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 Khadgad Masonary Stone, Belast, Grit, Red Gravel & Crusher Dust Mine Project for STP WORK ORDER NO. 2658 & Package No. RJ-14-76
(ii).Location / site (GPS Co-ordinate) Latitude : 23036’10.62” to 23°36’14.52” N Longitude : 73058’02.58” to73°46’06.36” E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)0.4837 ha.
(iv).Capacity of the Mining Lease (TPA) 49497
(v).Period of Mining Lease 1
(vi).Expected cost of the Project 15
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.2012/07 
Name of Consultant/RQPnimish Singhwi
Address 15 new glass factory sunderwas udaipur
Mobile No.9414110360
Landline No.2492060
Email Idnimesh.singhvi@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.  1.60 km
2. (ii). Nearest Infrastructural along with distance in kms  0.0 km
(iii). Nearest Railway Line along with distance in kms  40.33 km
(iv). Nearest National Highway along with distance in kms  6.95 km
(v). Nearest State Highway along with distance in kms  6.95 km
(vi). Nearest Major District Road along with distance in kms 6.95 km
(vii). Nearest Any Other Road along with distance in kms  0.07 km
(viii). Nearest Electric transmission line pole or tower distance in kms  0.0 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  0.63 km
(x). Nearest In-take for drinking water pump house distance in kms  0.0 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  0.0 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
Nil
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Moran River (About 1.57 km in SW direction) Mahi River About 8.90 km in SE direction
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Protected Forest (about 8.09 km NE direction) Protected Forest (about 4.5 km SE direction)
6. Inland, coastal, marine or underground waters Nil
7. State, National boundaries Nil
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas MDR-43 (About 6.95 Km in NE direction) NH-927A (About 6.95 Km in NE direction) SH 10 (About 6.95 Km in NE direction)
9. Defence installations Nil
10. Densely populated or built-up area, distance from nearest human habitation S. No Villages Distance Population Direction 1 Khadgad 1.75 1563 NE 2 Panchwati 3.78 605 NE 3 Jogpur 2.26 2732 SE 4 Sagwara 9.72 29439 NE 5 Surajgaon 5.02 2711 NE 6 Chitri 5.26 746 SE 7 Semliya 2.97 1624 SW 8 Khuntwara 1.48 1339 SW 9 Bhemai 6.51 1882 SW 10 Ambara 3.10 4818 NW 11 Obri 8.42 5243 NW 12 Gamra 6.13 2069 NW 13 Nagriya 6.92 2488 NW 14 Daiyana 2.26 1275 NW
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) S. No School/Hospital/Dispensary Distance Direction 1 Adarsh Govt. Sr. Sec. School 6.76 SE 2 Vedant Academy School Chitri 5.26 SE 3 Govt. High School Obri 8.90 NW 4 Primary Dispensary 8.85 NW 5 Govt. Hospital, Sagwara 9.79 SE 6 Govt Sen Sec School, Sagwara 9.66 SE
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Moran River (About 1.57 km in SW direction) Mahi River About 8.90 km in SE direction Canal 0.63 km in NE direction Lake (About 8.70 km in NW direction)
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) Nil
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) The area comes under Seismic Zone –II
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/RJ/MIN/7148/2017
File NumberTo be assigned
Date of Apply EC22 Jun 2017
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)RajasthanDungarpurDungarpur
(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.)Other22 Jun 2017
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameSHRI HARISH CHANDRA PATEL
DesignationOwner
Company SHRI HARISH CHANDRA PATEL
AddressKhudgad
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