Declaration Template: Indicator 1.

4
Data/Declaration required for Q3:

Storm Water Drains(SWD)/Nallahs

Yes  No 
Whether 100% Storm water drains/Nallah (Secondary/
Tertiary) have screens/filters at a suitable distance? SWDs – Not Available in the ULB 
Nallahs – Not Available in the ULB 

If the ULB is in 10 Lakh+ population category,

Whether there are Automated/Mechanical screens on Yes  No 
Secondary Nallahs for collection and cleaning of waste?

Whether 100% of the storm water drains/nallahs in the ULB

are free from solid waste (floating/visible)? Yes  No 
Whether there are boundaries existing around all Storm
water drains/Nallah and they are well maintained? Yes  No 
Whether there are any encroachments around storm water
drains/Nallah? Yes  No 
Whether sewage/septic tank effluents are discharged/
disposed in the storm water drains/nallahs of the ULB? Yes  No 
Documents to be submitted by the ULB for evaluation: (For months of Nov, Dec & Jan)

Photographs of the storm water drains/nallahs showing the

placement of screens/filter, no floating solid waste, existence Attached  Not Available. 
of boundary walls, non-existence of encroachments.

I hereby declare that the data/information provided above table, on Swachhatam portal and in the attached
documents is true to the best of my knowledge and reflects the status of the progress on ground in the ULB.

Signature & Stamp of the Nodal Officer/Head of the ULB

Name: ULB Code:
Designation: ULB Name:
Date:

Prepared by
Prepared by