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 SASEENDRAN K
(ii).Location / site (GPS Co-ordinate) 11°24'27.31"N to 11°24'30.20"N 75°50'14.88"E to 75°50'17.59"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)0.4245 ha.
(iv).Capacity of the Mining Lease (TPA) 10747.6
(v).Period of Mining Lease 5
(vi).Expected cost of the Project 25
(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 KV
Address N SQUARE MINING & ENVIRONMENTAL SOLUTIONS LTD,XAITOON COMPLEX,EDAPPAL PO,MALAPPURAM
Mobile No.9447177533
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.  20 km
2. (ii). Nearest Infrastructural along with distance in kms  1.5 km
(iii). Nearest Railway Line along with distance in kms  20 km
(iv). Nearest National Highway along with distance in kms  28 km
(v). Nearest State Highway along with distance in kms  3 km
(vi). Nearest Major District Road along with distance in kms 1.5 km
(vii). Nearest Any Other Road along with distance in kms  0.2 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  19 km
(x). Nearest In-take for drinking water pump house distance in kms  19 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  19 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
None within 0.5 Kms 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 None within 0. 5 Kms of the project site
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration None within 0. 5 Kms of the project site
6. Inland, coastal, marine or underground waters None within 0.5 Kms of the project site
7. State, National boundaries None within 0.5 Kms of the project site
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas National Highway: Kozhikode, 28 Kms. State high way: Koyilandy- Thamarassery, 3 Kms . Panchayath Road:Kuttanpoor- 0.2kms
9. Defence installations None within 0. 5 Km of the project site
10. Densely populated or built-up area, distance from nearest human habitation The nearest human settlements are 55m away from project site.
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Hospital : Taluk Hospital,Nanmind 3 Kms. School : Nanminda HSS school 1.5 Kms. Church : Nearest church 9km. Temple : Nanminda Temple, 1.5Kms. Mosque/Masjid : Nanminda.1.5 Kms.
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) None within 0.5 Km of the project site
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) Not applicable, since this is Fresh proposal
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) No, Permit area is not susceptible to natural hazard,as 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/14715/2018
File NumberH-3522
Date of Apply EC23 Apr 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.)FORM IM23 Apr 2018
(2.)ID CARD23 Apr 2018
(3.)LOI23 Apr 2018
(4.)RQP23 Apr 2018
(5.)TAX & POS23 Apr 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameBUILDING STONE QUARRY OF MR SASEENDRAN.K
Designationproprietor
Company BUILDING STONE QUARRY OF MR SASEENDRAN.K
AddressKaniyarakkal House,Kizhakkumuri(PO),KOZHIKODE
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