1

APPENDIX I (See Paragraph-6)

FORM 1 (I) Basic Information

S. No. Item Details

1. Name of the Project/s Mohuda Road metal Quarry In district of 2. S. No in the schedule 1 (a) 3. Proposed capacity / area /length/tonnage to be 2.200Acres or 0.89ha. handled /command area /lease area/number of wells to be drilled 4. New /Expansion /Modernization New 5. Existing Capacity / Area etc. * 2.200Acres or 0.89ha. 6. Category of project i.e. ‘A’ or ‘B’ “B2” 7. Does it attract the general condition? If yes, Yes please specify. 8. Does it attract the specific condition? If yes, No please specify. 9. Location Refer to Toposheet No: 74A/11 Latitude : N 190 16’ 57.1’’ to 190 16’ 59.8’’ Longitude : E 84°44'10.0" to 840 44’ 14.2” Plot/Survey/Khata No. 1978/1, Khata No-669 Village Mohuda Tahasil Kukudakhandi District Ganjam State Odisha 10 Nearest railway station/airport along with The nearest railway station is at which is distance in kms. about 8 km from the mine lease area. The nearest airport is Airport at 195 km south from the mining site. 11 Nearest Town, city, District, Headquarters The nearest town is Berhampur which is at a distance along with distance in kms. of 7 kms from the lease area. The District Head Quarter is Chattrapur at a distance covering 27km. 12 Village Panchayats, Zilla Parisad, Municipal Village- Mohuda, Zilla Parisad – Ganjam, Municipal Corporation, Local body (complete postal Corporation-Berhampur, Local Body- Kukudakhandi. addresses with telephone nos. to be given) 13 Name of the applicant Smt. Kuni Sahu 14 Registered address Smt. Kuni Sahu AT-Lathi PO/PS.- Berhampur District- Ganjam, Odisha 2

15 Address for correspondence : Smt. Kuni Sahu AT-Lathi P/O PS- Berhampur District- Ganjam, Odisha Name Smt. Kuni Sahu Designation (Owner/Partner/CEO) Owner Address Smt. Kuni Sahu AT-Lathi PO /PS- Berhampur District- Ganjam, Odisha Pin code 16. Details of Alternative sites examined, if any, Village-District-State Location of these sites should be shown on a 1. topo sheet. 2. NA 3. 17. Interlinked Projects NA 18. Whether separate application of interlinked NA project has been submitted? 19 If yes, date of submission NA 20 If no, reason NA

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 NA ? (b) The Wildlife (Protection) Act, 1972 ? (c) The C.R.Z Notification, 1991 ? 22 Whether there is any Government NA 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 the project is propose to be set up? (a) Name of the Court NA (b) Case No. (c)Orders/directions of the Court, if any and its relevance with the proposed project. 3

(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.) 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 Yes Details of Land use is given below. use, land cover or topography including Type of land At the At the end increase in intensity of land use (with use beginning of of the 5 the plan year plan respect to local land use plan) period period (In ha.) (2019-20) (in ha.) Mining 0.327 0.433 Top soil Nil Nil Overburden Nil Nil dump Mineral Nil Nil storage Sub-Grade Nil Nil Storage Infrastructure Nil Nil Roads 0.012 0.012 Green belt Nil 0.12 area Screening Nil Nil plant/Washing Plant Tailing pond Nil Nil Total land 0.339 0.565 degradation Area which will 0.551 0.325 remain untouched Total 0.89 0.89 1.2 Clearance of existing land. Vegetation No NA and buildings? 1.3 Creation of new land uses? No NA

1.4 Pre-construction investigations e.g. No NA bore houses, soil testing? 1.5 Construction works? No Nil 1.6 Demolition works? No Nil

1.7 Temporary sites used for construction No ------works or housing of construction workers? 1.8 Above ground buildings, structures or Mining will be carried out as per approved earthworks including linear structures, Yes Mining Plan. cut and fill or excavations 4

1.9 Underground works including mining No No underground mining work as the lease or tunneling? hold area is a flat valley area.

1.10 Reclamation works? Yes Nil

1.11 Dredging? No NA

1.12 Offshore structures? No NA 1.13 Production and manufacturing Yes Open Cast Semi-Mechanized method of processes? mining of Road Metal Quarry with production capacity of 1200 Cum. 1.14 Facilities for storage of goods and No NA materials? 1.15 Facilities for treatment or disposal of No NA solid waste or liquid effluents? 1.16 Facilities for long term housing of No As the local labours are available, no housing operational workers? facility will be required. 1.17 New road, rail or sea traffic during No ------construction or operation? 1.18 New road, rail, air water borne or other No ------transport infrastructure including new or altered routes and stations, ports, airports etc? 1.19 Closure or diversion of existing No NIL transport routes or infrastructure leading to changes in traffic movements? 1.20 New or diverted transmission lines or No NIL pipelines? 1.21 Impoundment, damming. Culver ting, No ------realignment or other changes to the hydrology of watercourses or aquifers? 1.22 Stream crossings? No ------1.23 Abstraction or transfers of water from No ------ground or surface water? 1.24 Changes in water bodies or the land No ------surface affecting drainage or run-off? 1.25 Transport of personnel or materials for No ------construction, operation or decommissioning? 1.26 Long-term dismantling or No NIL decommissioning or restoration works? 1.27 Ongoing activity during Yes No decommissioning activity proposed. decommissioning which could have an impact on the environment? 5

1.28 Influx of people to an area in either No ------temporarily or permanently? 1.29 Introduction of alien species? No ------

1.30 Loss of native species or genetic No ------diversity? 1.31 Any other actions? No ------

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 specially undeveloped or agricultural land Yes Non Forest Govt. land will be (ha) converted to Mining purposes.

2.2 Water (expected source & competing users) Yes Water requirement will be 5 KLD. unit: KLD Water would be purchased from wells and tube wells from nearby areas. 2.3 Minerals (CuM) Yes Road Metal Quarry 1200 Cum of annual production. 2.4 Construction material- stone, aggregates, and No Nil /soil (expected source –MT)

2.5 Forests and timber (source –MT) No Nil

2.6 Energy including electricity and fuels (source, No ---- competing users) Unit : fuel (MT), energy (MW) 2.7 Any other natural resources (use appropriate No Not Applicable standard units) 6

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 No Not Applicable hazardous (as per MSIHC rules ) to human health or the environment (flora, fauna, and water supplies)

3.2 Changes in occurrence of disease of affect No Nil disease vectors (e.g. insect or water borne diseases) 3.3 Affect the welfare of people e.g. by changing Yes Socio-economic condition will living conditions? improve and will have positive impact due to increasing earning sources of nearby peoples.

3.4 Vulnerable groups of people who could be No Nil affected by the project e.g. hospital patients, children, the elderly etc.

3.5 Any other causes. No Nil

4. Production of solid wastes 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 10% Generated of waste.

4.2 Municipal waste (domestic and or commercial No Nil wastes) 4.3 Hazardous wastes (as per Hazardous Waste No Nil Management Rules) 4.4 Other industrial process wastes No Nil

4.5 Surplus product No Nil

4.6 Sewage sludge or other sludge from effluent No Nil treatment. 7

4.7 Construction or demolition wastes No Nil

4.8 Redundant machinery or equipment No Nil

4.9 Contaminated soils or other materials No Nil

4.10 Agricultural wastes No Nil

4.11 Other solid wastes No Nil

5. Release or 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 No Negligible emission is seen due to from stationary or mobile sources vehicular movement on the unmetalled road. 5.2 Emission from production processes No ------5.3 Emissions from materials handling including No Not Applicable storage or transport

5.4 Emissions from construction activities No Nil including plant and equipment

5.5 Dust or odours from handling of materials No Nil including construction materials, sewage and waste 5.6 Emissions from incineration of waste No Nil

5.7 Emission from burning of waste in open air No Nil (e.g./materials, construction debris) 5.8 Emission from any other sources No Nil

6. Generation of Noise and Vibration, and Emissions of Light and Heat: S. No. Information/Checklist confirmation Yes/No Details thereof (with approximate quantities /rates, wherever possible) with source of information data. 6.1 From operation of equipment e.g. engines, Yes Noise w i l l b e g e n e r a t i n g ventilation plant, crushers from movement o f mining machineries 4 transport vehicles. 6.2 From industrial or similar processes No Nil

6.3 From construction or demolition No Nil 8

6.4 From blasting or piling No No, heavy blasting will not be adopted in the mining lease area. 6.5 From construction or operational traffic No Nil

6.6 From lighting or cooling systems No Proposed mining is open cast 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 Nil

7. Risks of contamination of land or water from releases of pollutants in to the ground or in to Sewers, surface waters groundwater, costal waters or the sea:

S. No. Information/Checklist confirmation Yes/No Details thereof (with approximate quantities /rates, wherever possible) with source of information data. 7.1 From handling, storage, use or spillage of No No anticipation of pollution of ground hazardous materials water or surface water as the mining operation will be carried out much above the ground water table and the mining will be Open cast Semi-Mechanized mining. There will be no effluent discharge from the mines. 7.2 From discharge sewage or other effluents to No Nil water or the land (expected mode and place of discharge) 7.3 By deposition of pollutants emitted to air in to No Air quality will be within the the land or in to water prescribed SPCB norms though there will be mining activities. 7.4 From any other sources No Nil

7.5 Is there a risk of long term build up of No Nil pollutants in the environment from these sources? 8. Risk of accidents during construction or operation of the project, which could affect human health or the 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 No Nil 9

storage, handling, use or production of hazardous substances 8.2 From any other causes No Nil 8.3 Could the project be affected by natural No This project area is coming under low disasters causing environmental damage (e.g. damage risk zone in the context of floods, earthquakes, landslides, cloudburst seismic intensity. etc.)?

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. S. No. Information/Checklist confirmation Yes/No Details thereof (with approximate quantities /rates, wherever possible) with source of information data. 9.1 Lead to development of supporting. Laities, ancillary development or development stimulated by the project which could have impact on the environment e.g.:  Supporting infrastructure (roads. Power Supply, waste or waste water treatment, Yes Roads a n d transport facility w i l l etc.) b e improved due to frequently available of mine vehicles. Project proponent will organize regular medical checkup Camps and recreational activities. Employment to l oca l people will be generated. Overall living standard of nearby  Housing development people will have positive impact. No ------ Extractive industries No ------ Supply industries  Other No ------No ------9.2 Lead to after-use of the site, which could Yes After excavation of mineral, the area have an impact on the environment will be reclaimed and total area will be plantation as per approved mining plan

9.3 Set a precedent for latter developments No ------

9.4 Have cumulative effects due to proximity to No ------other existing or planned projects with similar effects 10

(III) Environmental Sensitivity

S. No. Areas Name/ Aerial distance (within 15 km.) Identity Proposed project location boundary 1 Areas protected under international No N.A conventions national or local legislation for their ecological, landscape, cultural or other related value

2 Areas which are important or sensitive for No N.A ecological reasons-Wetlands, watercourses or other water bodies, costal zone, biospheres, mountains, forests

3 Ares used by protected, important or No Nil sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration 4 Inland, costal, marine or underground waters No Nil 5 State, national boundaries No ------6 Routes or facilities used by the public for No ------access to recreation or other tourist, pilgrim areas 7 Defense installations No Nil 8 Densely populated or built-up area No ------9 Areas occupied by sensitive man-made land Yes Hospitals and schools are available in uses (Hospitals, schools, places worship, nearby City. community facilities)

10 Areas containing important, high quality or No ------scares resources

(Groundwater resource, forestry, agriculture, fisheries, tourism, minerals) 11 Areas already subjected to pollution or No ------environmental damage.(those where existing legal environmental standards are exceeded) 12 Areas susceptible to natural hazard which No This project area is coming under low could cause project to present environmental damage risk zone in the context of problems seismic intensity (earthquakes, subsidence, land slides, erosion, flooding or extreme or adverse climatic conditions ) 11

(IV) Proposed Terms of Reference for EIA studies

 Purpose and Brief of the Project.  Project description in terms of type, need, size and magnitude of operation, technology & process description and other details of utilities including site /location map, plan and relevant sections for the proposed mining and waste management.

The EIA study will be done for the mines site (core zone) and area within 10 km radius (buffer zone), both of which comprise the ‘study area’. The following data, through field survey and Baseline Data Generation (One season) for Rapid EIA/EMP Studies.

PROPOSED TERMS OF REFERENCE FOR EIA STUDIES. To study the area surrounding 10 km. radius of the mine lease area as the centre. The TOR for EIA broadly includes:  Project details like technology, methodology, production, handling of waste, waste dumping etc.  To conduct a literature review and to collect data relevant to the study area;  To undertake environmental monitoring so as to establish the baseline environmental status of the study area;  To identify various existing and expected pollution loads due to various activities in the ambient levels:  To identify impact on Air, water regime, ecology and land environment.  To prepare an Environmental Management Plan (EMP) outlining the measures for reducing the adverse impact and improving the environmental quality and scope for future expansions for environmentally sustainable development; and collection of the environment data as per the following table Sl. Attribute Parameters Frequency of Monitoring No.

1 Ambient air SPM, RSPM SO2, NOX AND CO 24 hourly samples twice a week for quality three months covering one season for at least four locations. Monitoring as per NAAQ norms. 2 Meteorology Wind speed and direction, Data collected from secondary sources temperature, relative humidity, like IMD rainfall & could cover 3 Water quality Physical, Chemical and One season sampling/analysis from Bacteriological parameters surface and ground water sources. 4 Ecology Existing terrestrial and aquatic Through field visits flora and fauna 5 Noise levels Noise levels in dB (A) Recording at regular interval for per location for one season 6 Soil Parameters related to agricultural Soil sampling / analysis for one and afforestation potential season. 12

7 Land use Trend of land use change for Based on data published in district different categories census handbooks 8 Socio economic Socio-economic characteristics, Secondary sources like census aspects labor force characteristics, boom handbooks. town effects etc. 9 Geology Geological history Based on data collected from secondary sources and exploration undertaken during the course of mining 10 Hydrology Drainage area and pattern, nature Based on data collected from of streams, aquifer characteristics, secondary sources recharge and discharge areas 11 Hydrogeology Ground water assessment As per GEC 1997.

Identification and evaluation of impacts through dispersion modeling and preparation of EIA report with Environmental Management plan (Basing on the above baseline data).  Details of fauna (wild and domestic), flora within a distance of 5 km from the project site (including forest details).  Major habitat within 15 km radius.  Major industries within 15 km radius.  Sensitive places / historical monuments and sanctuaries within 10 km radius.  Land use pattern within core zone and buffer zone (10 km radius around the core zone) including the cropping pattern.  Demography and Socio-economic based on last available Census data for entire study area.  Relevant meteorological data, for previous decades from Meteorological Department (IMD).  Study of present environmental protection and mitigation measures in nearby operating similar projects, if any.  Geo-hydrological aspects based on available data from various sources.  Identification of water bodies, hills, roads etc. within 10 km radius and collecting data regarding discharge of streams and flood levels etc. from existing records, if any river lies in study area. The environmental impacts would be anticipated in core and buffer zone on:  Topography  Climate  Water Quality (Surface/Ground)  Hydro-geological Regime  Air quality  Noise Levels  Flora and Fauna (terrestrial, aquatic)  Traffic density  Land-Use  Socio-Economic Conditions  Habitat  Health, culture, human environment including public health, occupational health and safety.  Sensitive Places/Historical Monuments 13

 Aesthetics and Visual intrusion  The impacts would be anticipated based on experience of similar projects and success of this mine operation during the past. Proposed Environmental Safeguards and Monitoring Mechanism  Reclamation of areas disturbed during construction but not required for any activity during operation.  Measures to control the surface and ground water pollution due to various effluents to be discharged  Measures to control air pollution due to proposed activities/ operation.  Green belt development and identification of flora species which can be planted in and around the project  Measures to control noise pollution and mitigate adverse impact on workers and habitat in core and buffer zone  Pronounce the improvement in socio-economic conditions and benefits the people will get on implementation of the project  Measures to control health hazard of workers and surrounding population  Total and specific cost of implementation of control measures  Environmental monitoring, implementation organization and feedback mechanism to effect mid course corrections.  Impact due to displacement, if any

The experience of similar project(s) will be made use of for envisaging the pollution control measures by pronouncing the success in the past.

“I hereby given undertaking that the data and information given in the application and enclosures are true to the best of my knowledge and believe and I am aware that if any part of the data and information submitted is found to be false or misleading at any stage, the project rejected and clearance given, if any to the project will be revoked at our risk and cost.

Date:

Place: Lathi Smt. Kuni Sahu Lessee

AT/PO-Lathi P.S. – Berhampur District- Ganjam, Odisha