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 “Shahabad Stone (Cherty Lime Stone) Quarry”at Sy No.11/2, Taranahalli Village, Chittapur Taluk, Kalburagi District, Karnataka over an extent of 1-26 Acre.
(ii).Location / site (GPS Co-ordinate) 17 09 15.9 76 54 09.9 17 09 16.1 76 54 08.8 17 09 22.6 76 54 09.8 17 09 22.2 76 54 11.0
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)0.647 ha.
(iv).Capacity of the Mining Lease (TPA) 25933
(v).Period of Mining Lease 20
(vi).Expected cost of the Project 24
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.BNG/318/2013/A 
Name of Consultant/RQPKrishna,murthy
Address Nagarabhi
Mobile No.7022632709
Landline No.08064544
Email Idelegance198@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 km
2. (ii). Nearest Infrastructural along with distance in kms  0 km
(iii). Nearest Railway Line along with distance in kms  5.6 km
(iv). Nearest National Highway along with distance in kms  11.5 km
(v). Nearest State Highway along with distance in kms  1.7 km
(vi). Nearest Major District Road along with distance in kms 0.9 km
(vii). Nearest Any Other Road along with distance in kms  3.3 km
(viii). Nearest Electric transmission line pole or tower distance in kms  1.1 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  6.3 km
(x). Nearest In-take for drinking water pump house distance in kms  1.1 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
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Waterbody: Kagina River - 6.3 Kms (E)
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 None
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas SH 149 - 1.7 Kms (E) (Shahabad to Gulbarga Road)
9. Defence installations None
10. Densely populated or built-up area, distance from nearest human habitation Shahabad - 4.5 kms (SE)
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Shahabad - 4.5 kms (SE)
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) None
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) None
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
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/19203/2018
File NumberDEIAA/KLB/67/2018
Date of Apply EC23 Nov 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)KarnatakakalaburagiChitapur
(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.)EMP23 Nov 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameBALGOVIND
DesignationProponent
Company BALGOVIND
AddressHanamaji Kusale R/o Shahabad, Chittapur Taluk, Kalburgi District
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