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 Girna River Sand Ghat Gut no- 8 to 15,1564,1562,1555,1556
(ii).Location / site (GPS Co-ordinate) 20°31'29.93"N 74° 4'1.46"E 20°31'30.18"N 74° 4'1.02"E 20°31'35.77"N 74° 4'4.55"E 20°31'35.52"N 74° 4'5.00"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)0.30 ha.
(iv).Capacity of the Mining Lease (TPA) 2399.84
(v).Period of Mining Lease 1
(vi).Expected cost of the Project 58
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?No
Reason for not hiring the Consultant/RQP Not Applicable, Since it is 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.  0.44 km
2. (ii). Nearest Infrastructural along with distance in kms  17.7 km
(iii). Nearest Railway Line along with distance in kms  44.3 km
(iv). Nearest National Highway along with distance in kms  25.7 km
(v). Nearest State Highway along with distance in kms  1 km
(vi). Nearest Major District Road along with distance in kms 5.58 km
(vii). Nearest Any Other Road along with distance in kms  0 km
(viii). Nearest Electric transmission line pole or tower distance in kms  0 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  17.7 km
(x). Nearest In-take for drinking water pump house distance in kms  0 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  0 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
The proposed activity of sand extraction will be carried out at Girna river at post Junibez, apart from this no protected area is present within 10 km radius of proposed project.
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests The proposed activity will be carried out in girna river. GSDA approval is obtained.
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Not present within 10 km radius of proposed site
6. Inland, coastal, marine or underground waters The proposed activity will be carried out in girna river. GSDA approval is obtained.
7. State, National boundaries No state boundary is present within 10 km radius
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas Railway line is present at 44.3 km from project site.
9. Defence installations Not envisaged
10. Densely populated or built-up area, distance from nearest human habitation Nearest human habitation is beyond 200 meters from project site.
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Schools, Hospitals and small temples are present at nearby villages
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) The proposed activity will be carried out in girna river. GSDA approval is obtained.
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) Not Applicable
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 Applicable
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/MH/MIN/12181/2018
File NumberDEIAA/MH/NSK/038/2018
Date of Apply EC09 Jan 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)MaharashtraNashikKalwan
(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
NIL
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameDMO NASIK
DesignationDMO
Company DMO NASIK
AddressCollector Office, Nasik
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