APPENDIX I (See paragraph – 6) FORM 1 (I) Basic Information Sl. Item Details No. 1. Name of the project/s Baulasahi Sand Quarry

2. S.No. in the schedule 1(a) 3. Proposed capacity/area/length/ tonnage to be Total production of 4800 cu.m of handled/command area/lease area/ number of wells to be sand from lease area 15.44 Acres drilled during plan period will be obtained. 4. New/Expansion/Modernization New 5. Existing capacity/area etc., 4800 Cu.m / 6.248Ha 6. Category of Project i.e ‘A’ or ‘B’ B2 7. Does it attract the general condition? If yes, please specify Yes, Manual 8. Does it attract the specific condition? If yes, please specify No 9. Location Toposheet No. 73H/4 Lat: 20o03’40.50”N to 20o04’28.68” N Long:85o 09’45.54” E to 85o10’18.10” E Plot/Survey/Khasra No. Plot No:664, : Total of 15.44 Acres Khata No.430 Village Baulasahi Tehsil District Nayagarh State 10. Nearest railway station/airport along with distance in Kms Nayagarh is the nearest Rly Station which is 20 km from quarry site. The nearest airport is Biju Pattanaik International Airport, Bhubaneswar which is at a distance of 92 Km from the project site. 11. Nearest Town, city, District Headquarters along with Nearest town Itamati, is situated at distance in Kms a distance of 10Km.The district Headquarters is Nayagarh at distance of 26 Km 12 Village Panchayats, Zilla Parishad, Municipal Corporation, At:- Baulasahi Local body (complete postal addresses with telephone nos. PO-Baulasahi, to be given) Tahasil- - Nayagarh, Odisha 13 Name of the applicant Sri Maheswar Jena 14 Registered Address At/ PO:-Baulasahi PS- Itamati, District- Nayagarh, Odisha

1 15 Address for correspondence: At/ PO:-Baulasahi PS- Itamati, District- Nayagarh, Odisha Name Sri Maheswar Jena Designation (Owner/Partner/CEO) Owner Address At/ PO:-Baulasahi PS- Itamati, District- Nayagarh, Odisha Pin Code Pin-752092 E-Mail Telephone No. Mob- 9938487276 Fax No. 16 Details of Alternative Sites examined, if any. Location of Village-District-State these sites should be shown on a topo sheet 1. Not Applicable

17 Interlinked Projects NIL

18 Whether separate application of interlinked projects has been Not Applicable submitted? 19 If yes, date of submission Not Applicable

20. If no, reason Not Applicable

21 Whether the proposal involves approval/clearance under: If The proposal does not involve any yes, details of the same and their status to be given. approval/clearance under the said (a) The Forest (Conservation) Act, 1980 ? act & notification. (b) The Wildlife (Protection) Act, 1972 ? (c) The C.R.Z Notification, 1991 ? 22 Whether there is any Government Order/Policy Not Applicable 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 the project is propose to be set up? (a) Name of the Court Not litigation pending against the (b) Case No. project. (c) Orders/directions of the Court, if any and its relevance with the proposed project.

2 Expected Project Cost: (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 possible) with S.No. Information/Checklist confirmation Yes/No source of information data 1.1 Permanent or temporary change in land Yes This is a river bed sand mining project. use, land cover or topography including Hence there will be no change in land increase in intensity of land use (with use/topography of the area due to natural respect to local land use plan) sediment supply. 0.960 ha area will be used for mining activity for sand excavation. 1.2 Clearance of existing land, vegetation and No No clearance is required as the area comes buildings? under revenue land and there is no vegetation within the river bed.. 1.3 Creation of new land uses? Yes There will be continuing deposition of sand during flood/rainy season. 1.4 Pre-construction investigations e.g. bore Yes Not required. Sand will be direct sell to houses, soil testing? market. 1.5 Construction works? No Not Applicable

1.6 Demolition works? No No demolition works are involved. 1.7 Temporary sites used for construction No Temporary site for temporary Office/rest works or housing of construction workers? shelter etc only. Local laborers from nearby area will be employed. No housing will be required. 1.8 Above ground buildings, structures or Yes There will be no building/structure to stay as earthworks including linear structures, cut work will be carried out in day time only. and fill or excavations Local laborer will be employed in priority. 1.9 Underground works including mining or Yes Not Applicable. As this is a opencast manual tunneling? river mining project. 1.10 Reclamation works? No Not Applicable. As this is a river bed mining project by open cast method. 1.11 Dredging? No Not Applicable

1.12 Offshore structures? No Not Applicable 1.13 Production and manufacturing processes? Yes The project is river bed mining project confined to excavation of sand from the proposed site with the help of spade, axe and tractors. No other reduction or manufacturing process is involved which would change the land use or topography of the area.

3 1.14 Facilities for storage of goods or Yes Mineral excavated will be loaded directly materials? into tractor for transportation. Hence no storage facility will be required. 1.15 Facilities for treatment or disposal of solid No There will be no OB cover and no waste will waste or liquid effluents? be generated. Liquid effluent portable toilets will be used hence no sewage/liquid effluent will be generated. 1.16 Facilities for long term housing of Most of the workers will be employed from operational workers? No 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 required. construction or operation? 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 other transport infrastructure including new or No Existing facilities are sufficient. altered routes and stations, ports, airports etc?

1.19 Closure or diversion of existing transport The project does not involve any closure or routes or infrastructure leading to changes No diversion of existing transport routes or in traffic movements? infrastructure leading to changes in traffic movements. 1.20 New or diverted transmission lines or The project does not involve any new or pipelines? No diversion of transmission lines or pipeline. 1.21 Impoundment, damming, culverting, No impoundment or damming is involved in realignment or other changes to the No the project. No ground water intersection is hydrology of watercourses or aquifers? involved hence no change is anticipated in the hydrology of watercourses or aquifers by the mining operation 1.22 Stream crossings? Yes Proposed project will not disturb natural drainage pattern. 1.23 Abstraction or transfers of water form No Total water requirement is about 2KLD day ground or surface waters? water requirement fulfill all nearby village.

1.24 Changes in water bodies or the land No There will be no change in the flow pattern surface affecting drainage or run-off? of the water body as the proposed project will not disturb natural drainage pattern, nallah of the area. 1.25 Transport of personnel or materials for No No construction is proposed. The staff and construction, operation or the workers involved in the project will use decommissioning? the local transport for communication to the project area. 1.26 Long-term dismantling or No No dismantling work will be carried in this decommissioning or restoration works? project

4 1.27 Ongoing activity during decommissioning No No decommissioning activity is proposed. which could have an impact on the environment?

1.28 Influx of people to an area in either No There will temporary influx of people for temporarily or permanently? employment and for business opportunities.

1.29 Introduction of alien species? No Not Applicable

1.30 Loss of native species or genetic No Not Applicable. diversity?

1.31 Any other actions? No No other action will be involved for the excavation of Sand. 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 /rates, S.No. Information/checklist confirmation Yes/No wherever possible) with source of information data 2.1 Land especially undeveloped or agricultural Yes The mining activity is land (ha) concentrated in the proposed lease area. It does not fall in the forest land and is devoid of any vegetation. 2.2 Water (expected source & competing users) No Water requirement will be unit: KLD 2KLD. Water will be supplied from nearby areas. 2.3 Minerals (MT) A total of 4800cu.m. of Sand during plan period will be excavated. 2.4 No No construction activity is Construction material – Stone, aggregates, Stone proposed. Only temporary office/ / soil (expected source – MT) 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 (source, No Transportation will be done competing users) Unit: fuel (MT), energy through tractors or trucks (MW) operating on diesel. No storage for diesel is proposed. 2.7 Any other natural resources (use appropriate No No other natural resources will standard units) be used.

5 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 hazardous No No hazardous, toxic, semi (as per MSIHC rules) to human health or the toxic substance or any other environment (flora, fauna, and material will be used in the water supplies) mining operations 3.2 Changes in occurrence of disease or affect disease No Not Applicable vectors (e.g. insect or water borne diseases)

3.3 Affect the welfare of people e.g. by changing living No Socio-economic condition conditions? will improve and will have positive impact due to increase earning sources of nearby peoples. 3.4 Vulnerable groups of people who could be affected by No No Vulnerable groups of the project e.g. hospital patients, children, the elderly people will be affected by etc., the project. 3.5 Any other causes No There will be no effect due to other cause.

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

Details thereof (with approximate S.No. Information/Checklist confirmation Yes/No quantities/rates, wherever possible) with source of information data 4.1 Spoil, overburden or mine wastes No No waste will be generated during the mining operation as there will be no OB & soil. 4.2 Municipal waste (domestic and or commercial No Not Applicable wastes)

6 4.3 Hazardous wastes (as per Hazardous Waste No No Hazardous waste (as per Management Rules) Hazardous Waste Management Rules) will be generated. 4.4 Other industrial process wastes No There will be no industrial process waste involved in the project. 4.5 Surplus product No No surplus product will generate. 4.6 Sewage sludge or other sludge from effluent No There is no effluent treatment treatment plant in the proposed project. 4.7 Construction or demolition wastes No No construction or demolition waste is involved. 4.8 Redundant machinery or equipment No There is no redundant machinery or equipments.

4.9 Contaminated soils or other materials No No contamination of soil as there is absence of soil. 4.10 Agricultural wastes No No agricultural waste will be generated.

4.11 Other solid wastes No No other solid waste generated.

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

Details thereof (with approximate S.No. Information/Checklist confirmation Yes/No quantities/rates, wherever possible) with source of information data 5.1 Emissions from combustion of fossil fuels from Yes There will be emission of stationary or mobile sources gases from combustion of fuel used in the transportation vehicles(tractors etc,) The emissions are temporary type. However proper mitigation measures will be taken to reduce impacts from such

7 emissions. The vehicles moving for transportation have valid PUC certificates. 5.2 Emissions from production processes Yes • Particulate matter emissions (dust) from Mining Operations and transportation. 5.3 Emissions from materials handling including Yes Fugitive emissions are storage or transport envisaged from material handling and transportation areas. • Emissions of SO2, NOx and CO are envisaged due to vehicular movements. • Dust emission will be controlled by spraying of water. 5.4 Emissions from construction activities including No Not Applicable plant and equipment 5.5 Dust or odors from handling of materials including No The mining activities may construction materials, sewage and waste cause to increase PM levels locally. The impact will be reversible, marginal and temporary in nature. Dust suppression will be done by sprinkling of water. However, there will be no odors generation substances.

5.6 Emissions from incineration of waste No Not Applicable 5.7 Emissions from burning of waste in open air (e.g. No Not Applicable slash materials, construction debris) 5.8 Emissions from any other sources No Nil

6. Generation of Noise and Vibration, and Emissions of Light and Heat:

Yes/No Details thereof (with approximate quantities/rates, wherever S.No. Information/Checklist confirmation possible) with source of information data with source of information data

8 6.1 From operation of equipment e.g. engines, Yes Noise will be generated ventilation plant, crushers from movement of transport vehicles.

6.2 From industrial or similar processes No There will be not be any industrial process involve.

6.3 From construction or demolition No No Construction or demolition work involves.

6.4 From blasting or piling No Not Applicable

6.5 From construction or operational traffic No During the operation phase (transportation of mineral) noise will be generated from the transportation vehicle which will be within prescribed limit. 6.6 From lighting or cooling systems No The proposed mining is opencast thus emission of light and heat will be negligible. All the mining operation will be done in day only. No cooling system is required. 6.7 From any other sources No Not other source generates Noise and vibration. Heat etc.

7. Risks of contamination of land or water from releases of pollutants into the ground or into sewers, surface waters, groundwater, coastal waters or the sea:

Details thereof (with approximate S.No. Information/Checklist confirmation Yes/No quantities/rates, wherever possible) with source of information data 7.1 From handling, storage, use or spillage of No No hazardous materials hazardous materials Will be handled.

9 7.2 From discharge of sewage or other effluents to Yes No risk of contamination water or the land (expected mode and place of due to discharge of any discharge) effluent because only waste water discharges to land from septic tank. 7.3 By deposition of pollutants emitted to air into the No Dust generated during the land or into water mining process, loading and transportation may cause impact on the air but the measure followed will control the air pollution. 7.4 From any other sources No Not envisaged

7.5 Is there a risk of long term build up of pollutants in No Not envisaged the environment from these sources?

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

Details thereof (with approximate S.No. Information/Checklist confirmation Yes/No quantities/rates, wherever possible) with source of information data

8.1 From explosions, spillages, fires etc from storage, No Not Applicable handling, use or production of hazardous substances 8.2 From any other causes No Nil

8.3 Could the project be affected by natural disasters No The area is not prone to causing environmental damage (e.g. floods, flood and earthquake. No earthquakes, landslides, cloudburst etc)? such incident is reported in this area comes in seismic Zone-II.

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 Details thereof (with approximate S. No. Information/Checklist confirmation Yes/No quantities/rates, wherever possible) with source of information data 9.1 Lead to development of supporting. Roads and transport facility

10 lities, ancillary development or development will be improved due to stimulated by the project which could have frequently available of impact on the environment e.g.: mine vehicles. Project proponent will organize • Supporting infrastructure (roads, power supply, regular medical checkup waste or waste water treatment, etc.) camps and recreational activities. Employment to local people will be generated. Over all living standard of nearby people will have positive impact. • housing development • extractive industries • supply industries • other 9.2 Lead to after-use of the site, which could have No The mining area will be an impact on the environment reclaimed during rainy season or during flood. 9.3 Set a precedent for later developments No The construction sand is proposed to be sold in the market or to the localite for building/construction purposes. 9.4 Have cumulative effects due to proximity to other No No effect on planned existing or planned projects with similar effects projects.

(III) Environmental Sensitivity

Aerial distance (within 15 S.No. Areas Name/ km.) Identity Proposed project location boundary

1 Areas protected under international conventions, No Nil national or local legislation for their ecological, landscape, cultural or other related value 2 Areas which are important or sensitive for No Nil ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests

11 3 Areas used by protected, important or sensitive No Nil species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration 4 Inland, coastal, marine or underground waters No The project lies on Duant River. 5 State, National boundaries No Nil

6 Routes or facilities used by the public for access No The site is well connected to recreation or other tourist, pilgrim areas by fair weather road. Haul roads inside mine lease area also exists. 7 Defence installations No Nil

8 Densely populated or built-up area Baulasahi 2Km in from the lease area.

Itamati 15 Km from the lease area.

Hospital 6 KM in from the lease area i.e. Sankhei Hospital. School Kodiekahania :0.5Km

Temple Pindikeswar Shiv Temple at Km from lease area. 9 Areas occupied by sensitive man-made land uses No Hospitals and schools are (hospitals, schools, places of worship, community available in nearby villages facilities) and in Sankhei Kodiekahania. Community facilities are also available at Itamati :15 Km. 10 Areas containing important, high quality or scarce No ---- resources (ground water resources, surface resources, forestry, agriculture, fisheries, tourism, minerals)

11 Areas already subjected to pollution or No Not Applicable environmental damage. (those where existing legal environmental standards are exceeded) 12 Areas susceptible to natural hazard which could No As per the 2002 Bureau of cause the project to present environmental Indian Standards (BIS) problems map, Nayagarh falls under (earthquakes, subsidence, landslides, erosion, seismic zone II flooding or extreme or adverse climatic conditions)

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