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 M/s Srilakshmi Stone Crusher
(ii).Location / site (GPS Co-ordinate) N11°50'48.118" to N11°50'56.33" E75°46'51.28" to E75°47'47.00.19"
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)3.3966 ha.
(iv).Capacity of the Mining Lease (TPA) 141370
(v).Period of Mining Lease 12
(vi).Expected cost of the Project 170
(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 bangalore
Mobile No.9880788836
Landline No.25432447
Email Idgems.blr@globalmining.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.  30 km
2. (ii). Nearest Infrastructural along with distance in kms  3 km
(iii). Nearest Railway Line along with distance in kms  44 km
(iv). Nearest National Highway along with distance in kms  40 km
(v). Nearest State Highway along with distance in kms  0.2 km
(vi). Nearest Major District Road along with distance in kms 1 km
(vii). Nearest Any Other Road along with distance in kms  0.26 km
(viii). Nearest Electric transmission line pole or tower distance in kms  1 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  40 km
(x). Nearest In-take for drinking water pump house distance in kms  5 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  40 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: Kannavam forest is about 0.22Km & Alaram Wild life sanctuary about 12.00Km River: Ajarkandy River,3.00Km Coast : Thalassery Coast - 54 Kms Rivulet: Nedumpuramchal Thodu, 3.00Km
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 Coast : Thalassery Coast - 54 Kms
7. State, National boundaries Karnataka State boundary is about 14.5 Kms from the project site.
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas National Highway: Kalpetta - Thalassery (NH-17) 40Km. State high way: Kalpetta – Thalassery-Baveli Rd (SH-59), 0.220Km Major District Road: Kozhikode- 28 Mile Stone Road, 1Km
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 Poolakutty is located at 0.89 Kms away from the mine.
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Hospital: Peravoor, 9.0Km . School : Poolakutty Lp School, Poolakutty, 2.0Km Church : St. Mary, Elapeedika,1.5Km Mosque : Peravoor Masjid, Peravoor , 8.00 Kms Temple : Sree Muthapan Temple Puralimala, Peravoor, 9.5Km Anganwadi: Poolakutty, 2 km
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/15826/2018
File Number226/ECA/KNR/2018/DEIAA
Date of Apply EC13 Jun 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)KeralaKannurKannur
(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.)Form1m13 Jun 2018
(2.)500m radius certificate13 Jun 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameMS SRILAKSHMI STONE CRUSHER
DesignationOwner
Company MS SRILAKSHMI STONE CRUSHER
Address27th Mile Poolakutty P O Nidumpoyil Kannur District
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