Application for Permission to Construct New Factory

F:\archana\Year 2009-10\MIDC permissions 21 Oct 09\Final Forms\MPCB\Application for permission to construct new factory.doc

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FORM NO. 1 AND QUESTIONNAIRE

(For Submission)

APPLICATION FOR PERMISSION TO CONSTRUCT NEW FACTORY, TO EXTEND EXISTING

FACTORY AND TO TAKE INTO USE AN EXISTING BUILDING AS A FACTORY

GENERAL NOTES:

1. Form No. 1.

2. A flow-chart of the manufacturing processes to be carried out in the proposed factory

supplemented by a brief description of the processes in its various stages.

3. Plans in duplicate, drawn to scale, showing –

(a) The site of the factory and immediate surroundings including adjacent

buildings and other structures, roads, drains etc.

(b) The plans, elevation, vies and cross-sections of various buildings, indicating all

the relevant details relating to natural lighting, ventilation and means of escape

in case of fire or in emergencies.

(c) The plans, showing clearly the position of carious plants, aisles, machinery‟s

etc. indicating the distances between the adjacent machines and between

machines and the adjacent walls or pillar etc. the passage ways through the

working room shall also be shown clearly on plans.

(d) All the departments and sections should be clearly mentioned on plans and the

number of workers likely to work in such departments and/or sections should

also be mentioned on plans.

(e) Such other particulars as the Chief Inspector may require.

Notes:- (i) For additions and alterations to the existing factories the proposed

changes should be shown in the following distinctive colours:-

(a) Proposed work in Pink Colour, and

(b) Proposed demolition in Yellow Colour.

(ii) All the drawings should be suitably dimensioned. This office cannot undertake

their scaling.

(iii) The site or Block plans must be drawn to a minimum scale of 1 : 500. Scale for

building plans and cross section must be drawn to a minimum scale of 1 : 100.

Here affix Court Fee

Stamp of Rs. 2.50


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(iv) Wherever the word „section‟ appears the relevant section the Factories Act,

1948 is meant; similarly wherever the word „rule‟ appears the relevant rule

under the Maharashtra Factories Rules, 1963 is meant.

1. General :

(i) Have the site and plans of your factory building/extension been approved by the

Municipality or the local health authorities? If so, please send a copy of the approval letter.

(ii) Are the necessary drawings as mentioned in the General Note submitted in duplicate with

the principal dimensions shown in the drawings? (Drawings should be self-explanatory.)

(iii) Is Statistical Form attached, submitted, duly filled in for all work-rooms, go-downs, offices

etc. Which are proposed to be constructed or extended?

(iv) Has the work commenced?

(v) What will be the total maximum number of workers employed per day (including all shifts)

in the entire factory?

Males:

Females:

(vi) What will be the maximum number of workers working in the entire factory at any one

time

Males:

Females:

(vii) Are all work-rooms not more than 18 meters wide window on both the outer (longer)

walls?

Note : If not provision of efficient forced draught ventilation will be insisted upon in respect of

any such work-room and details of this, viz., capacity of the forced draught fans, resultant

air changes per hour, proposed to be obtained should be furnished.

(viii) Are there any hot processes or those giving off fumes and/or dust proposed to be carried

out? If so, please indicate how the nuisance is proposed to be eliminated or minimized?

Note : Galvanized iron sheet or asbestos cement sheet is not acceptable as roof material unless it

is covered with tiles or a false ceiling of heat resisting material provided below or at

increased minimum heights as approved by the Chief Inspector of Factories.

2. Roof:

(i) Type of roof.


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(ii) Material to be used for roof covering (It should be noted that the minimum height from

floor to the roof should not be less than 3.75 metres.)

Note :- Galvanised iron sheet or asbestos cement sheet is not acceptable as roof material unless it

is covered with tiles or a false ceiling of heat resisting material is provided below or at

increased minimum heights as approved by the Chief Inspector of Factories.

3. Walls :

(i) What will be the material used for the construction of the walls ?

(ii) Will the walls be plastered smooth inside?

4. Floor :

(i) What will be the material used for flooring?

5. Windows and Skylights :

(Please fill in the attached statistical Form in respect of every work-room, office, godown etc)

Note :- (i) Sill height of windows at working level should bot exceed 1 (one) metre.

(ii) Please state whether all the windows are fully openable. If not, what is the percentage

of such windows are openable?

6. Doors :

(i) Is the minimum size of every door affording exit from work-room, office etc.

(195 centimetres x 90 centimetres)

(ii) Are all the doors affording exit from work-rooms, office etc (except those of the sliding

type) opening outwards or in the directions of the nearest exit ?

7. Emergency Exits :

(i) Are Fire exits provided in accordance with the provisions of Rule 70 (9).

8. Latrines and Urinals :

(i) Are these in accordance with the requirements of Section 19 read with rules 45 to 53?

(ii) (a) Is separate enclosed accommodation provided for males and females?

(b) Please state the number of Latrines provided for :

Existing Proposed Existing Proposed

(1) Males (2) Females

(c) Please state number of Urinals provided for Males :

Existing ………………………………. Proposed………………………….

(iii) Is the proposed accommodation approved by the Health Department?


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Note :- Latrines and urinals communicating with work-room, office etc. can not be accepted [ Vide

section 19 (1) (c) ] .

9. Wash Places :

(i) Are the proposed wash places in accordance with the requirements of section 42 read

with rule 4?

(ii) (a) Is separate enclosed accommodation provided for male and females ?

(b) Please state the number of proposed taps on stand pipes, wash basins and bath-

rooms for the use of males and females separately.

10. If your factory is situated in a common compound covered under section 93 of Factories Act,

1948, please fill in the Form attached to this Questionnaire

11. Cloak Room :

(i) Is cloak-room provided for workers ? if so, state the area.

(ii) Is separate cloak-room provided for female workers ? if so, state the area

(iii) Will lockers be provided for workers? Are the arrangements made for drying of wet

clothing? (Please see Rule 75).

12. Canteen:-

(Applicable to factories where more than two hundred and fifty workers are ordinarily employed.)

(i) Are the plans of the canteen submitted in duplicate to the Chief Inspector of Factories for

approval ?

(ii) Is proposed canteen in accordance with the requirements of section 46 read with rules 79 to

85?

(iii) Is the floor area of the dining hall calculated ate the rate of 1 sq. metre per dinner for 30 per

cent of the maximum number of workers working at any one time ?

(iv) Please state maximum number of workers working at any time and the floor area of the

dining hall in each section.

(1) Males :

(2) Females :

(v) Is separate enclosed accommodation provided in the dining hall for female workers ?

(vi) Are doors and windows of the Canteen made fly-proof?

(vii) Is the proposed Canteen situated at a distance of not less than 15 metres from latrines,

urinals, boiler house, coal stock, ash dumps or any other source of smoke or obnoxious

fumes ?


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13. Shelters, Rest Rooms and Lunch Rooms:

(Applicable to those factories wherein more than 150 workers are ordinarily employed.)

Note :- It should be noted that the provision of shelter and lunch room required under section 47 is

distinct from dinning hall of the Canteen required under section 46.

(i) Are the plans of the proposed work submitted in duplicate to the Chief Inspector of

Factories for approval ?

(ii) Is the proposed work in accordance with the requirements of section 47 read with rule

86 ?

(iii) Is the proposed shelter, rest room and lunch room conveniently situated for workers ?

(iv) What is the approximate number of workers likely to take advantage of this

accommodation ?

(v) Is the floor area of the proposed work sufficient to accommodate the workers at the

rate of 1 sq. metre per head ?

14. Creches

(Applicable to factories where in more than fifty women workers are ordinarily employed)

(i) Are the plans of the Creches submitted in duplicate to the Chief Inspector of Factories for

approval ?

(ii) Is the proposed Creche in accordance with the requirements of section 48 read with rules

87 to 91 ?

(iii) What is the approximate number of children to be accommodated in the Creche ?

(iv) Is the floor are of the Creche provided at the rate of 2 sq. metres per child ? Please state

the floor area.

(v) Are the following provided:-

(a) A wash for children and for washing their clothes.

(b) Sanitary accommodation for children

(c) A cupboard for storage of clothing, food etc.

(d) A room for the Nurse

(e) A suitable fenced and shady open air playground for older children

(f) Accommodation for storage of milk, food etc.

(g) Mother‟s feeding room.

15. Ambulance Room :

(Applicable to factories wherein more than five hundred workers are ordinarily employed.)

(i) Are the plans of the Ambulance room submitted in duplicate to the Chief Inspector of

Factories for approval ?


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(ii) Is the proposed Ambulance room in accordance with the requirements of section 45 (4)

read with rule 78 ?

(iii) Is the floor area of the Ambulance room minimum 24 sq. metres ?

(iv) Are the floor and the walls of proposed Ambulance room to be made of smooth, hard and

impervious materials ?

(v) Are the following provided :-

(a) Doctor‟s examination room.

(b) Sitting room for visitors

16. Layout of Machinery.

(i) Are aisles and passage ways in the factory clearly marked on the layout ?

(ii) Is a clear distance of 1 metre maintained between any machine and the nearest wall/column

and also in between machines ?

(iii) Does the layout provide a free passage way giving access to the means of escape in the case of

fire and emergency ?

Signature of the Applicant

Date :

Place :

Name and address of the Architect :


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A P P E N D I X

(To be filled in, in case the factory is or will be situated in a common compound under section 93

of the Factories Act. 1948)

(i) Name and Address of the owner of the compound :

(ii) Maximum number of workers working at a time in all the factories situated in the compound :

(a) Males:

(b) Female:

(iii) Number of latrines provided in the compound :

(a) Males :

(b) Female :

(iv) Number of urinals provided in the compound :

(a) Males :

(b) Female :

Note :- Separate enclosed accommodation shall be provided for female workers.

(v) Is no objection letter from the owner of the compound, allowing to start or extend a factory

for the purpose under reference obtained ? If so, please attach a copy.

Note :- It would be preferable, if in addition to supplying information under items (ii) to (v) above

you obtain a certificate to that effect from the owner of the compound and attach a copy

thereof here.

Signature of the Applicant

Date :

Place :


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D E C L A R A T I O N

1. From date , it is proposed to employ workers at

factory.

2. From , we started our production by employing ten or more than ten workers

and by using power.

3. From , we have started production at factory by employing 20 or more

workers, and without using electrical power.

4. I declare that the factory premises of which application is made was not rejected in

past by the Director, Industrial Safety and Health, Maharashtra State, Mumbai nor we

received any letter from the said Department. Also before this any officer is rejected

our application as per the Factory Act 1948.

5. Plans of the Factory Premises are approved / not approved by the Director, Industrial

Safety and Health, Maharashtra State, Mumbai vide in his letter no.

dated or submitted for approval on or will be

submitted within days.

Name of the Factory

Date :

Name of the Occupier

Place :

Signature of the Occupier


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The Maharashtra Factories Rules, 1963

FORM - 2 ( See rules 5 and 14 )

Application for Registration and Notice of Occupation specified in sections 6 and 7 ( To be submitted in TRIPLICATE )

1. Full name of factory with factory licence number, if

already registered.

2. Full postal address and situation of the factory

3. Full address to which communication relating to the

factory should be sent.

4. A flow chart of the manufacturing process :

a) Carried on the factory during the last twelve

months (in the case of factories in existence on

the date of commencement of the Act)

AND

b) To be carried on in the factory during the next

twelve months (in the case of the all factories)

AND

c) Supplemented by a brief description of the

process in its various stages, list of the raw

materials used, intermediate products including

emission of toxic gases, etc. finished products,

by-products, their quantities, method of storage

and handling, loading and transport and details of

the arrangements for the disposal of trade waste

and effluents the likely hazards and the methods

to control or eliminate them.

5. Name of manufactured. To be manufactured.

a) The principal product

b) Other product.

6. Nature and total amount of (H.P.) power installed.

7. Maximum number of workers proposed to be

employed on any one day during the year.

8. Maximum number of workers employed on any one

day during the last twelve months (in the case of


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factory in existence on the date of commencement

of that.)

9. Full name and residential address of the person who

shall be manager of the factory for the purpose of

the Act.

10. Full name and residential address of the occupier-

(i) The proprietor of the factory in case of private

firm / proprietary concern.

(ii) Directors in case of public limited liability

company / firm.

(iii) Where a managing agent has been appointed,

the name of the managing agent and director

thereof.

(iv) Shareholder in case of a private company.

(v) The Chief Administrative Head in case of a

Government factory or a factory runs by a local

authority or by any statutory corporation or

body.

11. In case of a factory constructed or extended after

the date of the commencement of these rules.

a) Reference number and date of approval of the

plans where for old or new building or for

construction or extension of factory by the State

Government / Chief Inspector.

b) Reference number and date of approval of the

arrangement, if any, made for the disposal of

trade waste and effluents and the name of the

authority.

12. Full name and address of the owner of the premises

of the building (including the precincts thereof

referred to in section 93.)

13. Amount of fee (Rupees ) paid

in treasury on vide challan No.

(enclosed)

14. Amount of fee (Rupees )

Cheque vide enclosed cross postal

order No. dated on


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Bank / Postal Office

drawn in favour of the Chief Inspector of Factories.

15. Amount of fee (Rupees ) paid

by bank adjustment vide order No. dated

(copy enclosed).

Signature of Occupier

Date

Signature of Manager

Date

Note:

1. This form should be completed in ink in block letters or typed.

2. Any subsequent change in any of the particulars given in columns 1 to 15 above

should be reported immediately.

3. In case of factory where number of provision to sub-section (1) and (2) of section 100

a person has been nominated as occupier, information required in the item No. 10

should be supplied only in respect of that person, and the form should be accompanied

by the nomination duly signed by the directors or the shareholders, as case may be.

4. Only one of the item No. 13 or 14 or 15 of the form should be filed as may be

applicable to the case, item No. 14 should be filled in case of factories in Greater

Mumbai and such factories outside Greater Mumbai as may prefer to pay the amount

by crossed postal order except Government factories. Item No. 15 should be filled in

the case of Government factories only and item No. 13 in all other cases.

5. Item No. 12 is to be filled only when more than one factory is situated in the same

premises or in building.


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FORM NO. 3 ( See Rules 5, 8 and 11 )

For the year

Application for * licence / Renewal of licence of a factory.

1. Full name the factory

2. Full postal address and situation of the factory

3. Full address to which communication should be

carried (where the factory address serves the

purpose of communication also, this information

need not be given)

3(A) A flow chart of the manufacturing process is

supplemented by a brief description of the process

in its various stages, list of the raw materials used,

intermediate products including emission of toxic

gases etc. finished products, by-products, their

quantities, methods of storages and handling

loading and transport and details of the

arrangement for the disposal of trade waste and

effluents control or eliminate them.

4. Maximum number of workers to be employed on

any one day during the year.

5. Installed H. P.

5(A) The period (not exceeding three years) for which

licence or renewal of licence is applied for

6. Name and residential address of Occupier

7. Name and residential address of manager

8. Amount fee (Rupees )

paid vide * treasury chalan / crossed cheque / postal

order on or by

book adjustment vide order No.

dated the .

9. Signature of Occupier

10. Signature of Manager

Date :

Place :

* Strike out whichever is not applicable.

Here affix

Court Fee

Stamp of

Rs.2.50


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MAHARASHTRA STATE ELECTRICITY BOARD

FORM No. A-1

To,

The Maharashtra State Electricity Board,

(Office)

1. I/We here request you to supply electrical energy to

the premises owned/occupied by me/us hereinafter

described.

2. I/We hereby agree to keep supply and pay for the

side energy security as may be demand in

accordance with the rates and conditions of supply

of the board in force from time to time and further

declare and agree to take supply energy for the

under mentioned purpose for my/our benefide use

for a period of not less than two years from the date

of commencement of supply.

3. I/We also undertake to supply within three months

from the date the board intimates that it is the ready

to supply to our premises failing which I/We

undertake to pay the board the minimum charges as

may be applicable.

4. In the event of death of individual/desolutions of

amalgamation of the company I/We hereby

nominate Shri/Smt./Sau

to receive or adjust the deposit

outstanding in/our name.

5. This requisition is for :

a) A new service, b) Re-connection, c) An alteration

to may existing installation, d) A temporary service,

e) A change of name Shri. .

6. Description of premises

House No. Land Survey No.

Street

District : Town/Village

Owner‟s Name :

Owner‟s Address :


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Incandescent Lamps Fans Plugs Heater etc. Motors Total

Demand

No. Wattage of

each

No. Wattage of

each

No. Wattage of

each

No. BHP of

each

KW/HP

7. My/Our requirement are as follows :

The wiring will be charged out by :

Name of the licenced wiring contractor :

His Licence No. :

His Address :

Date : (Signature of the applicant)

Name of applicant : .

Occupation : .

Address : .

.

(Strike out Items not applicable)


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Application for Consent / Authorisation

Date :

Form

To,

The

Maharashtra Pollution Control Board,

Sir,

I/We hereby apply for *

1. Consent to Establish/Operate/Renewal of consent under section 25 and 26 of the

Water (Prevention & Control of Pollution) Act, 1974, as amended.

2. Consent to Establish / Operate / Renewal of consent under section 21 of the Air

(Prevention & Control of Pollution) Act, 1981, as amended.

3. Authorization / renewal of authorization under rule 5 of the Hazardous wastes

(Management and handling) Rules , 1989,as amended in January,2000, in connection

with my / our /existing/ proposed/ altered /additional manufacturing /processing

activity from the premises as per the detail given below

Part A: General

1. Details of the planning permission obtained from

the local body/Town and Country Planning

authority / Metropolitan Development authority /

designated authority.

Name of the local body under whose jurisdiction the

unit is located and name of the license issuing

authority.

2. (a) Are you registered industrial unit ?

(b) If yes, give the number and date of registration.

3. Gross capital investment of the unit without

depreciation till the date of application (Cost of

building, Land, Plant and Machinery). [To be

supported by an affidavit / undertaking on Rs. 20/-

stamp paper, annual report or certificate from a

Chartered Accountant for proposed unit(s), give

estimated figure].


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4. If the site is located near sea-shore / river bank /

other water bodies / Highway, Indicate the crow fly

distance and the name of the water body, if any.

5. Does the location satisfy the Requirement Under

relevant Central / State Government Notification

such as Coastal Regulation Zone? Notification on

Ecologically Fragile Area, Industrial Location

Policy, etc. If so, give details.

6. If the site is situated in notified industrial estate

(a) Whether effluent collection, treatment and

disposal system has been provided by the

authority.

(b) Will the applicant utilize the system if

provided?

(c) If not provided, details of proposed

arrangement.

7. (a) Total plot area

(b) Built-up area.

(c) Area available for the use of treated sewage /

trade effluent for gardening / irrigation.

8. Month and year of commissioning of the unit.

9. Number of workers and office staff

Workers Staff Hrs. of shift Weekly off

10. (a) Do you have a residential colony within the

premises in respect of which the present

application is made?

(b) If yes, please state population staying.

(c) Indicate its location and distance with reference

to plant site.

11. List of products and bi-products manufactured in

tones/month, Kl/month or numbers/month with their

types i.e. Dyes, Drugs etc. (Give figures

corresponding to maximum installed production

capacity).

12. List of raw materials and process chemicals with

annual consumption corresponding to above stated

production figures, in tones/month, Kl/month or

numbers/month.


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13. Description of process of manufacture for each of

the products showing input, output, quality and

quantity of solid, liquid and gases wastes, if any

from each unit process. (To be supported by flow

sheet and / or material balance and water balance

sheet).

Part B: Waste Water aspects

14. Water consumption for different uses (m3/day)

(i) Industrial cooling, spraying in mine Pits or

boiler feed, pollution of hydro generation sets.

(ii) Domestic purpose.

(iii) Processing whereby water gets polluted and the

pollution are easily Bio-degradable.

(iv) Processing whereby water bets polluted and the

pollutants are not easily Bio-degradable and are

toxic.

(v) Other such as agriculture, gardening, etc.

(specify).

15. Source of water supply, Name of the authority

granting permission if applicable and quantity

permitted.

16. Quantity of waste water (effluent) generated

(m3/day)

(i) Domestic : (v) Boiler Blowdown :

(ii) Industrial : (vi) Cooling water blowdown :

(iii) Process : (vii) DM Plants / Softening :

(iv) Washing : (viii) Tail race discharge from :

17. Water budget calculation accounting for difference

between water consumption and effluent generated.

18. Present treatment of sewage / canteen effluent (Give

sizes / capacities of treatment units)

19. Present treatment of trade effluent (Give sizes /

capacities of treatment units) [A schematic diagram

of the treatment scheme with inlet / outlet

characteristics of each unit operation / process is to


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be provided. Include details of residue Management

system (ETP sludges)].

20. (i) Are sewage and trade effluents mixed together?

(ii) If yes, state at which stage – Whether before,

intermittently or after treatment.

21. Capacity of treated effluent sump, Guard Pond if

any.

22. Mode of disposal of treated effluent with respective

quantity, m3/day

(i) Into stream / river (name of river)

(ii) Into creek / estuary (name of creek / estuary)

(iii) Into sea

(iv) Into drain / sewer (owner of sewer)

(v) On land for irrigation on owned land / lease

land.

Specify cropped area (To be supported by

relevant documents)

(vi) Quantity of treated effluent re-used / re-cycled

m3/day. Provided a location map of disposal

arrangement indicating the outlet(s) for

sampling.

23. (a) Quality of untreated / treated effluents (Specify

pH and concentration of SS, BOD, COD and

specific pollutants relevant to the industry. TDS

to be reported for disposal on land or into steam

/ river.

(b) Enclose a copy of the latest report of analysis

from the laboratory approved by State Board /

Committee / Central Board / Central

Government in the Ministry of Environment

expected characteristics of the untreated /

treated effluents.

Part C: Air emission aspects

24. Fuel consumption

Coal LSHS Furnace Natural Other

Oil Gas Specify

a) Fuel consumption (TPD/KLD) :

b) Calorific value :


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c) Ash content % :

d) Sulphur content % :

e) Other (specify) :

25. (A) Details of stack

(Process & fuel stacks: D.G. Set)

(a) Stack numbers(s) 1 2 3 4

(b) Attached to

(c) Capacity

(d) Fuel type

(e) Fuel quantity (Kg/hr.)

(f) Material of construction

(g) Shape (round/rectangular)

(h) Height m (above ground level)

(i) Diameter/ size in meters

(j) Gas quantity, Nm3/hr.

(k) Gas temperature 0C

(l) Exit gas velocity, mt/sec

(m) Control equipment preceding the stack

(n) Nature of pollutants likely to present in the

stack gases such as C12, Nox, Sox, TPm

etc.

(o) Emissions control system provided

(p) In case of D.G. Set generation capacity in

KVA (Attach specification including

residue management systems of each of

the control equipment indicating inlet /

outlet concentration of relevant pollutants)

(B) Whether any release of odoriferous compounds

such as Mercaptans, Phorate etc. Are coming

out from any storages or process house.

26. Do you have adequate facility for collection of

samples of emissions in the form of port holes,

platforms, ladder etc? As per Central Board

Publication “Emission regulation Part-III”

(December, 1985).

27. Quality of treated fuel gas emissions and process

emissions. Quantity of treated fuel gas emissions

and process emissions.

28. (Specify concentration of criteria pollutants and

industry / process-specify pollutants stack wise.

Enclose a copy of the latest report of analysis from

the laboratory approved by State Board/ Central

Board / Central Government in the Ministry of


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Environment & Forests. For proposed unit furnish

expected characteristics of the emissions.

Part D: Hazardous Waste aspect.

29. Information about Hazardous Waste Management

as defined in Hazardous Waste (Management and

Handling) Rules, 1989 as amended January 2000.

Type / Category of Waste as per

Schedule-I Schedule-II Qty. Method of

Cat. No. Type Class Type Kg/day Collection

Reception

Storage

Transport

Treatment

Disposal

30. Details about use of Hazardous of Waste

(i) Name of the Hazardous Waste / Spent chemical :

(ii) Quantity used / month. :

(iii) Partly from whom purchased :

(iv) Party to whom sold :

31. (a) Details about technical capability and

equipments available with the applicant to handle

the Hazardous Waste.

(b) Characteristics of Hazardous Waste(s). Specify

concentration of relevant pollutants. Enclose a

copy of the latest report of analysis from the

laboratory approved by State Board / Central

Board / Central Govt. in the Ministry of

Environment and Forest. For proposed units

furnish expected characteristics.

32. Copy of format of manifest / record keeping

practiced by the applicant.

33. Details of self-monitoring (source and environment

system).

34. Are you using any imported Hazardous Waste? If

yes, give detail.


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35. Copy of actual user Registration / Certificate

obtained from Ministry of Environment and Forest,

Govt. of India for use of Hazardous Waste.

36. Present treatment of Hazardous Waste, if any (give

type and capacity of treatment units).

37. Quantity of Hazardous Wastes disposal

(i) Within factory.

(ii) Outside the factory (specify location and

enclosed copies of agreement)

(iii) Through sale (enclosed documentary proof and

copies of agreement)

(iv) Outside State / Union Territory, if yes,

particulars of (1 and 3) above.

(v) Other (specify).

Part E: Additional information.

38. (a) Do you have any proposals to upgrade the

present system for treatment and disposal of

effluents / emissions and / or hazardous waste?

(b) If yes, give the details with time – schedule for

the implementation and approximate

expenditure to be incurred on it.

39. Capital and recurring (O&M) expenditure and

various aspect of environment protection such as

effluent, emission, hazardous waste, solid waste,

tree plantation, monitoring, data acquisition etc.

(give figures separately for items implemented / to

be implemented.

40. To which of the pollution control equipment,

separate meters for recording consumption of

electric energy are installed?

41. Which of the pollution control items are connected

D.G. set (captive power source) to ensure their

running in the event of normal power failure?

42. Nature, quantity and method of disposal of non-

hazardous solid waste generated separately from the

process of manufacture and waste treatment. (Give

details of area / capacity available in the applicants

land).


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43. Hazardous Chemicals – Give details of Chemicals

and quantity handled and stored

(i) Is the unit a Major Accident Hazard unit as per

Mfg. Storage Import Hazardous Chemicals

Rules?

(ii) Is the unit an isolate storage as defined under the

MSIHC Rules?

(iii) Indicate status of complains of rules 5, 7, 10,

11, 12, 13 and 18 of the MSIHC Rules?

(iv) Has approval of site been obtained from the

concerned authority?

(v) Has the unit prepared am off-site Emergency

Plan? Is it updated?

(vi) Has information on imports of chemicals been

provided to the concerned authority?

(vii) Does the unit possess a policy under the PLI

Act?

44. Brief details of tree plantation / green belt

development with applicant‟s premises (in hectors)

45. Information of scheme for waste Minimization,

resource recovery and recycling – implemented and

to be implemented separately.

46. (a) The applicant shall indicate whether industry

comes under Public Hearing. If so, the relevant

documents such as EIA, EMP, Risk Analysis etc.

shall be submitted, if so, the relevant documents

enclosed shall be indicated accordingly,

(b) Any other additional information that the

applicant desires to give.

(c) Whether Environmental Statement submitted?

If submitted, give date of submission.

47. I / We further declare that the information furnished above is correct to the best my /

our knowledge.

48. I / We hereby submit that in case of any change what is stated in the application in

respect of raw materials, products, process of manufacture and treatment and / or

disposal of effluent, emissions, hazardous waste etc. in quality and quantity, a fresh

application for Consent / Authorization shall be made and until the grant of fresh

Consent / Authorization no change shall be made.

49. I / We undertake to furnish any other information within one month of its being called

by the Board.


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50. I / We enclosed herewith a demand draft of Rs. drawn in

favour of Maharashtra Pollution Control Board as the fee for Consent / Authorization

for a period upto .

Yours faithfully,

Signature :

Name :

Designation :

Accompaniments :

1. Index / Site Plan showing the surrounding such as village, town, river, sea shore,

Transport Routes etc.

2. Detailed layout plan of the factory premises showing structures, water supply line,

storm drain, sewers for domestic effluents, for trade effluents, location of effluent

treatment and its disposal and any other useful information, drawing, tables etc.

3. Manufacturing process of each product with flow diagram and material balance.

4. Latest Joint Vigilance sample analysis report.

5. Details of air pollution control devices provided or proposed to be provided.

6. Ambient air quality report, if available.

7. Small Scale Industry‟s Certificate / No Objection Certificate from Directorate of

Industries, Govt. of Maharashtra / D.G.T.D. Licence.

8. Xerox copy of consent granted under Air & Water (P.& C.P.) Acts.

9. TLV of raw material.

10. Gross block investment certificate from C.A. / audited balance sheet.

11. Process flow sheet.

12. Chemical reactions involved in each process.

13. NOC from local body for proposed industry.

14. Water budget calculations.


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APPLICATION FOR ENVIRONMENTAL CLEARANCE

ANNEXURE – D

APPLICATION FROM

GENERAL INFORMATION

1.1) Does the proposal related to New project / expansion /

renovation / modernization / others. (Give details)

1.2) Plant capacity

Name of project

Installed capacity

Expansion capacity

1.3) Total cost of the proposed project

1.4) Pollution abatment cost such as control equipment /

Pollution Monitoring / Green belt Development

2. DETAILS OF THE SITE

2.1) Does the site fall under notified industrial area (i.e.

Maharashtra Industrial Development Corporation,

Private / Co-operative Industrial Estate). If not,

details thereof.

2.2) Whether the proposed site falls within 500 mt. of

the high tide line and low tide line. If yes, distance

from high tide line.

2.3) Whether the proposed site falls in the Balkumb

Kolshet area (Thane District) / Murud Janjira

(Raigad District) / Dahanu Tq. (Thane District). If

yes, details of location.

2.4) Whether the proposed site is within a distance of 25

KM from National Park / Sanctuary / Biosphere

Reserve / Monuments / Heritage site / Reserve

Forests. If yes, details thereof.

2.5) Present use of the land i.e. Agriculture / Grazing /

Forest / Mangrove / Marshy / Industrial / Others.

2.6) TOTAL LAND REQUIRED

a) Plant

b) Storage

c) Future expansion


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d) Area covered under Green belt development

plan. Layout plan showing green belt. Details

of afforestation programme. ( Please enclosed)

2.7) Types of natural system and distance from the site

such as Forest / Grass land / Mangroves / Water

body / Water shed.

2.8) Human settlement distance from the site – Kind of

settlement.

3. WATER

3.1) Consent under Water Act

a) Whether obtained

b) Conditions imposed, if any. How these are

proposed to be complied

3.2) Water requirement

m3/per day.

3.3) Source of Water Supply (ground water Canal,

River, Public supply system etc.)

3.4) Water balance at site.

3.5) Lean season water availability.

WASTE WATER DETAILS

3.6) Total – daily discharge

1) Cooling

2) Processing

3) Domestic

4) Any other

3.7) Details of percentage of Recycling envisaged.

3.8) Details of effluent treatment method.

3.9) Effluent disposal by Open channel / Pipe line /

Covered drain / Others.

3.10) Final point of discharge (Land / Nallah / Stream /

Sewer / River / Estuary / Sea)

Distance from the plant.

3.11) If to be used for gardening / afforestation, give

land development details.

4. ATMOSPHERIC EMISSION


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4.1) Maharashtra Pollution Control Board Consent under

Air Act, 1981.

4.2) Climatic conditions at the site (i.e. Arid, Semi-Arid

etc.)

4.3) Maximum / Minimum / Mean Annual Temperature

/ Rainfall.

4.4) Frequency Inversion in different seasons.

4.5) Thermal heat.

a) Source

b) Method of abatment

4.6) Odour

a) Source

b) Method of abatment

4.7) Nature and concentration of Emission of SPM, gas

(Carbon Monoxide, Carbon Dioxide, NOx, CHn,

etc.) from the project.

4.8) Control measures proposed to mitigate the air

emission such as stack, Dust Collector etc.

4.9) Whether the control measures proposed will be

sufficient to control the air pollution.

5. SOLID / HAZARDOUS WASTES / TOXIC WASTE

5.1) Quality of Solid / Hazardous / Toxic Wastes

generated per months.

5.2) Nature of Solid / Hazardous / Toxic Waste.

5.3) Disposal method of Solid / Hazardous / Toxic

Wastes such as land fill, Incinerator.

5.4) Recovery / Recycling / Possibilities.

5.5) Possible user of Solid Waste.

5.6) a) Does the Toxic / Hazardous Waste attract

Hazardous Waste (Management Handling) Rules

1989. If yes, whether Authorization from

Maharashtra Pollution Control Board obtained.

b) Conditions in the Authorization. Indicate how

they are to be compiled with.

5.7) Method of disposal of Solid Waste.

a) Anticipated Environment problems.

b) Proposed mitigation measures.


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6. NOISE VIBRATION

6.1) Ambient Noise level

6.2) Source of Noise vibration during the operation of

the plant.

6.3) Noise and vibration control measures proposed.

6.4) Are the proposed control measures sufficient to

mitigate the Noise and vibration level.

7. ENERGY REQUIREMENT

7.1) Total power requirement

a) Existing

b) Proposed

7.2) Source of supply

7.3) Complete Environmental details to be furnished

separately if captive power unit is proposed.

8. PROCESS DETAILS

8.1) Detail Manufacturing process / flow chart and

technology transfer, if adopted.

8.2) Plant and Machinery and in-built anti-pollution

equipment.

RAW MATERIAL

8.3) List of Raw Materials used in process with quantity

tones per month (which attracts Hazardous

Chemicals Rules, 1989).

8.4) Precautionary measures adopted in transportation

and handling of / Explosive Material.

8.5) Provide layout plan of the plant or part or both

indicating area(s) where Hazardous / Hazardous /

Toxic / Flammable / Explosive Material(s) will be

stored.

8.6) Indicate safety distance and capacity of each

storage.

8.7) Storage facilities for Hazardous / Toxic /

Flammable / Explosive Material and safety

provision.

8.8) PRODUCTION

Main product MT/PM.

By-product MT/PM


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Intermediate product MT/PM

8.9) Are the proposed products banned abroad for

manufacturing.

8.10) Precautionary measures adopted in case of

Hazardous / Toxic / Flammable products.

8.11) The Quality of Hazardous substance to be stored,

the location of the tank area from Road /

Residential Area / Near Industries.

8.12) Risk assessment Report and Disaster Management

plan for the project in case Hazardous substance is

to be handled.

9. a) Environmental Impact Assessment

b) Environment Management Plan

10. Details of Environmental Management Cell.

I hereby give an undertaking that the data and information given above are true to the

best of my knowledge and belief and I am aware that if any part of the data / information

submitted is found to be false or misleading at any stage, the project be rejected and the

clearance given, if any, to the project is likely to be revoked at our risk and cost.

Signature of the applicant

with name and full address.

Date:

Place:

Given under the seal of organization on

behalf of whom the applicant is signing.

In respect to item for which data are not required or is not available as per the

declaration of project proponent, the project would be considered on that basis.

Report – prepared as per guidelines

of MOEF issued from time to time.

However, this may not be necessary

in case of projects covered in

Annexure “B” upto investment of

Rs. 20 crores and in Annexure “C”

if the investment is upto Rs. 10

Crores.

Application for Permission to Construct New Factory

Documents

Transcript of Application for Permission to Construct New Factory