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 Gokulsara (Minor Mineral) Project Category ‘B2’(M.L.Area – 3.36 ha ) Production Capacity of 5936 Brass/6month at Khasra no 01 to 03, 08 to 11 for Gokalsara Village, Tehsil –Dhamangaon, District - A
(ii).Location / site (GPS Co-ordinate) N 20° 49' 58.31" E 78°18' 42.83" N 20° 49' 58.89" E 78° 18' 45.01" N 20° 49' 58.15" E 78° 18' 45.83" N 20° 49' 53.66" E 78° 18' 48.28" N 20° 49' 48.47" E 78° 18' 47.53" N 20° 49' 45.60" E 78° 18'
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)3.36 ha.
(iv).Capacity of the Mining Lease (TPA) 26878
(v).Period of Mining Lease 1
(vi).Expected cost of the Project 109
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.NABET/EIA/1619/IA007 
Name of Consultant/RQPGlobal Management and Engineering Consultants
Address Saharan Tower, 308, Officers Campus Ext., Sirsi Road, Khatipura, Jaipur
Mobile No.9928599571
Landline No.2353241
Email Idinfo@gmecinternational.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.  3.0 km
2. (ii). Nearest Infrastructural along with distance in kms  2.0 km
(iii). Nearest Railway Line along with distance in kms  12.0 km
(iv). Nearest National Highway along with distance in kms  0 km
(v). Nearest State Highway along with distance in kms  3 km
(vi). Nearest Major District Road along with distance in kms 0 km
(vii). Nearest Any Other Road along with distance in kms  0.50 km
(viii). Nearest Electric transmission line pole or tower distance in kms  2.0 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  0 km
(x). Nearest In-take for drinking water pump house distance in kms  2 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 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 There is Madhya Pradesh State boundaries about 80.0 km in North direction from Gokalsara sand ghat Site.
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas There is SH-244 at a distance of ~ 3.0 km towards East direction from Gokalsara Sand Ghat Site.
9. Defence installations No, Defense installations
10. Densely populated or built-up area, distance from nearest human habitation Village Gokalsara is about 2.0 km in SW direction from the Gokalsara sand ghat Site.
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) a) School: Primary School facility is available at village – Gokalsara is about 2.0 km in SW direction from the Gokalsara sand ghat Site. b) Hospital: PHC facility is available Gokalsara(2.0 Km, towards SW direction), from Gokalsara sand ghat Site. c) Temple: Mata ji /ka mandir is about 2.0 Km, towards SW direction from Gokalsara sand ghat Site.
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Quarry mine area is falls in river Wardha.
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) The area is not subjected to the pollution or environmental damage.
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 is prone to flooding during heavy rains. The area is falls in Seismic Zone –II (Source: National Disaster Management Authority, www.ndma.gov.in/en/zone-map.html,)
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/MH/MIN/18779/2018
File Number18779
Date of Apply EC04 Nov 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)MaharashtraAmravatiDhamangaon Railway
(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.)Mining plan letter04 Nov 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameTEHSILDAR AMRAVATI
DesignationTehsildar
Company TEHSILDAR AMRAVATI
AddressCollector office Amravati State-Mharashtra
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