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 DBR/12/BURIDIHING/ GAMONGHAT (SAND & CLAY)MPA AT NAWJAN AREA
(ii).Location / site (GPS Co-ordinate) 27 18’47.92”N - 94 53’05.68”E 27 18’50.53”N - 94 53’01.80”E 27 18’56.62”N- 94 53’09.03”E 27 18’54.39”N - 94 53’12.75”E
Annexure-GPS file      
(iii).
Type of LeaseCluster Area
Size of the Mining Lease (in ha.)3.5 ha.
(iv).Capacity of the Mining Lease (TPA) 8000
(v).Period of Mining Lease 2
(vi).Expected cost of the Project 16.58
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.DGM/RQP/37/2018 
Name of Consultant/RQPPRABAL KUMAR GOSWAMI
Address H/No. 17, Ganga PAth, Anandapur.Hengrabari, Ganeshpuri P.O. Dispur, Guwahati - 781006
Mobile No.9435116542
Landline No.78966525
Email Idgoswami.prabal16@gmail.com
(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.  0.6 km
2. (ii). Nearest Infrastructural along with distance in kms  4 km
(iii). Nearest Railway Line along with distance in kms  0.6 km
(iv). Nearest National Highway along with distance in kms  0.6 km
(v). Nearest State Highway along with distance in kms  0.6 km
(vi). Nearest Major District Road along with distance in kms 0.6 km
(vii). Nearest Any Other Road along with distance in kms  2 km
(viii). Nearest Electric transmission line pole or tower distance in kms  1 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  3 km
(x). Nearest In-take for drinking water pump house distance in kms  00 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  00 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
 No such area located in the 15 km of the project site.
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests No such area located in the 15 km of the project site.
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration No such area located in the 15 km of the project site.
6. Inland, coastal, marine or underground waters No such area located in the 15 km of the project site.
7. State, National boundaries No such area located in the 15 km of the project site.
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas No such area located in the 15 km of the project site.
9. Defence installations NIL
10. Densely populated or built-up area, distance from nearest human habitation Nearest village is about 4.0 Km away.
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) School about About 4.0 Km, Hospital about 7.0 Km Place of Worship about 4.5 Km
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) No such area located in the 15 km of the project site.
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) No such area located in the 15 km of the project site.
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 proposed project site hashistory of natural disasters such earthquakes and flood etc. The site lies in Seismic Zone V.
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/AS/MIN/20022/2019
File NumberTo be assigned
Date of Apply EC20 Nov 2019
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)AssamDibrugarhDibrugarh West
(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.)FORM 120 Nov 2019
(2.)FORM 1M20 Nov 2019
(3.)Challan20 Nov 2019
(4.)Forest Office letter20 Nov 2019
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameEMERALD CONSTRUCTION
DesignationPARTNER
Company EMERALD CONSTRUCTION
AddressSG COMMERCIAL COMPLEX, THANA CHARALI, DIBRUGARH
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