APPENDIX I (See paragraph – 6) FORM 1 (I) Basic Information Sl. Item Details No. 1. Name of the project/s Khamarigaon Decorative Stone Mine 2. S. No. in the schedule 1(a) 3. Proposed capacity/area/length/ tonnage Production : 30,000 cum per annum to be handled/command area/lease Lease Area 14.101 Ha area/ number of wells to be drilled 4. New/Expansion/Modernization New 5. Existing capacity/area etc., 14.101 Hectares 6. Category of Project i.e. ‘A’ or ‘B’ B2 7. Does it attract the general condition? If No yes, please specify 8. Does it attract the specific condition? If No yes, please specify 9. Location Toposheet No: 74A/02 Latitude - 190 05’ 18.5 ’’ to 190 05’ 24.2’’N Longitude - 840 33’ 38.4’’ to 840 33’ 53.0’’E Plot/Survey/Khasra No. Total Area: 14.101 Hectares List Attached as Annexure 1 Village Khamarigaon Tehsil Patrapur District Ganjam State Odisha 10. Nearest railway station/airport along Railway Station: Jhadupudi railway station at with distance in Kms a distance of about 8.7 Km in SE direction. Airport: Bijju Patnaik International Airport at a distance of about 183 km in NE direction. 11. Nearest Town, City, District Nearest Town: Ichchapuram about 12.9 Headquarters along with distance in Kms Kms in SW direction Dist. Headquarter: Chatrapur at a distance of about 53 Kms in NE direction. 12 Village Panchayats, Zilla Parishad, Village -Khamarigaon Municipal Corporation, Local body Dist: Ganjam, Odisha (complete postal addresses with telephone nos. to be given) 13 Name of the applicant M/s Galaxy Enterprises Prepared By : ENVIRTA Sustainable Solutions India Pvt. Ltd. i 14 Registered Address Sastri Nagar, 4th Lane, Near Utkal Cinema Hall Berhampur-760009, Dist Ganjham, Odisha 15 Address for correspondence: M/s Galaxy Enterprises Sastri Nagar, 4th Lane, Near Utkal Cinema Hall Berhampur-760009, Dist Ganjham, Odisha Name M/s Galaxy Enterprises Designation (Owner/Partner/CEO) Managing Director Address Sastri Nagar, 4th Lane, Near Utkal Cinema Hall Berhampur-760009, Dist Ganjham, Odisha Pin Code 760009 E-Mail Telephone No. Fax No. 16 Details of Alternative Sites examined, if It is a site specific project any. Location of these sites should be shown on a topo sheet 17 Interlinked Projects Nil 18 Whether separate application of Not Applicable interlinked projects has been submitted? 19 If yes, date of submission Not Applicable 20. If no, reason Not Applicable 21 Whether the proposal involves Not Applicable approval/clearance under: If yes, details of the same and their status to be given. (a) The Forest (Conservation) Act, 1980 ? (b) The Wildlife (Protection) Act, 1972 ? (c) The C.R.Z Notification, 1991 ? 22 Whether there is any Government Not Applicable Order/Policy relevant/relating to the site? 23 Forest land involved (hectares) Nil 24 Whether there is any litigation pending against the project and/or land in which Prepared By : ENVIRTA Sustainable Solutions India Pvt. Ltd. ii the project is propose to be set up? Not Applicable (a) Name of the Court (b) Case No. (c) Orders/directions of the Court, if any and its relevance with the proposed project. (II) Activity 1. Construction, operation or decommissioning of the Project involving actions, which will cause physical changes in the locality (topography, land use, changes in water bodies, etc.) Details thereof (with approximate quantities /rates, wherever S.No. Information/Checklist confirmation Yes/No possible) with source of information data 1.1 Permanent or temporary change in Yes The Topography of the core zone will land use, land cover or topography be changed due to the mining including increase in intensity of operation in the form of mine pits, land use (with respect to local land surface dumps, haulage roads, use plan) infrastructural facilities, etc. 1.2 Clearance of existing land, vegetation No The ML area comes under non forest and buildings? land category. The small scrubs existing within mining zone and dumping site will be cleaned for the mining activity. 1.3 Creation of new land uses? Yes It will be used in mining and related activities. 1.4 Pre-construction investigations e.g. Yes Pre mining investigation has been bore houses, soil testing? done with bore holes 1.5 Construction works? Yes Site services will be constructed as per Mines Act and Mines Rule. 1.6 Demolition works? No No demolition works are involved. 1.7 Temporary sites used for construction No Temporary site for temporary works or housing of construction Office/rest shelter etc only. Local workers? labour from nearby area will be employed. No housing will be required. 1.8 Above ground buildings, structures or Yes Site office, storage room and rest Prepared By : ENVIRTA Sustainable Solutions India Pvt. Ltd. iii earthworks including linear shelter. structures, cut and fill or excavations 1.9 Underground works including mining No Not Applicable. As this is Mining or tunneling? project by Opencast Semi mechanized method. 1.10 Reclamation works? Yes Backfilling and afforestation 1.11 Dredging? No Not Applicable 1.12 Offshore structures? No Not Applicable 1.13 Production and manufacturing Yes Open cast semi mechanized method. processes? 1.14 Facilities for storage of goods or Yes Decorative stone will be mined and materials? transported. Temporary stack yards are provided within quarry lease area. 1.15 Facilities for treatment or disposal of No Not Applicable solid waste or liquid effluents? 1.16 Facilities for long term housing of Most of the workers will be employed operational workers? No from nearby villages. Hence long term housing facilities are not involved 1.17 New road, rail or sea traffic during No No new road, rail or sea traffic is construction or operation? required. Existing facilities for transportation of minerals will be utilized. Only temporary approach roads will be made which connects to existing tar road. 1.18 New road, rail, air waterborne or Existing Facilities are sufficient. other transport infrastructure No including new or altered routes and stations, ports, airports etc? 1.19 Closure or diversion of existing The project does not involve any transport routes or infrastructure No closure or diversion of existing leading to changes in traffic transport routes or infrastructure movements? leading to changes in traffic movements. 1.20 New or diverted transmission lines or The project does not involve any new pipelines? No or diversion of transmission lines or pipeline. Prepared By : ENVIRTA Sustainable Solutions India Pvt. Ltd. iv 1.21 Impoundment, damming, culverting, realignment or other changes to the Yes Not Applicable hydrology of watercourses or aquifers? 1.22 Stream crossings? No Existing Facilities are sufficient. 1.23 Abstraction or transfers of water form Yes Accumulated water is proposed to be ground or surface waters? utilized for plantation & water sprinkling. 1.24 Changes in water bodies or the land No During mining no alteration or surface affecting drainage or run-off? changes in the passage/route of river 1.25 Transport of personnel or materials for No Decorative stone will be transported construction, operation or through trucks by road. decommissioning? Workers will come from nearby villages On their convenience. 1.26 Long-term dismantling or No No dismantling work will be carried in decommissioning or restoration this project. works? 1.27 Ongoing activity during No No decommissioning activity is decommissioning which could have an proposed. impact on the environment? 1.28 Influx of people to an area in either Yes For employment and for business temporarily or permanently? opportunities 1.29 Introduction of alien species? No Not Applicable 1.30 Loss of native species or genetic No Not Any diversity? 1.31 Any other actions? No Not Applicable Prepared By : ENVIRTA Sustainable Solutions India Pvt. Ltd. v 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): Details thereof (with approximate quantities S.No. Information/checklist confirmation Yes/No /rates, wherever possible) with source of information data 2.1 Land especially undeveloped or agricultural Yes Non Forest will used in mining land (ha) process. 2.2 Water (expected source & competing users) Yes Water requirement will be 7.5 unit: KLD KLD. Water will be supplied from nearby areas. 2.3 Minerals (MT) Yes Decorative stone 30,000 cu. m/MT annual production. 2.4 Construction material – Stone, aggregates, No No construction activity is Stone / soil (expected source – MT) proposed. Only temporary office/rest shelter etc. will be provided. 2.5 Forests and timber (source – MT) No No forest and timber products will be used in the proposed project. 2.6 Energy including electricity and fuels Yes Transportation will be done (source, competing users) Unit: fuel (MT), through dumpers or trucks energy (MW) operating on diesel. No storage for diesel is proposed. 2.7 Any other natural resources (use No No other natural resources will appropriate standard units) be used. 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. Details thereof (with approximate S.No. Information/Checklist confirmation Yes/No quantities/rates, wherever possible) with source of information data 3.1 Use of substances or materials, which are Yes Charcoal & Gun Powder hazardous (as per MSIHC rules) to human health will be used in limited Prepared By : ENVIRTA Sustainable Solutions India Pvt. Ltd. vi or the environment (flora, fauna, and quantity. water supplies) 3.2 Changes in occurrence of disease or affect disease No If proper hygiene is not vectors (e.g. insect or water borne diseases) maintained insect and water borne diseases may occur. 3.3 Affect the welfare of people e.g.