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 Mun River Bed Sand Mining Project, N/v- Palodi
(ii).Location / site (GPS Co-ordinate) Pillar No Latitude Longitude P- 1 20°52'29.15"N 76°44'50.37"E P-2 20°52'28.95"N 76°44'50.87"E P-3 20°52'30.53"N 76°44'51.71"E P-4 20°52
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)0.30 ha.
(iv).Capacity of the Mining Lease (TPA) 1710
(v).Period of Mining Lease 1
(vi).Expected cost of the Project 1.00
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.NABET/EIA/1619/SA 055 
Name of Consultant/RQPFEES (I) Pvt. Ltd.
Address 27, ASHOK VATIKA, KHATIPURA ROAD, JHOTWARA, JAIPUR, RAJASTHAN-302012
Mobile No.9672567222
Landline No.2466841
Email Idfulgroenviro@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.  ~ 6.40 km km
2. (ii). Nearest Infrastructural along with distance in kms  ~0.60 km km
(iii). Nearest Railway Line along with distance in kms  0.00 km
(iv). Nearest National Highway along with distance in kms  0.00 km
(v). Nearest State Highway along with distance in kms  ~2.00 km km
(vi). Nearest Major District Road along with distance in kms 0.00 km
(vii). Nearest Any Other Road along with distance in kms  ~2.10 km km
(viii). Nearest Electric transmission line pole or tower distance in kms  ~0.60 km km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  0.00 km
(x). Nearest In-take for drinking water pump house distance in kms  ~2.60 km km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  0.00 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
Not within 10 km radius of study area.
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Mun River:- It is a river bed sand mining project and project site is located on Mun River. Purna River:- ~4.50 km towards NE direction from mining lease area. Vaan River :- ~5.50 km towards NNW direction from mining lease area.
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration No such areas which are protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration are present within the study area.
6. Inland, coastal, marine or underground waters Not within 10 km radius of study area.
7. State, National boundaries Not within 10 km radius of study area.
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas SH-173 ~ 7.30 km towards WSW direction from mining lease area. SH-197 ~ 2.00 km towards NE direction from mining lease area. MSH24 ~ 6.30 km towards SSE direction from mining lease area.
9. Defence installations Not within 10 km radius of study area.
10. Densely populated or built-up area, distance from nearest human habitation Zadegaon Village (Population- 1,316 as per census,2011) ~2.10 km towards SSE direction from mining lease area. Palodi Village (Population- 1,013 as per census,2011)~0.60 km towards SW direction from mining lease area. Nimba Village (Population- 539 as per census, 2011)~2.00 km towards North direction from mining lease area.
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Hospital: Primary Hospital at village Zadegaon ~2.10 km towards SSE direction from mining lease area. School: Primary School at village palodi ~0.50 km towards SW direction from mining lease area. Shree Shivaji High School at village Nimbha ~2.00 km towards North direction from mining lease area. Temples: Mahadev Temple at village Nimbha ~2.00 km towards North direction from mining lease area.
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Shegaon-Taluka:- Area comes under Non-notified safe block as per Categorization of Assessment Units by CGWA.
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) The area is not subjected to pollution or environmental damage.
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) Moderate Risk Zone:- Areas fall under Seismic Zone III (Moderate risk zone) as per India Seismic Zone classification. Source:http://www.ndma.gov.in (No such severe erosion & flooding observe in last 10 years as per field discussion)
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/18989/2018
File NumberTo be assigned
Date of Apply EC16 Nov 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)MaharashtraBuldanaShegaon
(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)
NameTEHSILDAR SHEGAON
DesignationTehsildar
Company TEHSILDAR SHEGAON
AddressTehsil -Shegaon , District - Buldana , State Maharashtra
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