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 Shirange Stone Quarry
(ii).Location / site (GPS Co-ordinate) 15 53 11 N & 74 04 13 E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)4.50 ha.
(iv).Capacity of the Mining Lease (TPA) 300000
(v).Period of Mining Lease 5
(vi).Expected cost of the Project 750
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.NABET/RIA/1518/RA020 
Name of Consultant/RQPM/s Sadekar Enviro Engineers Pvt. Ltd.
Address 310, Dempo Tower, EDC, Patto, Panajim, Goa
Mobile No.9820144125
Landline No.83224370
Email Idsadekarenviro@rediffmail.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.  3.1 km km
2. (ii). Nearest Infrastructural along with distance in kms  -- km
(iii). Nearest Railway Line along with distance in kms  23.5 km km
(iv). Nearest National Highway along with distance in kms  24.9 km km
(v). Nearest State Highway along with distance in kms  3.8 km km
(vi). Nearest Major District Road along with distance in kms 3.8 km km
(vii). Nearest Any Other Road along with distance in kms  0.984 km km
(viii). Nearest Electric transmission line pole or tower distance in kms  15 km km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  2.573 km 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
Madhai Wildlife Santury 10.8 KM in the south east direction
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Backwaters of Tillari Dam-0.309 Km in the north east direction. Wall of Tillari Dam-3.0 Km in the south east direction
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Madhai Wildlife Santury 10.8 Km in the south east direction
6. Inland, coastal, marine or underground waters Arabian Sea-38 Km in th west direction
7. State, National boundaries Maharashtra-Goa-Karnataka Boundary 7 km in the east direction
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas Not within 5 km of study
9. Defence installations Not within 5 km of study
10. Densely populated or built-up area, distance from nearest human habitation Village Khanyale is 0.984km in the NW direction
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Dodamarg Taluka-11 Km in the south west direction
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Tillari Dam wall-3 kms in the NE direction Tillari Dam Back waters-0.309 Km in the NE direction
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) Not within 5 km of study 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) Not within 5 km of study 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/ModernizationExpansion
New Proposal NumberDIA/MH/MIN/17354/2018
New File NumberTo be assigned
Date of Apply EC15 Sep 2018
Proposal NumberDIA/MH/MIN/17353/2017
File Number(Previous EC)21/99/2017-DSO
Date of Previous EC25 Apr 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)MaharashtraSindhudurgDodamarg
(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.)M/s Prathyam Ventures Pvt. Ltd.15 Sep 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameM/S PRATHYAM VENTURES PVT. LTD.
DesignationDirector
Company M/S PRATHYAM VENTURES PVT. LTD.
AddressPlot No. 03, 1st Floor, Ashirwad Towers, Bhedshi Road, Dodamarg Dist. Sindhudurg (M.S)
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