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APPENDIX – I

(See paragraph -6)

FORM- 1

(I)Basic information:

S.No. Item Details1 Name of the projects/s: Stone Quarry

Village - Milarabad

2 S. No. in the schedule Category B2;<5 ha3 Proposed capacity / area/ length/

tonnage to be handled / command area/ lease area/ no. of wells to be drilled.

About 75637 tons of stone per year

4 New/ expansion / Modernization. expansion5 Existing capacity area etc. -6 Category of project i.e. ‘A’ or ‘B’ ‘B2’7 Does it attract the general

foundation? If Yes, please specify.No. as no wild life, critically polluted,

eco-sensitive areas and inter-state/National boundary exist within

10 km.8 Does it attract the specify

condition? If yes, please specify. No, It does not attract any specific

condition9 Location Khasra No-389

Area – 2.86 ha (7.14 acre)

MilarabadBasna

Mahasamund

Plot/survey/khasra no.

VillageTahsilDistrict

State Chhattisgarh10 Nearest railway station/ airport

along with distance in KMS.Railway station in Bagbahara is about 85 km

11 Nearest town, city, District Headquarters along with distance in KMS.

Mahasamund, district, H.Q. is about 120km

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12 Village Panchayat, zilla parishad, municipal corporation, local body (complete postal address with telephone Nos. to be given.)

Gram Panchayat - MilarabadVillage Milarabad

Tehsil – Basna Dist. – Mahasamund

13 Name of the applicant. Shri Vijay Agrawal14 Registered Address. Shri Vijay Agrawal

Niwasi- Main Road, Tehsil- Basna,

District- MahasamundChhatisgarh

Address for correspondence Shri Vijay Agrawal Niwasi- Main Road, Tehsil- Basna,

District- MahasamundChhatisgarh

493554Mobile No.+919425502941

Name

Designation (Owner/ Partner/ CEO)AddressPin codeEmailTelephone no.Fax no.

16 Details of alternative sites examined, if any. Location of these sites should be show on a Toposheet.

No alternative sites proposed

17 Interlinked project. There is no interlinked project.18 Whether separate application of

interlinked project has been submitted?

No,

19 If yes, date of submission Not Applicable20 If no, reason No clearance is required under the

mentioned Acts/rules

21 Whether the proposal involves approval / clearance under ; if yes, details of the same And their status to be given.

(a) The forest (conservation) Act, 1980?

(b)The wild life (protection) Act, 1972

No clearance is required under the mentioned Acts/rules.

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(c) The C.R.Z. notification, 1991?

22 Whether there is any govt. order/ policy relevant/ relating to the site?

No

23 Forest land involved (hectares) No forest land is involved

24 Whether this is any litigation pending against the project and / or land in which.The project is proposed to be setup?

(a) Name of the court(b)Case No.(c) Orders/ Directions of the

court, if any and its relevant with the proposed project.

No litigation or case is pending against the applied area

Capacity corresponding to sectoralactivity (such us production capacity for manufacturing, mining lease area and production capacity for mineral production, area for mineral exploration, land for linear transport infrastructure, generation capacity for power generation

(II) Activity

1. Construction, Operation or decommissioning of the Project involving action, which will cause physical changes in the locality (topography, land use, changes in water bodies etc.)

S. No.

Information/Checklist confirmation

Yes/No Details thereof (with approximate quantities/ rates

wherever possible) with source of information data

1.1 Permanent or temporary change in

land use, land cover or topography

including increase in intensity of

land use(with respect to local land

Yes The proposed project is open cast

semi mechanized quarry which

will create depression after

excavation of stone.

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use plan)

1.2 Clearance of existing land,

vegetation and buildings?

No The area is partially covered by

soil which is scanty vegetation

and any co-building, no clearance

will be required.

1.3 Creation of new land uses No No new land use(s) will be created.

1.4 Pre-construction investigation e.g.

bore houses, soil testing?

No No permanent construction isinvolved therefore no investigations are required.

1.5 Construction work? No No permanent construction is required.

1.6 Demolition work? No No demolition is required.

1.7 Temporary sites used for

construction works or housing of

construction workers?

No Not required as no construction work for housing of workers.

1.8 Above ground buildings,

structures or earthworks including

linear structures, cut and fill or

excavations.

No No cut and fill or excavations for any structure are required, above the ground.

1.9 Underground works including mining or funneling?

No No such activities proposed.

1.10 Reclamation work? Yes No Reclamation work will be taken up as proposed in mining plan.

1.11 Dredging? No No dredging activity would be required.

1.12 Offshore structures? No The area is not located at seashore.

1.13 Production and manufacturing processes?

Yes The production of stone by open cast semi-mechanized quarry.

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1.14 Facilities for storage of goods or

materials?

Yes The mined out stone will be stored within the lease area for a limited period.

1.15 Facilities for treatment or disposal

of solid waste or liquid effluents?

No No solid or liquid waste will be generated; hence, treatment facilities are not required.

1.16 Facilities for long term housing of

operational workers?

No Not required as no construction work for housing of workers as workers engaged will be from the nearby villages only.

1.17 New road, rail or sea traffic during

construction or operation?

No No new road or rail traffic would be generated during any stage of project. Only haul path will be created/ constructed fortransportation of mined out stone after crushing.

1.18 New road, rail or air waterborne or

other transport infrastructure

including new or altered routes

and station, ports, airports etc.?

No No new road, rail etc is required (1.17).Only haulage path is required for shipment of mined out stone after crushing.

1.19 Closure or diversion of existing

transport routes or infrastructure

leading to changes in traffic

movements?

No No closure or diversion of existing routes or infrastructure will be required to changes traffic movements.

1.20 New or diverted transmission lines

or pipelines?

No No diversion of transmission lines or pipelines will be made.

1.21 Impoundment, damming,

converting, realignment or other

changes to the hydrology of

watercourses or aquifers?

No Since water table is below the depth of quarrying. Thus no changes is envisage in this regard.

1.22 Stream crossings? No No stream crossing is involved.

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1.23 Abstraction or transfer of water

form ground or surface waters?

No Mining activities does not require any abstraction or transfer of ground or surface water.

1.24 Changes in water bodies or land

surface affecting drainage or run-

off?

No No change would occur in water bodies or the land surface to affect the run-off.

1.25 Transport of personnel or materials for construction, operation or decommissioning?

No No transport of personnel or material is required for quarry of stone.

1.26 Long-term dismantling or decommissioning or restoration works?

No Not required

1.27 Ongoing activity during decommissioning which could have an impact on the environment?

No No such activity envisaged.

1.28 Influx of people to an area in

either temporarily or permanently?

No No influx of people will be there either temporarily or permanently.

1.29 Introduction of alien species? No No introduction of alien species will occur or expected.

1.30 Loss of native species or genetic

diversity?

No No loss of native species or genetic diversity will occur or anticipated but as a part of green belt development plan native species that are suitable to the soil conditions will be developed as and when required.

1.31 Any other actions? No No any other action is required.

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2. Use of Natural resources for construction or operation of the Project (such as land, water, materials or energy, especially any resources which are non-renewable or in short supply):

S. No.

Information/Checklist confirmation

Yes/No Details thereof (with approximate quantities/ rates wherever

possible) with source of information data

2.1 Land especially undeveloped

or agricultural land (HA)

No Declared quarrying area is undeveloped Govt.land.

2.2 Water (expected source &

competing users) unit: KLPD

Yes As much about 7 KLPD water will be required for Quarrying operation sprinkling of water on the haulage road as and when required for the suppression of dust generated due to transport vehicles and for plantation purpose.

2.3 Minerals (MT) No No other mineral will be used.

2.4 Construction material - stone,

aggregates, and/ soil (expected

source - MT)

No No construction material from other places is required, as there shall be no construction.

2.5 Forests and timber (source -

MT)

No No timber is required for any purpose.

2.6 Energy in clouding electricity

and fuels (source, competing

users) Unit: Fuel (MT),

Energy (MW)

Yes Moderate quantity of POL will be required in machines used for miningas well as transportation vehicle.

2.7 Any other natural resources

(use appropriate standard

units)

No None of the other natural resources will be used.

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3. Use , storage transport, handling or production of substances or materials , which could be harmful to human health or the environment or raise concerns about actual or perceived risks to human health.

S. No. Information/Checklist confirmation

Yes/No Details thereof (with approximate quantities/ rates wherever possible) with source of information data

3.1 Use of substances or materials which are hazardous (as per MSIHC rules) to Human health or the environment (flora , fauna and water supplies)

No None of the hazardous substances or material will be used or handled during the project.

3.2 Changes in occurrence of disease or affect disease vectors (e.g. insect or water borne disease)

No The project will have nosuch changes in occurrence of disease or affect disease vectors.

3.3 Affect the welfare of people e.g.

by changing living conditions?

Yes Economic source will improve & thus living conditions & standard will also be improved.

3.4 Vulnerable groups of people

who could be affected by the

project e.g. hospital patients ,

children, the elderly etc.

No The project will have no affect on any type/class of vulnerable people.

3.5 Any other causes No No causewould harm the human health or the environment.

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4. Production of solid waste during construction or operation or decommissioning(MT/month)

S. No.

Information/Checklist confirmation

Yes/No Details thereof (with approximate quantities/ rates wherever possible) with source of information data

4.1 Soil, overburden or mine

wastes

Yes This project area is covered with soil. The removed soil and about 10% generated waste will be stacked on lease boundary.

4.2 Municipal waste(domestic and

commercial waste)

No There is no residential (1.5, 1.7) or commercial arrangement, in turn it would not generate any municipal waste.

4.3 Hazardous waste (as per

hazardous waste management

Rules)

No Release of any hazardous solid waste material is not at all expected during various stages of this mining project.

4.4 Other industrial process

wastes

No No industry or subsidiary of project exists and therefore would not generate any industrial waste.

4.5 Surplus product No Not applicable.4.6 Sewage sludge or other sludge

from effluent treatment

No There will not be any kind of sewage sludge or other sludge generation, therefore would not generate any effluent, which may require any type of treatment.

4.7 Construction or demolition

wastes

No Project does not involve any construction or demolition activity( 1.5 and 1.6)

4.8 Redundant machinery or

equipment

No Redundant machinery or equipment not required.

4.9 Contaminated soils or other

materials

No Owing to nature of the project, it does not produce waste to contaminate any of the material by releasing harmful solid, liquid or emissions.

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4.10 Agricultural wastes No Being no requirement of agricultural material during any phase of project, no agriculturalwastes will be generated inthis mining project.

4.11 Other solid wastes No No any other solid waste generation is expected or envisaged during various stages of the project.

5. Release of pollutants or any hazardous, toxic or noxious substances to Air (Kg/hr.)

S. No.

Information/Checklist confirmation

Yes/No Details thereof (with approximate quantities/ rates wherever possible) with source of information data

5.1 Emissions from combustion of fossil fuels from stationary or mobile sources

Yes There will be small amount of exhaust emission from the machinery and vehicles utilized in quarry area. Such emissions will be kept within the permissible norms of limit with proper maintenance.

5.2 Emissions from production

processes

Yes Machinery used for excavation and loading purpose, generates someemission pollution which will be kept within the permissible norms of limit.

5.3 Emissions from materials

handling including storage or

transport

Yes Dust emission is envisaged due to vehicles movement. Due care will be taken by moving the vehicle at slow speed and also adequate dust suppression system will be installed on haulage road, if required.

5.4 Emissions from construction activities including plant and equipment

No No construction (1.5, 1.6, 1.7, 1.8), plant (4.6) and equipment (2.6, 4.8) are involved that may liberate harmful emissions.

5.5 Dust or odors from handling

of materials including

Yes Some amount of dust will generate in mining, Blasting, crushing and transportation of mined out stone. Due

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construction materials, sewage

and waste

care will be taken for dust emanation. (5.3)

5.6 Emissions from incineration of waste

No Not applicable.

5.7 Emissions from burning of

waste in open air (e.g. slash

materials, construction debris)

No There is no production or remains of the slash material or construction debris that may require burning therefore, no emission is expected from burning.

5.8 Emissions from any other

sources

No There is no any other source of harmful emission is envisaged.

6. Generation of noise and vibration and Emissions of light and Heat:

S. No.

Information/Checklist confirmation

Yes/No Details thereof (with approximatequantities/ rates wherever possible)

with source of information data6.1 From operation of equipment

e.g. engines, ventilation plant,

crushers

Yes Transport vehicles may generate noise (50-55 db) during operation; the noise pollution will be maintained within the permissible norms of limit. However, personals working close to machines will be provided ear plugs/ear muffs for further protection.

6.2 From industrial or similar processes

No Not applicable

6.3 From construction or

demolition

No There is no construction (1.5) or demolition (1.6) is not needed to attract this point.

6.4 From blasting or piling Yes Blasting is required to break the hard rock. This will generate noise and vibrations but measures will be taken to keep the noise/ vibration within the

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permissible norms of limit by using nitrates for limited controlled blastingwhich will reduce the noise and vibration to considerable extend.

6.5 From construction or operational traffic

No Vide reasons mentioned earlier (1.5, 1.17) no construction or operational traffic is expected to cause any noise,vibration, emissions of light or heat.

6.6 From lighting or cooling systems

No The project requires no specific lighting or cooling systems.

6.7 From any other sources No No other source is envisaged to generate noise, vibration, emissions of light and heat.

7. Risks of contamination of land or water from releases of pollutant into the

Ground or into sewers, surface water, groundwater, coastal water or the sea:

S. No.

Information/Checklist confirmation

Yes/No Details thereof (with approximate quantities/ rates wherever possible)

with source of information data7.1 From handling storage , use or

spillage of hazardous materials

No The handled material (3.1) does not contain any hazardous material therefore its spillage is not possible.

7.2 From discharge of sewage or

other effluent to water or the

land (expected mode and place

of discharge)

No Since no sewage (4.6, 5.5) or other effluents are envisaged for discharge, it will not contaminate water or the land.

7.3 By deposition of pollutants

emitted to air into the land or

into water

No Dust will be generated during crushing,blasting excavation and loading of mined out stone. These effects are localized, transitory and intermittent in nature. Even thendue care will be taken for dust emanation by deployment of movable type of water sprinkling system.

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7.4 From any other sources No There will not be any other sources that may be expected to release any pollutants.

7.5 Is there a risk of long term

buildup of pollutants in the

environment from these

sources?

No There is no risk to build up pollutants in the environment as impact on air quality is localized; transitory and intermittent have no insignificant effect on the environment.

8. Risk of accidents during construction or operation of the project, which could affect human health or environment

S. No.

Information/Checklist confirmation

Yes/No Details thereof (with approximate quantities/ rates wherever possible) with source of information data

8.1 From explosions, spillages ,

fires etc. from storage,

handling, use or production of

hazardous substances

No As there is no storage, spillage, fire, etc. therefore no production of any hazardous substance is expected from any activity at any stage of the project.

8.2 From any other causes No There is no any other cause to have risk of accidents during the operation or any other stage of the project.

8.3 Could the project be affected

by natural disasters causing

environmental damage (e.g.

floods, earthquakes,

landslides, cloudburst etc.)?

No This mining project is not located in earthquakes or landslide prone zone. It is located on hard and stable rock- safe zone. Although it is non-operational during rainy days also,therefore no risk of accident is envisaged during any natural disasters.

9. Factors which should be considered (such as consequential development) which could lead to environmental effects or the potential for cumulative impacts with other existing or planned activities in the locality.

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S. No.

Information/Checklist confirmation

Yes/No Details thereof (with approximate quantities/ rates wherever possible)

with source of information data9.1 Lead to development of

supporting, lilies, ancillary development or development stimulated by the project which could have impact on environment e.g.:

Supporting infrastructure (roads, power supply, waste or waste water treatment, etc.)

Housing development Extractive industries Supply industries Others

No The project has no conventional structures of developmental work, solid or fluidal wastes or harmful emissions therefore it would not have any impact on the environment of any type of existing, developmental or other planned activities.

9.2 Lead to after-use of the site,

which could have an impact on

the environment

No The project would not have any adverse impact on the environment after-use of the site as at the close of the mine under reclamation it is proposed that this mine area to be water filled and used for pisciculture as well as will help in recharging the ground water and can also be used as localizes irrigation purpose.

9.3 Set a precedent for later

developments

Yes A better after use scenario which is likely to increase aesthetic beauty of the area in addition to benefit of better greenery would set a precedent for subsequent entrepreneurs who venture such projects.

9.4 Have cumulative effects due to

proximity to other existing or

planned projects with similar

effects

No There is no adversecumulativeenvironmental effect envisaged due to proximity on other existing or planned activities in the locality but a better planned and executed project will yield a better result individually, which in turn will give better

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cumulative effect also.

(III) Environmental Sensitivity:

S.No.

Areas Name/Identity

Aerial distance (within 15 km.) proposed project location

boundary1 Areas protected under

international conventions, nation or local legislation for their ecological, landscape , cultural or related value

No No such areas are there in1Km aerial distance from project location.

2 Area which are important or sensitive for ecological reasons –wetland, watercourses or other water bodies, coastal zone, biospheres, mountains, forests

No No ecologically protected/ sensitive/important area is located in the region.

3 Area used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration

No No such important / sensitive species of flora or fauna are located in the region.

4 Inland, coastal, marine or underground waters

No No underground water will be affected as the ground water level is quite below the proposed quarry bottom.

5 State, national boundaries No There is no state, national boundary close to the area as prescribed under applicable act, rules or guidelines.

6 Routes or facilities used by the

public for access to recreation or

other tourist, pilgrim areas

No No route or facilities are available in the area, which are being used for public access to recreation or other tourist, pilgrim.

7 Defense installations No The area is not located close to any of the defense installations.

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8 Densely populated or built-up area

No Village Milarabad is a small thinly populated non built-up area,Which is 1.0 km from the area.

9 Areas occupied by sensitive man-

made land uses (hospital , school,

places of worship, community

facilities )

No No sensitive man made land use(hospital, school, places of worship, community facilities) are exists nearby the area under study.

10 Areas containing important, high quality or scarce resources (ground water resources, surface resources, forestry, agriculture, fisheries, tourism, minerals )

No No area exists nearby containing important, high quality or scarce resources.

11 Areas already subjected to

pollution or environmental

damage ( those where existing

legal environmental standards are

exceeded)

No The area is not either polluted or environmentally damaged.

12 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)

No The area is safe with naturalhazardous (8.3) However, the project is non-functional during rainy days.

(IV) Proposed Terms of Reference for EIA studies."It is here by declared that the data and information submitted in the applicationand the documents enclosed all true to the best of my knowledge and belief. If anlpart of the data and information submitted is found to be false, misleading orfabricated at any stage, the authorities are entitled to cancel the proiect and themoney involve can be forfeited.',Date:

Place:

NOTE:l.

6n z'san-Signature df the

Applicant

The proiects involving clearance under coastal Resulation zoneNotification, 1991 shall submit with the application a C.n.Z. map dul;demarcated by one of the authorized agencies, showing the projectactivities, w.r.t. c.R.Z (at the stage of roR) and the recommendations ofthe State coastal zone Management Authority (at the stage of EC).Simultaneous action shall also be taken to obtain the requisite clearanccunder the provisions of the c.R.Z. Notification, i991 for the activities tobe located in the CRZ.

The projects to be located within l0 km of the National parks, sanctuaries,Biosphere Reserves, Migratory corridors of wild Animals, the projectproponent shall submit the map duly authenticated showing Oy .i,i.fwildlife warden showing these' features vis-a-vis the project loiation andthe Recommendation or comments of the chief wildrife warden 'thereon(at the stage of EC)."

All correspondence with the Ministry of Environment &Forests includings.bmission of application fbr ToR/Environment clearances, subsequeniClarifications, as may be required from time to time, participation in theEAC Meeting on behalf of the project proponent shall be made bv thcauthorized. signatory only. The authorized signatory should also submit adocument in support of his claim of being an authorized signatory fbr thespecific project.

2.

3.

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