(See Paragraph-6)
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 Proposed ordinary Sand Quarry in Nala of Adjecent Survey No 68 of Govanakoppa Village Shirhatti Taluk Gadag District
(ii).Location / site (GPS Co-ordinate) N 15 0 09.97 to 15 0 21.67 E 75 40 35 . 84 to 75 40 48.55
Annexure-GPS file      
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)2.0236 ha.
(iv).Capacity of the Mining Lease (TPA) 100260
(v).Period of Mining Lease 5
(vi).Expected cost of the Project 50
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.RQP/GOA/052/87/A 
Name of Consultant/RQPS.B Naganur
Address 2nd floor nanjundeshwara complex 5th cross canel road basaveshwara badawane Hosapete
Mobile No.9880641510
Landline No.08023238
(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.  0.88 km
2. (ii). Nearest Infrastructural along with distance in kms  1.4 km
(iii). Nearest Railway Line along with distance in kms  62 km
(iv). Nearest National Highway along with distance in kms  50 km
(v). Nearest State Highway along with distance in kms  0.1 km
(vi). Nearest Major District Road along with distance in kms 1.6 km
(vii). Nearest Any Other Road along with distance in kms  1.4 km
(viii). Nearest Electric transmission line pole or tower distance in kms  1.4 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  4.1 km
(x). Nearest In-take for drinking water pump house distance in kms  0.98 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  0.98 km
3. Areas protected under 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
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration
6. Inland, coastal, marine or underground waters
7. State, National boundaries
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas
9. Defence installations
10. Densely populated or built-up area, distance from nearest human habitation
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities)
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals)
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded)
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)
Is proposed mining site located over or near fissure/fracture for ground water recharge?No
Whether the proposal involves approval or clearance under the following Regulations or Acts namely?
The Forest (Conservation) Act,1980?No
The Wildlife (Protection) Act,1972?No
The Coastal Regulation Zone (C.R.Z) notification,2011?No
Is forest land involved (ha)?No
Whether there is any litigation pending against the project and/or land in which the project is proposed to be set up?No
Proposal NumberDIA/KA/MIN/15806/2018
File NumberDEIAA7(3)1/2018-19
Date of Apply EC12 Jun 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(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-1m12 Jun 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
Company J P RAGHU
Address# 272 champakanagara sakleshpura Taluk Hassan District