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 Gram Panchayat Bakalo
(ii).Location / site (GPS Co-ordinate) 22°58'36.87"N 82°45'57.08"E 22°58'36.84"N 82°45'57.95"E 22°58'30.29"N 82°45'54.45"E 22°58'31.02"N 82°45'54.11"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)2.10 ha.
(iv).Capacity of the Mining Lease (TPA) 31500
(v).Period of Mining Lease 2
(vi).Expected cost of the Project 1
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?No
Reason for not hiring the Consultant/RQP NA
(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.  Road bridge on Geruw km
2. (ii). Nearest Infrastructural along with distance in kms  Nearest Railway Stat km
(iii). Nearest Railway Line along with distance in kms  Nearest Railway Stat km
(iv). Nearest National Highway along with distance in kms  National Highway-78 km
(v). Nearest State Highway along with distance in kms  State Highway 2 is km
(vi). Nearest Major District Road along with distance in kms Premnagar Chandannag km
(vii). Nearest Any Other Road along with distance in kms  Small village road i km
(viii). Nearest Electric transmission line pole or tower distance in kms  Not nearby the lease km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  Not nearby the lease km
(x). Nearest In-take for drinking water pump house distance in kms  Not nearby the lease km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  Not nearby the lease 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 Banjhi RF at about 1.5 km in west direction.
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 Area 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 20m.
7. State, National boundaries State boundary of MP is situated at about 88 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 nearby the area.
10. Densely populated or built-up area, distance from nearest human habitation Bakalo is thinly populated village at the distance of 1.0km from the lease area
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Primary school in village Bakalo at the distance of 1.0km.
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) 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/5113/2017
File Number074/EC/Surajpur
Date of Apply EC02 Mar 2017
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)ChhattisgarhSurajpurSurajpur
(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 1M02 Mar 2017
(2.)EMP02 Mar 2017
(3.)additional02 Mar 2017
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameGRAM PANCHAYAT BAKALO
Designationsarpanch
Company GRAM PANCHAYAT BAKALO
AddressGram Panchayat Bakalo
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