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/19978/2016
(ii). Name of Project for which Forest Land is required :
NH-4A, WLS/NP/RF Goa
(iii). Short narrative of the proposal and Project/scheme for which the forest land is required :
Four Laning of existing Goa/Karnataka Border(Anmod) - Mollem Section of NH-4A from Km 84.133 to Km 97.000 in the state of Goa
(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) :
59400
(viii). Area of forest land proposed for diversion(in ha.):
32.085
(ix). Non-forest land required for this project(in ha.):
1.887
(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 :
Central 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.
Wildlife - North
31.015
0
2.
North
1.07
1.887
Total
32.085
1.887
B-2.2
Details of Districts involved
District wise breakup
S.no
District Name
Forest Land(ha.)
Non-Forest Land(ha.)
1.
South Goa
32.085
1.887
Total
32.085
1.887
B-2.3
Village wise breakup
Villages wise breakup
S.no
Village
Forest Land(ha.)
Non-Forest Land(ha.)
1
Mollem
31.583
1.887
2
Surla
0.502
0
Total
32.085
1.887
B-2.4
Component wise breakup
Component wise breakup
S.no
Component
Forest Land(ha.)
Non-Forest Land(ha.)
1
Road
32.085
1.88
Total
32.085
1.88
C.
Maps of forest land proposed to be diverted
Division 1. : North
(i). Area of forest land proposed to be diverted(in ha.) :
1.07
(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.
1.07
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:
Division 2. : Wildlife - North
(i). Area of forest land proposed to be diverted(in ha.) :
31.015
(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.
31.015
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):
0
(iii). Temporary Employment(Number of person-days):
300000
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? :
Yes
(a). Whether Project or a part thereof is located within a Protected Area ? :
Yes
(b). Status of approval of the Supreme Court :
Approval under cons
(ii). Status of approval of the Standing Committee of National Board for the Wildlife(NBWL) to the Project :
Approval obtained
(a). MoEF File No :
6-2/2020 WL
(b). Copy of approval of Standing of the NBWL:
No Data
(c). Date of Approval :
20 Apr 2020
J.
Applicability of special provisions governing Scheduled Areas
(i).Whether the Project or a part thereof is located in a Scheduled Area? :
Yes
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 Approval
2
MOEF notificate exempting EIA
3
MOEF notificate exempting NOC from Gramsabha
4
Form 1 and 14 of Survey No 22
5
Form 1 and 14 of Survey No 31
6
Form 1 and 14 of Survey No 32
7
Form 1 and 14 of Survey No 33
8
Form 1 and 14 of Survey No 34
9
Form 1 and 14 of Survey No 35
10
Form 1 and 14 of Survey No 36
11
Form 1 and 14 of Survey No 37
12
Form 1 and 14 of Survey No 38
13
Form 1 and 14 of Survey No 39
14
Form 1 and 14 of Survey No 51
15
Form 1 and 14 of Survey No 52
16
Form 1 and 14 of Survey No 53
17
Form 1 and 14 of Survey No 54
18
Form 1 and 14 of Survey No 55
19
Form 1 and 14 of Survey No 56
20
Form 1 and 14 of Survey No 57
21
Form 1 and 14 of Survey No 58
22
Form 1 and 14 of Survey No 59
23
Form 1 and 14 of Survey No 61
24
Form 1 and 14 of Survey No 62
25
Form 1 and 14 of Survey No 67
26
Project Description of the project
27
Checklist of the Forest Diversion Proposal
28
Typical cross sections of the Proposed road
29
wildlife Sanctuary and National Park Cadastral/Land Plans
30
Reserved Forest Cadastral/Land Plans
31
Complete alignment plan with indication of Existing road usage and Proposed Road
32
Index Map of the project stretch
33
Geo-referenced Map of the project stretch
34
Form I & XIV of Sy.No 73 Surla village
35
Document verification certificate
36
Archeological importance Certificate
37
Compensatory afforestation Certificate
38
Cost of felling of Trees Certificate
39
Minimum forest area demand certificate
40
No Violation of FCA 1980
41
Unqualified Commitment Certificate
42
Net Present Value Certificate
43
Wildlife and National Park Area statement
44
Reserved Forest Area statement
45
Non Forest Area Statement
46
Exemption of Environmental Clearance
47
No Objection Certificate from Gramsabha
48
Form A of the Proposal
49
Cost Benefit Analysis
50
Submission of FDP to DCF WL&ET(North), DCF(North) and District Collector South Goa
51
Submission of EIA report
52
Request to process FCA Proposal
53
Compliance to the observations raised by RO Bangalore
54
Minutes of 57th Standing Committee of NBWL meeting
55
Compliance to REC recommendations
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