Download Application for Consent for Discharge

The accompanying form in triplicate to be submitted- Member-Secretary, Meghalaya Pollution Control Board, Shillong EXPLANATORY NOTE FOR FILLING FORM 'A' AND THE ANNEXURE The notes are given only for those which explanation is considered desirable. Other items are self-explanatory. FORM A (1) Here mention the names of the declared Area. (2) Here mention the name of the owner of the land/premises if other than the applicant industry or factory. If the land (premises belong to the factory/industry, say self). (3) Here mention the case as to which the consent is sought far. (4) Here mention the local name of the river/stream tidal waters/sea, as may be applicable. ANNEXURE TO FORM 'A'- Outlet means the arrangement for discharge of the effluent for which the consent is sought for. Discharging means the effluent going out of the outlet. Existing means that which is in operation at the time of applying for the consent. New means that which will be brought into operation in future. Altered means that which has been modified due to changes in quantity and/or quality of discharge arrangement and/or point of discharge etc. Item 1 Here give the name of t he person who is authorized by the Institution/ Industry/factory/local body etc., to transact their legal business. Item 2 Here give the registered name of the institution/factory/Industry etc. under which the business is carried out. Item 5 Here state the concerned institution such as M.I.D.C., C.LD.C.O. etc. under whose administrative control the factory/Industry etc. set up. Item 6 Applicable to only those areas which are prohibited areas such as the Ordinance Factories, Mint etc. Item 13(B) State the method of measurement of hourly/daily maximum quantity of effluents i.e., by flow meters, venturi meters, V notch, Sump measurements, or approximately estimated etc. Item 16(A) If the effluent is treated, give separately the method of treatment and flow diagram of the treatment process. Item 16(B) Here mention 'Yes' if any other authority such as the local body, M.I.D.C., or State Department has already approved the discharge of effluent either with or without treatment, at the time of establishment of factory/ Industry Item 19 Here give the quantity of effluent of different types such as domestic, industrial or mixed etc. proposed to be or is let into the strum/river, lands, lakes, sea etc. as may be applicable. Item 22(a) Analysis to be furnished shall cover as many parameters as are expected to be found to the effluent. If some of the parameters are not expected to be found, say not applicable. If some or the parameters other than those listed under the items are expected, the same may be mentioned at the end. The analysis report shall be separately furnished for domestic, industrial and combined effluents. Item 22(b) Here toxicity means the which is established by bio-assay studies on fish as per procedure given in the standard methods. Item 24 This item is meant to cover such highly Polluting substances which do not ordinarily find way in the effluents, but are required to be handled in the premises and which may, by accident, join the effluent in large quantities. Price Rs. One Hundred only (To be submitted in Triplicate) FORM 'A' APPLICATION FOR CONSENT FOR DISCHARGE UNDER SECTION 25/26 OF THE WATER ACT, 1974 Application for consent for discharge in (1) ........................... ............................................. Area which is a "Water Pollution Prevention Area" ........................ From: ................... ................... ................... To, The Member-Secretary, Meghalaya Pollution Control Board, Shillong. Sir, I/We hereby apply for CONSENT under the Water (Prevention & Pollution) Act, 1974 to make discharge for land/premises owned by (2) .......................... ................................................... (3) (a) Sullage/Sewage via drains outfall sewers/treatment works (b) Trade effluent via drains/outfall sewer/treatment works. (c) Solid wastes into (4)- (i) Stream ................... River OR (ii) On land for irrigation, bearing Survey No. ....... Adjoining at a distance of ...... stream/river OR (iii) Lake, pond adjoining/at a distance of ................Stream/River OR (iv) Directly on land for open percolation into subterrianian strata of Survey No. ............ adjoining at a distance of ...................Stream/River OR (v) Tidal waters/estuarine waters known as ......................... 2. The annexure, appendices, other particulars and plans in triplicate are attached herewith. 3. I/We further declare that the information furnished in the Annexure/Appendices, and plans is correct to the best of my/our knowledge. 4. I/We hereby submit that in case of change either of the point or quantity discharge or its quality a fresh application for CONSENT shall be made and until such CONSENT is granted, no change shall be made. P.T.O 5. I/We hereby agree to submit to the Board, an application for renewal of CONSENT four month in advance of the date of expiry of the consented period for outlet/discharge, if to be continued thereafter. 6. I/We undertake to furnish any other information within one month of its being called by the Board. Yours Faithfully, Signature ................. Name of Applicant............... ...................... Address of applicant ............ ...................... ...................... Accompaniments (Note - Strike out entries not relevant) ANNEXURE TO FORM - A Existing Outlet/Discharge ____________________________ New/Altered Note:- Any applicant knowingly giving incorrect information or suppressing any information pertaining thereto shall be liable to punishment under the Act. While filling this Annexure the Applicant not concerned with any of the items shall state "Not concerned" against the relevant one. 1. Full Name of Applicant with address ................................................................... ...................... ...................... (Tel. No.) .................... 2. Full Name of land/premises/institute/factory/ industry/Local Body with Address. ................................................................... ...................... ...................... (Tel. No.) .................... 3. Give revenue/city survey No. of land/premises for which the application is make stating District, Taluka and Village District ..................... Taluka ................... Town .................... Village .................... City Survey No. ............... Area in Hectares ............... Revenue Survey No. .............. Area in Hectares ............... 4. State month & year in which the land/premises/ institute/factory/industry/ was actually put into commission, or in proposed to be put into commission, or the month and year from which the local body id functioning. 5. State the Civil/Military Defence/Industrial Estate. Under whose administrative jurisdiction the application's land/premises is situated. Collectorate ................... Corporation ................... Municipality .................. Village Panchayat/Cantonment .......... Defence Department .............. State Government ................ Prohibited Area ................ 6. (a) State whether land/Premises/factory/industry has been declared as prohibited area. (b) If yes, state the name of the authority and furnish a certified copy of the order under which the area has been declared as prohibited area. 7. Is the Industry/factory for which application is made closed on Sunday/holiday. Yes/No 8. State working seasons per year for the industry/factory Full Year From To From To From To From To ____________________Every Year 9. (a) Number of workers attending the factory Shift No. 1 Shift No. 2 Shift No. 1 Hrs. Hrs. Hrs. (b) Number of workers residing in the pemises 10. (For Local Bodies only) (a) Present population (b) Population covered by regular sewerage facilities .................... (c) Population covered by conservancy latrines (d) Population having septic tanks/pit/privy facilities 11. Give the list of raw materials such as metals, alloys, chemicals, oils, fuels, etc. used per month Metric Tonnes:- Metal and Alloy Name Weight Chemical Inorganic/Dyes Organic/Pesticides Name Weight Oil and Grease Name Weight Fuels (a) Wood Name Weight (b) Coal Name Weight (c) Gases Name Weight (d) Other Name Weight (b) Give the list of Names of Products and by Products manufactured per month in MT Serial No. Name of Product Quantity in MT per month 12. State the daily quantity of water in litres utilized- USES Domestic Industrial Agriculture Other 13. State the hourly maximum and daily maximum which the application is made; Quantity of effluent arising from land Premises for In litres (a) Domestic Hourly Maximum Daily Maximum (b) Industrial (c) Agriculture (d) Other use (e) Total quantity of effluent (B) State how measurements for rate and quantity are carried out ................. 14. State whether storm water drains are kept separate from Industrial/domestic effluent drains Yes/No 15. (a) Is domestic effluent allowed to get mixed in Industrial/Domestic effluent drains Yes/No (b) If yes, state the ratio. Domestic/Industrial 16. (a) Describe, if any, treatment for industrial or domestic effluent or one for combined effluent is made? If yes, state the process of treatment in brief (separately) Yes/No (b) Is the quality of effluent emanating either without or after treatment approved by any authority. Yes/No (c) If approved, furnish the authority (Two certified copies to be served) 17. Is there any provision for disposal of Already made Proposed to be made (a) Domestic effluent in public underground sewer Yes/No Yes/No (b) Industrial effluent in public underground sewer Yes/No Yes/No (c) Give the name of public authority owning the sewer Yes/No Yes/No 18. Is there any provision for disposal of Already made Proposed to be made (a) Domestic effluent over land for irrigation Yes/No Yes/No (b) Industrial effluent over land for irrigation Yes/No Yes/No (c) Domestic effluent in the underground strata Yes/No Yes/No (d) State the area of land used for (a) above in hectares (e) State the area of land used for (b) above in hectares 19. (a) Give quantitative disposal of effluent in litres per day for the places mentioned below:- Domestic Industrial Mixed (i) Stream/River ............... (ii) On lands for irrigation ............ (iii) On lands for percolation .......... (iv) Lake/Pond ................ (b) If disposal into Stream/River, State (i) Ratio of volume effluent to receiving water at the point of discharge during the driest & the monsoon periods. (ii) Maximum safe carrying capacity of Stream/River 20. Is there any provision for equalizing or holding Lagoons for tanks to store the effluent during unfavourable stream or tidal conditions:- Already made Proposed to be made (i) Domestic effluent .............. (ii) Industrial effluent .............. (iii) Combined effluent ............ 21 Is sufficient land available/can be made available in case of disposal of pumping effluent or land will have to be considered? Yes/No 22. (a) Give details of composition of Domestic/industrial/Combined effluents in respect of the following:- Effluent before treatment Effluent before Treatment At Max. Dis. (1) At Min. dis. (2) At Ave. dis. (3) At Max. Dis. (1) At Min. dis. (2) At Ave. dis. (3) (i) PH (ii) Colour-Units (iii) Temperature 0C (iv) Suspend solids (a) Total mg/l. (b) Fixed mg/I (c) Volatile mg/I (v) Dissolved solids (a) Total mg/l. (b) Fixed mg/I (c) Volatile mg/I (vi) Total Volatile solids mg/I (vii) (a) Ammoniacal Nitrogen mg/I (b) Free ammonia as NH3 (viii) Nitrates (mg/I) N (ix) Dissolved oxygen mg/I (x) B.O.D. 5, days 200C mg/I (xi) C.O.D. mg/I (xii) Oil and greases mg/I (xiii) Chloride, (as Cl), mg/I (xiv) Phosphates (P), mg/I (xv) Phenolic coumpounds, (as Phenol), mg/I (xvi) Cyanides (as CN) mg/I (xvii) Sulphates (as SO4) mg/I (xviii) Sulphrdes (as S) mg/I (xix) Sulphites (as SO3), mg/I (xx) Insecticides mg/I (xxi) Total residual chlorine (as Cl2) mg/I (xxii) Fluoride (as F), mg/I (xxiii) Boron (as B) mg/I (xxiv) Arsenic (as As) mg/I (xxv) Barium (as Ba), mg/I (xxvi) Percent Sodium (xxvii) Cadmium (as Cd) mg/I (xxviii) Copper (as Cu), mg/I (xxix) Lead (as Pb), mg/I (xxx) Chromium:- (a) as Cr. mg/I (b) Hexa valency (as Cr) mg/I (xxxi) Mercury (as Hg.) mg/I (xxxii) Nickel (as Ni.), mg/I (xxxiii) Selenium (as Se), mg/I (xxxiv) Silver (as Ag), mg/I (xxxv) Zinc (as Zn), mg/I (xxxvi) (a) Iron (as Fe), Maganese (as Mr), mg/I (b) any other Metals, mg/I (xxxvii) Carbon Chloroform Extracts (xxxviii) (a) Pesticides (mg/I) (name) (b) Herbicides (mg/I) (name) (xxxix) Coliform organisms MPN. Per 100ml. (monthly average) (xE) Bioassay for Toxic constituents' TL. 50 (96 hours). Note:- (i) Furnish a copy of the analysis report of representative samples carried out by a competent laboratory. (ii) Methods of determination as approved by the Board will be followed for determination of above mentioned parameters. 22. (b) In the effluent toxic Yes/No (c) State if the industrial effluent is having Yes/No (i) Unpleasant smell Yes/No (ii) Irrigating and/or harmful Yes/No (iii) Corrosive Yes/No (d) Is there any sudden change of temperature exceeding 10oC at any time. 23 (a) Are facilities available with the applicant for carrying out the following testes of the waste Water Existing Proposed (i) Physical Yes/No Yes/No (ii) Chemical Yes/No Yes/No (iii) Bacteriological Yes/No Yes/No (iv) Toxicological Yes/No Yes/No (b) If yes, details of equipment. 24. Has the Land/Premises, etc. for which application is made, open? Highly polluting matter Toxic Organic Inorganic Microbiological 25 State details for solid water Seasonal water, spillage, Rejected Materials Description Quality Method of Collection Method of disposal Signature ........... Name and Address of the applicant on behalf of .............. ................. Name and Address of the firm.... ................