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 “Building Stone Quarry” over an extent of 4-00 Acres at Sy No.87, Goravinakallu village, Hosadurga Taluk, Chitradurga
(ii).Location / site (GPS Co-ordinate) A - 13° 49'23.8"N - 76° 16'59.5"E B - 13° 49'23.8"N - 76° 17'03.8"E C - 13° 49'19.7"N - 76° 17'03.7"E D - 13° 49'19.7"N - 76° 16'59.4"E O - 13° 49'28.8"N - 76° 16'14.5"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)1.616 ha.
(iv).Capacity of the Mining Lease (TPA) 92619
(v).Period of Mining Lease 5
(vi).Expected cost of the Project 5.5
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.RQP/BNG/342/2014/A 
Name of Consultant/RQPGanesha
Address Bangalore
Mobile No.8277358855
Landline No.152511
Email Idganeshrqp@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.  1.15 km
2. (ii). Nearest Infrastructural along with distance in kms  3 km
(iii). Nearest Railway Line along with distance in kms  22.05 km
(iv). Nearest National Highway along with distance in kms  25.60 km
(v). Nearest State Highway along with distance in kms  3.06 km
(vi). Nearest Major District Road along with distance in kms 1.25 km
(vii). Nearest Any Other Road along with distance in kms  0.55 km
(viii). Nearest Electric transmission line pole or tower distance in kms  1.05 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  3.90 km
(x). Nearest In-take for drinking water pump house distance in kms  0.5 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  0.5 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
NA
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Honnenahalli pond - 3.90 kms(NE)
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration NA
6. Inland, coastal, marine or underground waters NA
7. State, National boundaries NA
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas Hosadurga to Holalakere road - 3.30 kms(SW)
9. Defence installations --
10. Densely populated or built-up area, distance from nearest human habitation Hosadurga town – 3 Km (w)
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Hosadurga town – 3 Km (w)
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) NA
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) NA
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) NA
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/KA/MIN/19089/2018
File NumberDEIAA 11/2018-19
Date of Apply EC19 Nov 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)KarnatakaChitradurgaHosdurga
(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)
NameSRI T YATHISH
DesignationProponent
Company SRI T YATHISH
AddressVidyanagara, Hosadurga
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