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 Quarry owned by Sajith Lal M
(ii).Location / site (GPS Co-ordinate) N 11° 37’ 34.78’’-N 11° 37’ 39.10’’ E 76° 03’ 3.66’’ -E 76° 03’ 9.63’’
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)0.9915 ha.
(iv).Capacity of the Mining Lease (TPA) 41563.9
(v).Period of Mining Lease 5
(vi).Expected cost of the Project 60
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.RQP/BNG/338/2014/A 
Name of Consultant/RQPMAHESH.S
Address T.C 31/580,NAVADEEPAM,S.N NAGAR,PETTAH(P.O),TRIVANDRUM-695024
Mobile No.9446303422
Landline No.2405383
Email Idmaheshsurendranpillai@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.  2.5 km
2. (ii). Nearest Infrastructural along with distance in kms  2.23 km
(iii). Nearest Railway Line along with distance in kms  43 km
(iv). Nearest National Highway along with distance in kms  3.63 km
(v). Nearest State Highway along with distance in kms  1.5 km
(vi). Nearest Major District Road along with distance in kms 1.5 km
(vii). Nearest Any Other Road along with distance in kms  0.46 km
(viii). Nearest Electric transmission line pole or tower distance in kms  4 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  8 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  2 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
Padiri Reserve Forest -19.2km NE Periya Reserve Forest -27.79km NW Wayanad Forest -30.7km N Wayanad Wildlife Sanctuary -34.8km NE Muthanga Forest -35.28km-NE
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Karlad Lake , 8 km , W Pookode Lake,9.67km, SW Chaliyar River,33.7km SW
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration None within the study area
6. Inland, coastal, marine or underground waters Karlad Lake , 8 km , W Pookode Lake,9.67km, SW Chaliyar River,33.7km SW
7. State, National boundaries None within the study area
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas National Highway: Kalpetta - Sultan Bathery Highway (NH-766), 3.63 Kms . State high way(SH 54): Kalpetta – Kozhikode, 1.5Km Major District Road: Kalpetta-vavadi Road, 1.50Km
9. Defence installations None within the study area
10. Densely populated or built-up area, distance from nearest human habitation The nearest house is 280 m towards West and nearest town is Vengapally, 2.08 km, NW
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Church-St.Mary’s Church,Puzhamudi, 1.69 km Temple –Gramam Temple Kalpetta,2.86 Km Mosque – Kalpetta Juma Masjid, 3.64 Km Hospital- Fatima Mata Mission Hospital, Kalpetta – 3.2km School- RCLP Vengapally LP School – 1.8km
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Padiri Reserve Forest -19.2km NE Periya Reserve Forest -27.79km NW Wayanad Forest -30.7km N Wayanad Wildlife Sanctuary -34.8km NE Muthanga Forest -35.28km-NE
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) None within the study 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) No, This area is generally not prone to any natural disasters.
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/16926/2018
File NumberTo be assigned
Date of Apply EC08 Feb 2019
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)KeralaWayanadVythiri
(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.)Approval Letter26 Nov 2018
(2.)500m Certificate26 Nov 2018
(3.)EC Affidavit27 Dec 2018
(4.)EDS reply letter08 Feb 2019
(5.)FORM 1M08 Feb 2019
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameIGT PVT LTD
DesignationOwner
Company IGT PVT LTD
AddressSRM Road, Lissi Jn. Cochin-18;
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