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 Anish S
(ii).Location / site (GPS Co-ordinate) 10°43’12.86” N to 10°43’15.62” N 76°51’17.51” E to 76°51’22.42” E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)0.5940 ha.
(iv).Capacity of the Mining Lease (TPA) 22712
(v).Period of Mining Lease 4
(vi).Expected cost of the Project 20
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.DMG/KERALA/RQP/5/2016 
Name of Consultant/RQPDr. K.SOMAN
Address Geomarine solutions Pvt LtdPonnaniMalappuram-679577
Mobile No.9847083000
Landline No.2663330
Email Idkunjusom@yahoo.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.  0.052 km
2. (ii). Nearest Infrastructural along with distance in kms  0.068 km
(iii). Nearest Railway Line along with distance in kms  15 km
(iv). Nearest National Highway along with distance in kms  15 km
(v). Nearest State Highway along with distance in kms  2 km
(vi). Nearest Major District Road along with distance in kms 2 km
(vii). Nearest Any Other Road along with distance in kms  0.052 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  5 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  5 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
None with in the10Km 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 Gayathri Puzha-8km
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration None with in the 5Km radius from the quarry boundary
6. Inland, coastal, marine or underground waters Gayathri Puzha-8km
7. State, National boundaries Tamilnadu-2.7 Km
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas Hospital-Health center Vannamada-3KM School-Vannamada-3KM Temple-Malayandi-Koudannur-3Km Church-Kozhinjampara-9Km Mosque-Vannamada-3KM Road-Panchayath Road-0.052
9. Defence installations None with in the 5Km radius from the quarry boundary
10. Densely populated or built-up area, distance from nearest human habitation Nearest House-0.068
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Hospital-Health center Vannamada-3KM School-Vannamada-3KM Temple-Malayandi-Koudannur-3Km Church-Kozhinjampara-9Km Mosque-Vannamada-3KM Road-Panchayath Road-0.052
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Gayathri Puzha-8km
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) None with in the 10Km 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) No,
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/16881/2018
File NumberDIA/KL/PL/48/2018
Date of Apply EC08 Sep 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)KeralaPalakkadChittur
(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 RQP Certificate27 Aug 2018
(2.)annexure NABL Certificate27 Aug 2018
(3.)ANNEXURE 26AS27 Aug 2018
(4.)Annexure-LOI27 Aug 2018
(5.)Attested photo and id proof08 Sep 2018
(6.)Tax and possession08 Sep 2018
(7.)Land documents08 Sep 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameBUILDING STONE QUARRY OF MR ANISH S
DesignationProprietor
Company BUILDING STONE QUARRY OF MR ANISH S
AddressMr Anish S, S/o Sundaran Punarvasu (H) Ambattupalayam Chittur College P.O, Palakkad
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