FORM - A
Form for seeking prior approval of Central Government under section 2 of the Forest(Conservation) Act,1980 for Diversion of fresh forest area
PART - I
(To be filled up by User Agency)
A.
General Details
A-1.
Project Details
(i). Proposal No. :
FP/GA/ROAD/19776/2016
(ii). Name of Project for which Forest Land is required :
Four Laning of existing Goa/Karnatalka border-Panaji Goa section of NH-4A from Km97.000 to Km153.075 in the state of Goa on BOT (Toll) basis under NHDOIII (Anmod to PanajiSection))
(iii). Short narrative of the proposal and Project/scheme for which the forest land is required :
Four Laning of existing Goa/Karnatalka border-Panaji Goa section of NH-4A from Km97.000 to Km153.075 in the state of Goa on BOT (Toll) basis under NHDPIII (Anmod to PanajiSection)
(iv). State :
Goa
(v). Category of the Proposal :
Road
(vi). Shape of forest land proposed to be diverted :
Linear
(vii). Estimated cost of the Project(Rupees in lacs) :
120000
(viii). Area of forest land proposed for diversion(in ha.):
31.53
(ix). Non-forest land required for this project(in ha.):
59.21
(x). Total period for which the forest land is proposed to be diverted(in years):
100
A-2.
Details of User Agency
(i). Name :
PUBLIC WORKS DEPARTMENT
(ii). Address1 :
EXECUTIVE ENGINEER WD XV(NH) PWD PONDA
(iii). Address2 :
NIL
(iv). State :
Goa
(v). District :
North Goa
(vi). Pin :
403401
(vii). Landmark :
GOVT BUILDING PONDA TISK
(viii). Email address :
ee15-pwd.goa@nic.in
(ix). Landline Telephone No. :
832-2313024
(x). Fax No. :
832-2313024
(xi). Mobile No. :
9370699881
(xii). Website (if any) :
www.pwd.gov.in
(xiii). Legal status of User Agency :
State Government
A-3.
Details of Person Making Application
(i). First Name:
Mohan
(ii). Middle Name:
S
(iii). Last Name:
Karki
(iv). Gender:
Male
(v). Designation:
Executive Engineer
(vi). Address 1:
Executive Engineer WD XV(NH) PWD Ponda Goa
(vii). Address 2:
NIL
(viii). State:
Goa
(ix). District:
North Goa
(x). Tehsil:
Tiswadi
(xi). Pin:
403001
(xii). Landmark:
NIL
(xiii). Email Address:
ae1eexv@gmail.com
(xiv). Landline Telephone No.:
832-2313024
(xv). Fax No.:
08322313024
(xvi). Mobile No.:
9168694726
(xvii). Copy of documents in support of the competence/authority of the person making this application to make application on behalf of the User Agency:
B.
Details of land required for the Project
B-1.
Details of proposal seeking prior approval of Central Government under the Act for diversion of forest land for the Project already submitted in the past
List of proposal submitted in Past
S.no
Proposal Status.
Proposal No.
Moef File No.
Area Proposed for Diversion(Ha.)
Area Diverted(Ha.)
Date of In-Principle Approval
Date of Final Approval
NIL
B-2.
Details of forest land proposed to be diverted
B-2.1
Details of Divisions involved
Details of Divisions involved
S.no
Division Name
Forest Land(ha.)
Non-Forest Land(ha.)
1.
North
31.53
59.21
Total
31.53
59.21
B-2.2
Details of Districts involved
District wise breakup
S.no
District Name
Forest Land(ha.)
Non-Forest Land(ha.)
1.
North Goa
31.53
49.85
1.
South Goa
0
9.36
Total
31.53
59.21
B-2.3
Village wise breakup
Villages wise breakup
S.no
Village
Forest Land(ha.)
Non-Forest Land(ha.)
1
Mollem
14.16
0.02
2
Collem
0.06
0
3
Sangod
12.27
0.77
4
Dharbandora
4.89
4.01
5
Usgao
0.15
5.22
6
Piliem
0
4.67
7
Bandora
0
8.71
8
Priol
0
7.29
9
Velinga
0
0.31
10
Cuncolim
0
0.69
11
Cundaim
0
4.77
12
Boma
0
7.94
13
Adcolna
0
5.45
14
Corlim
0
5.41
15
Ella
0
3.95
Total
31.53
59.21
B-2.4
Component wise breakup
Component wise breakup
S.no
Component
Forest Land(ha.)
Non-Forest Land(ha.)
1
Road
31.53
59.2059
Total
31.53
59.2059
C.
Maps of forest land proposed to be diverted
Division 1. : North
(i). Area of forest land proposed to be diverted(in ha.) :
31.53
(ii). Nature of the Project:
Linear
(b). No. of Segments :
One
Segment wise details
Segments
Segment Area(in ha.)
Kml File of Segments
(To view KML file on google the same may be downloaded and then open if in google earth install in your computer).
1.
31.53
View File
(iii). Copy of Survey of India Toposheet indicating boundary of forest land proposed to be diverted:
(iv). Scanned copy of the Geo-referenced map of the forest land proposed to be diverted prepared by using GPS or Total Station:
D.
Justification for locating the Project in forest land and details of alternatives examined:
(i). Copy of note containing justification for locating the Project in forest land:
(ii). Whether a copy of map indicating location of alternative examine is required to be provided:
No
(a). Reason for not providing such map:
Up-gradation of Existing Road
E.
Employment likely to be generated
(i). Whether the Project is likely to generate employment ?:
Yes
(ii). Permanent/Regular Employment(Number of persons):
10
(iii). Temporary Employment(Number of person-days):
109500
F.
Displacement of People due to the Project, if any
(i). Whether Project involves displacement?:
No
G.
Details of Cost-Benefit analysis for the Project
(i). Whether the Project requires Cost-Benefit analysis?:
Yes
(a). Copy of Cost-Benefit analysis:
H.
Status of Environmental Clearance
(i). Whether the Project requires Clearance under the Environment (Protection) Act 1986 ? :
No
I.
Status of Wildelife Clearance
(i). Whether the Project or a part thereof is located in any Protected Area or their Eco sensitive zone? :
No
J.
Applicability of special provisions governing Scheduled Areas
(i).Whether the Project or a part thereof is located in a Scheduled Area? :
No
K.
Status of settlement of rights under the Forest Rights Act,2006 on the forest land proposed to be diverted
(i). Whether the process for settlement of Rights under the Forest Rights Acts 2006 on the forest land proposed to be diverted has been completed? :
No
L.
Details of land identified for Compensatory Afforestation
(i). Whether non-forest or Revenue forest land is required to be provided by User Agency?:
No
(ii). Whether the area of non-forest land or Revenue forest land required to be provided by User Agency for raising Compensatory Afforestation is less than area of forest land proposed to be diverted ?:
No
(iii) . Reason for not providing Non-Forest Land:
Central Govt. Project
Additional information Details
Documents
S.No
Documents
Remarks
1
Administrative Sanction
2
Typical Cross Sections of the project Road
3
Index Map of the Project Road
4
Brief Note on the Project
5
Document Verification Certificate
6
Unqualified Commitment certificate
7
Survey of India TopoSheet No - D43C3
8
No violation of Forest Conservation Act
9
EIA exemption certificate from the Project Proponent
10
Gramsabha Exemption Certificate from the Project Proponent
11
Cost of Felling of Trees
12
Compensatory Afforestation Certificate
13
Archeological Importance Certificate
14
Sr. No -2 Darbandora
15
Sr. No -57 Darbandora
16
Sr. No -95 Darbandora
17
Sr. No -100 Darbandora
18
Sr. No -207 Darbandora
19
Sr. No -12 Molem
20
Sr. No -21 Molem
21
Sr. No -9 Sangod
22
Sr. No -15 Sangod
23
Sr. No -27 Sangod
24
Sr. No -30 Sangod
25
Sr. No -252 Usgaon
26
Sr. No -21 Darbandora
27
Initial Social Impact Assessment
28
Exemption of Environment Clearance
29
Exemption of Gram Sabha
30
with reference to letter dated 12/08/2016 and 24/10/2016.
31
Cost benefit Analysis
32
Revised Form - A
33
Sr. No-13-1 Molem
34
Sr. No-13-1-A Molem
35
Sr.NO- 16-1 Sangod
36
Sr.NO- 17-1 Sangod
37
Sr.NO- 27-1 Sangod
38
Sr.NO- 30-1 Sangod
39
Sr.NO- 37-1 Sangod
40
Sr.NO- 57-1 Sangod
41
Sr.NO- 34-1 Colem
42
Sr.NO- 34-2 Colem
43
Sr.NO- 34-3 Colem
44
Sr.NO- 13-2 Molem
45
Sr.No- 13-3 Molem
46
Sr.No- 13-4 Molem
47
Sr.No- 14-1 Molem
48
Sr.No- 14-2 Molem
49
Sr.No- 15-1 Molem
50
Sr.No- 16-1 Molem
51
Sr.No- 17-1 Molem
52
Sr.No- 17-1-A Molem
53
Sr.No- 17-2 Molem
54
Sr.No- 22-1 Molem
55
Sr.No- 22-1-A Molem
56
Sr.No- 22-1 Dharbandora
57
Sr.No- 22-2 Dharbandora
58
Sr.No- 73-1 Dharbandora
59
Sr.No- 93-1 Dharbandora
60
Sr.No- 98-1 Dharbandora
61
Sr.No- 207-1 Dharbandora
62
Revised Forest Area Statement
63
Revised Non Forest Area Statement
64
Net Present Value certificate
65
Minimum Demand Certificate
66
Revised forest area statement
67
Non forest area statement
68
Undertaking for FRA
69
Revised Plan
70
Covering letter for submission of revised documents
71
Revised Cost benefit analysis
72
Compliances to the observations raised by Regional Office, Bangalore
73
CA land
74
Submission of CA land details
75
Submission of Toposheet and KML of CA land
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