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 & Murom Mine
(ii).Location / site (GPS Co-ordinate) 19°59'5.67"N 77°35'52.89"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)3 ha.
(iv).Capacity of the Mining Lease (TPA) 81424.30
(v).Period of Mining Lease 5
(vi).Expected cost of the Project 90
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.NABET/EIA/1720/IA0028 
Name of Consultant/RQPEcoFootForward Environmental Consultancy
Address D/318, Neelkanth Business Park, Ramdev Nagar, Vidyavihar (W), Mumbai - 400086
Mobile No.9892814129
Landline No.25144129
Email Idamey@ecofootforward.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.  1.44 km
2. (ii). Nearest Infrastructural along with distance in kms  1.85 km
(iii). Nearest Railway Line along with distance in kms  96 km
(iv). Nearest National Highway along with distance in kms  26.57 km
(v). Nearest State Highway along with distance in kms  1.41 km
(vi). Nearest Major District Road along with distance in kms 26.57 km
(vii). Nearest Any Other Road along with distance in kms  0.01 km
(viii). Nearest Electric transmission line pole or tower distance in kms  1.90 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  0.74 km
(x). Nearest In-take for drinking water pump house distance in kms  14.23 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  12.14 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
Not present within 5 km radius from proposed project site.
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Not present within 5 km radius from proposed project site.
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Not present within 5 km radius from proposed project site.
6. Inland, coastal, marine or underground waters Pus river present south of proposed project site at an approximate aerial distance of 7.04 km.
7. State, National boundaries State boundary of Telangana present at an approximate aerial distance of 74.10 km
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas Not present
9. Defence installations Not present
10. Densely populated or built-up area, distance from nearest human habitation Nearest Village is Shivaji Nagar where human habitation is present at an approximate aerial distance of 1.85 km.
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Taluka Pusad, which has hospitals, schools, places of worship etc is present at an approximate aerial distance of 9.00 km
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Not present within 5 km from proposed project site
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) Not present
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 proposed project site falls under Seismic Zone - II (Least Active),i.e., Low Damage Risk Zone for Earthquake Hazard; Moderate Damage Risk Zone - A for Cyclone Hazard and the proposed project site is not liable to floods. Hence, the proposed project site is not susceptible to natural hazard.
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/15933/2018
File NumberDIA/MH/MIN/15933/2018
Date of Apply EC20 Jun 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)
NameP.K. JADHAV CONSTRUCTION COMPANY
DesignationProponent
Company P.K. JADHAV CONSTRUCTION COMPANY
AddressBhagya Nagar, Nagpur Road, Taluka-Pusad, District-Yavatmal
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