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 Takalgavhan Sandghat (Minor Mineral) Mining Project Adjacent Khasra No. Gaothan (13 to 18) for Takalgavhan, Tehsil – Aundha (Nagnath), District - Hingoli, State - Maharashtra.
(ii).Location / site (GPS Co-ordinate) Latitude “N” Longitude “E” 19°28'58.10"N 76°56'48.85"E 19°28'57.34"N 76°56'50.24"E 19°28'52.32"N 76°56'46.95"E 19°28'49.09"N 76°56'44.63"E 19°28'44.06"N 76°56'40.28"E 19°28'40.60"N 76°56'3
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)3.12 ha.
(iv).Capacity of the Mining Lease (TPA) 9900
(v).Period of Mining Lease 1
(vi).Expected cost of the Project 15.64
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.NABET/EIA/1619/IA007 
Name of Consultant/RQPGmec International
Address Saharan tower, 308, Officers Campus, extension, Near Sanskar School, Sirsi Road, Khatipura, Jaipur, 302012
Mobile No.9928793002
Landline No.2353241
Email Idinfo@gmecinternational.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.  0.0 km
2. (ii). Nearest Infrastructural along with distance in kms  1.0 km in East direc km
(iii). Nearest Railway Line along with distance in kms  30.0 km in SE direct km
(iv). Nearest National Highway along with distance in kms  0.0 km
(v). Nearest State Highway along with distance in kms  0.0 km
(vi). Nearest Major District Road along with distance in kms 0.0 km
(vii). Nearest Any Other Road along with distance in kms  4.70 km in South- Ea km
(viii). Nearest Electric transmission line pole or tower distance in kms  1.0 km in East direc km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  River Purna km
(x). Nearest In-take for drinking water pump house distance in kms  1.0 km in East direc km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  0.0 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
NO
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests The quarry area is itself part of water body i.e. River Kayadhu, there are number of tributes of River Kayadhu is also available in Study Area.
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration NO
6. Inland, coastal, marine or underground waters The project lies in Kayadhu, River.
7. State, National boundaries NO
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas Other Road Is about 4.70 km in South- East direction from the study quarry area.
9. Defence installations NO
10. Densely populated or built-up area, distance from nearest human habitation Takalgavhan Village is located at 1.0 km towards East from the study area.
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) a) School: -The Primary school facility is available at village – Takalgavhan (1.0 km, in East direction), b) Hospital: -PHC facility is available Takalgavhan (1.0 Km, in East direction), c) Temple: Mandir at Takalgavhan (1.0Km, in East direction), from the quarry area.
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Quarry mine area is falls in river Kayadhu
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) NO
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) The area is falls in Seismic Zone –II
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/14372/2018
File NumberDIA/MH/MIN/14372/2018
Date of Apply EC05 Apr 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)MaharashtraHingoliAundha (Nagnath)
(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.)NABET CERTIFICATE05 Apr 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameMAHSUL SAHAYAK
DesignationTehsildar
Company MAHSUL SAHAYAK
AddressCOLLECTORE OFFICE HINGOLI
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