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 Granite Building Stone Quarry of Mr. Vasundharan.K
(ii).Location / site (GPS Co-ordinate) N12degree 12 minutes 41.601 sec to N 12 degree 12 minutes 45.072 sec E 75 degree 19 minutes 55.009 sec to E 75 degree 19 minutes 57.612 sec
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)0.491 ha.
(iv).Capacity of the Mining Lease (TPA) 25100
(v).Period of Mining Lease 4
(vi).Expected cost of the Project 27
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.sl.no.75 
Name of Consultant/RQPGlobal Environment & Mining Services
Address 394, 5th Block, 5th Main, 1st Stage, 1st Cross, HBR Layout
Mobile No.8050103670
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.  1.5 km
2. (ii). Nearest Infrastructural along with distance in kms  18 km
(iii). Nearest Railway Line along with distance in kms  18 km
(iv). Nearest National Highway along with distance in kms  25 km
(v). Nearest State Highway along with distance in kms  7.5 km
(vi). Nearest Major District Road along with distance in kms 18 km
(vii). Nearest Any Other Road along with distance in kms  0.25 km
(viii). Nearest Electric transmission line pole or tower distance in kms  3 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  6 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  6 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
 None within 5km 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 Rajagiri Forest, 30kms
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration None within 5km of the project site
6. Inland, coastal, marine or underground waters Madakkal Coast, 22kms
7. State, National boundaries Karnataka State boundary is 15kms from the project site
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas National Highway: Edapally-Panvel highway 25kms State Highway: Malabar hill highway, 7.5kms Major District road:Odayanchal-Cherupuzha Rd, 18kms
9. Defence installations None within 5km of the project site
10. Densely populated or built-up area, distance from nearest human habitation The nearest habitant Olayambadi Village is located at 1.0kms away from the quarry.
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Hospital: Govt. Hospital, Peringome-3.5kms School: Govt. High School, Peringome, 3.5kms Church: St. Joseph Church, Madakkampoyil, 0.70kms Temple: Sree Iyappa Shethram temple, 0.55kms Mosque/Masjid: Pedana Juma Masjid, 0.94kms
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) No, 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, Permit 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/6779/2017
File Number50/KNR/2017/DEIAA
Date of Apply EC02 Jun 2017
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)KeralaKannurTaliparamba
(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.)Form1M31 May 2017
(2.)500mCertificate31 May 2017
(3.)AffidavitForEC31 May 2017
(4.)DeclarationOfIndividual31 May 2017
(5.)NABETCertificate31 May 2017
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameMR VASUNDHARAN K
DesignationOwner
Company MR VASUNDHARAN K
AddressMadhumandiram, Madakkampoyil, Peringome (P.O.), Kannur District, Kerala
Print