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 Jabir Quarry
(ii).Location / site (GPS Co-ordinate) Latitude: 12°13'30.75"N Longitude: 75°25'45.54"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)1.7137 ha.
(iv).Capacity of the Mining Lease (TPA) 50000
(v).Period of Mining Lease 12
(vi).Expected cost of the Project 25
(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
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.  2.5 km
2. (ii). Nearest Infrastructural along with distance in kms  2 km
(iii). Nearest Railway Line along with distance in kms  50 km
(iv). Nearest National Highway along with distance in kms  32 km
(v). Nearest State Highway along with distance in kms  30 km
(vi). Nearest Major District Road along with distance in kms 30 km
(vii). Nearest Any Other Road along with distance in kms  2 km
(viii). Nearest Electric transmission line pole or tower distance in kms  10 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  10 km
(x). Nearest In-take for drinking water pump house distance in kms  3 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  3 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
None within 5Km radius
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests None within 5Km radius
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration None within 5Km radius
6. Inland, coastal, marine or underground waters None within 5Km radius
7. State, National boundaries Karnataka(State)-145Km
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas Rayarome-Moonnamkunnu Thuvengadu
9. Defence installations None within 5Km radius
10. Densely populated or built-up area, distance from nearest human habitation Alakkode 7km Therthally 5km Nellipara 5km Cherupuzha 8km Karuvanchal 9km
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Tourist & Pilgrim areas Rayarome Juma Masjid 2km Alakkode Church 7km Arangam Sree Mahadeva Temple 6km Schools & Colleges Rayarome Govt HSE 2 km Alakkode NSS HSS 7km Mary Giri HSS,Therthally 5km St.Sebastian English Medium School,Rayarome 3km Mary Matha College, Alakkode 7km Sir Syed College,Taliparamba 20km Hospitals Karuvanchal vellad Hospital 10km Co-operative Hospital,Alakkode 7km Taliparamba Hospital 20km
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) None within 5Km radius
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) No notified / Recognized polluted area within 15km distance.
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/8443/2017
File Number54/KNR/2017/DEIAA
Date of Apply EC17 Aug 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.)Letter of Intent17 Aug 2017
(2.)Mining Plan Approval Letter17 Aug 2017
(3.)500m Radius Certificate17 Aug 2017
(4.)NABL CERTIFICATE17 Aug 2017
(5.)Lab Reports17 Aug 2017
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameJABIR QUARRY
DesignationSingleOwner
Company JABIR QUARRY
AddressMalikantakath House Moonnamkunnu (P.O) Rayarome,Alakkode(Via), Kannur-670 571, Kerala
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