APPENDIX I (See paragraph – 6) FORM 1 (I) Basic Information Sl. Item Details No. 1. Name of the project/s Mundamarai Stone 2. S.No. in the schedule 1(a) 3. Proposed capacity/area/length/tonnage to be Production of 6360cu.m from handled/command area/lease area/ number of wells to be lease area 8.475Ha drilled 4. New/Expansion/Modernization New 5. Existing capacity/area etc., 6360Cu.m / 8.475Ha 6. Category of Project i.e ‘A’ or ‘B’ B2 7. Does it attract the general condition? If yes, please Yes, Manual specify 8. Does it attract the specific condition? If yes, please No specify 9. Location Toposheet No.74A/10 E 84036’2.01” to E 84036’26.253” & N19038’27.27” to N19038’44.99” Plot/Survey/Khasra No. Plot No.1, 304 Ac 20.941. Village Mundamaria Tehsil Dharakote District Ganjam State Odisha 10. Nearest railway station/airport along with distance in Berhampur is the nearest Rly Station Kms which is 48 km from quarry site. The nearest airport is Bhubaneswar which is at a distance of 160Km from the project site. 11. Nearest Town, city, District Headquarters along with Nearest town Aska, is situated at a distance in Kms distance of 9 Km. The district Headquarter is Ganjam at distance of 60Km 12 Village Panchayats, Zilla Parishad, Municipal Mundamarei Panchayat, At: Corporation, Local body (complete postal addresses with Mundamarei, Tahsil- Dharakote, Dist: telephone nos. to be given) Ganjam,Odisha, Zila Parisad – Ganjam 13 Name of the applicant Jagannath Patra 14 Registered Address At/P.O-Mundamarei,P.S-Dharakote, Pin:761114, Odisha. 15 Address for correspondence: At/P.O-Mundamarei,P.S-Dharakote, Pin:761114, Odisha Name Jagannath Patra 1 Designation (Owner/Partner/CEO) Owner Address At/P.O- Mundamarei , P.S- Dharakote, Odisha Pin Code 7561114 E-Mail Telephone No. 9437358948 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. 2.Not Applicable 3. 17 Interlinked Projects NIL 18 Whether separate application of interlinked projects has Not Applicable been submitted? 19 If yes, date of submission Not Applicable 20. If no, reason Not Applicable 21 Whether the proposal involves approval/clearance under: Not Applicable 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 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 Applicable (b) Case No. (c) Orders/directions of the Court, if any and its relevance with the proposed project. 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.) 2 Details thereof (with approximate quantities /rates, wherever possible) with S.No. Information/Checklist confirmation Yes/ source of information data No 1.1 Permanent or temporary change in land use, Yes Total 0.763 ha land will be utilized in this land cover or topography including increase project. in intensity of land use (with respect to local land use plan) 1.2 Clearance of existing land, vegetation and No Not Applicable buildings? 1.3 Creation of new land uses? Yes As per the table given above on Sl.No.1.1 1.4 Pre -construction investigations e.g. bore Yes Geological survey and mining plan has houses, soil testing? been prepared after conducting different test 1.5 Construction works? No Not Applicable 1.6 Demolition works? No Not Applicable 1.7 Tempora ry sites used for construction works No Not Applicable or housing of construction workers? 1.8 Above ground buildings, structures or Yes Mining will be carried out as per the earthworks including linear structures, cut Approved mining plan and fill or excavations 1.9 Underground works including mining or Yes Mining of Stone quarry is accomplished tunneling? by manual method 1.10 Reclamation works? No Not Applicable 1.11 Dredging? No Not Applicable 1.12 Offshore structures? No Not Applicable 1.13 Production and manufacturing processes? Yes Manual method of mining of Stone quarry with production capacity of 6360 cu.m 1.14 Facilities for storage of goods or materials? Yes Stone quarry will be mined and transported. Temporary stack yards are provided within quarry lease area. 1.15 Facilities for treatment or disposal of solid No Not Applicable waste or liquid effluents? 1.16 Facilities for long term housing of operational workers? No Not Applicable 1.17 New road, rail or sea traffic during No The site is well connected by fair weather construction or operation? road from Mundamarai. Haul roads inside mine lease area also exists. Therefore no new road, rail or sea traffic required. 3 1.18 New road, rail, air waterborne or other trans port infrastructure including new or No Not Applicable altered routes and stations, ports, airports etc? 1.19 Closure or diversion of existing transport routes or infrastructur e leading to changes in No Not Applicable traffic movements? 1.20 New o r diverted transmission lines or pipelines? No Not Applicable 1.21 Impoundment, damming, culverting, realignment or other changes to the Yes Not Applicable hydrology of watercourses or aquifers? 1.22 Stream crossings? No Not Applicable 1.23 Abstra ction or transfers of water form ground Yes Accumulated water are proposed to be or surface waters? utilized for plantation & water sprinkling. 1.24 Changes in water bodies or the land surface No During mining no alteration or changes in affecting drainage or run -off? the passage/route of river 1.25 Transport of personnel or materials for No Ordinary river Stone will be transported construction, operation or decommissioning? through trucks by road to crusher. Workers will come from nearby villages On their convenience. 1.26 Long -term dismantling or decommissioning No No dismantling work will be carried in this or restoration works? project. 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 Supervising personnel – 1, temporarily or permanently? Unskilled/Semiskilled/skilled -02. 1.29 Introduction of alien species? No Not Applicable 1.30 Loss of native species or genetic diversity? No Not Any 1.31 Any other actions? No Not Applicable 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 Non Forest Govt. land will be land (ha) converted to mining process. 2.2 Water (expected source & competing users) Yes Water requirement will be 1KLD. unit: KLD Water will be supplied from 4 nearby areas. 2.3 Minerals (MT) Yes Ordinary River Stone 1272 cu. m annual production 2.4 Construction ma terial – Stone, aggregates, Stone No Not Applicable / soil (expected source – MT) 2.5 Forests and timber (source – MT) No Not Applicable 2.6 Energy including electricity and fuels (source, No --- competing users) Unit: fuel (MT), energy (MW) 2.7 Any oth er 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. 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 Not Applicable (as per MS IHC rules) to human health or the environment (flora, fauna, and water supplies) 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 Not Applicable the project e.g. hospital patients, child ren, the elderly etc., 3.5 Any other causes No Not Applicable 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 5 possible) with source of information data 4.1 Spoil, overburden or mine wastes No Not Applicable 4.2 Municipal waste (domestic and or commercial No Not Applicable wastes) 4.3 Hazardous wastes (as per Hazardo us Waste No Not Applicable Management Rules) 4.4 Other industrial process wastes No Not Applicable 4.5 Surplus product No No surplus product will generate. 4.6 Sewage sludge or other sludge from effluent No Not Applicable treatment 4.7 Co nstruction or demolition wastes No Not Applicable 4.8 Redundant machinery or equipment No There is no redundant machinery or equipment 4.9 Contaminated soils or other materials No Not Applicable 4.10 Agricultural wastes No Not Applicable 4.11 Other solid wastes No Not Applicable 5. Release of pollutants or any hazardous, toxic or noxious substances to air (Kg/hr) Details thereof (with approximate quantities/rates, S.No.