aredita wsdta |[arteft side trom centerline towards increasing a3M/siKM Se ears 33M/181 to 151.400KM. as pipeline Across and Parallel to NH chainage / Km direction a (8) Right side from centerline towards Increasing [chainage / Km direction saeabara Proposal to acquire Land No. 1.9. [{a) Left side from center ine No Nil [o) Right side from center ing Nil |Whether proposals in the same side where land is 1.10 |not to be acquired Se ifnot then where to fay the cable Within ROW, ai [Petals of already laid services, any,along the al proposed route 12 |Number of lanes (2/4/6/8 lanes) existing ‘Lane with paved shoulder ‘Lag [Proposed Number of lanes (2 lane with paved 3 Ni shoulders / 4 /6/8 lanes) yes then which side Not existing | 114 [fa Left side from centor Ine [Right side rom centerline Proposed Service Road 1.0 [alte side from center ine Not Applicable No service Road [0) Right side fom conter ine Rae Baral Amoth, Pratapolirh GA, ‘renee sreretrs oh1s. [whether proparalto ly Gas Pipeline safer the service road or between the service road and mai] ‘Not Applicable |ariagews Io service Road Feu ihe permission for laying of Petvolem Products lbioetine sal be considered fr approval rejecton| Ipased on the Ministry Circulars mentioned as |svove ves Whether carving of sewaue/#as pipeline has Be proposed on te parapet / part ofthe bridges. If |yes then mention the methodology proposed for tne same No IFerossing ofthe road nvoWed yest shal either [encased in pipes or trough structure or conduits | Yes, Method used i HOD For erossing| |pecialy uit or that purpose at the expenses of and parallel, Ihe agency owning the hie (a) Whether enstng drainage strocutures ae alowed to cary sewage/e3s pipeline te [b)iston a tine normal 19 NH Paral & Crossing ) what the distance of crossing the sewage/e3s pipeline from the existing structures? {crossings shall not be too near the existing Not Applicable |tructures onthe National Highway, the minimum distance being 15 meter. [a The casing pipe [or conduit pipe he case of [electri eable) carving te uit ine shal be of toe east iron, or reinforced cement concrete and hve adequate strenght and be large enough to Jpeit ready withdeawal ofthe carrie pipe/cabe IMention type of casing. No [eens ofthe csina/eondut pipe shall be sealed from the outside, so thatit doesnot act asa No \rsinage path if The casing/condul pipe should, 5 minim extend trom drain to cuts and toe of slope inthe No ils. gh The op ofthe casng/condult pipe shoud be at least 1.65 meter below the surface of the road |ubjec to being at least 03 below the dain ners. Mention the proposed details iy Mention the methodology proposed Tor |-rossing of road forthe proposed Sewage/sas pipe line, crossing shal be by boing method (HOO) Itrenchless Technolog special, where the lessting read pavement iof cement concrete or [dense bituminous concrete type. [0 The caing/eondut pipe sal be installed with Jan even bearing thoughout its length andin such !amannerasto prevent the formation ofa [waterway along No [Document / Drawings enclosed withthe proposal aa [cross section showing the sie of tench for open Irenching method (st normal size of 1.65 meter deep x 0.3 meter wide) () Should not be less than [50.cm wider than the outer diameter ofthe pipe i) Located as close tothe extreme edge ofthe ight of way as posse but not less than 30 meter Irom the centre-tines ofthe nearest carriageway |i) Shall sot be permitted to run along the Endlosed ational Highways when the road formation is situated in double cutting, Nor Shall these be laid lover the existing culverts and bridges (v) These Jnould tw sc ad that their top iat least 0.6 meter below the yround level 30 s ott obstruct drainage of the road lon. Meet Ges Resources Limiied rapt hater Aran Teeieres feaPTe eau Baral Amethi. Pratangar-G.A. ey Sti were TN spa aas007622 [cross section showing the sizeof pitand location of [cable for HOD method Enclosed 23 strip plan / Route plan showing Gas pipeline, \chainage, Width of ROW, distance of proposed Pipeline from the edge of ROW, Important mile stone, intersections, cross drainage works etc. Enclosed 24 Methodology for laying of showing Gas pipeline Enclosed 24a [Open trenching method. (May be alowed in utility corridor only where pavement is neither cement concrete nor dense bituminous concrete type.) If ves, what isthe Methodology of refining trench. Yes [a) The trench width should be atleast 30 cm, but not more than 60.em wider than the outer diameter lof the pipe, ves (0) For filing ofthe trench, Bedding shall be to = \depth of not less than 30 cm. t shall consist of |eranular material ree of lumps, clods and cobbles {and graded to yield a firm surface without sudden [change in the bearing value. Unsuitable soll and ves (The backfil shall be completed in two stages () side fl tothe level ofthe top of the pipe and (i) loverfilto the bottom of the road crust. ves (@) The side-il shall consist of granular material aid in 15 em layers each consolidated by mechanical tampering and controlled addition of moisture to [95% ofthe Proctor Density. Overfill shall be |compacted tothe same density as the material that had been removed. Consolidation by saturation or pending wil not be Permitted. Yes [e) The road crust shall be built to the same strength] las the existing crust on either side ofthe trench. [care shall be taken to avoid the formation of a dip lat the trench. Yes y ue) (UmsTeE e)y a® Rae Barat Amen Pritargane A rertett, wemns oe Src Mob 9a 33306876[f) The excavation shal be protected by flagman, signs and barricades, and red lights during night hours. ves Ig) required, a diversion shall be constructed at ithe expense of agency owning the utility line. ves 242 Horizontal Directional Driling (HOD) Method Enclosed 243 [Methodology for Laying of Gas pipeline through CO |works and method of laying. In cases where the carrying of Gas pipeline on the bridge becomes inescapable. NA [Draft License Agreement signed by two witnesses Yes Enclosed Performance Bank Guarantee in favour of NH Division has to be obtained as per MorTh guidelines ior a period of one year intially (extendable if required till satisfactory completion of work) as a security for ensuring/making good the excavated lrench for laying the Gas pipe line/ducts by proper ting and compaction, clearing debris/loose earth produced due to execution of trenching atleast SO rm away from the edge of the right of way. No ipayment shall be payable by the NHAI tothe licensee for clearing debris/loose earth. Performance 8G as per above isto be obtained, ‘As per new guidelines of MoRTH circular dt. 22.11.2016 4a |confirmation of BG has been obtained or not as per INHAL gudelines. We agree to pay Bank Guarantee |Amount, Which will be agreed by NHA [Affidavit / Undertaking from the Applicant forthe following ie to be furnised Yes 5a Not to Damage to other utility, if damaged then to pay the losses either to NH or to the |concerned agency. Yes 32 For Renewal of Bank Guarantee Not Applicable 53 For Confieming all standard condition of Ministry circulars and NH guideline Enclosed 54 For Shifting of Gas pipeline as and when required by INHAI at theic own cost. Enclosed 55 [For shifting Gas pipeline due to 4/6 lanning / lwidening of NH Enclosed For indemnity against al damages and claims clause xxv) Enclosed 37 [For traffic movement during laying of Gas pipeline to be managed by the Applicant. Enclosed 58 if any claim is raised by the Concessionaire then Ithe same has to be paid by the applicant, Enclosed 59 Prior approval ofthe NHAI shall be obtained before lundertaking any work of installation, shifting or Iepairs, or alterations to the Gas pipe line/any other tility located in the National highway right-of-ways. Enclosed 5.10 Expenditure, eny, incurred by NAAI for repairing any damage caused tothe National Highway by the laying, maintenance or shifting ofthe Gas pipe line willbe borne bythe applicant agency owning the line. Enclosed saa If the NHAI considers it necessary in future to move the utility line for any work of improvement of repairs to the road, it willbe carried out as desired lay the Hil ar the cast of ve anency owning the utility line within a reasonable time (not exceeding 60 days) ofthe intimation given. Noted Rajeev Chief Mon Se, eT Mb 9443330076[Cerificate from the applicant inthe folowing format i) Laying of Gas pipeline wil not have any |deeletrious effects on any of the bridge components land Roadway safty for traffic i) "We do not undertake that | will relocate service road / approach road / utilities at my own cost notwithstanding the permission granted withing such time as wl be stipulated by NH" for future 4/6 lanning or any other development. saa Yes; Enclosed |Who will sign the agreement on behalf of Gas, pipeline agency Rajeev Sachdeva (Chief Manager-CGD (8GRL) [Power of Attorney to sign the agreement is avalabe| lor not Yes [The Project Director/Excutive Engineers, will submit the following Certificates Yes [certificate for proposal for confirming ofall standard condition issued vide Ministry of Road [Transport and Highway Circular No.-NH-II/P/66/76 dated 18/19.11.1976, RW/NHA«I//66/76 dated 7.1 |11.5.1982, (i) RW/NH-12037/1/86/001 dated _A, |28.7.1993. il) RW/NH-11037/1/86/001 dated 29.1.1995 (iv) RW/NH-34066/2/95/ SBR dated 25.10.1999 and (v) RW/NH-34066/7/2003 S&R (8) ldated 17.9.2003, Yes, Enclosed Certiicate from XEN in the following format () "itis certified that any other location of the Gas pipeline \would be extremely dificult and unreasonable [costly and the installation of Gas pip line within |ROW will not adversely affect the design, stability & traffic safety of the highway nor the likely future improvement such as widening ofthe carriageway, leasing of curve etc”. 72] Yes, Enclosed ty tor 6 tanning (a) Where feasibility is available "/ do certify that here will be no hindrance to proposed six laning lbased on the feasibility report considering loroposed structures at the said location”. > |(p) incase feasibility report isnot available"! do certify thot cuffcient ROW is ovallable at site for laccommadating proposed six laning”. Agreed Rajeev Spchdeva / water Chet Mas GD. 0 pada oh ‘shorat apr Wricer rer Teetrenervtetteors Rae Barell Ameth. Pratapgam. GA Grae, rN wereere ah Mob oa 13550076 Page Sof6if ni section proposed to be taken up by NHAIon 1BOT basis -a cause is to be inserted in the |Agreement. "The permitted highway on which licensee has been granted the right of lay Gas pipeline/cable/duct has also been granted as aright lof way tothe concessionaire under the concession lagreement for up-gradation of (Jaunpur- Lucknow) INH No, 733 crossing & Parallel details as per |Annexure "A" attached on Build, Operate and Hransfer Basis and therefore, the licensee shall honor the same." crossing & parallel details attached as per annexure'A’ |Who will supervise the work of laying of Gas pipeline (BGRY india (@) On behalf of the Applicant Rajeev Sochdeva Chief Manager-CGD (BGRL) [b) On behalf of NH Division Person deputed by NHAI 10 [Who will ensure thatthe defects In road portion [after laying of water / Gas supply pipeline are corrected and ifnot corrected then what action will lbe taken. (a) On behalf ofthe Applicant Rajeev Sachdeva Chief Manager- CGD (BGRL) (6) On behalf of NH DWvision Person deputed by NHAI u ‘Who will pay the claims for damages done / \disruption in working of concessionaire if asked by the concessionaire (On behalf ofthe Applicant (@GRL) India 2 [A certificate trom Project Director/Executive [Engineer that he wil enter the proposed permission inthe register of records ofthe permissions in the prescribed Performa (Copy enclosed). Enclosed B I any previous approvals accorded for laying of lunderground water / Petroleum / Gas supply pipeline then Photocopy of register of records of lpermissions accorded as maintained by Project Dicector/Executive Engineer then copy be enclosed. Not Enclosed No previous approval Bharat Gas Resources Limied, Rajeev Sachdeva, CChiof Manager-CGD (BGRL) Bharat Gas Resources Limitos creer tren feenetey fearrree Rae Bareli Amethi, Pratapoarh.G A, ‘Srereen sri, rere che Mob 9413550076 Page GofDestination 7| Pipeline Road Pipeline | Crossing Sr. Village Name at Description of | Description | Chainage | Chainage | Width in No. Crossing Location inkm. | inkm, | Meter. National Highway [120.3MM Dia t | 731 (On Lucknow- | Steel with | viiage- Jaunpur.) Across at | 40MM OFC and Kamrauli, Tehsil - | 1 1s1.400 | o.ooxm =| 26m upsioc 180MM — dia Musafirkhana, JagdishpurRoad —_| MOPE Pipeline. Dist - Amethi No.t National Highway- [203MM Dia | | 731 (On Jaunpur- | Stee! along with Lucknow) Parallel | 40MM OFC Village Line-a Right Side only from 151.00KM- Kamrauli, Tehsil - 2 . (0.00Km -| aoom UPSIDC Road No. 7 151.400KM Musafirkhana, 0.400KM) | (BHEL) to SAIL Gate. Dist-Amethi. | Total length | 1990m. | Total Length | 426M ae Bharat Gas Resources timid Saree fren fener Mob. oa igaaicDetails of Laying Underground Pi ANNXEURE-2 1@ Across and parallel to NHAI-731 T | (i) [Name of company asking for Permission [Bharat Gas Resources Ltd (ii) [Contact Person : Name & Designation Rajeev Sachdeva Chief Manager-CGD BGRL (india) {iil |Full Address Bharat Gas Resources Limited Bharat Bhawan, 4 & 6 Currimbhoy Road, Ballard Estate, Mumbai, Maharashtra, India }-400001 (iv) [Telephone No. and Fax [9413330676 (v) [Details & purpose for laying the pipe HTransportation of Natural Gas for Domestic line crossing through NHAI Land and industrial use in,Amethi District. (Wi) [Any other details regarding laying (2) Distance of proposed site from the Within ROW of NHAI- 731 (launpurto icenter of the road llagdishpur- Lucknow) section. (b) Whether itis possible to lay the Yes proposed lines or not (reasons) [(c) Whether itis possible to cross the Yes proposed lines through existing _ lines lor not ( reasons) 2 Detalls regarding road alignment whether INot Applicable as crossing NH at U/G Cable / pipe is to be laid along the road| : |parpendicular ( |Name of Road INHAI-731, (li) [Category of road (to be ascertained National Highways. Detals as per annexure" {from km. stone on road side) (i) [wicth of the road (@) Formation width measured from Meters learthen bank (b) Black Topped carriageway width Meter each carriage width (c) Road Boundary (extent of highway IMeters land) (All these details are to be shown on the drawing also) (d ) Location of pipeline laying Along [As per annexure Details to be supplied on layout drawings ee ea ee (6 sets) enclosed. Rojoow Qignseys Her, gay Chet Menoge CB on r Se ear cenrone on na Se Reesea [GEOGRAPHICS OF THE PIPELINE Not Applicable as HDD Method. ROUTE (a) Dimension of the Pipeline trench ((B) Dimension of Protection pipe. las per cross section drawing Enclosed. (c) Diameter of the Pipeline / Cable. 1120.3 mm Dia Steel with OFC Pipeline & 180mm MDPE Pipeline. [Te Right of user [Not Applicable as HDD Method, 5 |(i) | This is to certify that no Govt. Land shall be Agreed loccupied by applicant except for the purpose of laying of UG Cables / Pipeline. (i. | This isto certify that the work shall bein | [Agreed accordance with the Govt. Rules and regulations in force from time to time and binding to Applicant. ii) | This isto Certify that all required cost and | [Agreed fees as per rules and regulation of the Govt. will be deposited timely. Rajeev Sachdeva Chief Manager- CGD (BGRL) BGRL (Indj feva &Go asin ge ae SAS, Brera — oh