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 Granite Building Stone Quarry of Shri David P V
(ii).Location / site (GPS Co-ordinate) N11degree 49’51.427” to N11degree 50’00.703” E76degree01’04.840” to E76degree01’10.806”
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)2.4843 ha.
(iv).Capacity of the Mining Lease (TPA) 100050
(v).Period of Mining Lease 10
(vi).Expected cost of the Project 98
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.73 
Name of Consultant/RQPGlobal Environment & Mining Services
Address HBR layout 5th block 5th main 1st cross 1st stage Banglore 560043
Mobile No.9880788836
Landline No.25432447
Email Idgems.blr@globamining.in
(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.  7 km
2. (ii). Nearest Infrastructural along with distance in kms  110 km
(iii). Nearest Railway Line along with distance in kms  110 km
(iv). Nearest National Highway along with distance in kms  35 km
(v). Nearest State Highway along with distance in kms  8 km
(vi). Nearest Major District Road along with distance in kms 2 km
(vii). Nearest Any Other Road along with distance in kms  0.4 km
(viii). Nearest Electric transmission line pole or tower distance in kms  5 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  35 km
(x). Nearest In-take for drinking water pump house distance in kms  6 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 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 Forest: Edappadi Vested Forest,300 m Pond: Puthamuttam, 1.00 Km River : Kabani River, 8.00 Km Cost : Kozhikode, 115 Km Rivulet: Edappadi Thodu, 2.5 Km
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration None within 5 Km of the project site
6. Inland, coastal, marine or underground waters Cost : Kozhikode, 115 Km
7. State, National boundaries Karnataka State boundary is about 10.0 Kms from the project site.
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas National Sulthan Bathery (NH-766), 35 Kms . State high way: Manathavady- Makkiyad (SH-59), 8 Km Major District Road: Manathavady Kartikulam Road : 2 Km
9. Defence installations None within 5 Km of the project site
10. Densely populated or built-up area, distance from nearest human habitation The nearest human habitant is at Ontayangadi Village is located at 1.0 Kms away from the mine.
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Hospital: St. Vincent Hospital, 5 Km, Vincentgiri School : St. Martin L P School, 2 Km, Ontayangadi Church : St. Martin Church, 2 Km, Ontayangadi Mosque : Badarguma Masjid, 2Km, Ontayangadi Temple : Edappadi Kuttichthen, 2Km, Edappadi Anganwadi: Edappadi, 0.70Km
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) None within 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, Lease 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/15290/2018
File NumberM-2207/18 (EC 4/18)
Date of Apply EC04 Jun 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)KeralaWayanadMananthavady
(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.)500m radius certificate18 May 2018
(2.)Form1m18 May 2018
(3.)Affidavit18 May 2018
(4.)Affidavit02 Jun 2018
(5.)EML02 Jun 2018
(6.)Form1m04 Jun 2018
(7.)Annexure04 Jun 2018
(8.)consent04 Jun 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameSHRI DAVID P V
Designationowner
Company SHRI DAVID P V
AddressShri David P V S/o Varghese Pallyan House, Peruvaka Arattuthara P.O Wayanad District Kerala
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