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 Kauakheda Sand Mine at Village-Kauakheda Tehsil-Chand District-Chhindwara khasra no. 95 Part Area- 2.000Ha
(ii).Location / site (GPS Co-ordinate) 1 21°56'28.79"N 79°10'5.12"E 2 21°56'28.93"N 79°10'6.77"E 3 21°56'42.72"N 79°10'1.50"E 4 21°56'42.69"N 79° 9'59.90"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)2.000 ha.
(iv).Capacity of the Mining Lease (TPA) 34762
(v).Period of Mining Lease 5
(vi).Expected cost of the Project 2
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.40/2013 
Name of Consultant/RQPBalraj Singh Choudhary
Address Ward No.16, Seoni Pran Moti, Chhindwara
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.  0.00 km
2. (ii). Nearest Infrastructural along with distance in kms  0.80 km
(iii). Nearest Railway Line along with distance in kms  0 km
(iv). Nearest National Highway along with distance in kms  32 km
(v). Nearest State Highway along with distance in kms  5 km
(vi). Nearest Major District Road along with distance in kms 5 km
(vii). Nearest Any Other Road along with distance in kms  0.40 km
(viii). Nearest Electric transmission line pole or tower distance in kms  0.60 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  0.350 km
(x). Nearest In-take for drinking water pump house distance in kms  0.050 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 within 1.0km from the mine 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 within 1.0km from the mine 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 within 1.0km from the mine area.
6. Inland, coastal, marine or underground waters None of these are present within 1.0km from the mine area.
7. State, National boundaries More than 200km.
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas None of these are present within 1.0km from the mine area.
9. Defence installations No
10. Densely populated or built-up area, distance from nearest human habitation Tehsil Chand is about 8km from mine area.
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) At Tehsil Chand is about 8km from mine 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 within 1.0km from the mine area.
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) None of these are present within 1.0km from the mine 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 within 1.0km from the mine 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/15991/2018
File NumberTo be assigned
Date of Apply EC24 Jun 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)Madhya PradeshChhindwaraChaurai
(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 Documents24 Jun 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameGRAM PANCHAYAT KAUAKHEDA
DesignationSarpanch
Company GRAM PANCHAYAT KAUAKHEDA
AddressVillage-Kauakheda, Tehsil-Chand Dist-Chhindwara
Print