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 Mrs. Santha Janardhanan, Pallarimangalam Village, Kothamangalam Taluk, Ernakulam District
(ii).Location / site (GPS Co-ordinate) Latitude:10°2'5.45"N, Longitude:76°39'8.41"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)0.3154 ha.
(iv).Capacity of the Mining Lease (TPA) 10592
(v).Period of Mining Lease 1
(vi).Expected cost of the Project 15
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.11/2017 
Name of Consultant/RQPC BALARAMAN
Address Paliam,Peoli Road,Kacheripadi,Kochi
Mobile No.9446404140
Landline No.2590259
Email Idbalramc28@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.  33 km
2. (ii). Nearest Infrastructural along with distance in kms  5 km
(iii). Nearest Railway Line along with distance in kms  33 km
(iv). Nearest National Highway along with distance in kms  7 km
(v). Nearest State Highway along with distance in kms  7 km
(vi). Nearest Major District Road along with distance in kms 7 km
(vii). Nearest Any Other Road along with distance in kms  0.500 km
(viii). Nearest Electric transmission line pole or tower distance in kms  0.300 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  0.800 km
(x). Nearest In-take for drinking water pump house distance in kms  0.500 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  0.30 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
 None within 500 m radius
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests None within 500 m radius
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration None within 500 m radius
6. Inland, coastal, marine or underground waters None within 500 m radius
7. State, National boundaries None within 500 m radius
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas None within 500 m radius
9. Defence installations None within 500 m radius
10. Densely populated or built-up area, distance from nearest human habitation Kothamangalam-5 Km
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Schools & Colleges Govt. Higher Secondary School,Adivad-3 Km Hospitals 1.St. Joseph Hospital –Kothamangalam , 8 Km 2. Mar Beselious Hospital – Kothamangalam, 8km Worship Marthoma Cheriya Palli- Kothamangalam, -8Km Pidavoor Temple – 1 Km Mosque - Pidavoor Juma Masjid , 1Km
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Nil
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) None
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) Nil
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/14841/2018
File NumberP-1294/18
Date of Apply EC30 Apr 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)KeralaErnakulamKothamangalam
(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.)BTR,Work Order-Contract Agreement,Affidavit30 Apr 2018
(2.)Work Order,LandClassification,Demarcation,Tax receipt,Letter,RQP Certificate,Encombarance30 Apr 2018
(3.)Consent30 Apr 2018
(4.)Land Document30 Apr 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameSANTHA JANARDHANAN
DesignationOwner
Company SANTHA JANARDHANAN
AddressVadakkeputhenpura House, Varapetty P O, Kothamangalam Ernakulam
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