1 APPENDIX I (See Paragraph-6) FORM 1 (I) Basic Information S. No. Item Details 1. Name of the Project/s Vejia Baijhala Black Stone Quarry In Cuttack district of Odisha 2. S. No in the schedule 1 (a) 3. Proposed capacity / area /length/tonnage to be 1.27 acre/0.5139 ha. handled /command area /lease area/number of wells to be drilled 4. New /Expansion /Modernization New 5. Existing Capacity / Area etc. * 1.27 acre/0.5139 ha. 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: 73 H/6 ,73 H/7 73 H/10 and 73 H/11 Latitude : N 200 27’57.5” to 200 27’59.5” Longitude : E 85028’24.5” to 85028’30.3” Plot/Survey/Khasra No. 1174/3887/P, Khata No-902 Village Vejia Tehsil Tigiria District Cuttack State Odisha 10 Nearest railway station/airport along with The nearest railway station is at Cuttack which is distance in kms. about 70 km from the mine lease area. The nearest airport is Bhubaneswar Airport at 105 km from the mining site. 11 Nearest Town, city, District, Headquarters The nearest town is Cuttack which is at a distance along with distance in kms. of 70 kms from the lease area. The District Head Quarter is Cuttack at a distance covering 70 km 12 Village Panchayats, Zilla Parisad, Municipal Village- Vejia, Panchayat- Nuapatna, Zilla Corporation, Local body (complete postal Parisad – Cuttack ,Local Body- Tigiria addresses with telephone nos. to be given) 13 Name of the applicant Sri Jyafat Khan 14 Registered address Sri Jyafat Khan S/O-Sri Nababuddin Khan 2 At – Pankala, G.P-Jemadeipur, P.S.- Tigiria, District- Cuttack. 15 Address for correspondence : Sri Jyafat Khan S/O-Sri Nababuddin Khan At – Pankala, G.P-Jemadeipur, P.S.- Tigiria, District- Cuttack. Name Sri Jyafat Khan Designation (Owner/Partner/CEO) Owner Address Sri Jyafat Khan S/O-Sri Nababuddin Khan At – Pankala, G.P-Jemadeipur, P.S.- Tigiria, District- Cuttack. Pin code 754035 16. Details of Alternative sites examined, if any, Village-District-State Location of these sites should be shown on a 1. toposheet. 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. (II) Activity 3 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 increase in intensity of land use (with use beginning end of the respect to local land use plan) of the plan 5 year period (in plan ha.) period (2019-20) (in ha.) Mining 0.0432 0.2041 Top soil Nil Nil Overburden Nil 0.0051 dump Mineral storage Nil Nil Sub-Grade Nil Nil Storage Infrastructure Nil Nil Roads 0.0165 0.0165 Green belt area Nil 0.0543 Screening Nil Nil plant/Washing Plant Tailing pond Nil Nil Total land 0.0597 0.28 degradation Area which will 0.4542 0.2339 remain untouched (River) Total 0.5139 0.5139 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? 4 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 1.9 Underground works including mining No No underground mining work. or tunneling? 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 Black Stone Quarry with production capacity of 1960 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. culverting, 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? 5 1.27 Ongoing activity during Yes No decommissioning activity proposed. decommissioning which could have an impact on the environment? 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 3 KLD. unit: KLD Water would be purchased from wells and tube wells from nearby areas. 2.3 Minerals (CuM) Yes Black Stone Quarry 1960 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) 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 6 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 The waste material will be utilized in maintenance of approached road to the mining site at regular interval. 0.0051 ha area will be reserved for dumping of waste material. 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. 4.7 Construction or demolition wastes No Nil 4.8 Redundant machinery or equipment No Nil 7 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.