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 Mining appln of Mr.Sandeep S. Choursiya,Gut No.186/1,Gunjkheda stone quarry proposal
(ii).Location / site (GPS Co-ordinate) 20°44'3.95"N, 78°20'38.76"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)2.00 ha.
(iv).Capacity of the Mining Lease (TPA) 81244
(v).Period of Mining Lease 5
(vi).Expected cost of the Project 30
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.1518/RA0036 
Name of Consultant/RQPPrashil Shukla
Address Enviro Techno consult Pvt Ltd.,Nagpur
Mobile No.9225230146
Landline No.32027888
Email Idenvirotechnoconsult@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.  0.567 km
2. (ii). Nearest Infrastructural along with distance in kms  2.8 km
(iii). Nearest Railway Line along with distance in kms  0.536 km
(iv). Nearest National Highway along with distance in kms  16.66 km
(v). Nearest State Highway along with distance in kms  0.902 km
(vi). Nearest Major District Road along with distance in kms 2.209 km
(vii). Nearest Any Other Road along with distance in kms  0.492 km
(viii). Nearest Electric transmission line pole or tower distance in kms  18 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  1.706 km
(x). Nearest In-take for drinking water pump house distance in kms  1.706 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  1.613 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
Bhor Reserve Forest -38 Km NE
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Water Body –Gunjkheda-1.2 km NW,Wardha river-3.324 Km W Coastal Area 580 Km, ,Marine Water -575 Km West
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Bhor Reserve Forest -38 Km NE
6. Inland, coastal, marine or underground waters Water Body –Gunjkheda-1.2 km NW,Wardha river-3.324 Km W Coastal Area 580 Km, ,Marine Water -575 Km West
7. State, National boundaries 83 Km N
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas Pulgaon sevagram Rd – 0.902 km SE
9. Defence installations Pulgaon -2.8 km SW
10. Densely populated or built-up area, distance from nearest human habitation Gunjkheda -2.3 km W
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) 2.8 Km Pulgaon SW
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Water Body –Gunjkheda-1.2 km NW,Wardha river-3.324 Km W Coastal Area 580 Km, ,Marine Water -575 Km West,quarry is agriculture area with single crop system, Fishing at Water Body 1.5 Km NE, Minerals quarry Basalt
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) No. Stone quarry is at safe distances from natural hazards like earthquake prone area, subsidence, landslide, erosion, flooding prone 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/19335/2018
File NumberDIA/MH/MIN/19335/2018
Date of Apply EC01 Dec 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)MaharashtraWardhaDeoli
(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)
NamePROJECT PROPONENT
DesignationPROJECT PROPONENT
Company PROJECT PROPONENT
Address68, mahakali nagar nagpur
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