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 Smt K Lakshmi W/o K Gopal Krishna Raju ROAD METAL & BUILDING STONE QUARRY Government Land Survey No.43 Village Ippalavalasa, Mandal – Seetanagaram Distt Vizianagaram, A P
(ii).Location / site (GPS Co-ordinate) Latitude 18 41’54.23” to 18 41’59.32” Longitude 83 32’33.23” to 83 32’ 35.51”
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)1.00 ha.
(iv).Capacity of the Mining Lease (TPA) 25002.72
(v).Period of Mining Lease 10
(vi).Expected cost of the Project 5.00
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.RQP/DMG/AP36/2017 
Name of Consultant/RQPB SESHA GIRI RAO
Address FLAT NO 301, SRI VENKATEWARA RESIDENCY VELTURIVARI STREET VIZIANAGARAM A P
Mobile No.9440771649
Landline No.269114
Email Idbseshagirirao@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.  4.66 km
2. (ii). Nearest Infrastructural along with distance in kms  1.00 km
(iii). Nearest Railway Line along with distance in kms  3.18 km
(iv). Nearest National Highway along with distance in kms  24.80 km
(v). Nearest State Highway along with distance in kms  10.80 km
(vi). Nearest Major District Road along with distance in kms 64.25 km
(vii). Nearest Any Other Road along with distance in kms  1.00 km
(viii). Nearest Electric transmission line pole or tower distance in kms  2.50 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  12.00 km
(x). Nearest In-take for drinking water pump house distance in kms  1.50 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  25.00 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
 None
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests None
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 None
7. State, National boundaries Odisha State boundary within distance of 14.25 Km. in towards NW direction near Hatigeda.
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas Quarry Lease is 2.14 km. nearer to Village Surammapeta which is NW that connects SH-36 Parvathipuram-Bobbilli-Ramabhadrapuram
9. Defence installations None
10. Densely populated or built-up area, distance from nearest human habitation 10. Densely populated or built-up area, distance from nearest human habitation Ippalavalasa 0.500 SE Viswambarapuram 2.93 NE Surammapeta 2.14 West to NW Jagannadhapuram 3.96 East to NE
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) 11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship, community facilities) Hospital At Seetanagaram 3.50 kms in SW School Ippalavalasa Primary School 0.800 km in South Temple Towards Ippalavalasa 1.30 Gram Panchayat Ippalavalasa 1.20 km in SE
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Groundwater Resources: The minimum depth of water table is about more than 50 meters based on the observation from nearby tube wells and water bodies. The groundwater resources will not be affected due to small scale mining. Surface resources: Tadipudi Reservoir is 12.00 Km. towards NW direction
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) Presently no such area is air marked but after EIA notification dated 14th September 2006 has been amended by Ministry of Environment, Forests and Climate Change, New Delhi by S.O. 141(E) dated 15th January 2016 the norms of environmental standards will be monitored accordingly
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 Such
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/AP/MIN/19859/2019
File NumberTo be assigned
Date of Apply EC15 Feb 2019
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)Andhra PradeshVizianagaramSeethanagaram
(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)
NameIPPALAVALASAROADMETAL
DesignationOwner
Company IPPALAVALASAROADMETAL
AddressD No 39-9-99/88/11 Flat No 402 Dwaraka Murali Apartments Murali Nagar Visakhapatnam
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