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 Koliyari Sandmine
(ii).Location / site (GPS Co-ordinate) 1. 20°40'26.96"N 81°34'19.67"E 2. 20°40'34.00"N 81°34'25.30"E 3. 20°40'30.74"N 81°34'30.21"E 4. 20°40'23.85"N 81°34'24.04"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)4.50 ha.
(iv).Capacity of the Mining Lease (TPA) 170000
(v).Period of Mining Lease 2
(vi).Expected cost of the Project 5
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?No
Reason for not hiring the Consultant/RQP It is a B2 category 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.  0.21 km
2. (ii). Nearest Infrastructural along with distance in kms  0.28 km
(iii). Nearest Railway Line along with distance in kms  4.9 km
(iv). Nearest National Highway along with distance in kms  4.78 km
(v). Nearest State Highway along with distance in kms  0.21 km
(vi). Nearest Major District Road along with distance in kms 0.21 km
(vii). Nearest Any Other Road along with distance in kms  0.43 km
(viii). Nearest Electric transmission line pole or tower distance in kms  0.3 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  0.57 km
(x). Nearest In-take for drinking water pump house distance in kms  0.28 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  0.41 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
None within the radius of 10 km
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Lease area lies in River Mahanadi. No river lies within the study area of 15 km. Seasonal Nala lies at a distance of about 0.55 km
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration None within the radius of 10 km
6. Inland, coastal, marine or underground waters None within the radius of 10 km
7. State, National boundaries No State or National boundary lie within the radius of 10 km
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas None within the radius of 10 km
9. Defence installations None within the radius of 10 km
10. Densely populated or built-up area, distance from nearest human habitation Dhamtari lies at a distance of about 3.5 Km.
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) School lies at a distance of about 0.42 km at Koliyari and Hospital lies at a distance of about 2.5 km at Rudri.
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Boyana PF lies at a distance of about 2.7 km from the lease area. Soram PF lies at a distance of about 3.75 km from the lease area. Dangimacha PF lies at a distance of about 8.0 km from the lease area. Mohlai PF lies at a distance of about 6.5 km from the lease area. Lilar PF lies at a distance of about 8.5 km from the lease area. Arud PF lies at a distance of about 6.5 km from the lease area. Lasunwahi RF lies at a distance of about 1.03 km from the lease area. Pathritola RF lies at a di
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) No
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) No
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/17127/2018
File Number17127/2018
Date of Apply EC05 Sep 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)ChhattisgarhDhamtariDhamtari
(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 1M05 Sep 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameGRAM PANCHAYAT KOLIYARI
DesignationINDIVIDUAL
Company GRAM PANCHAYAT KOLIYARI
AddressVILLAGE KOLIYARI TEHSIL DHAMTARI DISTRICT DHAMTARI CHHATTISGARH
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