such bins will be collected separately on daily basis. The quantity of solid wastes generated will be approximately 0.60 t/d. The recyclable waste will be dispose to recyclers.

The biodegradable waste will be collected in bins and will be disposed nearby municipal bins.

4.3 Hazardous wastes (as per Yes No hazardous waste generation. Hazardous Waste Management Rules) 4.4 Other industrial process wastes No Not applicable. 4.5 Surplus product No Not applicable. 4.6 Sewage sludge or other sludge No Not applicable. from effluent treatment 4.7 Construction or demolition wastes Yes The construction waste will consist of construction debris along with cement bags, small cut-pieces of steel, insulating and packaging materials etc. Cement bags, waste paper and cardboard packing material will be sold off to recyclers. Unusable steel scrap will also be collected at site and sold to recyclers. 4.8 Redundant machinery or No Not applicable. equipment 4.9 Contaminated soils or other No Not applicable. 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 noxious substances to air (kg/hr)

Sr. Information/Checklist Yes/ Details thereof (with approximate quantities/rates, No. confirmation No wherever possible) with source of information data 5.1 Emissions from combustion of Yes -- fossil fuels from stationary or mobile sources 5.2 Emissions from production No Not applicable. processes 5.3 Emissions from materials handling Yes At the time of transportation, dust will be generated. including storage or transport This will be restricted to the construction phase and to the construction site only. 5.4 Emissions from construction Yes At the time of transportation & construction, dust will activities including plant and be generated. Manually Water sprinkling will be equipment carried out to minimize dust suppression. 5.5 Dust or odours from handling of Yes Construction Phase: materials including construction Dust will be generated during construction activity. materials, sewage and waste Water sprinkling will be carried out to minimize dust suppression. On site sanitation facilities (septic tank and soak pit) will be provided during the construction phase. Temporary Solid waste storage will be provided at site and recycle material will be sold to recyclers.

Operation Phase: During the operational phase, sewage will be collected and treated at sewage water treatment plant.

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

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

Sr. Information/Checklist Yes/ Details thereof (with approximate quantities/rates, No. confirmation No wherever possible) with source of information data 6.1 From operation of equipment e.g. Yes During construction, the machinery used for engines, ventilation plant, crushers construction will be of high standard of reputed make and will adhere to International standards. These standards itself take care of noise pollution control/ vibration control and air emission control. Hence, insignificant impacts due to construction machinery are envisaged. Apart from this, the construction activities will be restricted to daytime only. 6.2 From industrial or similar processes No Not applicable. 6.3 From construction or demolition Yes Due to various construction activities, there will be short term noise impacts in the immediate vicinity of the project site. 6.4 From blasting or piling No Not applicable.

Sr. Information/Checklist Yes/ Details thereof (with approximate quantities/rates, No. confirmation No wherever possible) with source of information data 6.5 From construction or operational Yes During construction noise will be generated due to traffic construction activity but it will be for short term only. During operation phase noise will be generated due to traffic. 6.6 From lighting or cooling systems Yes LED lighting used 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:

Sr. Information/Checklist Yes/ Details thereof (with approximate quantities/ rates, No. confirmation No wherever possible) with source of information data 7.1 From handling, storage, use or Yes -- spillage of hazardous materials 7.2 From discharge of sewage or other yes Sewage will be collected and disposed into municipal effluents to water or the land sewer line with prior permission. (expected mode and place of discharge) 7.3 By deposition of pollutants emitted No Not applicable. to air into the land or into water 7.4 From any other sources No Not applicable. 7.5 Is there a risk of long term build up No Not applicable. 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

Sr. Information/Checklist Yes/ Details thereof (with approximate quantities/ rates, No. confirmation No wherever possible) with source of information data 8.1 From explosions, spillages, fires etc Yes -- from storage, handling, use or production of hazardous substances 8.2 From any other causes Yes During Construction phase possibility of accidents may be fall from height, scaffolds, temporary stairs, cutting and welding, electrical fitting etc During operation phase possibility of accidents may be electrical fire. 8.3 Could the project be affected by Yes Project area is categorized in the seismic zone III, natural disasters causing which is classified as having a moderate seismic environmental damage (e.g. floods, intensity. The structure Design is as per Codes to earthquakes, landslides, cloudburst negate the threat of environmental and other etc)? damages.

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

Sr. Information/Checklist Yes/ Details thereof (with approximate quantities/ rates, No. confirmation No wherever possible) with source of information data 9.1 Lead to development of supporting. yes Supporting infrastructure will be developed like road, facilities, ancillary development or water supply network, power etc. 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 yes Increase in demand for housing • Extractive industries yes Increase in demand in industrial facilities • Supply industries yes Increase in demand in supply industries • Others yes Increase in demand for commercial and recreational facilities 9.2 Lead to after-use of the site, which Yes Negligible increase in traffic and there will be positive could have an impact on the impact on socio-economic environment. environment 9.3 Set a precedent for later Yes The project will lead to development of Residential developments Raw Houses. 9.4 Have cumulative effects due to Yes As above proximity to other existing or planned projects with similar effects

(III) Environmental Sensitivity

Sr. Name/ Aerial distance (within 15 km.) from Proposed Areas No. Identity project location boundary 1 Areas protected under international No Not applicable. conventions, national or local legislation for their ecological, landscape, cultural or other related value 2 Areas which are important or Yes Vishwamitri River 7.41 km in W direction.[Please sensitive for ecological reasons - refer attached Annexure- 3(B)] Wetlands, watercourses or other Khadi is 4.23 km in SW direction.[Please refer water bodies, coastal zone, attached Annexure- 3(C)] biospheres, mountains, forests Canal is 18.65 m in N direction [Please refer attached Annexure-3(D)] 3 Areas used by protected, important No Not applicable. or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration 4 Inland, coastal, marine or No Not applicable. underground waters 5 State, National boundaries No Not applicable.

Sr. Name/ Aerial distance (within 15 km.) from Proposed Areas No. Identity project location boundary 6 Routes or facilities used by the Yes Vadodara Railway Station is 11.97 km in SW direction. public for access to recreation or Airport is 7.22 km in SW direction. other tourist, pilgrim areas National Highway No. 8 is 4.90 km in SWW direction. T.S.D.F. (Nandesari) is located 20.07 km in NW direction. 7 Defense installations No Not applicable. 8 Densely populated or built-up area No -- 9 Areas occupied by sensitive man- Yes Shree Shikoter Mataji Mandir is located 1.20 km in SE made land uses (hospitals, schools, direction places of worship, community Podar International School is located 3.15 Km in SW facilities) direction. NDC Institute of Aircraft Maintenance Engineering College is located 3.65 Km in SSW direction. Sigma Institute is located 3.35 Km in SSW direction. 10 Areas containing important, high No Not applicable. quality or scarce resources (ground water resources, surface resources, forestry, agriculture, fisheries, tourism, minerals)

11 Areas already subjected to pollution Yes Indian Petrochemicals Corporation Limited or environmental damage. (those (Nandesari) is located 16.75 km in NWW direction. where existing legal environmental standards are exceeded) 12 Areas susceptible to natural hazard Yes Project area is categorized in the seismic zone III, which could cause the project to which is classified as having a moderate seismic present environmental problems intensity. The structure design is as per Codes to (earthquakes, subsidence, negate the threat of environmental and other landslides, erosion, flooding or damages. Please refer stability certificate of a extreme or adverse climatic structural engineer as per Annexure – 21. conditions)

(IV) Proposed Terms of Reference for EIA studies

Not Applicable.

“I hereby given undertake 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 project will be revoked at our risk and cost.”

Date: / /2015 Signature of the applicant Place: VADODARA With name and full address

Raiyani Rahul Mansukhbhai (Authorized Person)

M/S Mahalaxmi Associates “GAJANANA” Near Nimeta Garden, Vadodara-Ajwa Road, Vadodara-390 019 10