Chakshu Properties Private Limited APPENDIX - I FORM 1 (I) Basic Information Sr. Item Details No. 1. Name of the project/s Proposed Beach resort 2. S. No. in the schedule 8 (a) 3. Proposed capacity/ area/ length/ Total Plot Area:- 21,241.00 m2 tonnage to be handled/ command area/ Plot area within 0-200 m:- 11206.00 m2 lease area/ number of wells to be Plot area within 200-500 m:- 10035.00 m2 drilled Proposed Built Up Area:- 7801.36 m2 Survey No:-123/1 (Part A), Morjim village, Pernem Taluka, Goa. 4. New/ Expansion/Modernization New 5. Existing Capacity/Area etc. Not Applicable Category of Project i.e. ‘A’ or ‘B’ 6. B2 7. Does it attract the general condition? No If yes, please specify. 8. Does it attract the specific condition? No If yes, please specify. 9. Plot/ Survey/ Khasra No. 123/1 (Part A) Village Morjim Tehsil Pernem District North State Goa 10. Nearest railway station/airport along Aerial Distances with distance in kms. Thivim Railway Station – 11.76 Km Dabolim Airport – 29.36 Km 11. Nearest Town, City, District Aerial Distances Headquarters along with distance in Mapusa town – 9.07 Km kms. Panaji City – 18.16 Km 12. Village Panchayats, Zilla Parishad, Morjim Village Panchayat Municipal Corporation, Local body (complete postal addresses with Ph no:- 0832-2244310 telephone nos. to be given) 13. Name of the applicant M/s Chakshu Properties Pvt. Ltd. 14. Registered Address 3-D/2, Court Chambers, 35, New Marine Lines, Mumbai – 400 020. 15. Name Alpesh Desai Sadekar Enviro Engineers Private Limited Page 1 of 14 Chakshu Properties Private Limited Designation (Owner/Partner/CEO) Director Address Same as above Pin Code 400 020 Telephone no. 9820534788 Fax No. - 16. Details of Alternative Sites examined, if any. Location of these sites should No alternative be shown on a topo sheet. 17. Interlinked Projects No interlinked project 18. Whether separate application of interlinked project has been Not applicable submitted? 19. If yes, date of submission No 20. If no, reason Not applicable 21. Whether the proposal involves approval/ clearance under: if yes, details of the same and their status to be given. (a) The Forest (Conservation) Act, No 1980? (b) The Wildlife (Protection) Act, 1972? No (c) The C.R.Z Notification, 1991? No 22. Whether there is any Government Yes. The project has been granted CRZ NOC by Order/ Policy relevant/ relating to the Goa Coastal Zone Management Authority site? (GCZMA) vide reference no. GCZMA/N/14- 15/164/2889 dated 22.02.2016 – Attached as Annexure 1. 23. Forest land involved (hectares) No forest land involved. The copy of Form I and XIV is presented in pre-feasibility report. 24. Whether there is any litigation pending against the project and/or land in which the project is proposed to be set up? (a) Name of the Court No (b) Case No. (c) Orders/directions of the court, if any and its relevance with the proposed project. Sadekar Enviro Engineers Private Limited Page 2 of 14 Chakshu Properties Private Limited 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/No Details thereof (with approximate quantities No confirmation /rates, wherever possible) with source of information data 1.1 Permanent or temporary Yes The present land will be used for construction change in land use, land of proposed buildings causing permanent cover or topography change in the present land use pattern. including increase in intensity of land use (with respect to local land use plan) 1.2 Clearance of existing No Proposed project site is devoid of any Land, vegetation and vegetation or building. building? 1.3 Creation of new land uses? No Not applicable 1.4 Pre-construction Yes Soil investigation has been carried out. investigation e.g. borehole, soil testing? 1.5 Construction works Yes List of construction materials with estimated quantity of respective materials is presented in prefeasibility report 1.6 Demolition work No No demolition is required 1.7 Temporary sites used for Yes Temporary housing sheds for construction construction works or workers and site office for staff and security housing of construction persons within the plot premises. workers? 1.8 Above ground buildings, Yes Above ground buildings, structures are structures or earthworks proposed. including linear structures, Excavation to be carried out during cut and fill or excavations construction phase. 1.9 Underground works No Not applicable including mining or tunneling? 1.10 Reclamation works? No No reclamation is required 1.11 Dredging? No Not applicable 1.12 Offshore structures? No Not applicable 1.13 Production and No Not applicable manufacturing processes? 1.14 Facilities for storage of Yes Identified storage area for storage of goods and goods or materials? materials in plot premises is proposed. 1.15 Facilities for treatment or Yes Solid waste management plan presented in disposal of solid waste or prefeasibility report Sadekar Enviro Engineers Private Limited Page 3 of 14 Chakshu Properties Private Limited liquid effluent? Effluent management plan is presented in prefeasibility report 1.16 Facilities for long term No Temporary sheds will be provided to the housing of operational construction workers during the construction workers? period. 1.17 New road, rail or sea traffic No No new mode of traffic is envisaged. during construction or operation? 1.18 New road, rail, air No Existing infrastructure will be used. waterborne or other transport infrastructure including new or altered routes and stations, ports, airports etc? 1.19 Closure or diversion of No Existing approach road will be used for existing transport routes or transportation of construction materials to the infrastructure leading to site. charges in traffic movements? 1.20 New or diverted No Not applicable transmission 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 crossing? No Not applicable 1.23 Abstraction or transfers of No Detailed plan for meeting the water water from ground or requirement is presented in prefeasibility surface waters? report. 1.24 Changes in water bodies or No Natural Drainage will not be altered. Rain the land surface affecting water Harvesting system is proposed. drainage or run-off? 1.25 Transport of personnel or Yes Trucks/ Tempos will be used for transportation. materials for construction, operation or decommissioning? 1.26 Long-term dismantling or No Not applicable decommissioning or restoration works? 1.27 Ongoing activity during No Not envisaged decommissioning which could have an impact on the environment? 1.28 Influx of people to an area Yes About 50 persons are proposed to work during either temporarily or construction phase. permanently? About 158 occupants are estimated during Sadekar Enviro Engineers Private Limited Page 4 of 14 Chakshu Properties Private Limited operation phase. 1.29 Introduction of alien No Not applicable species? 1.30 Loss of native species or No Not applicable genetic 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/No Details thereof (with approximate quantities No. confirmation /rates, wherever possible) with source of information data 2.1 Land especially undeveloped No No agriculture land. The present land zoned or agricultural land (ha) as settlement zone. 2.2 Water (expected source & Yes Please refer prefeasibility report. competing users) unit: KLD 2.3 Minerals (MT) No Not applicable 2.4 Construction material – stone, Yes Details are presented in pre-feasibility report. aggregates, sand / soil (expected source – MT) 2.5 Forests and timber (source – Yes Use of timber shall be minimal and will be MT) used only for making doors and window panes. 2.6 Energy including electricity Yes During construction and fuels (source, competing Source – Goa Electricity Department users) Unit: fuel (MT), energy Back up source – DG (1 X 200 KVA) (MW) During operation phase Source – Goa Electricity Department Back up source – DG (1 X 500 KVA) 2.7 Any other natural resources No Not envisaged (use appropriate standard units) Sadekar Enviro Engineers Private Limited Page 5 of 14 Chakshu Properties Private Limited 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/No Details thereof (with approximate quantities/ No. confirmation rates, wherever possible) with source of information data 3.1 Use of substances or Yes Used oil from D.G sets materials, which are hazardous (as per MSIHC rules) to human health or the environment (flora, fauna and water supplies) 3.2 Changes in occurrence of No Safe working environment for onsite workers disease or affect disease will be ensured. Regular health for vectors (e.g. insect or water construction workers will be done during borne diseases) construction phase of project. 3.3 Affect the welfare of people Yes Direct employment to the locals during e.g. by changing living construction phase. conditions? Indirect employment to the local people has the project will create additional demand for civic amenities and other daily needs. There will be improvement in the socio-economic status of the people living in the vicinity. 3.4 Vulnerable groups of people No Not envisaged who could be affected by the project e.g. hospital patients, children, the elderly etc., 3.5 Any other causes No Not envisaged Sadekar Enviro Engineers Private Limited Page 6 of 14 Chakshu Properties Private Limited 4.