Water Supply Projects

INITIAL ENVIRONMENTAL EXAMINATION (IEE) CHECKLIST REPORT

For

Project name or Title

This IEE Checklist Report shall be used for proposed WATER SUPPLY PROJECTs to be located
within Environmentally Critical Areas (ECA).

Please check applicable project category

 Type Threshold
 6 wells and other systems (e.g.
Water Supply Systems (Complete System)
infiltration gallery, etc.)
Level III – with household connection
Water Supply System (Distribution Only)
and water treatment

For ECC applications, this IEE Checklist Report shall be submitted with:
 Proof of Compatibility with the existing Land Use Plan
 Proof of Authority over the Project Site
 Accountability Statements of Proponent (see attached form) and the Preparer (if
any, following Annexes 2-22 of Revised Procedural Manual for DAO 2003-30)
 Photographs or plates/vicinity map of the project site showing impact areas and
affected areas and communities
 Duly Accomplished Project Environmental Monitoring & Audit Prioritization
Scheme (PEMAPS) Questionnaire (see Annex 2-7d of Revised Procedural Manual for DAO
2003-30)

(No other documents shall be required as pre-requisite to ECC applications per DENR MC 2010-14)

Read the questions carefully and write the required information on the blank spaces
provided or otherwise check () the appropriate boxes □ or parenthesis ( ). Boxes
with check marks() are automatically required. Use additional sheets if necessary
and indicate this in the appropriate space.

Project proponents are strongly discouraged to engage the services

of consultants/facilitators/preparers to accomplish/fill-up the IEE
Checklist Report Form. The Report Forms have been designed to be
user-friendly.

Furthermore, EMB Regional Office is required to complete the

processing of an ECC application using the IEE Checklist Report
within twenty (20) 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.

PROJECT FACT SHEET

Project Name: ______________________________________________________

Project Location: _______________________________________________________

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 Total Project Land Area:

Total Project/Facilities _____________________________________________________

Area
(Area actually utilized)
Project Proponent: ______________________________________________________
______________________________________________________
Office Address:
Contact Person: ______________________________________________________
Designation: ______________________________________________________
Contact Information
Telephone Number: ______________________________________________________
Fax Number: ______________________________________________________
Mobile Number: ______________________________________________________
E-mail Address: ______________________________________________________

I. PROJECT DESCRIPTION
1.1 PROJECT LOCATION AND AREA: Street Name, Barangay, and Municipality/City, Province
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

See attached vicinity map/s and photographs of the project site and site development/layout plan

Geographic coordinates of the project area (Preferably use WGS 84 datum - GPS setting, otherwise
specify datum used).
Perimeter/Boundary points
Longitude Latitude
(based on OCT/TCT/etc)

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 1.2 PROJECT COMPONENTS

Facilities Number of Specification/Description/Remarks

Units (Include capacity, length or other size
description)
1. Water collection
Production wells
Infiltration gallery
Diversion/Collection Weir
Others, specify
2. Water treatment facility
Chemical treatment (e.g.,
precipitation, coagulation, etc.)
Physical treatment (e.g.,
screening, sedimentation, etc.)
Disinfection (e.g., chlorination,
etc.)
2
3. Water distribution system (Indicate service area in m and number
of households served)
__________________ square meters
__________________ households

Communal box/faucet (new)

Communal box/faucet (for
rehabilitation)
Water pipelines, distribution main
(new)
Water pipelines distribution main
(for rehabilitation)
Water pipelines, service line
(new)
Water pipelines service line (for
rehabilitation)
Pumping stations
4. Chemical storage facility
5. Waste water management facility
6. Solid waste management facility
7. Drainage System
8. Others, specify
_____________________
(Use additional sheets if needed)
___________________________________________________________________________________

1.3 UTILITIES/REQUIREMENTS (Operation Phase):

Utilities Source Estimated Demand/Consumption

Power/Electricity KWh
(Total)
Power/Electricity KWh
(From Renewable Energy
Sources)
Water m3/day
(Total)
(Fill-up table below if water is not
obtained from the local water utility)
Water m3/day
(Rainwater Collection
System)

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Water Source
[ ] ground water [ ] well [ ] spring [ ] others: ____________________________

[ ] Surface water [ ] river [ ] lake [ ] others: ____________________________

Location of water source

__________________________________________________________________________
(Sitio/Zone, Barangay, Municipality/City, Province, Region)

Energy/Water Efficiency
Utilities Estimated Savings Proposed Efficiency/Conservation
Measures
Power/Electricity KWh

3
Water m /day

1.4 MANPOWER

a. Construction Phase
Manpower Expertise/Skills Total
Requirement

b. Operation Phase
Manpower Expertise/Skills Total
Requirement

1.5 INDICATIVE PROJECT COST

Project Cost (PhP): ____________

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 II. ENVIRONMENTAL IMPACTS AND MANAGEMENT PLAN

Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
LAND

 Consistency with land Current land use w/in 1km radius

(as per zoning ordinance):
 See attached proof of compatibility with
use land use
 Residential
 Commercial/ Institutional
 Industrial
 Agricultural/ Recreational
 Protected Areas
 Others, specify
____________

Actual land uses w/in 1km radius:

 Residential
 Commercial/ Institutional
 Industrial
 Agricultural/ Recreational
 Protected Areas
 Others, specify
_____________

 Disturbance to wildlife Existing vegetation in the area:

 Compliance with conditions of DENR/LGU  Annual inspection of area  Cost integrated in the
due to vegetation  Forestland SLUP, Tree Cutting Permit, ROW, PCA replanted/ revegetated construction /operation cost
clearing  Marshland Permit
 Grassland  Limit land clearing as much as possible
 Mangrove  Provide temporary fencing to vegetation
 Wetland
that will be retained

 Others, specify  Promote restoration of damaged or

_____________ destroyed vegetation where possible (e.g.,
tree planting);

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Possible Environmental/
Social Impacts
 Change in surface
landform/ topography/
terrain/slope
 Soil Erosion
Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Implementation
Slope:  Provide erosion control and slope  Regular inspection of slope  Slope/ Erosion Control
 flat (0-3%) protection measures protection measures in Cost: ___________
 gently sloping to rolling (3-18%)  Designate a Spoils Storage Area, with erosion-prone areas  Others, specify
 steep (>18%) topsoil set aside for later use and allow  Regular inspection for new ____ ________
maximum re-use of spoils eroded areas near the site
 Construction during dry season  Others, specify
 Stabilization of embankment with grasses ______________
or other soil cover
 Others, specify
______________
Is the project site located in an area
identified by MGB/PAG-ASA/  Compliance with the DENR Administrative
PHIVOLCS as hazard prone? Order No. 2003-30 and DENR
 Yes Administrative Order No. 2000-28,
Implementing Guidelines on Engineering
 No Geological and Geo-hazard Assessment
(EGGA).

 Soil/Land contamination Existing soil type in the area:  Implementation of the Ecological Solid  Daily inspection of  Cost integrated in the
due to improper solid  sandy Waste Management Plan (ESWMP) waste/recycling bins for construction /operation cost
waste disposal
 clay  Set-up temporary fence around the segregation

 sandy-loam
construction area  Daily inspection for presence

 Others, specify
 Implement re-use and recycling of waste of mixed garbage in the
materials facility
________________
 Implement proper segregation, collection  Weekly inspection of waste
and disposal of domestic wastes in accumulated
designated areas  Others, specify
 Implement proper collection, labeling and ___________
storage of hazardous waste
 Provide receptacles / bins for solid wastes
 Coordinate with the municipal / city waste
collectors
 Engage third party company for waste
collection
 Others, specify
________________

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Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
 Impairment of Presence of visually significant  Implement landscaping and other  Regular inspection of  Cost integrated in the
visual aesthetics landforms/landscape/structures? beautification measures landscaping and other construction/ operation cost
 Devaluation of land  Yes  Provide adequate buffer beautification activities
values  No  Compensate adjacent property owners  Regular monitoring of buffer
zones
 Others, specify
 Regularly monitor
________________
presence/absence of
complaints from adjacent
property owners
WATER

 Increased siltation due
to project activities
 Water quality
degradation
 Others, specify
__________
Specify nearest/receiving water
body:
____________________________
Distance to nearest/receiving water
body:
 0 to less than 0.5 km
 0.5 to 1 km
 More than 1 km
 Set-up proper and adequate sanitary
facilities
 Strictly require the contractor and its
workers to observe proper waste disposal
and proper sanitation
 Strictly observe proper waste handling and
disposal
 Provision of wastewater treatment facility
 Set up silt trap/stilling ponds to minimize
Regular (ocular) inspection of:  Cost integrated in the
 Drainage / canal systems construction/ operation cost
 Water treatment facility (i.e.,
grease trap, septic tank, etc.)
Quarterly monitoring of the
following:
 pH

If nearest/receiving water body is

downstream siltation  TSS concentration
fresh water, specify classification:  Provide ring canals around fuelling tanks/  BOD
 AA
motorpool/ maintenance areas  Total Coliform
 A
 Others, specify  Color
 B
______________
 Oil and Grease
 C
 D

If nearest/receiving water body is

coastal or marine water, specify
classification:
 SA
 SB
 SC
 SD

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Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation

Current Water Use:

 Fishery
 Tourist Zone / Park
 Recreational
 Industrial
 Agricultural

Distance of project area to the

nearest well used:
 0 to less than 0.5 km
 0.5 to 1 km
 More than 1 km

Use of the nearest well:

 Drinking/Domestic
 Industrial
 Agricultural
 Competition in water Size of population using receiving
use surface water:
 Depletion of water  ≤ 1,000 persons
resources  >1,000 and ≤ 5,000persons
 Implement rainwater harvesting and similar  Cost integrated in the
measures as an alternative source of water  Regularly monitor construction/ operation cost
 Observe water conservation measures; presence/absence of
 Careful selection of project site to avoid
complaints

 >5,000person disruption of traditional water uses  Regular coordination with

concerned agencies
 Obtain Water Permit from NWRB
 Regularly monitor
Available/nearest water source.  Improve efficiency of water supply and occurrences of water
 Deepwell distribution system shortages
 Water district/LGU  Implement community ponds and similar  Others, specify
 Surface water measures as alternative water source for
non-domestic uses
__________
 Others, specify
 Increase, when practical, storage
___________
capacities of water supply structures for
resilience to greater climate variations and
extremes
 Others, specify ________________

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Possible Environmental/
Social Impacts
 Increased occurrence
of flooding
AIR / NOISE
 Air quality degradation
 Nuisance due to noise
generation
Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Implementation
Is the project site located in an area  Use appropriate design for project facilities  Regularly monitor  Cost integrated in the
identified by MGB/PAG-ASA as
flood prone?  Implement appropriate drainage system
presence/absence of
complaints
construction/ operation cost
 Yes  Regularly remove debris and other
 Regular coordination with
materials that may obstruct water flow
 No concerned agencies
 Use appropriate technology (e.g. raised  Regularly monitor increased
hand-pumps) to protect drinking water from frequency of flooding
flood contamination
 Others, specify
 Others, specify
_____________
________________
Distance to nearest community:  Properly operate and maintain all emission  Regularly monitor  Cost integrated in the
 0 to less than 0.5 km sources (e.g. vehicles, pumps, generator, presence/absence of construction/ operation cost
 0.5 to 1 km etc) complaints
 More than 1 km  Install when applicable, the appropriate air
Regular (ocular) inspection of:
pollution control device/s
 Strictly enforce good housekeeping  Absence of white or black
practices smoke from vehicles,
generator, etc.
 Control vehicle speed to lessen
 Presence of truck cover
suspension of road dust
during deliveries
 Conduct water spraying to suppress dust
sources and minimize discomfort to nearby
residents
 Use covered vehicles to deliver materials
that may generate dust
 Other, specify
___________________
Distance to nearest community:  Properly operate and maintain all noise  Regularly monitor  Cost integrated in the
 0 to less than 0.5 km sources (e.g. vehicles, pumps, generator, presence/absence of construction/ operation cost
 0.5 to 1 km etc) complaints
 More than 1 km  Install when applicable, the appropriate  Regular monitoring of buffer
noise control device/s (e.g., mufflers, zones
silencer, sound barriers, etc.)
 Implement appropriate operating hours
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Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation

 Provide adequate buffer and/or planting of

trees
 Others, specify
______________

PEOPLE

 Displacement of  Provide relocation/disturbance  Regularly monitor  Cost integrated in the

residents in the project compensation packages presence/absence of construction/ operation cost
site and within its Size of population of host barangay:  Prioritize local residents for employment complaints
vicinity
 ≤ 1,000 persons  Promptly pay local taxes and other  Regular coordination with
 Displacement of
 >1,000 and ≤ 5,000persons
financial obligations LGU
Indigenous People  Others, specify
  Regular coordination with LGU
 Enhanced employment >5,000person
 Prior consultation & coordination to
______________
and/or livelihood
Classification of host barangay: minimize disruption on daily domestic
opportunities
 Reduced employment  Urban
activities & respect for IP rights and
cultural practices
and/or livelihood  Rural
 Ensure participation of IPs in consultations
opportunities
and dialogues
 Increased revenues for Available services within/near the
host barangay:  Provide appropriate traffic/warning
LGU
  Schools (e.g. elementary, high
signs, lighting, etc
Disruption/Competition
in delivery of public school, college)  Others, specify
services (e.g.,  Health facilities (e.g., clinics,
______________
education, peace and hospitals, etc.)
order, etc.)  Peace and order (e.g., police
 Enhanced delivery of outpost, brgy. Tanod, etc.)
public services (e.g.,
education, peace and
 Recreation and sports facilities
order, etc.)  Others, specify
______________
 Increase in traffic
volume and worsening
of traffic flow

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Possible Environmental/ Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/ Cost of Mitigation/ Monitoring
Social Impacts Implementation
 Impacts on community  Regular coordination with LGU  Regularly monitor  Cost integrated in the
health and safety  Provide appropriate warning signs, lighting presence/absence of construction/ operation cost
 Others, specify and barricades, whenever practicable complaints
__________  Observe proper housekeeping  Regular coordination with
LGU
 Provide on-site medical services for any
 Regularly monitor
emergency.
submission of reports to
 Participate in public awareness programs concerned agency
on health and safety  Others, specify
 Implement appropriate safety programs for ______________
both community and workers
 Strictly comply with fire, safety and similar
regulatory requirements
 Strictly comply with requirements of RA
6969
 Others, specify
____________________

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III. ABANDONMENT /DECOMMISSIONING/REHABILITATION POLICIES AND
GENERIC GUIDELINES (if Applicable)

Project Life or Service : ___________ years

Provide description of the Abandonment activities, such as, dismantling and waste
disposal.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
IV. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATION

Organization Chart:

4.1. Abandonment Plan (if Applicable)

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Attach drawing/plan of air pollution source and control installations (with
dimensions and descriptions)

13
Process Flow

14
Attach drawing/plan of waste water treatment facility (with dimensions and
descriptions)

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 SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENT

This is to certify that all the information and commitments in this Initial
Environmental Examination (IEE) Checklist Report are accurate and complete to the
best of my knowledge.

By the authority vested in me by the _____(Company Name) as

___(Position/Designation), I hereby commit to ensure implementation of all
commitments, mitigating measures and monitoring requirements indicated in this IEE
Checklist Report as well as the following:
 Conform to pertinent provisions of applicable environmental laws e.g.,
R.A. No. 6969 (Toxic Substances and Hazardous and Nuclear Wastes
Control Act of 1990), R.A. No. 9003 (Ecological Solid Waste
Management Act of 2000), R.A. No. 9275 (Philippine Clean Water Act
of 2004), and R.A. No. 8749 (Philippine Clean Air Act of 1999).
 Abide and conform to LGU development plans and guidelines.
 Promptly pay local taxes 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

______________________.

__________________________
NAME OF PROPONENT HEAD
(Position)
(Company Name)

SUBSCRIBED AND SWORN TO before me this _____ day of ____________

201__, affiant exhibiting his/her Community Tax Certificate No.
___________________ issued at ______________________ on
__________________________.

Doc. No. ____________________

Page No. ____________________
Book No. ____________________
Series of ____________________

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