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. SHERRY JOSEPH
(ii).Location / site (GPS Co-ordinate) 11°35’20.08” N to 11°35’26.02” N 75°48’14.26” E to 75°48’21.33” E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)2.1415 ha.
(iv).Capacity of the Mining Lease (TPA) 100000
(v).Period of Mining Lease 12
(vi).Expected cost of the Project 50
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.RQP/7/2016 
Name of Consultant/RQPNAZAR AHAMED K.V
Address NAZAR AHAMED K. V DMG/KERALA/RQP/7/2016 GEO MARINE SOLUTIONS PVT LTD PONNANI, KERALA-679577
Mobile No.8547097533
Landline No.2663330
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.  0.6 km
2. (ii). Nearest Infrastructural along with distance in kms  0.295 km
(iii). Nearest Railway Line along with distance in kms  45 km
(iv). Nearest National Highway along with distance in kms  35 km
(v). Nearest State Highway along with distance in kms  7 km
(vi). Nearest Major District Road along with distance in kms 0.6 km
(vii). Nearest Any Other Road along with distance in kms  0.6 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  2.5 km
(x). Nearest In-take for drinking water pump house distance in kms  1 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  0.75 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
NONE WITHIN 10 KM RADIUS FROM THE QUARRY BOUNDARY
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests NONE WITHIN 10 KM RADIUS FROM THE QUARRY BOUNDARY
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration NONE WITHIN 10 KM RADIUS FROM THE QUARRY BOUNDARY
6. Inland, coastal, marine or underground waters NONE WITHIN 10 KM RADIUS FROM THE QUARRY BOUNDARY
7. State, National boundaries NONE WITHIN 10 KM RADIUS FROM THE QUARRY BOUNDARY
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas NONE WITHIN 10 KM RADIUS FROM THE QUARRY BOUNDARY
9. Defence installations NONE WITHIN 10 KM RADIUS FROM THE QUARRY BOUNDARY
10. Densely populated or built-up area, distance from nearest human habitation DENSELY POPULATED AREA- PERAMBRA-15KM
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) HOSPITAL-PERAMBRA CKG GVT HOSPITAL-15 KM, SCHOOL- HOLY FAMILY HSPADATHUKADAV-6KM, MOSQUE - PANTHIRIKKARA-3 KM, CHURCH- HOLY FAMILY-3KM, TEMPLE - PANTHIRIKARA -2 KM
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) NONE WITHIN 10 KM RADIUS FROM THE QUARRY BOUNDARY
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) NONE WITHIN 10 KM RADIUS FROM THE QUARRY BOUNDARY
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) NONE WITHIN 10 KM RADIUS FROM THE QUARRY BOUNDARY
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/4887/2017
File NumberTo be assigned
Date of Apply EC22 Feb 2017
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)KeralaKozhikodeQuilandy
(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.)Annexure-LOI22 Feb 2017
(2.)ANNEXURE 500 M DETAILS22 Feb 2017
(3.)annexure NABL Certificate22 Feb 2017
(4.)annexure RQP Certificate22 Feb 2017
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameBUILDING STONE QUARRY OF MR SHERRY JOSEPH
DesignationProprietor
Company BUILDING STONE QUARRY OF MR SHERRY JOSEPH
AddressSherry Joseph Pazhaya Parambil(h) Chembanoda (po) Kozhikode-673528
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