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/Others/38703/2019
(ii). Name of Project for which Forest Land is required :
Change of land use pattern of diverted forest land for achieving the objectives of The Totgars Cooperative Sale Society Ltd., Sirsi along with construction of Ayurvedic Hospital
(iii). Short narrative of the proposal and Project/scheme for which the forest land is required :
Request to permit us to use the diverted forest land of Sy.No.47 of Chipgi Village in Sirsi Taluk for achieving the objectives of our Society along with construction of Ayurvedic Hospital.
(iv). State :
Karnataka
(v). Category of the Proposal :
Others
(vi). Shape of forest land proposed to be diverted :
Hybrid
(vii). Estimated cost of the Project(Rupees in lacs) :
700
(viii). Area of forest land proposed for diversion(in ha.):
2.02
(ix). Non-forest land required for this project(in ha.):
0
(x). Total period for which the forest land is proposed to be diverted(in years):
20
A-2.
Details of User Agency
(i). Name :
THE TOTGARS COOPERATIVE SALE SOCIETY LTD SIRSI
(ii). Address1 :
The Totgars' Cooperative Sale Society Ltd., Market Yard, Sirsi Uttara Kannada District, Karnataka
(iii). Address2 :
NIL
(iv). State :
Karnataka
(v). District :
Uttara Kannada
(vi). Pin :
581402
(vii). Landmark :
NIL
(viii). Email address :
tss@tssindia.in
(ix). Landline Telephone No. :
8384-236371
(x). Fax No. :
8384-
(xi). Mobile No. :
9008231123
(xii). Website (if any) :
NIL
(xiii). Legal status of User Agency :
Others
A-3.
Details of Person Making Application
(i). First Name:
Raveesh
(ii). Middle Name:
Achut
(iii). Last Name:
Hegde
(iv). Gender:
Male
(v). Designation:
GeneralManager
(vi). Address 1:
The Totgars Cooperative Sale Society Ltd, Market Yard, Sirsi
(vii). Address 2:
NIL
(viii). State:
Karnataka
(ix). District:
Uttara Kannada
(x). Tehsil:
NIL
(xi). Pin:
581402
(xii). Landmark:
NIL
(xiii). Email Address:
tss@tssindia.in
(xiv). Landline Telephone No.:
8384-236371
(xv). Fax No.:
NIL
(xvi). Mobile No.:
9008231123
(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
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
1
Approved
4015
F.No.FCA/11.2/193/KAR/BC/49
2.02
2.02
16 Jan 2002
13 Apr 2016
2
Approved
FP/KA/DISP/47/2000
F.No. FCA/11.2/193/KAR/BC/49
2.02
2.02
16 Jan 2002
13 Apr 2016
Total
4.04
4.04
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.
Sirsi
2.02
0
Total
2.02
0
B-2.2
Details of Districts involved
District wise breakup
S.no
District Name
Forest Land(ha.)
Non-Forest Land(ha.)
1.
Uttara Kannada
2.02
0
Total
2.02
0
B-2.3
Village wise breakup
Villages wise breakup
S.no
Village
Forest Land(ha.)
Non-Forest Land(ha.)
1
Chipagi F.Sy.No.47
2.02
0
Total
2.02
0
B-2.4
Component wise breakup
Component wise breakup
S.no
Component
Forest Land(ha.)
Non-Forest Land(ha.)
1
Ayurvedic Hospital
0.1038
0
2
Herbal Garden
0.0187
0
3
Canteen
0.0173
0
4
Bore/UG Tank
0.012
0
5
Parking-1
0.0856
0
6
Ayurvedic Research Centre
0.0815
0
7
Auction House
0.128
0
8
Courtyard
0.1083
0
9
Warehouse
0.0815
0
10
Areca Research Centre
0.0634
0
11
Rice Mill
0.0634
0
12
Doctors/Nurse Quarters
0.0395
0
13
Parking
0.0202
0
14
Parking-2
0.0548
0
15
Way
0.0088
0
16
Internal Road & Open space
1.1331
0
Total
2.0199
0
C.
Maps of forest land proposed to be diverted
Division 1. : Sirsi
(i). Area of forest land proposed to be diverted(in ha.) :
2.02
(ii). Nature of the Project:
Hybrid
(a). No. of patches :
One
Patch wise details
Patch No.
Area of Patch(in ha.)
Kml File of Patches
To view KML file on google the same may be downloaded and then open if in google earth install in your computer.
1.
0.91075877
View File
(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.
0.82
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:
Yes
(a). Copy of map indicating location of alternative examined:
E.
Employment likely to be generated
(i). Whether the Project is likely to generate employment ?:
Yes
(ii). Permanent/Regular Employment(Number of persons):
350
(iii). Temporary Employment(Number of person-days):
650
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?:
No
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?:
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:
Others
Additional information Details
Documents
S.No
Documents
Remarks
1
Letter of undertaking regarding NPV and Compensatory Afforestation
2
No construction work is being under taken at the diverted forest land in F.Sy.No47 of Chipagi village in Sirsi Taluk except erection of compound wall which has been done to comply the conditions laid down by the department while giving in-principle approval for the proposal.
3
Stage-|| approval of the Ministry of Forests, Environment & Climate Change for diversion of 2.02ha of forest land in Sy.No.47 of Chipagi village of Sirsi taluk for construction of hospital by the Totgars' Cooperative Sale Society Ltd., Sirsi.
4
Approval of the Government of Karnataka for diversion of 2.02ha of forest land in Sy.No.47 of Chipagi village of Sirsi taluk for construction of hospital by the Totgars' Cooperative Sale Society Ltd., Sirsi.
5
Approved layout plan in respect of stage -II approved project for diversion of 2.02ha forest land in F.Sy.No.47 of Chipagi village in Sirsi Taluka for construction of 100 bed modern hospital
6
Proposed layout plan for re-diversion of 2.02ha forest land in F.Sy.No.47 of Chipagi village in Sirsi taluka for multipurpose project involving construction of Areca nut Auction House, Ayurvedic Hospital, Warehouse, Rice Mill, Ayurvedic Research Centre, Areca nut Research Centre etc.,
7
Component-wise length width break up of all regular shaped components.
8
Compliance to EDS.
9
Clarification regarding the remark in Additional Information Details/General column.
10
GPS readings (Datum:WGS-84; in Degree.decimals of all corners of the diverted forest land as well as at a regular 20 meter interval.