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 T.N.SOMAN, SURVEY NO.292/1A, VELLAD VILLAGE
(ii).Location / site (GPS Co-ordinate) 12°08'52.90"-12°08'55.33"N 75°28'18.21"-75°28'21.06"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)0.5607 ha.
(iv).Capacity of the Mining Lease (TPA) 8000
(v).Period of Mining Lease 5
(vi).Expected cost of the Project 5
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.RQP7/2016 
Name of Consultant/RQPNAZAR AHMED KV
Address KARIMBANAKKAL BUILDING, EDAPPAL
Mobile No.9447177533
Landline No.85470975
Email Idgeologistna@gmail.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.  2.42 km
2. (ii). Nearest Infrastructural along with distance in kms  1.5 km
(iii). Nearest Railway Line along with distance in kms  25 km
(iv). Nearest National Highway along with distance in kms  17.5 km
(v). Nearest State Highway along with distance in kms  3.3 km
(vi). Nearest Major District Road along with distance in kms 0.3 km
(vii). Nearest Any Other Road along with distance in kms  3 km
(viii). Nearest Electric transmission line pole or tower distance in kms  0 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  0 km
(x). Nearest In-take for drinking water pump house distance in kms  0 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  0 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
Western Ghat Boundary: 10.5 km E
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Arabian Sea: 30.4 Km W Kuppam River: 4.1 km W Palakkayam Thattu Hill: 5 km ES Pazhassi Dam : 24Km SE
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Brahmagiri Wildlife Sanctuary : 17 km E Aralam Wildlife Sanctuary 43 km SE Nagarahole National Park 72 Km, ES
6. Inland, coastal, marine or underground waters Arabian Sea: 30.4 Km W Kuppam River: 4.1 km W
7. State, National boundaries Karnataka state boundary: 10.2 Km E
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas SH59(Malabar Hill Highway) Road -3.3 km W Anakuzhi Thermala Road, 0.3 Km N
9. Defence installations None within 10 km radius area
10. Densely populated or built-up area, distance from nearest human habitation Nearest house is about 100 m away. Nearest major habitation (town) is Vayattuparamba – 1 km WN
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) St. Joseph Hospital at Karuvanchal – 4.25 km GHS School at Karuvanchal- 2.08 km St. Alphonso Church, Thermala – 1.5 km
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) The applied area consists of good reserves of granite building stone. There are no scarce resources such as water resource, forest, fishery or tourism spot in the applied mining area or in the vicinity of the project site.
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) NA
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) NA
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/12819/2018
File NumberTo be assigned
Date of Apply EC05 Feb 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)KeralaKannurTaliparamba
(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)
NameNSQUARE MINING AND ENVIRONMENTAL SOLUTIONS LLP
DesignationPROPRIETOR
Company NSQUARE MINING AND ENVIRONMENTAL SOLUTIONS LLP
AddressKARIMBANAKKAL BUILDING
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