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”at Sy No. 45/7, Belur (J) Village, Kalaburagi taluk, Kalaburagi district over an extent of 3-13 Acres.
(ii).Location / site (GPS Co-ordinate) N 170 24’18.3” E 760 51’43.3” N 170 24’20.7” E 760 51’45.3” N 170 24’23.2” E 760 51’41.5” N 170 24’21.3” E 760 51’39.6” N 170 24’19.8” E 760 51’40.6”
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)1.266 ha.
(iv).Capacity of the Mining Lease (TPA) 52242
(v).Period of Mining Lease 20
(vi).Expected cost of the Project 146
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.RQP/BNG/318/2013/A 
Name of Consultant/RQPKrishnamurthy
Address Nadarabhi
Mobile No.7022632709
Landline No.08065451
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  4.3 km
(iv). Nearest National Highway along with distance in kms  1.2 km
(v). Nearest State Highway along with distance in kms  4.4 km
(vi). Nearest Major District Road along with distance in kms 1.6 km
(vii). Nearest Any Other Road along with distance in kms  6.3 km
(viii). Nearest Electric transmission line pole or tower distance in kms  1.4 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  6.4 km
(x). Nearest In-take for drinking water pump house distance in kms  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 Kumasi Pond - 6.4 Kms (NW)
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 NH 218 - 1.2 Kms(SE) (Humnabad to Gulbarga Highway)
9. Defence installations None
10. Densely populated or built-up area, distance from nearest human habitation Kalaburagi - 6.5 Kms(S)
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Kalaburagi - 6.5 Kms(S)
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/19386/2018
File NumberDEIAA/KLB/68/2018
Date of Apply EC03 Dec 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)KarnatakakalaburagiGulbarga
(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.)EMP03 Dec 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameSIDDANGOWDA
DesignationProponent
Company SIDDANGOWDA
AddressBank Colony Gunj, Kalburgi
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