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 Banki Crusher Stone Quarry at Village- Banki, Tehsil & District- Seoni (M.P.)
(ii).Location / site (GPS Co-ordinate) A. 22°15’53.76”N 79°28’40.56”E B. 22°15’56.25”N 79°28’41.19”E C. 22°15’56.93”N 79°28’38.81”E D. 22°15’58.16”N 79°28’39.25”E E. 22°15’57.94”N 79°28’40.09”E F. 22°16’1.95”N 79°28’41.27”E G. 22°16’
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) 4365
(v).Period of Mining Lease 10
(vi).Expected cost of the Project 10
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.RQP/DGMMP/163/2016 
Name of Consultant/RQPBRAJKISHOR RAHANGDALE
Address MOTI NAGAR, WARD NO.25, BEHIND AGRO OFFICE, DIST-BALAGHAT(M.P)
Mobile No.9009804027
Landline No.4025627
Email Idbraj13081982@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.  5.42 km
2. (ii). Nearest Infrastructural along with distance in kms  25.5 km
(iii). Nearest Railway Line along with distance in kms  21.0 km
(iv). Nearest National Highway along with distance in kms  6.81 km
(v). Nearest State Highway along with distance in kms  23.4 km
(vi). Nearest Major District Road along with distance in kms 23.4 km
(vii). Nearest Any Other Road along with distance in kms  0.26 km
(viii). Nearest Electric transmission line pole or tower distance in kms  0.30 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  9.53 km
(x). Nearest In-take for drinking water pump house distance in kms  1.10 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
No such area is located within the 10 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 No such area is located within the 10 km radius of the 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 area is located within the 10 km radius of the mining lease area.
6. Inland, coastal, marine or underground waters Not Applicable
7. State, National boundaries Madhya Pradesh & Maharashra Border- 64.0Km
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas NH-7
9. Defence installations None
10. Densely populated or built-up area, distance from nearest human habitation Nandni approx-1.10 Km SE Direction
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) All facilities are available in District Seoni approx-25.5 Km
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Areas not containing important, high quality or scarce resources
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) The area is neither subjected to the pollution nor 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 likelihood
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/17275/2018
File Number200-17/09/2018
Date of Apply EC12 Sep 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)Madhya PradeshSeoniSeoni
(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 Documents12 Sep 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameMUKESH PARDHI
DesignationLessee
Company MUKESH PARDHI
AddressWard No. 18, Tilak Ward Balaghat, Tehsil & Dist- Balaghat
Print