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 Mr. Biju Varghese. Punnathanam
(ii).Location / site (GPS Co-ordinate) N 09 degree 48 minutes 48.63 seconds to N 09 degree 48 minutes 50.76 seconds E 76 degree 38 minutes 58.19 seconds to E 76 degree 39 minutes 01.00 seconds
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)0.393 ha.
(iv).Capacity of the Mining Lease (TPA) 50000
(v).Period of Mining Lease 3
(vi).Expected cost of the Project 27
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.Sl. No.69 
Name of Consultant/RQPGlobal Environment & Mining Services
Address 394, HBR Layout, 5th Block, 5th Main, 1st Cross, 1st Stage, Bangalore
Mobile No.8050103670
Landline No.432447
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.  15 km
2. (ii). Nearest Infrastructural along with distance in kms  40 km
(iii). Nearest Railway Line along with distance in kms  40 km
(iv). Nearest National Highway along with distance in kms  70 km
(v). Nearest State Highway along with distance in kms  15 km
(vi). Nearest Major District Road along with distance in kms 20 km
(vii). Nearest Any Other Road along with distance in kms  0.30 km
(viii). Nearest Electric transmission line pole or tower distance in kms  2 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  15 km
(x). Nearest In-take for drinking water pump house distance in kms  0 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  0 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
 nil
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Idukki forest is at a distance of 60kms
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration None within 5kms of the project site
6. Inland, coastal, marine or underground waters Alapuzha-85kms
7. State, National boundaries Karnataka State boundary is located at 210kms from the project site
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas National Highway: Eranakulam, 70kms State Highway: Pala, 15kms Major District Road: Kottayam-Muvattupuzha, 20kms
9. Defence installations Nil
10. Densely populated or built-up area, distance from nearest human habitation The nearest habitant Pazhamala Village is located at 0.64kms away from the mine
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Hospital: Ramapuram-3kms School: Neerumthanam, 1.50kms Church: Ramapuram-Amanakara-Pius X Monastery Church-1.30kms Temple: Palliampuram-Mahadeva temple-0.87kms
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) Nil
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/4931/2017
File NumberK16/DEIAA/Q15/17
Date of Apply EC24 Feb 2017
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)KeralaKottayamMeenachil
(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.)Affidavit24 Feb 2017
(2.)Declaration of Individual24 Feb 2017
(3.)Form-1M24 Feb 2017
(4.)NABET Certificate24 Feb 2017
(5.)NABL Certificate24 Feb 2017
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameBIJU VARGHESE PUNNATHANAM
DesignationOwner
Company BIJU VARGHESE PUNNATHANAM
AddressMr. Biju Varghese. Punnathanam
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