FORM 1
CONSOLIDATED CONSENT & AUTHORIZATION
Application for consent for discharge/continuation of discharge under section 25/26 of the Water
(Prevention and Control of Pollution)Act ,1974 and for emissions/continuation of emission under section 21
of the Air (Prevention and Control of Pollution) Act, 1981 and for grant/renewal of authorisation for
generation or collection or storage or transport or reception or recycling or reuse or recovery or pre-
processing or co-processing or utilisation or treatment or disposal of hazardous and other waste under
Hazardous and other waste (Management and Transboundary Movement) Rules 2016 read with
Environment (Protection) Act 1986.
From , Dated
MAA VAISHNO GRANITE (OLD NAME 20/03/2023
K.N.R.C.), GATA No 1623 A, 1623 B, Vill
ALIPURA, KABRAI, Teh. MAHOBA, MAHOBA,
210424
City:
Block:Mahoba
District:MAHOBA
To ,
The Member Secretary,
U. P. Pollution Control Board,
Lucknow.
Sir,
I/We apply for Consolidated Consent to Operate and Authorization under section 25/26 of the Water
(Prevention and Control of Pollution) Act, 1974, under Section 21 of the Air (Prevention and Control of
Pollution) Act, 1981 and Hazardous and other Waste (Management and Transboundary Movement) Rules
2016 noted under Environment (Protection) Act 1986 to make discharge/emission/disposal of hazardous and
other waste from
SULABH SAXENA for a period upto 5 years
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 the quantity of discharge or its
quality, a fresh application for CONSENT shall be made and until such CONSENT is granted no
change shall be made
5. I /We hereby agree to submit to the Board and application for renewal of consent one month in
advance of the date of expiry of the consent period
6. I/We undertake to furnish other information within one month of its being called by the Board.
Accompaniments:-
1. CONSENT WATER (Attached)
2. CONSENT AIR (Attached)
3. NOC (Attached)
4. Report showing project cost (Attached)
Yours faithfully,
Signature
Name of the applicant: SULABH SAXENA
Address of the Applicant: 625, GANDHI NAGAR,
MAHOBA
ANNEXURE TO FORM
New Outlet
NOTE- Any applicant knowingly giving incorrect information or suppressing any information pertaining
thereto shall be liable to be punished under the Act.
While filling this Annexure the applicant not concerned with any of the item shall state 'No concerned'
against the relevant one:
7. Is the industry/factory for which application is made Yes
closed on Sunday/Holiday
8. State working days per year and working season for the Aug to Jul
industry/factory
9. a) Number of workers attending the factory shift wise &/ 20
or per day :
b) Number of workers residing in the premises : 20
10. For local bodies only:-
a)Present population :
b)Population covered under regular sewer facilities :
c)population having septic tank/Soak pit facilities :
d)Population covered by conservancy latrines :
11. For Industries Only:-
A. Give the list of raw materials
Raw Material Material Trade Qty Principle Use
Name Name
STONE STONE 550 CRUSHING
BOULDER BOULDER
(Ton/Day)
Fuel Details:-
Fuel Consumption
Diesel 1.3
B. Give the list Products and By Product Details
Product Name Quantity
STONE GRIT(Ton/Day) 500
ByProduct Name Licence Qty Installed Qty
STONE DUST (Ton/Day) 50 50
C. Give the list of possible Inter-mediate Products:
Name of Product Quantity per month
Section A
12. State daily quantity of water utilized :
Source Consumption Quantity
Domestic 1.0
Others(Plantation) 1.0
Others(Dust Suppression) 2.0
13. A) State the hourly maximum and daily quantity of effluents arising from land/premises for which
the application is made:
Generation Waste Water Generation Quantity
Domestic 0.5
(B) State how measurement of rate and quantity are carried
out:
14. State whether storm water drains are kept separate from Yes
Industrial / Domestic Effluents?
15. (a)Is domestic effluent allowed to get mixed in industrial No
effluents?
16. (a)Describe if any treatment industrial or domestic effluent Yes
or one for combined effluent is made.
If yes, state the process of treatment in brief
(b)Is the quantity of effluent emanating either without or Yes
after treatment approved by the authority?
(c)If approved, furnish the authority (Two certified copies
to be sent)
(d)If any effluent from any shop/ shops toxic? If so
volume of this effluent
17. Is there any provision for disposal ?
Name Status (Already made) Status (proposed to)
18. State the area of land used for
(a)Above in Hectares
19. Give the quantitative disposal of effluent in liters provided for the places mentioned below
Name Mode Mixed
20. Is there any provision for equalizing or made holding lagoons of tanks
Name Mode
Domestic 0.5
21. Is sufficient land available / can be made available? In Yes
case pumping effluent: on lands have to considered.
22. (a)Give details of composition of Domestic / Industrial / Combined effluent in respect of the
Following
Name of Effluent Effluent before treatment Effluent after treatment
Note:-
1)Furnish a copy of the analysis report of representative samples carried out by a competent laboratory
2)Methods of determination as approved by the Board will be followed for determination of above
mentioned parameters.
(b)Is the effluent toxic Yes
(c)State if the Industrial effluent is having Unpleasant Smell
(d)Is there any hidden change of temperature exceeding Yes
10*c at any time
23. (a)Are facilities available with the applicant for carrying out the following test of the waste waters
Name Existing Proposed
(b)If yes, give details of equipments
24. Has the land/premises, etc., for which the application is Yes
made open?
Highly polluting material :
Toxic Organic Inorganic Microbilogical : Cooling Tank
25. State details for solid waste
Type of Solid Composition Quantity Method of Method of
Waste Collection Disposal
Section A
New
12. Fuel Consumption in Tonnes/day
Fuel Name Daily Unit Calorific Ash Sulphur Others
Comsumpt value contents contents
ion(T/day)
13. Atmospheric Emission from each stack
Total no. of stacks:
Material for construction of
Stack:
Stack Attached to:
Height above ground level(in
metres):
Height above roof(in metres):
Stack Top:
Inner dimensions (in meters):
Gas quantity-m^3/hr:
Flue gas temperature 'C:
Exit velocity of gas/sec:
(a) Flue gas emission
Stack Type of Quantit Type of So2 Nox CO/HC Particul Others
No. fuel y of firing ates
fuel/hr
(b) Process Emission
Quantity of So2 Co2 Analysis of Particulates Other
gas (in vent in mg/Nm3 Specify
Nm^3/hr) hydrocarbon
s
(c) Particulate analysis :
(d) Chemical Composition(if available) :
14. Give details of flue gas sampling arrangements :
15. Give details of laboratory facilities available for :
analysis of emission
16. Is there sufficient space available for installing air :
pollution control equipment
17. Details of Air Pollution :-
Stack Name Equipment Name State
18. State the total quantity of air handled by ventilation equipments,specify size and [Link]
equipments, installed or to be installed
Equipment Name Equipment Size No. of equipments Status
19. Give the following details
(a) Total investment in the factory and the year of : Investment:-33418440
investment. Year of Investment is :-1925
(b) The estimated expenditure for implementation of :
the scheme to control air pollution
(c) Expenditure incurred to update progress :
achieved(physical) for air pollution control, if any,
and the year/years of investment along with physical
progress achieved. The firm should give details of
action taken to date and the expenditure incurred and
the time required for the scheme.
(d) Annual operation and maintenance-cost of Air :
Pollution Control Plant, if any
(e) Further action that is being taken up by the firm :
to control air pollution.
20. Other relevent information, if any :
Signature
Name and Address of the applicant on
behalf of : SULABH SAXENA,625,
GANDHI NAGAR, MAHOBA
Name and Address of the Firm on behalf
of which application is made : SULABH
SAXENA,625, GANDHI NAGAR,
MAHOBA
Explanatory Notes for filing in form and the Annexure .
The notes are given only for those items for which explanations is considered desirable .
Form-
[Link] mention the name of the owner of the land/premises, if other than the applicant industry or factory in
continuation of legal business as per Air (Prevention and Control of Pollution) Act,1981. lf the
land/premises belongs to the factory/ industry, say self
[Link] mention the date up to which the consent is sought for.
Annexure to form-
'Existing 'means that which is operation at the time of applying for consent .
'New' that which has been modified due to change in quantity and/or qua|ity of emission.
'Altered' means that which has been modified due to change in quantity and/or quality of discharge
arrangement and/or point of discharge etc.
Item 1 :Here mention name of the owner of the land/premises if other than the applicant industry or factory
in continuation of of legal busines as per Air (Prevention and Control of Polution ) Act ,1981 if
land/premises belong to the factory/industry say self .
Item 1(a) : The industrtes are categorised based on the investment as follows : Major industry- having
investment of more than 2 crores. Medium industry- having investment of 10 lakhs to 2 [Link] scale
industry having investment of less than 10 lakhs rupees
In place of above criteria kindly give category as per latest notification
Item 2 :Here give the registered name of the industry/institution factory/local bodies etc under which the
business is carried out.
Item 6 : Applicable to only those are as which are prohibited areas such astheOrdinance Factories, Mint, etc.
Item 10(c) : Here State the temperature in C in summer winter monsoon and post monsoon seas on.
Item 10(d) : Here state the seasonal average wind direction and speed in and around the site of the plant. The
above information can be had from representative Meterological centre .
Item 13 : Analysis of the flue gas emission, process emission and particulars analysis should be done for
each stack, emissions. Where ever stacks are not provided the shop floor specific concentration should be
reported . Chemical Analysis of particulars matter in the emission should be furnished giving details such as
organic matter ,metals ,non-metals , redioactive, substances, asbastos, silicates etc.
Item 17 : Here mention the detailed specifications of control system used or proposed to be used with
efflciency . Also furnish ihe layout of the control system with dimensions.
Item 18 : Here state the total quantity of ventilation air handled by equipments' such as roof extractors,
Evaporative coolers etc
Additional Documents suggested for submission:
1 :Separate Demand Draft towards consent fee Water & Air .
2 : Annual Report or certificate frorn Chartered Accountants in support of fixed assets,current assets and
current liabilities .
3 :Layout plan showing the location of stacks (chimneys), effluent treatment plant, effluent disposal areas,
air pollution control devices, hazardous waste treatment and disposal areast .
4 : Manufacturing process flow sheet, with description note on the manufacturing process for each product .
5 : Copies of latest consenVauthorisation/Environmental Impact Assessment Clearance .
6 : Copies of SSI registration Letter of IntenV industrial licenses, clearances from the Department or any
other relevant document (ifapplicable) .
7 : Copies of planning permission certificate issued by the local bodies/District Town & Country
Planning/Metropolitan Development Authorities .
8 : Compliance report on the latest CTE /CTO conditions stipulated under Water & Air Acts issued to the
Unit .
Common General Information required for consent to operate under Water Pollution
(Prevention & Control) Act, 1974 and Air Water Pollution (Prevention & Control)Act,
1981.
1. (a) Full name of the applicant with address : SULABH SAXENA,625, GANDHI
NAGAR, MAHOBA
(Tel. No.) -
(b) Is the firm registered? : YES
(c) If yes, give the number & date of registration and
: ,
authority with whom registered.
(d) Full Address of the registered office :
(e) Names, designation and full address of persons like : SULABH SAXENA
Partners, Managing Director/Manager etc. 625, GANDHI NAGAR, MAHOBA
MAHOBA
8318391252
(f) Under which category does the industry fall: : small
Large/Medium/Small Scale.
2. Full name of the : MAA VAISHNO GRANITE (OLD
Land/Premises/Institute/Factory/Industry/Local body NAME K.N.R.C.)
with address
Address:GATA No 1623 A, 1623 B,
Vill ALIPURA, KABRAI, Teh.
MAHOBA, MAHOBA, 210424
Tel. No.:-
E-mail :
3. Give revenue /City Survey No. of the land/premises : District:MAHOBA
for which the application is made: Town/Village:
City Survey no./Revenue Survey no.:
Khata No.:
Area in Hectares:
4. State month and year in which the plant was actually : June,2007
put into commissions or is proposed to be put into
commission:
5. State the Civil/Military /Defence/industrial Estate etc. : Civil
under whose administrative jurisdiction the
occupiers/industrial plant is situated: District:MAHOBA
Corporation:
Village Panchayat
Contonment:
Defence Deptt:
State Govt:
Prohibited areas:
Others:
6. (a) State whether plant site has been declared as : NO
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
