APPENDIX I
(See Paragraph-6)
FORM 1M
Note : If space provided against any parameter is inadequate,Kindly upload supporting document under 'Additional Attachments if any'  at the last part of the Form 1M. Please note that all such Annexures must be part of single pdf document.
(I)Basic Informations
S.No.Item Details
(i).Name of the Mining Lease site Kotrabundeli Dolomite Stone (Low Grade) Quarry Mine of Tilak Chandravanshi
(ii).Location / site (GPS Co-ordinate) BL1 21°43'59.51"N 81°12'11.61"E BL2 21°44'01.96"N 81°12'06.04"E BL3 21°44'03.71"N 81°12'09.70"E BL4 21°44'04.56"N 81°12'09.94"E BL5 21°44'06.70"N 81°12'13.74"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)2.129 ha.
(iv).Capacity of the Mining Lease (TPA) 99820
(v).Period of Mining Lease 30
(vi).Expected cost of the Project 36
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?No
Reason for not hiring the Consultant/RQP Due to Category of B2 Project
(II) Environmental Sensitivity
S.No Areas Distance in kilometer / Details
1. (i).  Nearest rail or road bridge over the concerned river,rivulet,nallah etc. in kms.  1.50 km
2. (ii). Nearest Infrastructural along with distance in kms  0.580 km
(iii). Nearest Railway Line along with distance in kms  58.50 km
(iv). Nearest National Highway along with distance in kms  24.00 km
(v). Nearest State Highway along with distance in kms  7.90 km
(vi). Nearest Major District Road along with distance in kms 9.30 km
(vii). Nearest Any Other Road along with distance in kms  2.00 km
(viii). Nearest Electric transmission line pole or tower distance in kms  0.500 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  0.470 km
(x). Nearest In-take for drinking water pump house distance in kms  0.580 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  2.40 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
 No such sensitive areas are located
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests No such important or sensitive area for ecological reasons are located
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration No study record found for such sensitive species or activites for study area.
6. Inland, coastal, marine or underground waters No such sensitive areas are located within study area except- - River -11.00 km (Surhi river at south) - Reservior - 1.20 km - Ground Water table is 35 meter deep and proposed depth of mining is 18 meter deep, hence no impact on water table is expected.
7. State, National boundaries There is no state or, national boundary close within 05 km aerial distance from project location.
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas No route or facilities are available in the study area, which are being used for public access to recreation or other tourist, pilgrim.
9. Defence installations The area is not located close to any of the defense installations moreover the such defense area is not situated with in study area.
10. Densely populated or built-up area, distance from nearest human habitation - Densely populated or have built-up area - Sahaspur Lohara at 12.70 km. - Distance from nearest human habitation- Kotrabundeli village at 580 m
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) At Doma Tola at 2.00 km / Kawardha at 29.00 km distance
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) No such important areas are located around the study area or mine area except- Ground Water resources: - Ground Water table is 35 meter deep and proposed depth of mining is 18 meter deep, hence no impact on water table is expected. Surface Water resources: No important surface water resources are located within mines or around the mine area except river, nalla or reservoir as stated in point number 2 and 6 above.
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) None around the study area.
14. Areas susceptible to natural hazard which could cause the project to present environmental problems (earthquakes, subsidence, landslides, erosion, flooding or extreme or adverse climatic conditions) The area is safe with natural hazardous or flood prone area and No such sensitive areas are located within study area.
15.
Is proposed mining site located over or near fissure/fracture for ground water recharge?No
16.
Whether the proposal involves approval or clearance under the following Regulations or Acts namely?
(a).
The Forest (Conservation) Act,1980?No
(b).
The Wildlife (Protection) Act,1972?No
(c).
The Coastal Regulation Zone (C.R.Z) notification,2011?No
17.
Is forest land involved (ha)?No
18.
Whether there is any litigation pending against the project and/or land in which the project is proposed to be set up?No
19.
New/Expansion/ModernizationNew
Proposal NumberDIA/CG/MIN/16969/2018
File NumberDEAIAA_kdm_2018_47
Date of Apply EC29 Aug 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)ChhattisgarhKabirdhamNo Data
(III) EC Attachments
1 Uploaded PFR (Pre Feasibility Report) File Annexure-PFR file
2 Uploaded Approved Mining Plan File Annexure-Approved Mining Plan file
3 Uploaded District survey report Annexure-District Survey Report
4 Uploaded Cover Letter Annexure-Cover Letter
Uploaded Additional attachments, if any
S.No. Attached File Date of Submission
(1.)EMP29 Aug 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameTILAK CHANDRAVANSHI
DesignationOWNER
Company TILAK CHANDRAVANSHI
AddressVISHWANATH CHANDRAVANSHI MATHPARA WARD NO 12, VILLAGE & TEHSIL-KAWARDHA
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