9/30/2019 Single Window Clearance

Home   See All Services

The form available on this page is not saved and submitted to MIDC online.
If you need to submit the forms online to MIDC, please Register here or login using your login credentials.

Property Details

Fields marked with (*) are mandatory.

Applicant Information

* Name :
Address :

Upto 500 characters.

State : ---Select--- District : ---Select---
City/Town : PIN :
Contact Phone : * Contact Mobile :

Education Qualification : Special Category : Select

* Contact Email : Preference Category : Select

Registered Office Details

* Company Name :
Address :

Upto 500 characters.

State : ---Select--- District : ---Select---
City / Town : PIN :
Phone : Fax :
Website : * Constitution Type : Select

* Contact Email1 : Contact Email3 :

Contact Email2 : Contact Email4 :
Note: Contacts will receive email alerts on MIDC Queries & Processing at the above email addresses.
Property Details
Is Plot MIDC or Non-MIDC ? : MIDC

District of present unit : ---Select---

* Industrial Area of present unit : ---Select---
Note:-  Please enter plot number in the format "Block Number-Unit Number"
Use "-" as separator between the Block Number and the Unit Number.
e.g-123,In cases where there is no block number
e.g-C-123,In cases where there is a block number allotted.
In case if you have multiple adjacent Plots then please mention all the plot numbers separated by a ","
e.g.-A-1,A-2,A-3,A-4,A-5,A-6,A-7
* Present Property No. :
(Plot/Shed/Gala)
* Area in m2 :

Plot/Unit Contact Information

Unit Phone No. : Unit Fax No. :

Unit Email Address :

* Type of Industry/Activity : Engineering Details, If others

https://services.midcindia.org/services/FillFormAnon.aspx?AMId=514 1/10
9/30/2019 Single Window Clearance

EM Acknowledgement
Number :
(If Applicable)
Date of Acknowledgement :

Application form for Application for Consent Authorisation

   
FORM
Common Application for Consent under Water (Prevention and Control of Pollution) Act, 1974, Air (Prevention and Control of Pollution) Act,
1981 and Authorization under Hazardous Wastes (Management and Handling) Rules, 1989 as amended.
                                No. ..........
Accompanying form in triplicate to be submitted by the applicant. One copy may be retained by the applicant.
Explanatory note for filling in application form for Consent/Authorization
1. Any applicant knowingly giving incorrect information or suppressing any Information pertaining to any of the items of the application shall
be liable for punishment as per provisions under the relevant Act.
2. The application form shall be submitted at the respective Sub - Regional Officer of the Board under whose jurisdiction the applicant‘s
activity falls.
3. The application shall be accompanied by the consent fee in the form of Demand Draft in favor of Maharashtra Pollution Control Board. Fee
paid is Not refundable
4. For the items marked * strike out which is not relevant
5. If any of the items is not relevant to the activity of the applicant, please state ”Not Applicable‘.
6. If the space for reply provided for any item is inadequate, use additional sheets, duly referenced.
7. Item 1 : Give the name of the person who is authorized by the applicant to transact their business.
8. Item 2 : Also state the concerned instructions under whose administrative area the unit falls.
9. The form shall be accompanied by the relevant documents specified on the last page of the application.
10. Capital Investment -Consent fee is to be paid based on gross block investment of the unit without depreciation till the date of application.
The gross block capital investment shall include cost of land, building, plant and machinery without depreciation same shall be certified by
Chartered Accountant. In case of proposed unit total project cost shall be considered.
Note: The from may be get download from the MPCB Website: http://mpcb.mah.nic.in From fee of Rs.100/- may be added in the current fee
in case the downloaded from is use
 
-2-
PAYMENT OF CONSENT FEES
The Fee Structure is as under :-

Capital investment of industry

Sr.No (Including land ,Building,Machinery Consent to Establish Consent to Operate
withought depreciation)

0.01% of Capital Investment  0.01% of 0.01% of Capital Investment  0.01% of

1. More than Rs. 100 Crores
Capital Investment Capital Investment
2. Between Rs. 50 Crs. to 100 Crs. Rs.75,000/- Rs.75,000/-
3. Between Rs. 10 Crs. to 50Crs. Rs.50,000/- Rs.50,000/-
4. Between Rs. 5 Crs. to 10 Crs. Rs.20,000/- Rs.20,000/-
5. Between Rs. 1 Crs. to 5 Crs. Rs.10,000/- Rs.10,000/-
6. Between Rs. 60 Lacs. to 1 Crs. Rs.3,000/- Rs.3,000/-
7. Between Rs. 10 Lacs. to 60 Lacs. Rs.1,500/- Rs.1,500/-
8. Below Rs.10 Lacs Rs.500/- Rs.500/-

The industries have been classified in different categories such as -

RED, ORANGE, GREEN depending on pollution potential. The above referred consent fee for Combined Consent to Operate is for a period of
1, 2, 3 years for industries in RED, ORANGE & GREEN category respectively. The industries can opt for multiple period of consent (maximum
up to five times ) by paying corresponding higher fee, subject to their complying with requirement of installation of pollution control facilities
 
Fees for Local Bodies (under Water (P.&.C. P.) Act,1974 only.
Municipal Corporation Rs. 20,000/-

https://services.midcindia.org/services/FillFormAnon.aspx?AMId=514 2/10
9/30/2019 Single Window Clearance

—A“ Grade Municipal Corporation Rs. 10,000/-

—B“ Grade Municipal Corporation Rs. 5,000/-
—C“ Grade Municipal Corporation Rs. 2,000/-
 
Consent fees should be paid by way of Demand Draft drawn in favour of "MAHARASHTRA POLLUTION CONTROL BOARD“ only. Payable at
the HQ of the concerned Sub-Regional Officer.
 
-1-
Application for Consent/Authorisation

Date:

From

To,
The
Maharashtra Pollution Control Board,

Sir,
I/We hereby apply for *
(i) Consent to Establish⁄Operate⁄Renewal of consent under section 25 and 26 of the Water (Prevention & Control of Pollution) Act, 1974 as amen

Part A : General

1 *(a). Name of the Industry :

Designation, office address with e-mail of

  *(b). the Applicant Occupier/ Industry/Institution :
/Local Body.

  (c). Zip Code :

  (d). Telephone No :
  (e). FAX :
2 *(a) District : Ahmednagar

Name and location of the industrial

unit/premises for which the application is
  *(b) made. (Give Revenue Survey Number/Plot :
number name Of Taluka and District,also
telephone and fax Number)

Details of the planning permissions

obtained from the local body /Town and
(b) Country Planning Authority/Metropolitan :
Development authority/ Designated
Authority.

Name of the local body under whose

(c) jurisdiction the unit is located and name of :
the licence issuing Authority.

3 Names, addresses with telephone and fax :

Number of Managing Director / Managing
Partner and officer Responsible for matters

https://services.midcindia.org/services/FillFormAnon.aspx?AMId=514 3/10
9/30/2019 Single Window Clearance

connected with pollution Control and/or

Hazardous waste disposal.

Yes
4 (a) Are you registered Industrial unit ? :
No

If yes, give the number and date of

(b) :
Registration :

5 *(a) 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)
  (b) Investment Verified From :

If the site is located near sea-shore/river

bank/ other water bodies/Highway.
6 :
Indicate the crow fly distance and the name
of the water body, if any.

Does the location satisfy the requirement

under Relevant Central/State Govt.
7 Notification such as Coastal Regulation :
Zone. Industrial Location policy, Etc. If so
give details.
If the site is situated in the notified
8 :
Industrial estate
Whether effluent collection, treatment and
Yes
(a) disposal system has been provided by the :
No
authority.
Will the applicant utilise the system, if Yes
(b) :
provided. No

If not provided, details of proposed

(c) :
arrangement

9 (a) Total plot area. :

(b) Built-up area :
area available for the use of treated
(c) sewage/trade effluent for gardening/ :
Irrigation.
Month and year of commissioning of the
10 : Select
unit.
Workers Staff Hrs. Of shifts Weekly off
11 Number of workers and office staff. :

Do you have a residential colony within the

Yes
12 (a) premises in respect of which the present :
No
Application is made?
(b) If yes, please state population staying : :
Indicate its location and distance with
(c) :
reference to plant site.
List of products and by-products
manufactured in tonnes/months, kl/month
or numbers/month with their types i.e.
13 :
Dyes, drugs etc. (Give figures
corresponding to maximum installed
production capacity.

https://services.midcindia.org/services/FillFormAnon.aspx?AMId=514 4/10
9/30/2019 Single Window Clearance

14 List of raw materials and process chemicals :

with annual consumption corresponding to
above stated Production figures, in
tonnes/month or kl/month or
Numbers/month.
Description of process of manufacture for
each of the products showing input,
output, quality and Quantity of solid, liquid
15 and gaseous 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

Water consumption for different uses

16 :
(m3/day)
Industrial cooling, spraying in mine pits or
(i) boiler feed, propulsion of hydro generation
sets.
(ii) Domestic purpose
Processing whereby water gets polluted
(iii) and the pollutants are easily bio- :
degradable.
Processing whereby water gets polluted
(iv) and the pollutants are not easily Bio- :
degradable and are Toxic.
(v) Other such as agriculture, gardening etc. : Total : 

Source of water supply, name of authority

17 granting permission if applicable and :
quantity Permitted

Quantity of waste water (effluent)

18 :
generated (m3/day)
(i) Domestic : (v) Boiler Blowdown : :
Cooling water
(ii) Industrial : (vi) :
blowdown
DM Plant/Softening
(iii) Process : (vii) :
Plant washings.
Tall race discharge
(iv) Washings : (viii) from Hydro power :
station.

Water budget calculations accounting for

19 difference between water consumption and
effluent generated.

Present treatment of sewage /canteen

20 effluent (Give sizes/capacities of Treatment :
units).

Present treatment of trade effluent (Give

sizes/capacities of treatment units) (A
schematic diagram of the treatment scheme
21 With inlet/outlet characteristics of each unit :
Operation/process is to be provided.
Include Details of residue Management
system (ETP Sludges)
Are sewage and trade effluents mixed Yes
22 (a) :
together ? No
If yes, state at which stage – whether
(b) : Before
before, intermitently or after treatment.
Capacity of treated effluent sump ,Guard
23   :
pond if any.

https://services.midcindia.org/services/FillFormAnon.aspx?AMId=514 5/10
9/30/2019 Single Window Clearance

24 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) :
On land for irrigation on owned land/lease
(v) land. Specify cropped area. (To be :
supported by relevant documents)

Quantity of treated effluent reused/

recycled. m3/day. Provide a location map of
(vi) :
disposal Arrangement indicating the
outler(s) for sampling.

Provide a location map of disposal

(vii) arrangement indicating the outler(s) for :
sampling.

Quality of untreated/treated effluents

(Specify pH and concentration of SS. BOD.
25 (a) COD And specific pollutants relevant to the :
industry. TDS to be reported for disposal on
land or into Stream/river.
Enclose a copy of latest report of analysis
from The laboratory approved by state
Board/ Committee /Central Board/ Central
(b) :
Government in the ministry Of Environment
expected characteristics of the
Untreated/treated effluent.
Part – C : Air emission aspects

26 Fuel consumption : Coal LSHS Furnace Oil Natural Gas Other (Specify)
(a) Fuel consumption (TPD/KLD) :
(b) Calorific value :
(c) Ash content % :
(d) Sulphur content % :
(e) Other (specify) :

Details of stack (process & fuel Stacks;

27 (A) : 1. 2. 3. 4.
D.G. Set)
(a) Stack number(s) :
(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 oC :
(l) Exit gas velocity, m/sec. :
(m) Control equipment preceding the stack :
Nature of pollutants likely to present in
(n) the stack Gases such as Cl2, NOx, Sox, :
TPM etc.
(o) Emissions control system provided :
(p) In case of D.G. Set power generation :
capacity in KVA (Attach specifications
including residue Management systems
of each of the control Equipment
https://services.midcindia.org/services/FillFormAnon.aspx?AMId=514 6/10
9/30/2019 Single Window Clearance

indicating inlet/outlet concentration of

relevant pollutants)

Whether any release of odoriferous

compounds such as Mercaptans, Phorate
27 (B) :
etc, are coming out From any storages or
process house.

Do you have adequate facility for collection

of samples of emissions in the form of port
28 Holes. Platform, ladder etc., As per Central :
Board Publication “Emission regulations
Part-III” (December, 1985)
Quality of treated flue gas emissions and
process Emissions. (Specify concentration of
criteria pollutants and Industry/process-
specific pollutants stack- wise Enclose a
29 copy of the latest report of analysis from :
The laboratory approved by State ministry
of Environment & forests. For proposed unit
furnish Expected characteristics of the
emissions.
Part – D : Hazardous Waste aspect

Information about Hazardous Waste

management as defined in Hazardous
30 :
Waste (Management & Handling ) Rules,
1989 as amended in Jan.2000.

Type/Category of Waste as per

------------------------------------------
Schedule-I Schedule-II Method of
Qty kg/day
Cat.No. Type Class Type Collection Reception Storage Transport Treatment Disposal

Please refer to copy of Schedule-I & II attached

31 Details about use of hazardous waste :
(i) Name of hazardous waste/ spent chemical :
(ii) Quantity used/month :

(iii) Party from whom purchased :

(iv) Party to whom sold :

Details about technical capability and

32 (a) Equipments available with the applicant to :
Handle the Hazardous Waste.

(b) Characteristics of hazardous waste(s). :

Specify concentration of relevnt of analysis
Or from the laboratory approved by State

https://services.midcindia.org/services/FillFormAnon.aspx?AMId=514 7/10
9/30/2019 Single Window Clearance

Board/central Govt. In the ministry of

Environment & forests. For proposed units
Furnish expected characteristics.

Copy of format of manifest/record. Keeping

33 :
practised by the applicant.

Details of self monitoring (source and

34 :
Environment system)

Are you using any imported hazardous

35 :
waste. If yes, give details.

Copy of actual user Registration/certificate

36 obtained from Ministry of Environment & :
Forests, GOI, for use of hazardous waste.

Present treatment of hazardous waste,: If

37 any (give type and capacity of treatment :
Units)

Quantity of hazardous waste disposal:

38 (i) :
Within factory

Outside the factory (specify location and

(ii) :
enclose Copies of agreement.)

Through sale (enclosed documentary proof

(iii) :
and Copies of Agreement.)

Outside state/Union Territory, if yes,

(iv) :
particulars Of (1 & 3) above.

(v) Other (Specify) :

Part – E: Additional Information

Do you have any proposals to upgrade the
present system for treatment and disposal
39 (a) :
of Effluent/emissions and /or hazardous
waste.

If yes, give the details with time. Schedule

(b) for the implementation and approximate :
expenditure to be incurred on it.

40 Capital and recurring (O&M) expenditure :

on various aspect of environment
protection Such as effluent, emission,

https://services.midcindia.org/services/FillFormAnon.aspx?AMId=514 8/10
9/30/2019 Single Window Clearance

hazardous waste, Solid waste tree

plantation, monitoring, data acquisition etc.
(give figures separately for items
implemented/to be implemented)

To which of the pollution control equipment

separate meters for recording
41 :
consumptions Of electric energy are
installed?

Which of the pollution control items. Are

Connected to D.G. Set (captive power
42 :
source) to ensure their Running in the event
of normal power failure

Nature, quantity and method of disposal Of

non-hazardous solid waste generated
43 separately from the process of manufacture :
and waste treatment. (Give details of
area/capacity available in Applicant’s land)

Hazardous Chemicals – Give details of

44 chemicals And quantities handled and :
stored.

Is the unit of major Accident hazard unit as

(i) per Mfg. Storage Import Hazardous :
Chemicals Rules?

Is the unit an isolated storage as defined

(ii) :
under The MSIHC Rules?

Indicate status of compliance of rules

(iii) :
5,7,10,11, 12,13, and 18 of the MSIHC Rules.

Has approval of site been obtained from

(iv) :
the Concerned authority ?

Has the unit prepared an off site Emergency

(v) :
Plan? Is it updated ?

has information on imports of chemicals

(vi) :
been Provided to the concerned authority?

Does the unit possess a policy under the PLI

(vii) :
Act ?

Brief details of tree plantation/green belt

45 Development within applicants premises (in :
hectares)

46 Information of schemes for waste :

Minimisation resource recovery and
recycling Implemented and to be
implemented separately

https://services.midcindia.org/services/FillFormAnon.aspx?AMId=514 9/10
9/30/2019 Single Window Clearance

The applicant shall indicate whether

Industry Comes under Public Hearing, if so,
the relevant Documents such as EIA, EMP,
47 (a) :
Risk Analysis Etc., shall be submitted ,if so,
the relevant Documents enclosed shall be
indicated accordingly.

Any other additional information that the

(b) :
applicants Desires to give.

Whether environmental Statement

(c) submitted ? If submitting, give date of :
submission.

48 I/We further declare that the information furnished above is correct to the best of my /our knowledge.
I/We hereby submit that in case of any change from what is stated in this application in respect of raw materials, products, process of
49   manufacture and treatment and/or disposal of effluent, emissions, hazardous wastes etc. In quality; a fresh application for Consent/
Authorisation shall be made and until the grant of fresh Consent / Authorisation no change shall be made.
50   I/We undertake to furnish any other information within one month of its being called by the Board.
I/We enclosed herewith a Demand draft for Rs. .Drawn in favour of Maharahtra
51  
Pollution Control Board as the fee for consent/authorisation 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.
Detailed layout plan of the factory premises showing structures, water supply line strorm Drain, sewers for the domestic effluents, for
2  
trade effluents, location of effluents treatment and its disposal and any other useful information, drawing, tables etc.
3   Detailed flow diagram of different process and point source of emissions.
4   Latest Joint Vigllance sample analysis report
5   Details of air pollution control devises 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 materials.
10   Capital investment certificate.
11   Process flow sheet.
12   Chemical reaction involved in each process.
13   NOC from local body for proposed industry.
14   Water budget calculations.

    

This site is best viewed with Internet Explorer 8.0 or higher at a minimum screen resolution of 1024x768

https://services.midcindia.org/services/FillFormAnon.aspx?AMId=514 10/10