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 Patperpali Khurd Temporary Quarry Lease
(ii).Location / site (GPS Co-ordinate) A 20° 59’ 16.71"N 82°27' 18.24"E B 20° 59’ 21.13"N 82°27' 17.96"E C 20° 59’ 21.59"N 82°27' 20.53"E D 20° 59’ 20.17"N 82°27' 20.76"E E 20° 59’ 16.89"N 82°27' 20.65"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)1.00 ha.
(iv).Capacity of the Mining Lease (TPA) 61161.6
(v).Period of Mining Lease 2
(vi).Expected cost of the Project 10
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?No
Reason for not hiring the Consultant/RQP not required
(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.  0.5 km
2. (ii). Nearest Infrastructural along with distance in kms  2.6 km
(iii). Nearest Railway Line along with distance in kms  0.5 km
(iv). Nearest National Highway along with distance in kms  3 km
(v). Nearest State Highway along with distance in kms  2.6 km
(vi). Nearest Major District Road along with distance in kms 2.6 km
(vii). Nearest Any Other Road along with distance in kms  2.6 km
(viii). Nearest Electric transmission line pole or tower distance in kms  2.6 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  13 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  40 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
there is any no international conventions, national or local legislation for their ecological, landscape, cultural or other related value
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests data not available
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration here is no any sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration
6. Inland, coastal, marine or underground waters rea like Inland, coastal, marine or underground waters are not present within the 5km radius and Ground water table data not available
7. State, National boundaries State boundary of Odisha is more than 13 km from the lease area
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas Routes or facilities used by the public for access to recreation or other tourist, pilgrim areas are not present
9. Defence installations Not installed near by the lease area
10. Densely populated or built-up area, distance from nearest human habitation Komakhan is thinly populated village which is present at a distance of 2.6 km in south direction from the lease area
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Primary school in village Komakhan
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) reas containing important, high quality or scarce resources are not present
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) Komakhan is thinly populated village Areas already subjected to pollution or environmental damage not present
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) Not Nearby the 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/11209/2017
File Number142/EC/MSD/2017
Date of Apply EC24 Nov 2017
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)ChhattisgarhMahasamundMahasamund
(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.)EMP24 Nov 2017
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameGANESH PRASAD KHETAN
DesignationOwnwe
Company GANESH PRASAD KHETAN
AddressGanesh Prasad Khetan, Khetan Building, Mudhapara, Raipur
Print