Form-1 (As per EIA Notification 2006)

For the Proposed Gravel and Pebbles Quarry Project- 1.21.5ha S.F.Nos: 297/1 (P) and 297/3 Palakollai Village Virudhachalam Taluk, District,

Proposed by N.Vaithiyanathan, S/o.Natesan, Palakollai Madura, Puthupettai, Virudhachalam, -606 115

APPLICATION FORM FOR OBTAINING ENVIRONMENT CLEARANCE FROM STATEENVIRONMENT IMPACT ASSESSMENT AUTHORITY (SEIAA), GOVERNMENT OF TAMILNADU,

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FORM 1 (I) Basic information

S. No Item Details Name of the project/s Palakollai Gravel and Pebbles Quarry project belongs 1 to Thiru.N.Vaithiyanathan, 2 S.No. in the schedule 1 (a) Capacity 6,446m3 (80% @ Pebbles 5,157m3 and 20%@ Gravel 1,289 m3) for the period of Two years. Proposed capacity/area/length/ Lease applied Area tonnage to be handled / command 1.21.5 Ha. The command area 3 area/lease area/number of wells to be drilled 0.32.5Ha (Effective quarrying area proposed). Opencast method of shallow mining is proposed, Machineries like excavator are proposed for quarrying Gravel and Pebbles up to 2m below ground level depth. Gravel and Pebbles formation is clearly inferred right from the surface. New/ Expansion/ Modernization It is a New Proposal Gravel and Pebbles Quarry Project 4 in Palakollai Village. Existing capacity / Area etc. The proposed quantity of reserves is 6,446m3 (80% @ Pebbles 5,157m3 and 20%@ Gravel 1,289 m3) (or) 1,074 Lorry Loads of Gravel and Pebbles. The proposed depth is 2m below the ground level for a period of Two years only.

Volume Pebbles Gravel Description in m3 @ 80% @20% 5 in m3 in m3 Geological 24,300 - - Resources Available 6,446 5,157 1,289 Mineable reserves Two years plan period As in the 6,446 5,157 1,289 approved mining plan 6 Category of project i.e. `A’ or ‘B’ Category-B2 Does it attract the general condition? The total project area is 1.21.5ha ie.,upto 25ha hence the 7 If yes, please specify. General conditions will not attract this project. Does it attract the specific condition? The project attracts specific condition of 10m safety If yes, please specify. distance maintained by Village Thar road situated on the 8 Northern side. 50m Safety distance maintained by NLC settlement & Odai on the Northern and Southern side of the applied area. Location Topo Sheet No.58-M/06 9 Latitude between 11°39'28.11"N to 11°39'32.31”N Latitude between79°23'34.03"E to 79°23'39.00”E

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Plot/ Survey/ Khasra No. 297/1(P) and 297/3 Village Palakollai Taluk Virudhachalam District Cuddalore State Tamil Nadu Nearest railway station/ airport along Ulundurpet Railway station - 9.5km- NW 10 with distance in kms Puducherry Airport- 37.5km- NW Nearest Town, city, District Nearest Town : Virudhachalam - 17.0km –SW 11 Headquarters along with distance in Nearest City : Cuddalore - 40km - NE

kms. District : Cuddalore - 40km -NE Village Panchayats, ZilaParis had, Village - Palakollai Municipal Corporation, Local body Panchyat Union - Marakkanam 12 (Complete postal addresses with Taluk - Virudhachalam telephone nos. to be given) District - Cuddalore 13 Name of the applicant N.Vaithiyanathan, Registered Address S/o.Natesan, Palakollai Madura, 14 Puthupettai, Virudhachalam, Cuddalore District-606 115 Mobile No. 94432 85803 & 99769 86574 Address for correspondence Name N.Vaithiyanathan, Designation (Owner/Partner/CEO) Proprietor/Owner S/o.Natesan, Palakollai Madura, Address Puthupettai, Virudhachalam, 15 Cuddalore District-606 115 Mobile No. 94432 85803 & 99769 86574 Pin code 606115 E-mail [email protected] Mobile No. 94432 85803 & 99769 86574 Fax No. - Details of Alternative Sites examined, There are no alternative sites examined. The project is 16 if any. Location of these sites should site specific. be shown on a Topo sheet 17 Interlinked Projects There is no interlinked projects Whether separate application of As there is no interlinked project, no application has 18 interlinked project has been been submitted submitted? If yes, date of submission As there is no interlinked project hence no application 19 has been submitted. If no, reason The project involves Gravel and Pebbles Quarry Project 20 only.

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Whether the proposal involves (a) The project does not attract the Forest approval/ clearance under: if yes, (Conservation) Act 1980. details of the same and their status to be given. (b) There is no wild life within the 10km radius from (a) The Forest (Conservation) Act, applied area and does not fall under the Wildlife 21 1980? (protection) Act 1972. (b) The Wildlife (Protection) Act, 1972? (C) The project doesn’t attract the C.R.Z. Notification, (c) The C. R. Z. Notification, 1991? 1991.

The precise area communication letter was issued by the District collector Cuddalore vide Whether there is any Government Rc.No.48/Mines/2017, Dated: 17.10.2018 22 Order/ Policy relevant/ relating to the

site? The Mining plan was approved by the Deputy Director, Department of Geology and Mining Cuddalore vide Rc.No. 48/Mines/2017, Dated: 04.12.2018. 23 Forest land involved (hectares) There is no forest land involved in the lease area. Whether there is any litigation pending against the project and/ or land in which the project is propose to be set up? There is no court case pending, litigations relating to the 24 (a) Name of the Court project directly and indirectly. (b) Case No. (c) Orders/ directions of the Court, if any and its relevance with the proposed project.

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(II) Activity 1. Construction operation or decommissioning of the project involving actions, which will cause physical changes in the locality (topography, land use changes in water bodies,etc.) Details thereof (with approximate Information/Checklist Yes/ S. No quantities/rates, wherever possible) with confirmation No sources of information data Topography of the area is almost plain terrain, the land use pattern will be changed after the quarrying of Gravel and Pebbles as per the Mining plan, Opencast method of shallow mining is proposed, Machineries like excavators are proposed for quarrying Gravel and Pebbles up to 2m below ground level depth. Permanent or temporary change The Lease applied area is plain topography in land use, land cover or will be slightly changed after the quarrying of 1.1 topography including increase in Yes Gravel and Pebbles as per the Mining plan. intensity of land use (with respect to local land use plan) Present Area at the end Description area in of lease period (Ha) (Ha) Quarrying pit Nil 0.32.5 Infrastructure Nil 0.01.0 Road Nil 0.01.0 Green Belt Nil 0.35.0 Un-Utilized Area 1.21.5 0.52.0 Grand Total 1.21.5 1.21.5

Clearance of existing land, There is no vegetation and building in this project 1.2 vegetation and building? No area, hence there is no requirement of clearing the vegetation and building. The quarrying activity is proposed to carry out within the quarry lease applied area. Temporary 1.3 Creation of new land uses? No approach road within the area will be form for the easy access of men and machinery which will be well maintained.

Pre-construction investigations Pre -construction investigation and soil testing is 1.4 No e.g. bore houses, soil testing? not proposed before quarrying operation.

There will be no major civil work in this project involved. The infrastructure facilities are 1.5 Construction works? Yes proposed in the quarry site on semi-permanent structures. There is no existing building within the quarry 1.6 Demolition works? No lease applied area; hence no demolition work is involved.

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No temporary sites are utilized for this project. Temporary sites used for Sites service on semi-permanent structure will be 1.7 construction works or housing of No constructed only after grant of quarry lease within construction workers? the safety barrier. There are no tall buildings or linear structure in Above ground buildings, and around the quarry site. There is no structures or Gravel and Pebbles requirement of cutting and filling in the site. The 1.8 No works including linear structures, proposed quarry is to exploit Gravel and Pebbles cut and fill or excavations. from unconsolidated sediments for 2m below the ground level only.

Conventional open cast shallow quarrying will be Underground works including 1.9 No adopted. No underground mining or tunneling is mining or tunneling? proposed.

The quarry operation is restricted up to a depth of 2m below the ground level for a period of Two Reclamation works? 1.10 No years only, after removing the Gravel and Pebbles

the quarried out lands will be leveled and used for agriculture purpose.

There is no such type of activities involved in this 1.11 Dredging? No opencast quarrying operation.

There is no such type of activities involved; It is 1.12 Offshore structures? No an inland quarrying project. Production and manufacturing No production and manufacturing is involved in 1.13 No processes? the Gravel and Pebbles Quarrying. There is no proposal for storage of material within the quarry lease applied area. The Excavated Gravel and Pebbles is used for filling 1.14 Facilities for storage of goods or No and leveling of low lying areas for Road Project materials? and other infrastructure development work in and around the District for a period of Two years. There is no wastage encountered during the quarrying operation, The Excavated Gravel and Pebbles is used for filling and leveling of low Facilities for treatment or lying areas for Road Project and other 1.15 disposal of solid waste or liquid No infrastructure development work in and around effluents? the District for a period of Two years. The Gravel and Pebbles will not produce toxic effluence in the form of solid, liquid or gas.

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The proposed project is 1.21.5ha for a period of Two years only. The required employees (7Nos) Facilities for long term housing 1.16 No are available in the nearby villages, hence long of operational workers? term housing of operational workers are not proposed. No new roads, rail or sea traffic is proposed during operation, the existing road will be utilized for New road, rail or sea traffic transportation of the Gravel and Pebbles. 1.17 during construction or operation? No However, internal roads within the quarry lease applied area will be developed and maintained. There is no such type of activities involved in this New road, rail, air waterborne or project. other transport infrastructure 1.18 No Existing road will be utilized for the including new or altered routes transportation of Gravel and Pebbles to the needy and stations, ports, airports etc.? sites. Closure or diversion of existing transport routes or infrastructure The project will not cause any changes and 1.19 No leading to changes in traffic hindrance in the existing traffic movements. movements? New or diverted transmission The project does not involve diversion of 1.20 No lines or pipelines? transmission/pipe lines. Impoundment, damming, culver The quarrying operation is restricted up to a 1.21 ting, realignment or other No depth of 2m below the ground level. The Ground changes to the hydrology of water occurrence in this area is at 35mts depth watercourses or aquifers? below the ground level. Hence there is no damage for ground water hydrology or aquifers.

There is no stream crossing within the quarry 1.22 Stream crossings? No lease applied area. The proposed quarrying does not require any Abstraction or transfers of water 1.23 No abstraction or transfer of water from the ground form ground or surface waters? or surface water bodies.

The quarry operation is restricted up to a depth of Changes in water bodies or the 2m below the ground level. Quarry operation will 1.24 land surface affecting drainage or No not affect the drainage pattern of the area. run-off? There is no change in water bodies or the land surface affected during run off.

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During operation phase, after grant of lease quarrying personnel will be brought from surrounding villages by jeep or van. Transport of personnel or The materials and tools shall be transported by 1.25 materials for construction, No trucks and tippers, the existing road and operational or decommissioning? infrastructure facilities are sufficient. No construction operation or decommissioning envisaged. Long-term dismantling or There is no Dismantling or decommissioning is 1.26 decommissioning or restoration No proposed in this project. works? Ongoing activity during decommissioning which could There is no such type of activities involved in this 1.27 No have an impact on the project. environment? During operational phase, the manpower requirement will be around 7. Local people are envisaged in this quarry operation. No child labor Influx of people to an area in will be deployed for any type of quarrying 1.28 either temporarily or Yes operation. All the labors engaged for quarrying permanently? operations will be trained, equipped with protective devices and insured till the end of life of quarry.

1.29 Introduction of alien species? No There are no causes to develop the alien species. There will no loss of native species or genetic Loss of native species or genetic diversity taken during the quarrying operation as 1.30 No diversity? the lease applied area is devoid of vegetation and agriculture. 1.31 Any other actions? No There are no any other actions.

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2. Use of Natural resources for construction or operation of the project (such as land, water, materials or energy, especially any resources which are non -renewable or in short supply): Details thereof (with approximate Information/Checklist Yes/ S. No quantities/rates, wherever possible) with confirmation No sources of information data

In the Village account the land is classified as patta land. Land especially undeveloped or 2.1 No The area is dry barren land devoid of agriculture agricultural land (ha) and habitations. At present the land is not used for any specific vegetation.

The project does not require huge water for quarrying operation, about 3.0KLD of water will be used for the project. 1. Drinking Water – 0.8 KLD & Domestic purpose Water (expected source & 2.2 Yes 2. Dust Suppression – 1.4 KLD competing users) unit: KLD 3. Green belt – 0.8 KLD Total – 3.0 KLD The source of water brought from approved water vendors and existing bore hole on nearby quarry area. There are no Minerals used for construction Minerals (MT) No 2.3 purposes.

Construction material - Stone, 2.4 aggregates, and/Soil (expected No There is no Construction material proposed. source-MT) Forests and timber There are no forests and timber material is 2.5 No (source-MT) proposed. The limited scale of activities adopted in Gravel and Pebbles Quarrying does not require Energy including electricity and high-tension electric power supply. 2.6 fuels (source, competing users) Yes Fuels are used for operating vehicles unit: fuel (MT),Energy (MW) during quarrying process. Fuels required for excavator for the entire project life 1,070liters of HSD Diesel. Any other natural resources (use There is no other natural resource will be 2.7 No appropriate standard units) required.

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3. Use, storage, transport, handling or production of substances or materials, which could be harmful to human health or the environment or raise concerns about actual or perceived risks to human health. Details thereof (with approximate Information/Checklist Yes/ S. No quantities/rates, wherever possible) with confirmation No sources of information data Use of substances or materials, There is no proposal for storage, handling or which are hazardous (as per transportation of any hazardous materials or 3.1 MSIHC rules) to human health or No substances as per MSIHC rules in this Gravel the environment (flora, fauna, and and Pebbles Quarry project. water supplies)

The Grave quarry operation will not produce Changes in occurrence of disease any toxic effluent in the form of solid, liquid 3.2 or affect disease vectors ( e.g. No and gas, hence the diseases related to insect or insect or water borne diseases) water borne diseases is not envisaged.

Welfare of people will get positive change due to the project, where a number of Welfare activities are being undertaken. Due to increase of the employment earning of local people and lifestyle of the people will enhance, around 7 Affect the welfare of people e.g. by 3.3 No peoples will be directly benefit to this project. changing living conditions? No child labor will be engaged for any type of quarrying operation. All the labor will be insured and the salary and benefits will be paid as per the Labor enforcement officers(Ministry of labor and welfare) Norms.

Vulnerable groups of people who There is no effect envisaged for the vulnerable could be affected by the project e.g. 3.4 No groups of people who could be affected by the hospital patients, children’s, the project. elderly etc.,

3.5 Any other causes No There is no other cause are envisaged

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4. Production of solid wastes during construction or operation or decommissioning(MT/mounts) Details thereof (with approximate Information/Checklist Yes/ S. No quantities/rates, wherever possible) with confirmation No sources of information data The Gravel and Pebbles Quarrying does not produce any waste. The entire Gravel and 4.1 Spoil, overburden or mine wastes No Pebbles is excavated. There are no wastages encountered during the quarrying period of two years only.

Small quantity of Municipal waste will be Municipal waste (domestic and or 4.2 Yes generated which shall be disposed as per commercial wastes) guidelines.

In this quarrying activities waste oil will be generated during the operation period it will Hazardous wastes (as per be sent to authorize Re- Circulars as per 4.3 Hazardous Waste Management No SPCB/ CPCB norms. Care and maintenance Rules) of vehicles by experience qualified mechanics will be undertaken to prevent breakdown and spillage of oils and lubes. Industrial wastages are not generated during 4.4 Other industrial process wastes No the quarrying operation. There is no such type of activities in this 4.5 Surplus product No quarry.

Sanitary facilities will be constructed as semi- Sewage sludge or other sludge form 4.6 Yes permanent structure and the sewage waste effluent treatment will be disposed as per the norms.

There are no Construction or demolition 4.7 Construction or demolition wastes No wastes involved in this quarry. No redundant machineries involved in this 4.8 Redundant machinery or equipment No project, only Excavator and tipper are involved in this quarry operation. Contaminated soils or other There is no contaminated material or soil 4.9 No materials observed in the quarry area.

4.10 Agricultural wastes No There is no agricultural waste anticipated.

4.11 Other solid wastes No There is no other solid waste anticipated.

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5. Release of pollutants or any hazardous, toxic or noxious substances to air (Kg/hr) Details thereof (with approximate Information/Checklist Yes/ S. No quantities/rates, wherever possible) with confirmation No sources of information data

The emissions of SO2(Sulfur dioxide) & Emissions form combustion of NO2(Nitrogen dioxide) may be due to use of 5.1 fossil fuels from stationary or Yes diesel operated quarry machinery and vehicles. mobile sources Better maintenance of equipment in good condition will help to reduce such emissions. Dust is the main pollutant produced in the proposed activity. Emission from loading and Emissions from production Yes plying of tippers can take place but they will 5.2 processes be maintained within limits by proper maintenance and sprinkling of water on haul roads, Tarpaulin covers during Transportation. Fugitive dust will be generated from material handling activities. Dust suppression by water sprinkling Emissions from materials handing 5.3 Yes will be carried out to control the dust emissions including storage or transport during loading and transportation. Gravel and Pebbles will be covered with Tarpaulin during Transportation to control the dust emission. Emissions form construction There is no major construction activities are 5.4 activities including plant and No envisaged. equipment Minor Dust will be generated during loading of Dust or odors form handling of material, transportation of Gravel and Pebbles 5.5 materials including construction No and it will be controlled. However, there is no materials, sewage and waste possibility of any odor generation as there are no organic solvents/processes involved.

Emissions from incineration of The Gravel and Pebbles Quarrying does not 5.6 No waste produce any toxic effluents. Emissions from burning of waste There is no such type of activities involved in 5.7 in open air (e.g. slash materials, No this project. construction debris) Emissions from other sources are not 5.8 Emissions from any other sources No envisaged.

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6.Generation of Noise and Vibration, and Emissions of Light and Heat: Details thereof (with approximate Information/Checklist Yes/ S. No quantities/rates, wherever possible) with confirmation No sources of information data Due to operation of machinery there is likely hood of some increase in noise level. The noise level at site will be maintained below From operation of equipment e.g. permissible limit. Measures like lubrication and 6.1 engines, ventilation plant, Yes preventive maintenance shall be taken to control crushers noise from the machinery. The vibration during the movement of machinery will be minimal for a short span which will be well within the prescribed limits. From industrial or similar There is no proposal of processing plant 6.2 No processes

6.3 From construction or demolition No No construction or demolition work takes place.

No drilling or blasting is proposed for this 6.4 From blasting or piling No Gravel and Pebbles Quarrying operation. The transport of Gravel and Pebbles through tippers can produce noise but are maintained From construction or operational within permissible limits, by keeping machinery 6.5 Yes traffic in proper condition as per RTO &TNPCB norms and maintenance under experience and qualified mechanics. The quarry operation will be carried out at the 6.6 From lighting or cooling systems No daytime only between 8Am to 6Pm hence; the lighting and cooling systems are not required.

This quarrying project is site specific which is involved only Excavator and Tippers; hence 6.7 From any other sources No external power other than HSD is not involved in this project.

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7. Risks of contamination of land or water from releases of pollutants into the ground or into sewers, surface water, ground water, coastal water or the sea: Details thereof (with approximate Yes/ S. No Information/Checklist confirmation quantities/rates, wherever possible) with No sources of information data No hazardous materials will be used in the process. From handling, Storage, use or spillage Oiling and lubrication of hauling vehicles 7.1 No of hazardous materials will be done by using oil tray to prevent spillage of oil. Vehicles and machinery will be well maintained The discharge of sewage will be Theto prevent Discharge leakage of of sewage oil. will be collected on collected on soak pits will be discharge soak pits and will be discharge to a place 7.2 No to a place authorized by municipal authorized by Municipal Authorities as per guide authorizes as per guidelines lines. There is likely hood of increase of particulate By deposition of pollutants emitted to matter due to quarrying operations. Regular 7.3 No air into the land or into water sprinkling of water will suppress dust at points/places of generation. An efficient and effective management plan is proposed for the project; hence it may not have 7.4 From any other sources No any significant impact on the surrounding environment. Is there a risk of long term buildup of There is no such type of activities involved in 7.5 pollutants in the environment from No this quarry. these sources?

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8.0 Risk of accidents during construction or operation of the project, which could affect human health or the environment Details thereof (with approximate Yes/ S. No Information/Checklist confirmation quantities/rates, wherever possible) with No sources of information data No explosions and spillages are proposed From explosions, spillages, fires etc., for quarry operation. The Gravel and Pebbles 8.1 form storage, handling, use or No will be loaded directly in to the tippers. The production of hazardous substances quarry operation does not produced hazardous material. Limited vehicles are only used for quarrying operation up to a depth of 2m below the ground level. Hence the accident is anticipated minimal. 8.2 From any other causes Yes However, all safety measures shall be taken to prevent any accidents. The quarrying activities will be monitored under the supervision of experienced and qualified competent mines foreman. There is no Earth quake, floods, Could the project be affected by Landslides; cloud burst recorded in the area. Its natural disasters causing conventional opencast quarrying proposed only 8.3 environmental damage (e.g. floods, No for 2m below the ground level which will not Earth quakes, landslides, cloudburst cause any adverse environmental damage due to etc.)? natural disasters.

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9. Factors which should be considered (such as consequential development) which could lead to environmental effects to environmental effects or the potential for cumulative impacts with other existing or planned activities in the locality Details thereof (with approximate Information/Checklist Yes/ S. No quantities/rates, wherever possible) with confirmation No sources of information data Lead to development of Living standard will be improved of the nearby supporting. cities, ancillary villagers. development or development stimulated by the project which This short span of project does not require any could have impact on the supporting infrastructures like roads, power environment e.g.: supply, waste treatment, etc.,

9.1  Supporting infrastructure (roads,

power supply, waste or waste The workers are available from the nearby No treatment, etc.) villages, hence the project will not attract  housing development housing Development, Extractive industries,  extractive industries supply industries or any other activities.  supply industries  other The quarry operation is restricted up to a depth Lead to after- use of the site, which of 2m below the ground level, after removing 9.2 could heaven impact on No the Gravel and Pebbles the quarried out lands environment will be leveled and used for agriculture purpose.

Set a precedent for later 9.3 No There is no later developments developments Have cumulative effects due to proximity to other existing or There is no cumulative impacts are envisaged. 9.4 No planned projects with similar effects

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(III) Environmental Sensitivity Name/ Aerial distance (within 10 km.) S. No Areas identity Proposed project location boundary Areas protected under international conventions, national or local No protected areas to be identified with in 10 1 legislation for their ecological, No km distance. landscape, cultural or other related value There is no eco sensitive area, wildlife sanctuary, National park, Monuments, CRZ etc. within the radius of 10km. Odai is passing southern side of the lease Areas which are important or applied area 50m safety distance has been sensitive for ecological reasons - Maintained. 2 Wetlands, watercourses or other Yes Gadilam River is passing about 9.5km from water bodies, coastal zone, Northern side of the lease applied area. biospheres, mountains, forests Semakottai Reserve Forest -1.0km Southwestern Kallamedu Reserve Forest- 2.5km Northestern Kuttadi Reserve Forest -5.0km Northwestern Visur Reserve Forest - 6.2km - Northwestern

Areas used by protected, important or sensitive species of flora or There is no such type of areas in the vicinity of 3 fauna for breeding, nesting, No the project site foraging, resting, over wintering, migration

Inland, coastal, marine or There is no Inland, coastal, marine or 4 No underground waters underground water around the site.

There is no State or National boundaries within 5 State, National boundaries No a radius of 10km.

Routes or facilities used by the There are no Tourist, pilgrim areas within 10 6 public for access to recreation or No km radius other tourist, pilgrim areas No defense installation found 10km near the 7 Defense installations No site

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Approximate distance & S. Name of the Approximate Direction from No Village population Yes lease applied 8 Densely populated or built-up area area 1. Nadiyapattu 2.0km – NE 500 2. Irulakkurichi 700m – SE 400 3. Kalar kuppam 2.5Km – SW 550 4. 2.0Km – NW 950 Palakollai Areas occupied by sensitive man- Ulundurpet is having all the facilities, which are made land uses at a distance of 11.5km on the Northwestern side 9 Yes (hospitals, schools, places of of the area. worship, community facilities)

The quarry operation is restricted to only 2m Areas containing important, high below the ground leveland proposed to quality or scarce resources excavate for a period of Two years only. Hence 10 (ground water resources, surface No the ground water will not be affected beside the resources,forestry, agriculture, area is devoid of agriculture, Forestry, Tourist fisheries, tourism, minerals) place etc.

Areas already subjected to pollution or environmental 11 damage. (those where existing No This is a fresh lease applied area. legal environmental standards are exceeded) Areas susceptible to natural hazard which could cause the project to present environmental problems The area is not susceptible to natural hazards 12 (Earthquakes, subsidence, No like landslides, Earth quake; it is a high stable landslides, erosion, flooding or land. extreme or adverse climatic conditions)

“I hereby given undertaking that the data and information given in the application and enclosures are true to the best of my knowledge and belief and I am aware that if any part of the data and information submitted is found to be false or misleading at any stage, the project will be rejected and clearance give, if any to the project will be revoked at our risk and cost.

Date: Place: Cuddalore

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1. Signature of the applicant with Name and Full Address

N.Vaithiyanathan, S/o.Natesan, Palakollai Madura, Puthupettai, Virudhachalam, Cuddalore District-606 115 Mobile No. 94432 85803 & 99769 86574

2. Signature of the Qualified Person

Dr.P.Thangaraju, M.Sc., Ph.D., Qualified Person

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