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/KA/ROAD/37738/2018   (ii). Name of Project for which Forest Land is required : Upgradation to Two Lane with Paved Shoulder of Belekeri to Hattikeri (766EE) and Kumta to Sirsi (NH766E) (excluding Stretch of NH66) in the State of Karnataka   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : The Project road is an improvement of existing intermediate lane/two lane to two lane with paved shoulder configuration. The purpose of improvement of road is to provide safe, better and smooth connectivity to the western and eastern part of the districts and the region.   (iv). State : Karnataka   (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) : 4596100   (viii). Area of forest land proposed for diversion(in ha.): 39.8466   (ix). Non-forest land required for this project(in ha.): 8.0399   (x). Total period for which the forest land is proposed to be diverted(in years): 99
A-2. Details of User Agency
  (i). Name : NATIONAL HIGHWAYS AUTHORITY OF INDIA PIU DHARWAD   (ii). Address1 : National Highways Authority of India Project Implementation Unit, 2nd Cross, Sattur Colony, Vidyagiri, Dharwad.   (iii). Address2 : NIL   (iv). State : Karnataka   (v). District : Dharwad   (vi). Pin : 580004   (vii). Landmark : Opposite JSS College   (viii). Email address : dha@nhai.org   (ix). Landline Telephone No. : 836-2461442   (x). Fax No. : 836-2461244   (xi). Mobile No. : 9945131911   (xii). Website (if any) : www.nhai.org   (xiii). Legal status of User Agency : Central Government
A-3. Details of Person Making Application
  (i). First Name: Potdar   (ii). Middle Name: NIL   (iii). Last Name: SD   (iv). Gender: Male   (v). Designation: Project Director   (vi). Address 1: National Highways Authority of India Project Implementation Unit, 2nd Cross, Sattur Colony, Vidyagiri, Dharwad.   (vii). Address 2: NIL   (viii). State: Karnataka   (ix). District: Dharwad   (x). Tehsil: NIL   (xi). Pin: 580004   (xii). Landmark: Opposite JSS College   (xiii). Email Address: piudharwad@gmail.com   (xiv). Landline Telephone No.: 836-2461442   (xv). Fax No.: 08362461244   (xvi). Mobile No.: 9822849505   (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.Honavar19.19863.6768
2.Sirsi20.6484.3631
Total39.84668.0399
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Uttara Kannada39.84668.0399
Total39.84668.0399
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Antharavalli(FS.no90,91,92,93,253,256,258,259)1.11080.5826
2Antharavalli(FS.no276,286,352,353,354,355)1.05950
3Alkonda(FSN2,23,27,32,34,36,37,65,66,26A,26A1)1.87530.6841
4Harita (FSN.2, 5,19, 20, 27, 39)0.20291.5086
5Dhivagi (Forest Svy.no.190, 112, 111, 96A1)2.23640.3324
6Bellangi (ForestSvy.no.37, 41, 42, 43)0.4980.4073
7Kodabale (ForestSvy.no.2, 23, 25, 27, 29, 59)12.21570.1618
8Devimane (ForestSvy.no.25, 28, 30, 39)1.18140.1494
9Hebre (ForestSvy.no.55, 68,111, 127,131, 143, 148,1.98510.2223
10Hosura (ForestSvy.no.9, 18)0.48390
11Theppara (ForestSvy.no.2, 25)0.50150.2314
12Bandala (ForestSvy.no.31, 36, 45,64,79, 82, 106,1.77570.4222
13Khurse (ForestSvy.no.60, 62, 82, 88, 90, 91, 92,934.16540.0959
14Sampakhanda (ForestSvy.no.15, 20, 79, 104, 107, 121.13750.2083
15Janmane (ForestSvy.no.80, 94, 112, 113, 118, 122,2.03480.3819
16Mattigar (ForestSvy.no.219, 220, 221, 257, 259, 261.83250.2635
17Neggu (ForestSvy.no.32, 78, 97, 98, 37/B1)0.45230.1265
18Oorathota (ForestSvy.no.88 , 88B)0.07380.1004
19Hostota (ForestSvy.no.1, 2,3, 34, 35, 44, 159, 161.50120.2838
20Hanumanthi (ForestSvy.no.1, 2, 20, 32,34, 35A1, 352.28670.2777
21Heepanalli (ForestSvy.no.68, 79, 80, 84, 85, 86, 10.75450.0151
22Mundagesara (ForestSvy.no.202, 330, 188/B1)0.48170
23Manajavalli01.5847
Total 39.8466 8.0399
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Utility corridor(irregular polygon in nonforestlan1.19540
2Paved Shoulder (Irregular Polygon in Nonforest Lan3.98470
3Earthern Shoulder (Irregular Polygon in Nonforest4.78160
4Footpath Cum Drain (Irregular Polygon in Nonforest1.99230
5Drain (Irregular Polygon in Nonforest Land)5.9770
6Embankment (Irregular Polygon in Nonforest Land)7.17240
7Retaining wall(Irregular Polygon in Nonforest Land4.78160
8Bridges (Irregular Polygon in Nonforest Land)3.18770
9Culverts(Irregular Polygon in Nonforest Land)3.18770
10Road (irregular polygon)3.58628.0399
Total 39.8466 8.0399
C. Maps of forest land proposed to be diverted
Division 1. : Sirsi
  (i). Area of forest land proposed to be diverted(in ha.) : 20.648   (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).
1.20.648    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. : Honavar
  (i). Area of forest land proposed to be diverted(in ha.) : 19.1986   (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).
1.19.1986    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: Widening 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): 20   (iii). Temporary Employment(Number of person-days): 50
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? : Yes   (a). Copy of documentry evidence in support of settlement of rights under the Forest Rights Act,2006 on the forest land proposed to be diverted:
L. Details of land identified for Compensatory Afforestation
  (i). Whether non-forest or Revenue forest land is required to be provided by User Agency?: Not Applicable   (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 ?: Not Applicable   (iii) . Reason for not providing Non-Forest Land: Not Applicable
Additional information Details
Documents
S.No Documents
Remarks
1Administrative approval
2Letter on Submission of project alignment in AutoCad & KML to Forest Dept. official E-mail ID.
3Compliance to EDS raised by DCF, Honnavara Forest Division.
4Compliance to EDS raised by DCF, Sirsi Forest Division.
5Compliance to EDS raised by DCF, Honnavara on 26.09.2019
6Compliance to EDS raised by DCF, Sirsi on 08.11.2019
7Compliance to EDS raised by DCF, Sirsi Forest Division 16.11.2019
8Compliance to EDS raised by RO, MOEFCC, Bengaluru 04.02.2020.
9Compliance to EDS Raised by PCCF 20.03.2020
10Compliance to EDS raised by RO, MOEFCC, Bengaluru 05.05.2020.
1120m interval coordinates of all corners of proposed RoW line within forest land requested for Diversion.
12Certificate on non-violation of Forest (Conservation) Act.
13Compliance to EDS raised by RO, MOEFCC, Bengaluru 03.08.2020.
14Cost Benefit Analysis for the Project..
15Details of diversion of 21.7629Ha Forest land for the project.
16Geo-reference map of Honavara Division showing forest and non-forest land along the alignment.
17Geo-reference map of Sirsi Division showing forest and non-forest land along the alignment.
18Justification for locating Project In forest land for Diversion of 21.7629Ha.
19Details of Non-Forest land proposed to be acquired for the project.
20SOI Toposheet showing project road.
21Typical Cross Section of the project road.
22Undertaking on Payment of NPV & Revised NPV for Diversion of 21.7629Ha forest land.
23Undertaking on Payment Of Tree Extraction Charges for Trees present in PROW.
24Undertaking on leaving Belekeri - Hattikeri NH766EE section form FC.
25Undertaking on Recognition of Forest Rights under FRA 2006 for the project.
26Undertaking on Payment of CA Cost.