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 Jaitpur Khurd Sand Mine Project at Village Jaitpur Khurd Tehsil-mohkhed District-Chhindwara khasra no.197 part over an area 1.318 hectare of Proponent Sarpanch/Sachiv Gram Panchayat Goreghat (Jaitpur
(ii).Location / site (GPS Co-ordinate) 1. 21°57'5.42"N, 78°56'38.23"E 2. 21°57'4.22"N, 78°56'38.28"E 3. 21°57'4.48"N, 78°56'48.77"E 4. 21°57'6.46"N, 78°56'48.64"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)1.318 ha.
(iv).Capacity of the Mining Lease (TPA) 2422
(v).Period of Mining Lease 05
(vi).Expected cost of the Project 1.5
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.40/2013 
Name of Consultant/RQPBalraj Singh Choudhary
Address Seoni Pran Moti, Chhindwara (MP)
Mobile No.9424936014
Landline No.0
Email Idbalrajgeo@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.  0.0 km
2. (ii). Nearest Infrastructural along with distance in kms  1.2 km
(iii). Nearest Railway Line along with distance in kms  1.4 km
(iv). Nearest National Highway along with distance in kms  2.3 km
(v). Nearest State Highway along with distance in kms  2.3 km
(vi). Nearest Major District Road along with distance in kms 0.75 km
(vii). Nearest Any Other Road along with distance in kms  0.50 km
(viii). Nearest Electric transmission line pole or tower distance in kms  0.200 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  0 km
(x). Nearest In-take for drinking water pump house distance in kms  .050 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
None of these are present nearby the quarry area.
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests None of these are present nearby the quarry area.
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration None of these are present nearby the quarry area.
6. Inland, coastal, marine or underground waters None of these are present nearby the quarry area.
7. State, National boundaries More than 100km from mine site.
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas More than 500m from quarry area.
9. Defence installations NO
10. Densely populated or built-up area, distance from nearest human habitation Small village is about 1.5km from mine site.
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) At District chhindwara which is about 28km from quarry area.
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) None of these are present nearby the quarry area.
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) None of these are present nearby the quarry 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) None of these are present nearby the quarry 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/MP/MIN/14535/2018
File Number12/2018
Date of Apply EC14 Apr 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)Madhya PradeshChhindwaraChhindwara
(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.)Relevant Documents14 Apr 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameSARPANCH GRAM PANCHAYAT GOREGHAT
DesignationOwner
Company SARPANCH GRAM PANCHAYAT GOREGHAT
AddressVillage- Jaitpur Khurd, Tehsil-Mohkhed, Dist-Chhindwara
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