APPENDIX I
(See Paragraph-6)
FORM 1M
Note : If space provided against any parameter is inadequate,Kindly upload supporting document under 'Additional Attachments if any'  at the last part of the Form 1M. Please note that all such Annexures must be part of single pdf document.
(I)Basic Informations
S.No.Item Details
(i).Name of the Mining Lease site Environmental Clearance for Building Stone Quarry over an extent of 0.8094 Ha. in Sy. No.215 of Nellikaru Village, Mangalore Taluk, Dakshina Kannada District of Smt. Roopa R. Shetty
(ii).Location / site (GPS Co-ordinate) A N 130 08’ 00.0” E 750 06’ 37.9” B N 130 07’ 59.8” E 750 06’ 35.2” C N 130 07’ 57.0” E 750 06’ 34.4” D N 130 07’ 57.3” E 750 06’ 38.8”
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)0.8094 ha.
(iv).Capacity of the Mining Lease (TPA) 156598
(v).Period of Mining Lease 20
(vi).Expected cost of the Project 20
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.284 
Name of Consultant/RQPDr.P.Virupakshi
Address NO-273, SPOORTHI 8TH MAIN BCC LAYOUT
Mobile No.9972346160
Landline No.23218808
Email Idvirupaksha_abhi@yahoo.com
(II) Environmental Sensitivity
S.No Areas Distance in kilometer / Details
1. (i).  Nearest rail or road bridge over the concerned river,rivulet,nallah etc. in kms.  35 km
2. (ii). Nearest Infrastructural along with distance in kms  1.80 km
(iii). Nearest Railway Line along with distance in kms  35 km
(iv). Nearest National Highway along with distance in kms  36 km
(v). Nearest State Highway along with distance in kms  13.5 km
(vi). Nearest Major District Road along with distance in kms 0.53 km
(vii). Nearest Any Other Road along with distance in kms  0 km
(viii). Nearest Electric transmission line pole or tower distance in kms  1.80 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  1.80 km
(x). Nearest In-take for drinking water pump house distance in kms  1.80 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  1.80 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
The area is not covered under international conventions
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests None with in 5.00 Km radial Distance
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration None within 5.00 Km radial distance
6. Inland, coastal, marine or underground waters None within 5.00 Km radial distance
7. State, National boundaries None within 5.00 Km radial distance
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas none within 5.00 Km radial Distance
9. Defence installations No defense installation within 5.00 Km radial distance
10. Densely populated or built-up area, distance from nearest human habitation Mudubidra 13.50 Km
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Mudu Bidra 13.50 Km
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) none within 5.00 Km radial distance
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) None witin 5.00 Km radial distance
14. Areas susceptible to natural hazard which could cause the project to present environmental problems (earthquakes, subsidence, landslides, erosion, flooding or extreme or adverse climatic conditions) None within 5.00 Km radial distance
15.
Is proposed mining site located over or near fissure/fracture for ground water recharge?No
16.
Whether the proposal involves approval or clearance under the following Regulations or Acts namely?
(a).
The Forest (Conservation) Act,1980?No
(b).
The Wildlife (Protection) Act,1972?No
(c).
The Coastal Regulation Zone (C.R.Z) notification,2011?No
17.
Is forest land involved (ha)?No
18.
Whether there is any litigation pending against the project and/or land in which the project is proposed to be set up?No
19.
New/Expansion/ModernizationNew
Proposal NumberDIA/KA/MIN/16547/2018
File NumberDEIAA/DK/EC-67/2018-19
Date of Apply EC30 Jul 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)KarnatakaDakshina KannadaMangalore
(III) EC Attachments
1 Uploaded PFR (Pre Feasibility Report) File Annexure-PFR file
2 Uploaded Approved Mining Plan File Annexure-Approved Mining Plan file
3 Uploaded District survey report Annexure-District Survey Report
4 Uploaded Cover Letter Annexure-Cover Letter
Uploaded Additional attachments, if any
S.No. Attached File Date of Submission
NIL
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameROOPA R SHETTY
DesignationOwner
Company ROOPA R SHETTY
AddressSP Garden Mudar Bajegoli Karkala Taluk Udupi District
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