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 Sajeev Quarry
(ii).Location / site (GPS Co-ordinate) Latitude: 8°53'28.86"N Longitude: 76°48'17.80"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)1.04 ha.
(iv).Capacity of the Mining Lease (TPA) 20000
(v).Period of Mining Lease 10
(vi).Expected cost of the Project 90
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.RQP/4/2016 
Name of Consultant/RQPV.K Roy
Address Saral,TC 27/487(2),Swaraj Lane, R.C Junction,Kunnukuzhy, Trivandrum.
Mobile No.9387805668
Landline No.4014111
Email Idvkroysaral@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.  4.5 km
2. (ii). Nearest Infrastructural along with distance in kms  15 km
(iii). Nearest Railway Line along with distance in kms  20 km
(iv). Nearest National Highway along with distance in kms  15 km
(v). Nearest State Highway along with distance in kms  10 km
(vi). Nearest Major District Road along with distance in kms 15 km
(vii). Nearest Any Other Road along with distance in kms  4 km
(viii). Nearest Electric transmission line pole or tower distance in kms  0.3 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  4 km
(x). Nearest In-take for drinking water pump house distance in kms  4 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  25 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 Sasthamkotta, 35 km
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration Nil
6. Inland, coastal, marine or underground waters Paravoor Kayal, 17 km
7. State, National boundaries Tamilnadu Border, 45 Km
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas 1.Papanasam Beach – Varkala, 20km 2.Thenmala, 30km a.Mosque 1.Chenyoor Juma Masjid, 1.5km 2.Ranuv Mosque, 2km 3.Vattappur Mosque,3km 4.Plamuttam Masjid, 3km 5.Cheroor Masjid, 3.5km b. Temple 1.Chervakkal Temple, 3km 2.Meeyana Kshethram, 4km 3.Velinalloor Temple, 5km 4.Veliyam Temple, 6km 5.Cherivelnallor Temple, 6km c. Church 1.Chervakkal Marthoma Church, 3km 2.Kottakkavila Salvation Army Church, 4km 3.Cherivelnallor Church, 4km 4.Puliyakode CSI Church, 5km
9. Defence installations Pallippuram CRPF Camp, 30km
10. Densely populated or built-up area, distance from nearest human habitation 1.Ambalamkunnu - 1.5km 2.Vattappara - 2.5km 3.Roadvila - 3km 4.Chervakkal - 3km 5.Oyur - 5km
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) a.Mosque 1.Chenyoor Juma Masjid, 1.5km 2.Ranuv Mosque, 2km 3.Vattappur Mosque,3km 4.Plamuttam Masjid, 3km 5.Cheroor Masjid, 3.5km b. Temple 1.Chervakkal Temple, 3km 2.Meeyana Kshethram, 4km 3.Velinalloor Temple, 5km 4.Veliyam Temple, 6km 5.Cherivelnallor Temple, 6km c. Church 1.Chervakkal Marthoma Church, 3km 2.Kottakkavila Salvation Army Church, 4km 3.Cherivelnallor Church, 4km 4.Puliyakode CSI Church, 5km
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Titanium Chavara, 32km
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) No
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/5521/2017
File NumberH/DEIAA/4313/17
Date of Apply EC01 May 2017
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)KeralaKollamKottarakkara
(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 Cirtificate22 Mar 2017
(2.)letter of Intent22 Mar 2017
(3.)Mine Plan Approval letter22 Mar 2017
(4.)ID Card22 Mar 2017
(5.)NABL Certificate22 Mar 2017
(6.)DD21 Apr 2017
(7.)Tax Receipt21 Apr 2017
(8.)Encumbrance Certificate01 May 2017
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameM SAJEEV QUARRY
DesignationOwner
Company M SAJEEV QUARRY
AddressRoadvila House, Ottumala, Kattadi P.O, Pooyappally, Kollam.
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