For ECC applications, this IEE Checklist Report shall be submitted with

SUBDIVISIONS AND HOUSING PROJECTSINITIAL ENVIRONMENTAL EXAMINATION ( IEE ) CHECKLIST REPORTforProject name or TitleProjectsSubdivision and housing projects,resettlement projects, economicand socialized housing project,open market housing and othersimilar (horizontal) landdevelopment projectsSubdivisions and Housing ProjectsProject SizeParametertotal land area, including allcommon and other areasCorresponding ProjectSize/ThresholdRegardless of areaFor 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 (ifany, following Annexes 2-22 of Revised Procedural Manual for DAO 2003-30) Photographs or plates/vicinity map of the project site showing impact areas andaffected areas and communities Duly Accomplished Project Environmental Monitoring & Audit PrioritizationScheme (PEMAPS) Questionnaire (see Annex 2-7d of Revised Procedural Manual for DAO2003-30)(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 spacesprovided or otherwise check () the appropriate boxes □ or parenthesis ( ). Boxeswith check marks() are automatically required. Use additional sheets if necessaryand indicate this in the appropriate space.Project proponents are strongly discouraged to engage the services ofconsultants/facilitators/preparers to accomplish/fill-up the IEE ChecklistReport Form. The Report Forms have been designed to be user-friendly.Furthermore, EMB Regional Office is required to complete the processing ofan ECC application using the IEE Checklist Report within twenty (20) workingdays upon receipt for duly-accomplished forms with complete attachmentsMisleading or erroneous answers are basis for legal actions and/or denial of ECCissuance.PROJECT FACT SHEETProject Name:Project Location:______________________________________________________________________________________________________________Total Project Land Area:_______________________________________________________Total Project Area(Area actually utilized)Project Proponent:1 IEE Checklist Report for Subdivisions and Housing Projects

Office Address:Contact Person:Designation:Contact Number/sLandline :Fax Number:Mobile :E-mail Address:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________I. PROJECT DESCRIPTION1.1 PROJECT LOCATION AND AREA: Street Name, Barangay, and Municipality/City, Province_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Attach vicinity map/s and photographs of the project site and site development/layout plan and survey planapproved by Geodetic Engineer.Geographic coordinates of the project area (Preferably use WGS 84 datum, otherwise specify datum used).Perimeter/Boundary pointsLongitudeLatitude(based on OCT/TCT/etc)2 IEE Checklist Report for Subdivisions and Housing Projects

1.2 PROJECT COMPONENTSFacilities No. of Units Area (sq. m.) /CapacitySpecification/Description / Remarks1. Residential lots2. Commercial Area (e.g. banks,restaurants, outlets, stores,etc.)3. Institutional Area (e.g. offices,schools, etc. – please specify)4. Amenities (e.g. swimmingpools, gym, Chapel, clubhouse, etc.)5. Open/Common Spaces (e.g.reception area, garden, parks,etc.)6. Road systemPrimary/Main roadSecondary roadAlley7. Common Parking area8. Water supply system9. Drainage system10. Support facilities (e.g.emergency generators, guardhouses/posts, etc.)11. Waste Water ManagementFacility12. Solid waste managementfacilities13. Others, specify____________________(Use additional sheets if needed)_____________________________________________________________________________________1.3 UTILITIES/REQUIREMENTS (Operation Phase):Utilities Source Estimated Demand/ConsumptionPower/Electricity(Total)Power/Electricity(From Renewable EnergySources)Water(Total)(Fill-up table below if water is notobtained from the local water utility)Water(Rainwater CollectionSystem)Water Source[ ] ground water [ ] well [ ] spring [ ] others: ____________________________KWhKWhm³/daym³/day[ ] Surface water [ ] river [ ] lake [ ] others: ____________________________Location of water source____________________________________________________________________________(Sitio/Zone, Barangay, Municipality/City, Province, Region)3 IEE Checklist Report for Subdivisions and Housing Projects

Energy/Water EfficiencyUtilities Estimated Savings Proposed Efficiency/ConservationMeasuresPower/ElectricityKWhWaterm³/day1.4 MANPOWERa. Construction PhaseManpowerRequirementExpertise/SkillsTotalb. Operation PhaseManpowerRequirementExpertise/SkillsTotal1.5 INDICATIVE PROJECT COSTProject Cost (PhP): ____________4 IEE Checklist Report for Subdivisions and Housing Projects

AL IMPACTS AND MANAGEMENT PLANBaseline Environment Preventive/ Mitigating Measures Monitoring Parameters/Implementation and frequencyCost of MCurrent land use w/in 1km radius(as per zoning ordinance): Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify________________ See attached proof of compatibility withland useActual land uses w/in 1km radius: Residential Commercial/ Institutional Industrial Agricultural/ Recreational Protected Areas Others, specify______________Existing vegetation in the area: Forestland Marshland Grassland Mangrove Wetland Others, specify____________________ Compliance with conditions of DENR/LGUSLUP, Tree Cutting Permit, ROW, PCAPermit Limit land clearing as much as possible Provide temporary fencing to vegetationthat will be retained Promote restoration of damaged ordestroyed vegetation where possible (e.g.,tree planting); Annual inspection of areareplanted/ revegetated Costconstcklist Report for Subdivisions and Housing Projects

Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/Implementation and frequencySlope: flat (0-3%) gently sloping to rolling (3-18%) steep (>18%)Note: if project site is located inan erosion prone area greaterthat 18% slope submit:IEEREGGAREstablish MMT. EMF and EGF(FOR FURTHER EVALUATIONAND CLARIFICATION) Provide erosion control and slopeprotection measures Designate a Spoils Storage Area, withtopsoil set aside for later use and allowmaximum re-use of spoils Compliance to the standard criteria forsanitary landfill development DAO 49 and50. Construction during dry season Stabilization of embankment with grassesor other soil cover Others, specify____________ Regular inspection of slopeprotection measures inerosion-prone areas Regular inspection for neweroded areas near the site Others, specify___________Requirements under EGGARCost of M SlopeCost: Othe____Compliance with Easement requirements (3meters for urban, 20 meters for agriculture,etc.) and ROWnIs the project site located in an areaidentified byMGB/PAGASA/PHIVOLCS ashazard prone? Yes NoExisting soil type in the area: sandy clay sandy-loam Others, specify____________________ Compliance with the DENR AdministrativeOrder No. 2003-30 and DENRAdministrative Order No. 2000-28,Implementing Guidelines on EngineeringGeological and Geo-hazard Assessment(EGGA). Implementation of the Ecological SolidWaste Management Plan (ESWMP) Set-up temporary fence around theconstruction area Implement re-use and recycling of wastematerials Implement proper segregation, collectionand disposal of domestic wastes in Daily inspection ofwaste/recycling bins forsegregation Daily inspection for presenceof mixed garbage in thefacility Weekly inspection of wasteaccumulated Costconstcklist Report for Subdivisions and Housing Projects

Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/Implementation and frequency Others, specify____________________designated areas Provide receptacles / bins for solid wastes Coordinate with the municipal / city wastecollectorsCost of M Engage third party company for wastecollection Others, specify________________Presence of visually significantlandforms/landscape/structures? Yes No Implement landscaping and otherbeautification measures Provide adequate buffer Compensate adjacent property owners Others, specify________________ Regular inspection oflandscaping and otherbeautification activities Regular monitoring of bufferzones Regularly monitorpresence/absence ofcomplaints from adjacentproperty owners CostconstSpecify nearest/receiving waterbody:____________________________Distance to nearest/receiving waterbody: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmIf nearest/receiving water body isfresh water, specify classification: AA Set-up proper and adequate sanitaryfacilities Strictly require the contractor and itsworkers to observe proper waste disposaland proper sanitation Strictly observe proper waste handling anddisposal Provision of wastewater treatment facility(e.g. oil and water separator, etc.) Set up silt trap/stilling ponds to minimizedownstream siltation Provision of three-chambered septic tankfor domestic sewageRegular (ocular) inspection of: Drainage / canal systems Water treatment facility (i.e.,grease trap, septic tank, etc.)Quarterly monitoring of thefollowing: pH TSS concentration BOD Total Coliform Color Costconstcklist Report for Subdivisions and Housing Projects

Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/Implementation and frequency Oil and Grease A B C D Others, specify___________Cost of MIf nearest/receiving water body iscoastal or marine water, specifyclassification: SA SB SC SDCurrent Water Use: Fishery Tourist Zone / Park Recreational Industrial AgriculturalDistance of project area to thenearest well used: 0 to less than 0.5 km 0.5 to 1 km More than 1 kmUse of the nearest well: Drinking/Domestic Industrial Agriculturalcklist Report for Subdivisions and Housing Projects

Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/Implementation and frequencySize of population using receivingsurface water: ≤ 1,000 persons >1,000 and ≤ 5,000persons >5,000personAvailable/nearest water source. Deepwell Water district/LGU Surface water Others, specify_________________________ Implement rainwater harvesting and similarmeasures as an alternative source of water Observe water conservation measures Careful selection of project site to avoiddisruption of traditional water uses Obtain Water Permit from NWRB Improve efficiency of water supply anddistribution system Others, specify________________________ Regularly monitorpresence/absence ofcomplaints Regular coordination withconcerned agencies Regularly monitoroccurrences of watershortages Others, specify____________Cost of M CostconstIs the project site located in an areaidentified by MGB/PAGASA asflood prone? Yes No Use appropriate design for project facilities Implement appropriate drainage system Regularly remove debris and othermaterials that may obstruct water flow Use appropriate technology (e.g. raisedhand-pumps) to protect drinking water fromflood contamination Others, specify________________________ Regularly monitorpresence/absence ofcomplaints Regular coordination withconcerned agencies Regularly monitor increasedfrequency of flooding Others, specify_________________ CostconstDistance to nearest community: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain all emissionsources (e.g. vehicles, generator, etc) Install when applicable, the appropriate airpollution control device/s Strictly enforce good housekeepingpractices Control vehicle speed to lessen Regularly monitorpresence/absence ofcomplaintsRegular (ocular) inspection of: Absence of white or blacksmoke from vehicles,generator, etc. Costconstcklist Report for Subdivisions and Housing Projects

Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/Implementation and frequency Presence of truck coverduring deliveriessuspension of road dust Conduct water spraying to suppress dustsources and minimize discomfort toresidents Use covered vehicles to deliver materialsthat may generate dust Other, specify____________________________Cost of MDistance to nearest community: 0 to less than 0.5 km 0.5 to 1 km More than 1 km Properly operate and maintain all noisesources (e.g. vehicles, generator, etc) Install when applicable, the appropriatenoise control device/s (e.g., mufflers,silencer, sound barriers, etc.) Implement appropriate operating hours Provide adequate buffer and/or planting oftrees Others, specify_____________________________ Regularly monitorpresence/absence ofcomplaints Regular monitoring of bufferzones CostconsttSize of population of host barangay: ≤ 1,000 persons >1,000 and ≤ 5,000persons >5,000personClassification of host barangay: Urban RuralAvailable services within/near thehost barangay: Provide relocation/disturbancecompensation packages Prioritize local residents for employment Promptly pay local taxes and otherfinancial obligations Regular coordination with LGU Prior consultation & coordination tominimize disruption on daily domesticactivities & respect for IP rights andcultural practices Ensure participation of IPs in consultations Regularly monitorpresence/absence ofcomplaints Regular coordination withLGU Others, specify_________________ Costconstcklist Report for Subdivisions and Housing Projects

Baseline Environment Preventive/ Mitigating Measures Monitoring Parameters/Implementation and frequency Schools (e.g. elementary, highschool, college) Health facilities (e.g., clinics,hospitals, etc.) Peace and order (e.g., policeoutpost, brgy. Tanod, etc.) Recreation and sports facilities Others, specify_______________________and dialogues Provide appropriate traffic/warning signs,lighting, etc Others, specify________________Cost of M Regular coordination with LGU Provide appropriate warning signs, lightingand barricades, whenever practicable Observe proper housekeeping Provide on-site medical services for anyemergency. Participate in public awareness programson health and safety Implement appropriate safety programs forboth community and workers Strictly comply with fire, safety and similarregulatory requirements Others, specify________________________ Regularly monitorpresence/absence ofcomplaints Regular coordination withLGU Regularly monitor submissionof reports to concernedagency Others, specify_________________ Costconstcklist Report for Subdivisions and Housing Projects

III. ABANDONMENT /DECOMMISSIONING/REHABILITATION POLICIES ANDGENERIC GUIDELINES (if Applicable)Project Life or Service : ___________ yearsProvide description of the Abandonment activities, such as, dismantling and wastedisposal.______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________IV. INSTITUTIONAL PLAN FOR EMP IMPLEMENTATIONOrganization Chart:4.1. Abandonment Plan (if Applicable)12 IEE Checklist Report for Subdivisions and Housing Projects

Attach drawing/plan of sewerage treatment facilities (with dimensions anddescriptions)13 IEE Checklist Report for Subdivisions and Housing Projects

SWORN STATEMENT OF ACCOUNTABILITY OF THE PROPONENTThis is to certify that all the information and commitments in this InitialEnvironmental Examination (IEE) Checklist Report are accurate and complete to thebest of my knowledge.By the authority vested in me by the ______(Company Name) as___(Position/Designation), I hereby commit to ensure implementation of allcommitments, mitigating measures and monitoring requirements indicated in this IEEChecklist Report as well as the following: Conform with pertinent provisions of applicable environmental lawse.g., R.A. No. 6969 (Toxic Substances and Hazardous and NuclearWastes Control Act of 1990), R.A. No. 9003 (Ecological Solid WasteManagement Act of 2000), R.A. No. 9275 (Philippine Clean Water Actof 2004), and R.A. No. 8749 (Philippine Clean Air Act of 1999). Abide and conform with 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 fromany 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__, affiantexhibiting his/her Community Tax Certificate No. ___________________ issued at______________________ on __________________________.Doc. No.Page No.Book No.Series of________________________________________________________________________________14 IEE Checklist Report for Subdivisions and Housing Projects