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 Kothurna Pebbles & Gravels Quarry Mining Project
(ii).Location / site (GPS Co-ordinate) Latitude -210 13’ 40.06”N Longitude -790 42’ 02.8”E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)1.0 ha.
(iv).Capacity of the Mining Lease (TPA) 5180
(v).Period of Mining Lease 5
(vi).Expected cost of the Project 15
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.1316/IA001 
Name of Consultant/RQPVardan EnviroNet
Address D-Sushant Lok III, Golf Couse Extension Road, Sec-57,Gurgaon haryana
Mobile No.9422108968
Landline No.2983404
Email Idvardan.jaipur@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.  Approx 9.4 SSW Direc km
2. (ii). Nearest Infrastructural along with distance in kms  None km
(iii). Nearest Railway Line along with distance in kms  Approx. 5.7 in NW di km
(iv). Nearest National Highway along with distance in kms  Approx 8.8 Km towar km
(v). Nearest State Highway along with distance in kms  Approx 6.2 Km toward km
(vi). Nearest Major District Road along with distance in kms none km
(vii). Nearest Any Other Road along with distance in kms  Approx 0.3 Km toward km
(viii). Nearest Electric transmission line pole or tower distance in kms  Approx 0.7 Km toward km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  0.2 km
(x). Nearest In-take for drinking water pump house distance in kms  0.2 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  0.2 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
 No such area is located within the 15 km radius of the mining lease area.
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests ? Nagzira Wildlife Sanctuary approx 11.5 km towards ESE. ? Project is situated in Wainganga River Bed Area. ? Kokka Tigar Reserved Approx 2.5 Km towards E
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration None
6. Inland, coastal, marine or underground waters No such area is located within the 15 km radius of the mining lease area.
7. State, National boundaries None
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas NH-6 Approx 8.8 Km towards SSW SH-254 Approx 10.3 Km towards S SH-271 Approx 6.2 Km towards W Internal road Approx 0.3 Km towards W Warthi Railway Station (Approx. 5.7 in NW direction)
9. Defence installations None
10. Densely populated or built-up area, distance from nearest human habitation Belgaon Approx 0.7 Km towards SE
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) ? Primary School at Belgaon Approx 0.7 Km towards SE ? Hospital at Kothurna Approx. 0.9 in N direction ? All Other facilities available in Kothurna Approx. 0.9 in N direction
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Same as item No.-2
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) The area is not subjected to the 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) No such areas observed The study area lies in Seismic Zone IV. However natural hazards due to earthquakes are not anticipated to be a major environmental issue.
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?Yes
StatusApplication for Wildlife Clearance yet to be submitted 
(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/5239/2017
File Number5239/2017
Date of Apply EC07 Mar 2017
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)MaharashtraBhandaraBhandara
(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)
NameBALAJI SYSTEM
Designationlessee
Company BALAJI SYSTEM
AddressSubhash Ward Warthi, Bhandara, Tehsil & Districh Bhandara, MH
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