FORM - 1 FOR WATER CONSENT
(To be submitted in triplicate)
Application for Consent for establishing or taking any steps for establishment of Industry/ Operation/ Process/ or any treatment/ disposal system for discharge, continuation of discharge under section 25 or section 26 of the Water (Prevention & Control of Pollution), Act 1974.
(See Rule 3)
The Member Secretary,
M.P. Pollution Control Board
I / We here by apply for Consent/ Renewal of consent under section 25 or section 26 of the Water (Prevention and Control of Pollution) Act. 1974 (No. 6 of 1974) for establishing or taking any step for establishment of Industry/ operation/ Process/ or any treatment/ disposal system to bring in to use any new/ altered outlet for discharge of sewage/trade effluent/ to continue to discharge Sewage/ trade effluent from land/ Premises owned by .
The other relevant details are as below:-
1. Full name of applicant ...
2. Nationality of the applicant
3. Status of the applicant
b) Proprietory concern
c) Partnership firm
(Whether registered or unregistered)
d) Joint family concern
e) Private Limited Company
f) Public Limited Company
g) Government Company
(1) State Government
(2) Central Government
h) Foreign Company
(If a Foreign Company, the details of
registration, incorporation etc.)
i) Any other Association or Body
4. Name, Address and Telephone No. of the
applicant [the full list of individuals, partners
persons, Chairman (Full time or part time)
Managing Directors, Managing Partners/
Directors (Full time or part time) other kinds . .
of office bears are to be furnished. With
their period of tenures in the respective office,
with telephone No. and address]
5. Address of the Industry
(Survey No, Khasra No, Location as per
the Revenue Record, Village, Firka. Tehsil,
District, Police Station or SHO, Jurisdiction
of the First-Class Magistrate) ..
6. Details of Commissioning etc:
a) Approximate date of the Proposed . ..
commissioning of work.
b) Expected date of Production/date of
production (if Existing) .. ..
7. Total Number of employees expected to be . .. .
8. a) Details of license, if any obtained under . . .
the provisions of Industrial Development
b) Total capital investment and category
(SSI/Medium/Large). (Gross capital
9. Name of the person authorized to sign this . .
form (the original authorized except in the
case of individual /proprietory concern to be ..
10. a) Attach the list of all raw materials and
Chemicals used per month.
b) Licensed annual capacity of the Factory /
Industry and name of Product.
c) Manufacturing Process in details. .
11. State daily quantity of water in kilolitres and .
its source (Domestic/Industrial/Process/Boiler /
12. a) State the daily maximum quantity of .
effluents & mode of effluents and mode
of disposal (sewer or drains or river)
also attach analysis repot of the effluents.
Type of effluent quantity in kilolitres mode
i) Domestic. ....
b) Quantity of effluent currently being discharged
or expected to be discharged.
c) What monitoring arrangement is currently
there are proposed.
13. 1) State weather you have any treatment
plat for industrials, domestic of combined
2) If yes, Proposal attach a description of
the process of treatment in details along with
drawing & design and give the investment
3) Attach information on the quality of treated ...
effluent vis-ΰ-vis the standards.
14. State details of solid wastes. Generated
From process and during waste treatment.
Description Quantity/Quality Method of collection Method of disposal
15. I / We further declare that the information furnished above is correct to be best of my /our knowledge.
16. I / We hereby submit that in case of change either of the point of the discharge or 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.
17. I / We hereby agree to submit to the State Board an application for renewal of consent four Months in advance of the date of expiry of the consented period for out let/ discharge to be continued thereafter.
18. I / We undertake to furnish any other information within one month or its being called by the State Board.
19. I / We enclose herewith cash receipt No./bank Draft No .Dated ...for (Rs.in Figures) (Rs.in words) ...)in favour of Member Secretary, Madhya Pradesh Pollution Control Board, as fees payable under section 25 of this Act.
1. Site plan & topo sheet.
2. Lay out and statement of (total area of the plant/ constructed area/ open area/ area reserved for plantation.
3. a) Name of Local Body / Panchayat.
b) NOC from GOI/State Govt./Local Body/ Panchayat / etc.
4. List of Industries, villages, rivers & lakes other important feature and distances from site, within a radius of 5/10 km. in case of medium / large industry.
5. A copy of Project Report.
6. Flow sheet of process and chemical involved (if any)
Signature of the Applicant.
GOVERNMENT OF MADHYA PRADESH
HOUSING & ENVIRONMENT DEPARTMENT
No F (121) 32/90 In exercise of the powers conferred by Section 64 of the Water (Prevention & Control of Pollution) Act, 1974 (No. 6 of 1974). the State government, after consultation with the Madhya Pradesh Pollution Control Board, hereby makes the following further amendments in the Water (Prevention & Control of Pollution) (Consent) Madhya Pradesh Rules, 1975 namely :-
In the said Rules :-
1) In clause (i) of rule 2 for works "License Fee" the words "Consent Renewal Fee" shall be substituted.
2) for sub rule (V) of rule 4, the following sub rule shall be substituted, namely :-
"(V) The application form should be duly accompanied with the consent fee as a specified in the following schedule:-
Industries having an investment of :-
1) More than 200 crores 1,50,000.00
2) More than 100 crores but less than 200 crores. 1,50,000.00
3) More than 50 crores but less than 100 crores. 75,000.00
4) More than 10 crores but less than 50 crores 60,000.00
5) More than 3 crores but less than 10 crores 40,000.00
6) More than 50 Lakhs but less than 3 crores 10,000.00
7) More than 50 Lakhs 1,000.00
The above consent fee includes the consent renewal fee for the first year.
"(5) The applicant shall pay an annual" Consent renewal fees" (except the fee for the first year) to the Board as specified in the following schedule namely:-
(A) Industries having an investment of :- Rs.
3. More than 50 crores but less than 100 crores. 30,000.00
4. More than 10 crores but less than 50 crores 20,000.00
5. More than 3 crores but less than 10 crores 15,000.00
(B) Annual consent renewal fee and consent fee chargeable from local bodies
extracting water from natural resources and discharging effluent into streams shall be as under :-
a) Municipal corporation 3000.00
b) Class A-A municipalities 2000.00
c) Class A municipalities 1000.00
d) Class B municipalities 500.00
e) Class C municipalities 250.00
f) Minimum fee 250.00
Provided that the consent application and consent renewal application received to the publication of this notification shall not be liable for the excess payment of difference of fees owing to pendncey of application.
By order and in the name of the
Governor of Madhya Pradesh
Government od Madhya Pradesh
Housing and Environment Department