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 Building Stone quarry of mr Sidharthan
(ii).Location / site (GPS Co-ordinate) 11°23’48.69” N to 11°23’51.39” N 75°46’53.03” E to 75°46’56.60” E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)0.5476 ha.
(iv).Capacity of the Mining Lease (TPA) 12062
(v).Period of Mining Lease 5
(vi).Expected cost of the Project 20
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.RQP/5/2016 
Name of Consultant/RQPK. Soman
Address DMG/KERALA/RQP/5/2016 VP-2/458, Vazhayila, Perrorkada Po Trivandrum 695 024
Mobile No.9847083000
Landline No.2663330
Email Idkunjusom@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.  1 km
2. (ii). Nearest Infrastructural along with distance in kms  0.051 km
(iii). Nearest Railway Line along with distance in kms  20 km
(iv). Nearest National Highway along with distance in kms  9 km
(v). Nearest State Highway along with distance in kms  6 km
(vi). Nearest Major District Road along with distance in kms 6 km
(vii). Nearest Any Other Road along with distance in kms  1 km
(viii). Nearest Electric transmission line pole or tower distance in kms  1 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  0.15 km
(x). Nearest In-take for drinking water pump house distance in kms  1 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  0.15 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
None within the radius of 5 Km
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests None within the radius of 5 Km
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration None within the radius of 5 Km
6. Inland, coastal, marine or underground waters None within the radius of 5 Km
7. State, National boundaries None within the radius of 5 Km
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas None within the radius of 5 Km
9. Defence installations None within the radius of 5 Km
10. Densely populated or built-up area, distance from nearest human habitation Nearest House 51m
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Hospital - MMC Hospital Modakkallur 8Km Distance School - Cheekkilode AUP School 1Km Distance Temple - Kandangulam 1.5Km Mosque -Cheekkilode 1Km Churche - koomulli 7Km
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) None within the radius of 5 Km
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) None within the radius of 5 Km
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 the radius of 5 Km
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/KL/MIN/12100/2018
File NumberH-629/2018
Date of Apply EC05 Jan 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)KeralaKozhikodeKozhikode
(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
(1.)Annexure Approval Letter05 Jan 2018
(2.)Annexure RQP Certificate05 Jan 2018
(3.)Annexure NABL05 Jan 2018
(4.)Annexure 500m Quarry Details05 Jan 2018
(5.)Annexure LOI05 Jan 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameBUILDING STONE QUARRY OF MR SIDHARTHAN
DesignationOwner
Company BUILDING STONE QUARRY OF MR SIDHARTHAN
AddressThiyyakkandi house Cheekkilode po Atholi via Kozhikode
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