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/WATER/30539/2017   (ii). Name of Project for which Forest Land is required : For construction Break Pressure Tank and Raising Main & Gravity Main Pipeline at Forest land Sy.No.33 of Chitradurga Village & Non-Forest land Sy.No. 85, 70 & 71 Kunchiganalur Village in Chitradurga District for supply of drinking water to Chitradurga City under AMRUT Project from Vani Villasa Sagar Source   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Diversion of 0.1981 hectare of forest land in Sy.No.33 of Chitradurga Village and 0.0756 ha. of non-forest land in Sy.85, 70 & 71 of Kunchiganalu Village & Chitradurga Division for construction BPT & Raising Main & Gravity Main Pipeline for supply of drinking water from Vani Villasa Sagar Source to   (iv). State : Karnataka   (v). Category of the Proposal : Drinking Water   (vi). Shape of forest land proposed to be diverted : Hybrid   (vii). Estimated cost of the Project(Rupees in lacs) : 11200   (viii). Area of forest land proposed for diversion(in ha.): 0.1981   (ix). Non-forest land required for this project(in ha.): 0.0756   (x). Total period for which the forest land is proposed to be diverted(in years): 30
A-2. Details of User Agency
  (i). Name : MUNICIPAL COMMISSIONER   (ii). Address1 : City Muncipal Council   (iii). Address2 : Opp New Town Police Station B D Road Chitradurga   (iv). State : Karnataka   (v). District : Chitradurga   (vi). Pin : 577501   (vii). Landmark : Opp New Town Police Station   (viii). Email address : itstaff_ulb_chitradurga@yahoo.com   (ix). Landline Telephone No. : 8194-222401   (x). Fax No. : 8194-   (xi). Mobile No. : 9164446005   (xii). Website (if any) : www.chitradurgacity.mrc.gov.in   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: C   (ii). Middle Name: NIL   (iii). Last Name: Chandrappa   (iv). Gender: Male   (v). Designation: MC   (vi). Address 1: City Municipal Council Opp New Town Police Station B D Road Chitradurga   (vii). Address 2: NIL   (viii). State: Karnataka   (ix). District: Chitradurga   (x). Tehsil: Chitradurga   (xi). Pin: 577501   (xii). Landmark: Opp New Town Police Station   (xiii). Email Address: itstaff_ulb_chitradurga@yahoo.com   (xiv). Landline Telephone No.: 81944-222401   (xv). Fax No.: NIL   (xvi). Mobile No.: 9164446005   (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.Chitradurga0.19810.0756
Total0.19810.0756
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Chitradurga0.19810.0756
Total0.19810.0756
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Chitradurga Village Sy.No.330.19810
2Kunchiganalu Village Sy.No.7000.0294
3Kunchiganalu Village Sy.No.7100.0192
4Kunchiganalu Village Sy.No.8500.027
Total 0.1981 0.0756
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Raising & Gravity Main Pipe line (L 232.9 x W 6 mt0.13970.0756
2Proposed BPT (24.175 x 24.175mtr) 5 Lakhs Ltr Ca0.05840
Total 0.1981 0.0756
C. Maps of forest land proposed to be diverted
Division 1. : Chitradurga
  (i). Area of forest land proposed to be diverted(in ha.) : 0.1981   (ii). Nature of the Project: Hybrid   (a). No. of patches : One
Patch wise details
Patch No. Area of Patch(in ha.) Kml File of PatchesTo view KML file on google the same may be downloaded and then open if in google earth install in your computer.
1.0.0584    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).
1.0.1397    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): 2   (iii). Temporary Employment(Number of person-days): 1000
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?: 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
1Approval from the Competent Authority Letter-1
2Approval from the Competent Authority Letter-2
3Component wise Breakup details and Pipe dia details
4Undertaking for NPV & Other Statutory Payments
5Authorization Letter
6Justification letter
7Toposheet Map
8Village Map
9Sy No 56 58 60 61 & 70 is handover to Chitradurga Muncipal vide Mysore Govt Notification No:AF-144-FT-142-38-8 dt 08-07-1940 & DCF ,Chitradurga Letter
10Plain Map
11Google map of Chitradurga Village
12Google map of Chitradurga & Kunchiganalu Village