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. Muhammed T.I
(ii).Location / site (GPS Co-ordinate) 12° 09'02.09"N - 12° 09'12.36"N 75°17'33.79"E - 75°17'40.21"E
Annexure-GPS file      
(iii).
Type of LeaseIndivisual Area
Size of the Mining Lease (in ha.)4.1078 ha.
(iv).Capacity of the Mining Lease (TPA) 150000
(v).Period of Mining Lease 12
(vi).Expected cost of the Project 75
(vii).
Have you hired Consultant/Registered Qualified Person(RQP) for preparing document?Yes
Accreditation No.RQP/7/2016 
Name of Consultant/RQPNazar Ahamed K.V
Address N Square Mining & Environmental Solutions LLPEdappal
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.  16 km
2. (ii). Nearest Infrastructural along with distance in kms  0.32 km
(iii). Nearest Railway Line along with distance in kms  16 km
(iv). Nearest National Highway along with distance in kms  11 km
(v). Nearest State Highway along with distance in kms  16 km
(vi). Nearest Major District Road along with distance in kms 3 km
(vii). Nearest Any Other Road along with distance in kms  3 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  12 km
(x). Nearest In-take for drinking water pump house distance in kms  6 km
(xi). Nearest In-take for Irrigation canal pumps distance in kms  12 km
3. Areas protected under international conventions, national or local legislation for  their ecological, landscape, cultural or other related value
 None within the 10 KM radius from the Project site
4. Areas which are important or sensitive for ecological reasons - Wetlands, watercourses or other water bodies, coastal zone, biospheres, mountains, forests None within the 10 KM radius from the Project site
5. Areas used by protected, important or sensitive species of flora or fauna for breeding, nesting, foraging, resting, over wintering, migration None within the 10 KM radius from the Project site
6. Inland, coastal, marine or underground waters coastal-Mattur(27KM)
7. State, National boundaries None within the 10 KM radius from the Project site
8. Routes or facilities used by the public for access to recreation or other tourist,pilgrim areas None within the 10 KM radius from the Project site
9. Defence installations None within the 10 KM radius from the Project site
10. Densely populated or built-up area, distance from nearest human habitation Nearest Human Settlement is 320 m
11. Areas occupied by sensitive man-made land uses (hospitals, schools, places of worship,community facilities) Nearest Hospital Ganakeeya Poly clinic-Mathamangalam(2Km),Mathamangalam English School (1.5 Km),Mosque-Mathamangalam(2Km),Church-Kuzhikkad(5Km),Temple-Kannamkkad(2.5Km)
12. Areas containing important, high quality or scarce resources.(ground water resources,surface resources,forestry,agriculture,fisheries,tourism,minerals) None within the 10 KM radius from the Project site
13. Areas already subjected to pollution or environmental damage.(those where existing legal environmental standards are exceeded) None within the 10 KM radius from the Project site
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, Lease 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/8031/2017
File Number68/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.)LOI31 Jul 2017
(2.)EC Affidavit31 Jul 2017
(3.)RQP Certificate31 Jul 2017
(4.)500M Quarry Details31 Jul 2017
(5.)Possession & Tax31 Jul 2017
(IV) Undertaking
The aforesaid application and documents furnished here with are true to my knowledge.
(IV).(i)
NameBUILDING STONE QUARRY OF MR MUHAMMED T I
DesignationProprietor
Company BUILDING STONE QUARRY OF MR MUHAMMED T I
AddressMr. Muhammed T.I
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