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 Achholi Flagstone Quarry
(ii).Location / site (GPS Co-ordinate) A 21°13'47.66"N 82° 3'35.99"E B 21°13'46.84"N 82° 3'35.90"E C 21°13'46.73"N 82° 3'36.64"E D 21°13'46.20"N 82° 3'38.33"E E 21°13'46.40"N 82° 3'39.07"E F 21°13'46.37"N 82° 3'40.14"E G 21°13'47.96"
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)0.58 ha.
(iv).Capacity of the Mining Lease (TPA) 3750
(v).Period of Mining Lease 30
(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.  10.0 km
2. (ii). Nearest Infrastructural along with distance in kms  0.5 km
(iii). Nearest Railway Line along with distance in kms  9.0 km
(iv). Nearest National Highway along with distance in kms  5.0 km
(v). Nearest State Highway along with distance in kms  00.00 km
(vi). Nearest Major District Road along with distance in kms 9.00 km
(vii). Nearest Any Other Road along with distance in kms  0.230 km
(viii). Nearest Electric transmission line pole or tower distance in kms  0.5 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  00.00 km
(x). Nearest In-take for drinking water pump house distance in kms  00.00 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  00.00 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
There are 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 Kurar river about 350 m west and Mahanadi River about 2.0 km west. Tumgaon Reserve Forest at about 7.0 km east of the area. Sirpur Reserve forest at about 8.5 km in east of the area.
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Data is not available Regarding sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration.
6. Inland, coastal, marine or underground waters Areas like Inland, coastal, marine are not present within the 5km radius of the mine area and Ground water table depth in mine area is approx 30m.
7. State, National boundaries State boundaries of Odisha is more than 50 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 for public access is not present
9. Defence installations Defence installations is not present
10. Densely populated or built-up area, distance from nearest human habitation Achholi is thinly populated village, this is about 0.5 km west from the lease area
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Primary School in Achholi at about 1.0km Temple and Hospital in Achholi at about 1.0km
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Not Nearby the area
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) Areas already subjected to pollution or environmental damage. (those where existing legal environmental standards are exceeded) are does not present within the lease 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 not either polluted or nor environmentally damaged.
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/15105/2018
File Number161/EC/MSD/2018
Date of Apply EC11 May 2018
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.)Letter of intent11 May 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameKUSHAL SAHU
DesignationOwner
Company KUSHAL SAHU
Addressvillage Tumgaon Tehsil & District Mahasamund
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