APPLICATON FOR ISSUE OF GROUND WATER CLEARANCE / NO OBJECTION

CERTIFICATE FOR INDUSTRY / CONSTRUCTION / HORTICULTURE /

COMMERCIAL / INFRA STRUCTURES / OTHER USERS

1. (I)Name of the applicant & company name

(II)Father’s / Husband’s Name in the case

of individuals.
(III)Complete Postal Address

2. (I) Name of owner of the land where Proposed

Pumping well is Existing

(if the applicant himself is not the owner)

(II)Postal address

(III) Firka Name :

(IV)Taluk Name :

(V) District Name :

(VI) Condact Phone Nos :

3. (I)Place of ground water extraction

Proposed.
T.S / S. F No. :
Village / town / Division :
Firka Name :
Taluk Name :
District Name :

(II) Place of ground water

Utilization .
T.S / S. F No. :
Village / town / Division :
Firka Name :
Taluk Name :
District Name :
4. Purpose for which water is to be extracted
or Used -Industry / Construction /
Horticulture / Commercial / Infrastructures /
other uses.
5. Required quantity of water
(I) Surface Water :
(II) Ground water :

6. Status of proposed well for extraction

Existing :

7. Details of Existing well if any :

(a)Type of well- Dug well / Dug cum Bore
Well / Bore well /Open well /Tube well
(b) Diameter of well ( in metre)
(c) Depth of well (in metre)
(d) In the case of dug cum bore well give
Details of both open and bore well .
(e) Recuperation hours
(d) Rock type Hard rock / Sedimentary /
Alluvium (can be blank if not known to
the applicant)

8. Whether well is located in Ayacut / Non

ayacut area.
9. Command area of well in Acres / Hectare:
10.Crops grown :
Type

I Crop
II Crop
III Crop

11. Details of pumps proposed / installed.

(a)Type of pump –Centrifugal / Turbine/
Submersible / jet / Compressor /
others.

12. Hours of pumping per day

13. Nearest well distance (in Metre)from the

Proposed extraction well (certificate to be
enclosed.
14. Nearest stream, river, tank(in metre) from
the proposed extraction well (certificate
to be enclosed ).

15.No.of any other wells in the location. :

16.Categorisation of Firka – Over exploited /

Critical /Semi critical /Safe(can be left blank
if not known to the applicant ). :

DECLARATION
I hereby declare that the above particulars are true to the best of my knowledge
and I herewith enclosed all the certificates and documents for Departmental
perusal.Based on the document verification only the service charges are paid to the
Government . I will forego the charges and I will not claim the refund of service charges
in the case of incorrectness of facts in the certificate.

Place :

Date : Signature of the applicant.

 Application-Annexure – I

WATER RESOURCES DEPARTMENT

State Ground and Surface Water Resources Data Centre
Tharamani , Chennai – 600 113.

Certificate on Spacing between wells

Certified that the spacing between the Applicant Thiru./Tmt ------------------------------------

for M/s------------------------------------------------- proposed pumping well, located in S.F.

No. ------------- of -------------------------------- Village, in -----------------------------Firka,----------

------------------Taluk,-----------------------------District and the adjacent / surrounding wells .,

1. First well’s (in S.F No.) depth is --------------m and the spacing is------------- m,

2. Second well’s (in S.F No.) depth is --------------m and the spacing is-------------m,

3. Third well’s (in S.F No.) depth is --------------m and the spacing is------------ m,

4. Fourth well’s (in S.F No.) depth is --------------m and the spacing is------------- m,

5. Fifth well’s (in S.F No.) depth is --------------m and the spacing is--------------m,

6. Sixth well’s (in S.F No.) depth is --------------m and the spacing is--------------m,

Place: Revenue Inspector

Date:
 Application-Annexure – II

WATER RESOURCES DEPARTMENT

State Ground and Surface Water Resources Data Centre
Tharamani , Chennai – 600 113.

Certificate on Spacing between proposed pumping wells and Palar river bank.

( vide G.O (Ms) No.1766 PWD dated 31.10.1988)

Certified that the spacing between the Applicant Thiru/Tmt. -------------------------for

M/s---------------------------------------------------- proposed pumping well, located in S.F. No.

------------- of ----------------------------------Village in ----------------------------Firka , --------------

-------Taluk , of--------------------------------District and the Palar River Bank is above 200

m vide above cited G.O. / does not fall in the Palar River basin.

And

Certified that the Applicant Thiru/Tmt.--------------------------------for M/s --------------------

------------------------proposed pumping well, located in located in S.F. No. --------------- of -

-----------------------------Village in ------------------------ Firka , ---------------------Taluk , of------

-------------------------- District does not fall with in the vicinity of 250 m from any public

drinking water sources.

Place: Revenue Inspector

Date:
 Application-Annexure – III

WATER RESOURCES DEPARTMENT

State Ground and Surface Water Resources Data Centre
Tharamani , Chennai – 600 113.

Certificate to be issued by Local body

Certified that the Panchayat / Municipality / Corporation has No OBJECTION

for pumping ----------------------Litres of Ground water from the well located in S.F. No. --

-------------- of ----------------------------------Village in ----------------------Firka , -------------------

------Taluk of--------------------------------District belongs to the applicant Thiru/Tmt -----------

--------------------------for M/s--------------------------------------------- proposal for the proposed

industries / construction / infrastructure projects and for all other commercial

purposes and to transport ground water from the above location to different places .

Place: President ,

Date: Panchayat / Municipality / Corporation

 Application-Annexure – IV

WATER RESOURCES DEPARTMENT

State Ground and Surface Water Resources Data Centre
Tharamani , Chennai – 600 113.

Certificate on Spacing between proposed pumping wells and Selected River banks.

(Vide G.O (1D) No.223 Environment & Forest (S3) Department dated 02.09.1998)

(Applicable only to the 14 types of industries cited in Annexure of G.O (Ms) No.213, for
Cauvery and its tributaries, Pennaiyaru, Palar, Vaigai & Thamiraparani Rivers)

Certified that the spacing between the Applicant Thiru. --------------------------for M/s-------

-------------------------------------- proposed pumping well, located in S.F. No. ------------- of -

---------------------------------Village in ------------------------Firka , -----------------Taluk , of-------

-------------------------District and the --------------------------- River Bank is above 5 km

vide above cited G.O.

Place: Revenue Inspector

Date:
 Application-Annexure – V

WATER RESOURCES DEPARTMENT

State Ground and Surface Water Resources Data Centre
Tharamani , Chennai – 600 113.

Certificate on Spacing between proposed pumping wells and Sea coast.

(Vide CE / SG&SWRDC Technical circular No.5 / 2010 / DD (G) /dated 02.07.2010 )

Certified that the spacing between the Applicant Thiru/Tmt. -----------------------------

for M/s----------------------------------------------- proposed pumping well located in S.F. No.

------------- of ----------------------------------Village in ------------------------ Firka , -----------------

---------Taluk , of--------------------------------District and the sea coast is ------------ km

away / above 10 Km away from the coast.

(Note: If the distance exceeds 10 km, exact distance need not be mentioned)

Place: Revenue Inspector

Date:
 Application-Annexure – VI

WATER RESOURCES DEPARTMENT

State Ground and Surface Water Resources Data Centre
Tharamani , Chennai – 600 113.

Certificate of Assurance

(Vide CE / SG&SWRDC Technical circular No.3 / 2010 / DD (G) /dated 05.04.2010 )

I, Thiru/Tmt. ------------------------------,applicant for M/S----------------------------------for the

groundwater drawal located in S.F. No. ------------- of ---------------------------------------------
Village in ----------------------------Firka , -------------------------------Taluk ,of-----------------------
---------, District, give the following certificate to the Chief Engineer / SG &SWRDC ,
PWD/WRD.

I assure that in the case of the, SG &SWRDC , WRD, issue the Ground
water Clearance to me / the firm , for industrial / commercial / Infrastructures
purposes, the electricity connection obtained for the purpose of Agriculture will be
changed to “ Commercial Purpose”.

Failing which ,I agree to cancel the Groundwater Clearance issued by

SG &SWRDC , WRD on behalf of Government of Tamilnadu.

Place: Applicant

Date:

Witness:

1.

2.
 Application-Annexure – VII

WATER RESOURCES DEPARTMENT

State Ground and Surface Water Resources Data Centre
Tharamani , Chennai – 600 113.

Certificate of Assurance

I, Thiru. -------------------------, applicant for M\S----------------------------------for the

groundwater drawal located in S.F. No. ------------- of ------------------------Village in ---------
---------------------Firka , --------------------------Taluk , of--------------------------------, District,
give the following certificate to the Chief Engineer / SG &SWRDC , PWD/WRD.

I assure that in the case of the, SG &SWRDC , PWD/WRD, issue the

Ground water Clearance to me / the firm , for industrial / Commercial / Infrastructures
purposes, located in S.F. No. ------------ of -------------------------------------------Village in ---
-----------------------------Firka , --------------------------Taluk , of-------------------------------
District, the Rain Water Harvesting Structure, as specified by the Department will be
constructed.

Failing which ,I agree to cancel the Groundwater Clearance issued by

SG &SWRDC , PWD on behalf of Government of Tamilnadu.

Place: Applicant

Date:

Witness:

1.

2.
 Application-Annexure – VIII

WATER RESOURCES DEPARTMENT

State Ground and Surface Water Resources Data Centre
Tharamani , Chennai – 600 113.

Certificate of Assurance

I, Thiru. -------------------------, applicant for M\S----------------------------------for the ground

water Drawal located in S.F. No. ------------- of -------------------------Village in ----------------
-------- Firka , --------------------------Taluk , of----------------------------, District, give the
following certificate to the Chief Engineer / SG &SWRDC , PWD.

I assure that in the case of the, SG &SWRDC , PWD/WRD, issue the

Ground water Clearance to me / the firm , for industrial / Commercial / Infrastructure

purposes, located in S.F. No. ----------- of ----------------------------------Village in --------------

------------Firka ,---------------------------------Taluk, of-------------------------------- District, a

separate bore well will be constructed, maintained and handed over to SG &SWRDC in

the above location for monitoring the water level.

Place: Applicant

Date:
 Application for the Groundwater Clearance -NOC-List of Documents to be
enclosed with the Application

1. Attested copy (Notary public) of registered land ownership document in the name of applicant or
registered lease agreement for a minimum period of 10 years in the name of applicant.

2. FMB Sketch (for well and industry Locations).

3. Not to scale topo sketch showing the location of the applicant wells and the industry, surrounding
wells with the spacing.

4. Chitta &Adangal copy

5. Copy of EB card with tariff paid details (Commercial connection).

6. Annexure I - The distance between the proposed well for groundwater extraction and
nearest wells and the depth of the wells to be certified by the revenue inspector of that area.

7. Annexure II - The distance between the well proposed for extraction and the bank of Palar river
(Palar basin rules) to be certified by the revenue inspector of that area (which is applicable for Palar
basin area) and the certificate of the distance between proposed well and nearby Drinking Water
supply scheme wells .

8. Annexure III - “No objection certificate” from the concerned village Panchayat for the proposed
quantity of groundwater extraction and transportation of ground water if any.

9. Annexure IV - The distance between the well proposed for extraction and nearest surface water
body such as tank, canal, stream, river etc., to be certified by the revenue inspector of that area.

10.Annexure V - The distance between the proposed well for groundwater extraction and the
coastal line (beach) to be certified by the revenue inspector of that area

11. Annexure VI - Undertaking letter by applicant regarding the change of EB service for agriculture
to commercial in the event of awarding groundwater availability certificate.

12. Annexure VII – Undertaking from the applicant towards construction of RWH if groundwater
availability certificate is awarded.

13. Annexure VIII - Applicants should submit the undertaking that they must erect and handover
one borewell to the State Ground and Surface Water Resources Data Centre for observation of
water level and quality.

14. Annexue IX (Certificate from local body for Surface Water Supply)

15. Latest EC (for the last 3 years)

16.Under taking of the applicant regarding the pumping test for issuing NOC.

17. Indemnity Bond with Notary public attestation

18. If existing company – copy of ISI Certificate, TNPCB Certificate, Food safety certificate etc.,