Water Supply Projects

INITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECLIST REPORT

For
Project name or Title
This IEE Checklist Report shall be used for proposed WATER S!PPL" PRO#ECTs to be located
within E$%&ro$'e$tally Cr&t&cal Areas (ECA)(
Please check applicable project category
Type T)res)ol*
Water upply ystems !Complete ystem"
# wells and other systems !e$g$
infiltration gallery% etc$"
Water upply ystem !&istribution 'nly"
(e)el III * with household connection
and water treatment
+or ECC appl&cat&o$s, t)&s IEE C)ec-l&st Report s)all .e su.'&tte* /&t)0
Proof of Compatibility with the e+isting (and ,se Plan
Proof of -uthority o)er the Project ite
-ccountability tatements of Proponent !see attached form" and the Preparer !if
any% following -nne+es ./.. of Re)ised Procedural 0anual for &-' .112/21"
Photographs or plates3)icinity map of the project site showing impact areas and
affected areas and communities
&uly -ccomplished Project En)ironmental 0onitoring 4 -udit Prioriti5ation
cheme !PE0-P" 6uestionnaire !see -nne+ ./7d of Re)ised Procedural 0anual for &-'
.112/21"
(No other documents shall be required as pre-requisite to ECC applications per DENR MC 2010-14)
Read the 8uestions carefully and write the re8uired information on the blank spaces
pro)ided or otherwise check !" the appropriate bo+es 9 or parenthesis ! "$ :o+es
with check marks!" are automatically re8uired$ ,se additional sheets if necessary
and indicate this in the appropriate space$
Project proponents are strongly *&scoura1e* to engage the ser)ices
of consultants3facilitators3preparers to accomplish3fill/up the IEE
Checklist Report Form$ The Report Forms ha)e been designed to be
user/friendly$
Furthermore% E0: Regional 'ffice is re8uired to complete the
processing of an ECC application using the IEE Checklist Report
within twenty !.1" working days upon receipt for duly/accomplished
forms with complete attachments$
Misleading or erroneous answers are basis for legal actions and/or denial of ECC issuance.
PRO#ECT +ACT SHEET
Project Na'e0 ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;
Project Locat&o$0 ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;
Total Project La$* Area0
1
Total Project2+ac&l&t&es
Area
!-rea actually utili5ed"
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Project Propo$e$t0 ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;
O33&ce A**ress0
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Co$tact Perso$0 ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;
4es&1$at&o$0 ;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;
Co$tact I$3or'at&o$
Telep)o$e Nu'.er0
+a5 Nu'.er0
Mo.&le Nu'.er0
E6'a&l A**ress0

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I( PRO#ECT 4ESCRIPTION
7(7 PRO#ECT LOCATION AN4 AREA0 treet <ame% :arangay% and 0unicipality3City% Pro)ince
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ee attached )icinity map3s and photographs of the project site and site de)elopment3layout plan
=eographic coordinates of the project area !Preferably use W= >? datum 6 8PS sett&$1, otherwise
specify datum used"$
Per&'eter29ou$*ary po&$ts
(.ase* o$ OCT2TCT2etc)
Lo$1&tu*e Lat&tu*e
2
7(: PRO#ECT COMPONENTS
(se additional sheets i! needed)
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
7(; !TILITIES2RE<!IREMENTS !'peration Phase"0
!t&l&t&es Source Est&'ate* 4e'a$*2Co$su'pt&o$
Power3Electricity
(Total)
@Wh
Power3Electricity
(+ro' Re$e/a.le E$er1y
Sources)
@Wh
Water
(Total)
!Fill/up table below if water is not
obtained from the local water utility"
m
3
3day
Water
(Ra&$/ater Collect&o$
Syste')
m
3
3day
+ac&l&t&es Nu'.er o3
!$&ts
Spec&3&cat&o$24escr&pt&o$2Re'ar-s
!Include capacity% length or other si5e
description"
A$ Water collection
Production wells
Infiltration gallery
&i)ersion3Collection Weir
'thers% specify
.$ Water treatment facility
Chemical treatment !e$g$%
precipitation% coagulation% etc$"
Physical treatment !e$g$%
screening% sedimentation% etc$"
&isinfection !e$g$% chlorination%
etc$"
2$ Water distribution system !Indicate ser)ice area in m
.
and number of
households ser)ed"
;;;;;;;;;;;;;;;;;; s8uare meters
;;;;;;;;;;;;;;;;;; households
Communal bo+3faucet !new"
Communal bo+3faucet !for
rehabilitation"
Water pipelines% distribution main
!new"
Water pipelines distribution main
!for rehabilitation"
Water pipelines% ser)ice line !new"
Water pipelines ser)ice line !for
rehabilitation"
Pumping stations
?$ Chemical storage facility
B$ Waste water management facility
#$ olid waste management facility
7$ &rainage ystem
>$ 'thers% specify
;;;;;;;;;;;;;;;;;;;;;
3
Water ource
C D ground water C D well C D spring C D othersE ;;;;;;;;;;;;;;;;;;;;;;;;;;;;
C D urface water C D ri)er C D lake C D othersE ;;;;;;;;;;;;;;;;;;;;;;;;;;;;
(ocation of water source
;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;
(#itio$%one& 'aran(a)& Municipalit)$Cit)& *ro+ince& Re(ion)
E$er1y2Water E33&c&e$cy
!t&l&t&es Est&'ate* Sa%&$1s Propose* E33&c&e$cy2Co$ser%at&o$
Measures
Power3Electricity @Wh
Water m
2
3day
7(= MANPOWER
a( Co$struct&o$ P)ase
Ma$po/er
Re>u&re'e$t
E5pert&se2S-&lls Total
.( Operat&o$ P)ase
Ma$po/er
Re>u&re'e$t
E5pert&se2S-&lls Total
7(? IN4ICATIVE PRO#ECT COST
Project Cost !PhP"E ;;;;;;;;;;;;
4
II( ENVIRONMENTAL IMPACTS AN4 MANA8EMENT PLAN
Possible En)ironmental3
ocial Impacts
:aseline En)ironment Pre)enti)e3 0itigating 0easures 0onitoring Parameters3
Implementation
Cost of 0itigation3 0onitoring
(-<&
Consistency with land
use
Current land use w3in Akm radius
!as per 5oning ordinance"E
Residential
Commercial3 Institutional
Industrial
-gricultural3 Recreational
Protected -reas
'thers% specify
;;;;;;;;;;;;
-ctual land uses w3in Akm radiusE
Residential
Commercial3 Institutional
Industrial
-gricultural3 Recreational
Protected -reas
'thers% specify
;;;;;;;;;;;;;
ee attached proof of compatibility with
land use
&isturbance to wildlife
due to )egetation
clearing
E+isting )egetation in the areaE
Forestland
0arshland
=rassland
0angro)e
Compliance with conditions of &E<R3(=,
(,P% Tree Cutting Permit% R'W% PC-
Permit
(imit land clearing as much as possible
Pro)ide temporary fencing to )egetation
that will be retained
-nnual inspection of area
replanted3 re)egetated
Cost integrated in the
construction 3operation cost
5
Possible En)ironmental3
ocial Impacts
:aseline En)ironment Pre)enti)e3 0itigating 0easures 0onitoring Parameters3
Implementation
Cost of 0itigation3 0onitoring
Wetland
'thers% specify
;;;;;;;;;;;;;
Promote restoration of damaged or
destroyed )egetation where possible !e$g$%
tree planting"F
Change in surface
landform3 topography3
terrain3slope
oil Erosion
lopeE
flat !1/2G"
gently sloping to rolling !2/A>G"
steep !HA>G"
Is the project site located in an area
identified by 0=:3P-=/--3
PIIJ'(C as ha5ard proneK
Les
<o
Pro)ide erosion control and slope
protection measures
&esignate a poils torage -rea% with
topsoil set aside for later use and allow
ma+imum re/use of spoils
Construction during dry season
tabili5ation of embankment with grasses
or other soil co)er
'thers% specify
;;;;;;;;;;;;;;
Compliance with the &E<R -dministrati)e
'rder <o$ .112/21 and &E<R
-dministrati)e 'rder <o$ .111/.>%
Implementing =uidelines on Engineering
=eological and =eo/ha5ard -ssessment
!E==-"$
Regular inspection of slope
protection measures in
erosion/prone areas
Regular inspection for new
eroded areas near the site
'thers% specify
;;;;;;;;;;;;;;
lope3 Erosion Control
CostE ;;;;;;;;;;;
'thers% specify
;;;; ;;;;;;;;
oil3(and contamination
due to improper solid
waste disposal
E+isting soil type in the areaE
sandy
clay
sandy/loam
'thers% specify
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Implementation of the Ecological olid
Waste 0anagement Plan !EW0P"
et/up temporary fence around the
construction area
Implement re/use and recycling of waste
materials
Implement proper segregation% collection
and disposal of domestic wastes in
designated areas
Implement proper collection% labeling and
storage of ha5ardous waste
&aily inspection of
waste3recycling bins for
segregation
&aily inspection for presence
of mi+ed garbage in the
facility
Weekly inspection of waste
accumulated
'thers% specify
;;;;;;;;;;;
Cost integrated in the
construction 3operation cost
6
Possible En)ironmental3
ocial Impacts
:aseline En)ironment Pre)enti)e3 0itigating 0easures 0onitoring Parameters3
Implementation
Cost of 0itigation3 0onitoring
Pro)ide receptacles 3 bins for solid wastes
Coordinate with the municipal 3 city waste
collectors
Engage third party company for waste
collection
'thers% specify
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Impairment of
)isual aesthetics
&e)aluation of land
)alues
Presence of )isually significant
landforms3landscape3structuresK
Les
<o
Implement landscaping and other
beautification measures
Pro)ide ade8uate buffer
Compensate adjacent property owners
'thers% specify
;;;;;;;;;;;;;;;;
Regular inspection of
landscaping and other
beautification acti)ities
Regular monitoring of buffer
5ones
Regularly monitor
presence3absence of
complaints from adjacent
property owners
Cost integrated in the
construction3 operation cost
W-TER
Increased siltation due
to project acti)ities
Water 8uality
degradation
'thers% specify
;;;;;;;;;;
pecify nearest3recei)ing water
bodyE
;;;;;;;;;;;;;;;;;;;;;;;;;;;;
&istance to nearest3recei)ing water
bodyE
1 to less than 1$B km
1$B to A km
0ore than A km
If nearest3recei)ing water body is
fresh water% specify classificationE
--
-
et/up proper and ade8uate sanitary
facilities
trictly re8uire the contractor and its
workers to obser)e proper waste disposal
and proper sanitation
trictly obser)e proper waste handling and
disposal
Pro)ision of wastewater treatment facility
et up silt trap3stilling ponds to minimi5e
downstream siltation
Pro)ide ring canals around fuelling tanks3
motorpool3 maintenance areas
'thers% specify
Regular !ocular" inspection ofE
&rainage 3 canal systems
Water treatment facility !i$e$%
grease trap% septic tank% etc$"
6uarterly monitoring of the
followingE
pI
T concentration
:'&
Total Coliform
Cost integrated in the
construction3 operation cost
7
Possible En)ironmental3
ocial Impacts
:aseline En)ironment Pre)enti)e3 0itigating 0easures 0onitoring Parameters3
Implementation
Cost of 0itigation3 0onitoring
:
C
&
If nearest3recei)ing water body is
coastal or marine water% specify
classificationE
-
:
C
&
Current Water ,seE
Fishery
Tourist Mone 3 Park
Recreational
Industrial
-gricultural
;;;;;;;;;;;;;;
Color
'il and =rease
&istance of project area to the
nearest well usedE
1 to less than 1$B km
1$B to A km
0ore than A km
,se of the nearest wellE
&rinking3&omestic
Industrial
8
Possible En)ironmental3
ocial Impacts
:aseline En)ironment Pre)enti)e3 0itigating 0easures 0onitoring Parameters3
Implementation
Cost of 0itigation3 0onitoring
-gricultural
Competition in water
use
&epletion of water
resources
i5e of population using recei)ing
surface waterE
N A%111 persons
HA%111 and N B%111persons
HB%111person
-)ailable3nearest water source$
&eepwell
Water district3(=,
urface water
'thers% specify
;;;;;;;;;;;
Implement rainwater har)esting and similar
measures as an alternati)e source of water
'bser)e water conser)ation measuresF
Careful selection of project site to a)oid
disruption of traditional water uses
'btain Water Permit from <WR:
Impro)e efficiency of water supply and
distribution system
Implement community ponds and similar
measures as alternati)e water source for
non/domestic uses
Increase% when practical% storage
capacities of water supply structures for
resilience to greater climate )ariations and
e+tremes
'thers% specify ;;;;;;;;;;;;;;;;
Regularly monitor
presence3absence of
complaints
Regular coordination with
concerned agencies
Regularly monitor
occurrences of water
shortages
'thers% specify
;;;;;;;;;;
Cost integrated in the
construction3 operation cost
Increased occurrence
of flooding
Is the project site located in an area
identified by 0=:3P-=/-- as
flood proneK
Les
<o
,se appropriate design for project facilities
Implement appropriate drainage system
Regularly remo)e debris and other
materials that may obstruct water flow
,se appropriate technology !e$g$ raised
hand/pumps" to protect drinking water from
flood contamination
'thers% specify
;;;;;;;;;;;;;;;;
Regularly monitor
presence3absence of
complaints
Regular coordination with
concerned agencies
Regularly monitor increased
fre8uency of flooding
'thers% specify
;;;;;;;;;;;;;
Cost integrated in the
construction3 operation cost
-IR 3 <'IE
9
Possible En)ironmental3
ocial Impacts
:aseline En)ironment Pre)enti)e3 0itigating 0easures 0onitoring Parameters3
Implementation
Cost of 0itigation3 0onitoring
-ir 8uality degradation
&istance to nearest communityE
1 to less than 1$B km
1$B to A km
0ore than A km
Properly operate and maintain all emission
sources !e$g$ )ehicles% pumps% generator%
etc"
Install when applicable% the appropriate air
pollution control de)ice3s
trictly enforce good housekeeping
practices
Control )ehicle speed to lessen
suspension of road dust
Conduct water spraying to suppress dust
sources and minimi5e discomfort to nearby
residents
,se co)ered )ehicles to deli)er materials
that may generate dust
'ther% specify
;;;;;;;;;;;;;;;;;;;
Regularly monitor
presence3absence of
complaints
Regular !ocular" inspection ofE
-bsence of white or black
smoke from )ehicles%
generator% etc$
Presence of truck co)er
during deli)eries
Cost integrated in the
construction3 operation cost
<uisance due to noise
generation
&istance to nearest communityE
1 to less than 1$B km
1$B to A km
0ore than A km
Properly operate and maintain all noise
sources !e$g$ )ehicles% pumps% generator%
etc"
Install when applicable% the appropriate
noise control de)ice3s !e$g$% mufflers%
silencer% sound barriers% etc$"
Implement appropriate operating hours
Pro)ide ade8uate buffer and3or planting of
trees
'thers% specify
;;;;;;;;;;;;;;
Regularly monitor
presence3absence of
complaints
Regular monitoring of buffer
5ones
Cost integrated in the
construction3 operation cost
PE'P(E
10
Possible En)ironmental3
ocial Impacts
:aseline En)ironment Pre)enti)e3 0itigating 0easures 0onitoring Parameters3
Implementation
Cost of 0itigation3 0onitoring
&isplacement of
residents in the project
site and within its
)icinity
&isplacement of
Indigenous People
Enhanced employment
and3or li)elihood
opportunities
Reduced employment
and3or li)elihood
opportunities
Increased re)enues for
(=,
&isruption3Competition
in deli)ery of public
ser)ices !e$g$%
education% peace and
order% etc$"
Enhanced deli)ery of
public ser)ices !e$g$%
education% peace and
order% etc$"
Increase in traffic
)olume and worsening
of traffic flow
i5e of population of host barangayE
N A%111 persons
HA%111 and N B%111persons
HB%111person
Classification of host barangayE
,rban
Rural
-)ailable ser)ices within3near the
host barangayE
chools !e$g$ elementary% high
school% college"
Iealth facilities !e$g$% clinics%
hospitals% etc$"
Peace and order !e$g$% police
outpost% brgy$ Tanod% etc$"
Recreation and sports facilities
'thers% specify
;;;;;;;;;;;;;;
Pro)ide relocation3disturbance
compensation packages
Prioriti5e local residents for employment
Promptly pay local ta+es and other
financial obligations
Regular coordination with (=,
Prior consultation 4 coordination to
minimi5e disruption on daily domestic
acti)ities 4 respect for IP rights and
cultural practices
Ensure participation of IPs in consultations
and dialogues
Pro)ide appropriate traffic3warning
signs% lighting% etc
'thers% specify
;;;;;;;;;;;;;;
Regularly monitor
presence3absence of
complaints
Regular coordination with
(=,
'thers% specify
;;;;;;;;;;;;;;
Cost integrated in the
construction3 operation cost
Impacts on community
health and safety
'thers% specify
;;;;;;;;;;
Regular coordination with (=,
Pro)ide appropriate warning signs% lighting
and barricades% whene)er practicable
'bser)e proper housekeeping
Pro)ide on/site medical ser)ices for any
emergency$
Regularly monitor
presence3absence of
complaints
Regular coordination with
(=,
Regularly monitor
submission of reports to
Cost integrated in the
construction3 operation cost
11
Possible En)ironmental3
ocial Impacts
:aseline En)ironment Pre)enti)e3 0itigating 0easures 0onitoring Parameters3
Implementation
Cost of 0itigation3 0onitoring
Participate in public awareness programs
on health and safety
Implement appropriate safety programs for
both community and workers
trictly comply with fire% safety and similar
regulatory re8uirements
trictly comply with re8uirements of R-
#O#O
'thers% specify
;;;;;;;;;;;;;;;;;;;;
concerned agency
'thers% specify
;;;;;;;;;;;;;;
12
III( A9AN4ONMENT 24ECOMMISSIONIN82REHA9ILITATION POLICIES AN4
8ENERIC 8!I4ELINES !if -pplicable"
Project (ife or er)ice E ;;;;;;;;;;; years
Pro)ide description of the -bandonment acti)ities% such as% dismantling and waste
disposal$
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IV( INSTIT!TIONAL PLAN +OR EMP IMPLEMENTATION
'rgani5ation ChartE
IV(7( -bandonment Plan !if -pplicable"
13
Attac) *ra/&$12pla$ o3 a&r pollut&o$ source a$* co$trol &$stallat&o$s (/&t)
*&'e$s&o$s a$* *escr&pt&o$s)
14
Process +lo/
15
Attac) *ra/&$12pla$ o3 /aste /ater treat'e$t 3ac&l&ty (/&t) *&'e$s&o$s a$*
*escr&pt&o$s)
16
SWORN STATEMENT O+ ACCO!NTA9ILIT" O+ THE PROPONENT
This is to certify that all the information and commitments in this Initial
En)ironmental E+amination !IEE" Checklist Report are accurate and complete to the
best of my knowledge$
:y the authority )ested in me by the ;;;;;(Compan) Name) as
;;;(*osition$Desi(nation)& I hereby commit to ensure implementation of all
commitments% mitigating measures and monitoring re8uirements indicated in this IEE
Checklist Report as well as the followingE
Conform to pertinent pro)isions of applicable en)ironmental laws e$g$%
R$-$ <o$ #O#O !,o-ic #ubstances and .a/ardous and Nuclear 0astes
Control 1ct o! 1220"% R$-$ <o$ O112 !Ecolo(ical #olid 0aste
Mana(ement 1ct o! 2000"% R$-$ <o$ O.7B !*hilippine Clean 0ater 1ct
o! 2004"% and R$-$ <o$ >7?O !*hilippine Clean 1ir 1ct o! 1222"$
-bide and conform to (=, de)elopment plans and guidelines$
Promptly pay local ta+es and other financial obligations$
Regularly submit reports to concerned agencies$
I hereby bind myself to answer any penalty that may be imposed arising from
any misrepresentation or failure to state material information in this IEE Checklist$
In witness whereof% I hereby set my hand this ;;;; day of ;;;;;;;;;; at
;;;;;;;;;;;;;;;;;;;;;;$
;;;;;;;;;;;;;;;;;;;;;;;;;;
<-0E 'F PR'P'<E<T IE-&
!Position"
!Company <ame"
,:CRI:E& -<& W'R< T' before me this ;;;;; day of ;;;;;;;;;;;; .1A;;%
affiant e+hibiting his3her Community Ta+ Certificate <o$ ;;;;;;;;;;;;;;;;;;;
issued at ;;;;;;;;;;;;;;;;;;;;;; on ;;;;;;;;;;;;;;;;;;;;;;;;;;$
&oc$ <o$ ;;;;;;;;;;;;;;;;;;;;
Page <o$ ;;;;;;;;;;;;;;;;;;;;
:ook <o$ ;;;;;;;;;;;;;;;;;;;;
eries of ;;;;;;;;;;;;;;;;;;;;
17