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 & Murrum Mining Project Sy No- 27-Part, Mauja Sevadas Nagar, Taluka- Pusad, District- Yavatmal, Maharashtra
(ii).Location / site (GPS Co-ordinate) Sr. No. Latitude Longitude A 190 54’47.20 ”N 770 30’ 40.5 ”E B 190 54’48.6 ”N 770 30’ 50.8 ”E C 190 54’51.5 ”N 770 30’ 49.3 ”E D 190 54’51.0 ”N 770 30’ 45.3 ”E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)2.0 ha.
(iv).Capacity of the Mining Lease (TPA) 28652
(v).Period of Mining Lease 5
(vi).Expected cost of the Project 20
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.1619/RA0037 
Name of Consultant/RQPvardan Environet
Address Gurugram Haryana
Mobile No.9024032841
Landline No.2983404
Email Idvardan.jaipur@gmail.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.  None km
2. (ii). Nearest Infrastructural along with distance in kms  Approx 1.10 Km towar km
(iii). Nearest Railway Line along with distance in kms  Approx. 43.40 Km in km
(iv). Nearest National Highway along with distance in kms  None km
(v). Nearest State Highway along with distance in kms  SH-183 Approx 0.05 km
(vi). Nearest Major District Road along with distance in kms None km
(vii). Nearest Any Other Road along with distance in kms  None km
(viii). Nearest Electric transmission line pole or tower distance in kms  Approx 1.10 Km towar km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  ? Pus Water Reservoi km
(x). Nearest In-take for drinking water pump house distance in kms  Approx 1.10 Km towar km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  None km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
 None, within 10 km distance from the periphery of lease area.
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests ? River Approx 6.20 km towards ENE ? Pus Water Reservoir approx 10.50 km towards NW ? Canal approx 1.60 km towards E ? Water Reservoir approx 3.77 km towards NW ? Water Reservoir approx 6.10 km towards NW
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration None, within 10 km distance from the periphery of lease area.
6. Inland, coastal, marine or underground waters None, within 10 km distance from the periphery of lease area.
7. State, National boundaries None, within 10 km distance from the periphery of lease area.
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas SH-183 Approx 0.05 Km towards N SH-213Approx 4.0 Km towards SE Washim Railway Station (Approx. 43.40 Km in NW direction) Nagpur Airport (Approx. 206.50 in NE direction)
9. Defence installations None, within 10 km distance from the periphery of lease area.
10. Densely populated or built-up area, distance from nearest human habitation Sevadas Nagar Approx 1.10 Km towards NE Pusad Approx 5.70 Km towards E
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Sevadas Nagar Approx 1.10 Km towards NE Pusad Approx 5.70 Km towards E
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) ? River Approx 6.20 km towards ENE ? Pus Water Reservoir approx 10.50 km towards NW ? Canal approx 1.60 km towards E ? Water Reservoir approx 3.77 km towards NW ? Water Reservoir approx 6.10 km towards NW
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) None, within 10 km distance from the periphery of lease area.
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 distance from the periphery of lease 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/MH/MIN/14052/2018
File NumberDIA/MH/MIN/14052/2018
Date of Apply EC22 Mar 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
NIL
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameSUDHIR UTTAMRAO DESHMUKH
Designationonwer
Company SUDHIR UTTAMRAO DESHMUKH
Addresspusad
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