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 Building Stone Quarry of Mr.Najeeb Hassan
(ii).Location / site (GPS Co-ordinate) 10°52'28.60"N - 10°52'32.68"N 76°09'49.24"E- 76°09'53.18"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)0.8749 ha.
(iv).Capacity of the Mining Lease (TPA) 38000
(v).Period of Mining Lease 5
(vi).Expected cost of the Project 25
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.DMG/KERALA/RQP/7/2016 
Name of Consultant/RQPNazar Ahamed K.V
Address N Square Mining & Environmental Solutions LLP, Edappal,Kerala
Mobile No.9447177533
Landline No.2677533
Email Idmailnsquaresolutions@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.  2.34 km
2. (ii). Nearest Infrastructural along with distance in kms  1 km
(iii). Nearest Railway Line along with distance in kms  6.68 km
(iv). Nearest National Highway along with distance in kms  10.12 km
(v). Nearest State Highway along with distance in kms  2.70 km
(vi). Nearest Major District Road along with distance in kms 1 km
(vii). Nearest Any Other Road along with distance in kms  1 km
(viii). Nearest Electric transmission line pole or tower distance in kms  1 km
(ix). Nearest Canal or check dam or reservoirs or lake or ponds distance in kms  1.58 km
(x). Nearest In-take for drinking water pump house distance in kms  3.78 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  6.7 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
No such protected areas within 0.5Km
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests Thootha Puzha-2.32Km, Coastal Area-31Km, Nelliyampathy-69Km, Silent Valley National Park-45Km.
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration No Such Protected species of flora or fauna within 0.5 Km from the project site.
6. Inland, coastal, marine or underground waters Coastal Area-31Km.
7. State, National boundaries State Boundary-54Km
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas Malampuzha Dam-57Km, Silent Valley National Park-45Km, Chulanur Peafowl Sanctuary-38Km, Nelliyampathy-69Km.
9. Defence installations No Defense installations within 0.5Km.
10. Densely populated or built-up area, distance from nearest human habitation The nearest human settlements are 116.1m away from project site.
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Hospital:- GAD Viyatnampadi, Koppam-0.8Km, Govt Hospital Koppam-2.75Km. Church:- St Pauls Church Pattambi -8Km. Mosque:- Masjidusalam, Viyatnampadi, Koppam-1.5Km, Kizhumury Juma Masjid, Rayiranellur -1.75Km . Temple:- Rayiranellur Malayil Temple-0.5Km. School:-Rayinellur U.P School -1.39Km, L.P School Edappalam-1.02Km.
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) Malampuzha Dam-57Km, Nelliyampathy-69Km, Chulanur Peafowl Sanctuary-38Km, Silent Valley National Park-45Km.
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) Not applicable.
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/18353/2018
File NumberDIA/KL/PL/53/2018
Date of Apply EC25 Oct 2018
Details of State of the project
S.No. State Name District Name Tehsil Name
(1.)KeralaPalakkadOttappalam
(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.)RQP Certificate23 Oct 2018
(2.)Form 1M23 Oct 2018
(3.)Tax23 Oct 2018
(4.)Land Documents23 Oct 2018
(5.)500m Details & LOI & Mining plan approval letter23 Oct 2018
(6.)Form 26 AS25 Oct 2018
(7.)Possession Certificate25 Oct 2018
(8.)Photo attestted25 Oct 2018
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameBUILDING STONE QUARRY OF MR NAJEEB HASSAN N
DesignationProprietor
Company BUILDING STONE QUARRY OF MR NAJEEB HASSAN N
AddressS/o Kunhi Marakkar Haji Nambrath House Valanchery P.O Malappuram-676 552
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