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 Basalt stone Mining Project Lease area 1.00 Ha, Sy.No 58 Part at Village–Kasola, Taluka- Pusad, District-Yavatmal (Maharashtra) By Sri. Sanjay Kaniram Jadhav
(ii).Location / site (GPS Co-ordinate) Pillar No. Latitude Longitude 1. N 19°5436.1" E77°39'07.6" 2. N 19°54'39.4" E77°39'04.5" 3. N 19°54'37.9" E77°39'02.4" 4. N 19°54'34.8" E77°39'05.5"
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)1.0 ha.
(iv).Capacity of the Mining Lease (TPA) 43054
(v).Period of Mining Lease 5
(vi).Expected cost of the Project 16.0
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.NABET/EIA/1619/RA0037 
Name of Consultant/RQPVardan EnviroNet
Address D-142, Sushant Lok – III, Sector – 57, Gurgaon,
Mobile No.9422108964
Landline No.2983404
Email Idjaipur@vardanenvironet.com
(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 km
2. (ii). Nearest Infrastructural along with distance in kms  Approx 0.75 Km towar km
(iii). Nearest Railway Line along with distance in kms  Approx 53.0 Km towar km
(iv). Nearest National Highway along with distance in kms  Approx 17.5 Km towar km
(v). Nearest State Highway along with distance in kms  Approx 0.4 Km toward km
(vi). Nearest Major District Road along with distance in kms 0 km
(vii). Nearest Any Other Road along with distance in kms  0 km
(viii). Nearest Electric transmission line pole or tower distance in kms  Approx 0.75 Km towar km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  Approx 2.0 Km toward km
(x). Nearest In-take for drinking water pump house distance in kms  Approx 0.75 Km towar 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
None, within 10 Km radius area of mine site.
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests None, within 10 Km radius area of mine site.
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Water reservoir Approx 2.0 Km towards SE direction. Veni Water reservoir Approx 7.0 Km towards S direction. Pus River Approx 4.7 Km towards SE direction. Sip Nadi Approx 5.3 Km towards E direction. Pun Nadi Approx 9.3 Km towards NE direction.
6. Inland, coastal, marine or underground waters None, within 10 Km radius area of mine site.
7. State, National boundaries None, within 10 Km radius area of mine site.
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas SH 183 Approx 0.4 Km towards SE direction. SH 213 Approx 8.3 Km towards WNW direction. NH 204 Approx 17.5 Km towards ESE direction. Kanhargaon Railway station Approx 53.0 Km towards W direction. Nagpur Airport Approx 196.2 Km towards NE direction.
9. Defence installations None, within 10 Km radius area of mine site.
10. Densely populated or built-up area, distance from nearest human habitation Pusad Approx 7.6 Km towards W direction.
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Pusad Approx 7.6 Km towards W direction.
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Water reservoir Approx 2.0 Km towards SE direction. Veni Water reservoir Approx 7.0 Km towards S direction. Pus River Approx 4.7 Km towards SE direction. Sip Nadi Approx 5.3 Km towards E direction. Pun Nadi Approx 9.3 Km towards NE direction.
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) None, within 10 Km radius area of mine site.
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) None, within 10 Km radius area of mine site.
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/13252/2018
File NumberDIA/MH/MIN/13252/2018
Date of Apply EC26 Feb 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)MaharashtraYavatmalPusad
(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.)PFR26 Feb 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameSRI. SANJAY KANIRAM JADHAV
DesignationOwner
Company SRI. SANJAY KANIRAM JADHAV
AddressMauza- Kasola, Taluka- Pusad, District Yavatmal, Maharashtra
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