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 Brick Earth Quarry, Village- Sargawan
(ii).Location / site (GPS Co-ordinate) A 23°18'53.28"N 83°33'37.35"E B 23°18'53.58"N 83°33'40.24"E C 23°18'48.16"N 83°33'39.09"E D 23°18'47.84"N 83°33'38.87"E E 23°18'47.29"N 83°33'37.47"E F 23°18'47.30"N 83°33'35.
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)1.619 ha.
(iv).Capacity of the Mining Lease (TPA) 4364.8
(v).Period of Mining Lease 10
(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.  3 km
2. (ii). Nearest Infrastructural along with distance in kms  5 km
(iii). Nearest Railway Line along with distance in kms  60 km
(iv). Nearest National Highway along with distance in kms  15 km
(v). Nearest State Highway along with distance in kms  1 km
(vi). Nearest Major District Road along with distance in kms 1 km
(vii). Nearest Any Other Road along with distance in kms  0.80 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 is no international convention, 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 Mehan river is present at a distance of about 650 meter north of the lease area A Small seasonal nala at present at a distance of about 50 meter south east of the lease area Protected Forest is situated at a distance of about 350 meter
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 as the state is land surrounding state
7. State, National boundaries Not present within 10km radius
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 nearby the lease area
10. Densely populated or built-up area, distance from nearest human habitation Sargawan is a small thinly populated village, Which is about 0.5km from the lease area
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Primary school, temple and Market in village Sargawan
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Areas 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) No, area does not subjected to pollution or environmental damage
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/4849/2017
File NumberDIA/BL/28/CG/MIN/4849/2017
Date of Apply EC21 Feb 2017
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)ChhattisgarhBalrampurramanujganj
(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 1 M21 Feb 2017
(2.)EMP21 Feb 2017
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameSHRI KAMIL AZAM
DesignationOwner
Company SHRI KAMIL AZAM
AddressShri Kamil Azam Village - Sargawan Tehsil - Sankargarh District - Balrampur
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