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 Mrs Betty Biju
(ii).Location / site (GPS Co-ordinate) 9°48'27.65"N to 9°48'32.41"N 76°49'15.90"E to 76°49'20.29"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)0.9790 ha.
(iv).Capacity of the Mining Lease (TPA) 61166
(v).Period of Mining Lease 5
(vi).Expected cost of the Project 30
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.DMG/KERALA/RQP/7/2016 
Name of Consultant/RQPNazar Ahamed K V
Address N Square MES LLP Xaitoon complex, Opp:Shukapuram Hospital Edappal, Malappuram
Mobile No.9249444055
Landline No.2677533
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.  0.2 km
2. (ii). Nearest Infrastructural along with distance in kms  0.25 km
(iii). Nearest Railway Line along with distance in kms  35 km
(iv). Nearest National Highway along with distance in kms  10 km
(v). Nearest State Highway along with distance in kms  0.7 km
(vi). Nearest Major District Road along with distance in kms 0.7 km
(vii). Nearest Any Other Road along with distance in kms  0.22 km
(viii). Nearest Electric transmission line pole or tower distance in kms  0.2 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  6 km
(x). Nearest In-take for drinking water pump house distance in kms  0.3 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  6 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
None within 0.3km of the project site
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Nearest River-0.3km Kochi Coastal Zone-65km forest-Kulamavu Forest-23km
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration None within 0.3km of the project site
6. Inland, coastal, marine or underground waters Kochi Coastal Area-65km
7. State, National boundaries None within 0.3km of the project site
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas None within 0.3km of the project site
9. Defence installations None within 0.3km of the project site
10. Densely populated or built-up area, distance from nearest human habitation The nearest human settlement is 87.9m away from project site
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Hospital-Arakkulam Primary Health Center-0.42km School-St.Thomas L.P School-0.25km Church-St,Thomas Church-0.3km Temple-Arakkulam Ayyappa Temple-0.3km Mosque-Kanjar Mosque-2.5km
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Kulamavu Forest-23km Pooyamkutty Forest Station-36.5km Vagamon pine forest-23 Thattekad Bird Spot-34km
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) Not Applicable,since this is fresh area
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) There is no history of such incidents
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/13998/2018
File Numberdeiaa_15/2018
Date of Apply EC20 Mar 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)KeralaIdukkiThodupuzha
(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.)EC and Village Affidavits20 Mar 2018
(2.)Form 1M20 Mar 2018
(3.)ID Proof20 Mar 2018
(4.)LOI&L20 Mar 2018
(5.)Tax20 Mar 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameBUILDING STONE QUARRY OF MRS BETTY BIJU
DesignationOwner
Company BUILDING STONE QUARRY OF MRS BETTY BIJU
AddressKudayathoor Village Thodupuzha Taluk
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