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/MP/Pipeline/146977/2021   (ii). Name of Project for which Forest Land is required : Madiya Multi Village Rural Water Supply Scheme   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Laying of Various Diameter Pipeline along the exiting Road Under ROW for providing drinking water in rural area 4.24122 ha forest has been proposed in South Sagar Division   (iv). State : Madhya Pradesh   (v). Category of the Proposal : Pipeline   (vi). Shape of forest land proposed to be diverted : Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 3000   (viii). Area of forest land proposed for diversion(in ha.): 4.24122   (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 : MP JAL NIGAM MARYADIT   (ii). Address1 : D, Wing, 2 Floor, Vindhyachal Bhawan, Bhopal   (iii). Address2 : NIL   (iv). State : Madhya Pradesh   (v). District : Bhopal   (vi). Pin : 462004   (vii). Landmark : Near Vallabh Bhawan, Bhopal   (viii). Email address : mpjalnigamdmo@gmail.com   (ix). Landline Telephone No. : 755-2579034   (x). Fax No. : 755-   (xi). Mobile No. : 8349662530   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Devendra   (ii). Middle Name: Kumar   (iii). Last Name: Jain   (iv). Gender: Male   (v). Designation: General Manager   (vi). Address 1: F-1, Sinchai Colony, Jabalpur Naka Road, Damoh   (vii). Address 2: NIL   (viii). State: Madhya Pradesh   (ix). District: Damoh   (x). Tehsil: Damoh   (xi). Pin: 470661   (xii). Landmark: NIL   (xiii). Email Address: gmdamoh.mpjalnigam@mp.gov.in   (xiv). Landline Telephone No.: 781-2222785   (xv). Fax No.: NIL   (xvi). Mobile No.: 8349662530   (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.Sagar South(T)4.241220
Total4.241220
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Sagar4.241220
Total4.241220
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Umariya Semra0.01470
2Lalbag0.350910
3Hurakutguwan0.01540
4Lalbag, Shikarpur0.256590
5Kalyanpur bir0.05720
6Chhirkheda0.069250
7Kharighumariya0.057070
8Menwarkalan0.031430
9Tilabujurg0.016640
10Dhakrai0.020220
11Mardanpur, Berkhedi0.1920
12pachwaha0.003430
13Imalia0.0370
14Khaharmau0.02180
15Chenpura0.0008250
16padrai0.0154050
17Sagoni puraina, midwasa0.13240
18Manakchauk0.001150
19Devlapur0.00420
20tahra tahri0.0030
21parasari kalan0.013440
22Bahadurpur0.011050
23Dabri0.0094250
24sarkhadi0.083760
25Padrai, tendudaber0.250980
26Darkoli0.11430
27mahuwa kheda0.054350
28panari0.075240
29simaria0.00720
30Jera, sagoni bhat (672, 668)0.310950
31Banjariya0.03650
32Buxwaha0.01660
33Bamhorighat0.012250
34Bisunpur0.0280
35Piperia gehalpur0.05150
36Bichhuwa0.01010
37gauraiya0.070830
38Gondi0.05980
39Dungariya0.01370
40Gousara0.06090
41samnapur0.08510
42bhilaiya0.009950
43khamariya gond0.162540
44hinnod0.025750
45barkhuwamahant0.024150
46saji0.060360
47Shobhapur0.04930
48Sahajpur bujurg0.100950
49Jhamra0.045850
50Tendubaber0.222890
51mochal0.2608350
52Rehli0.0590
53Badua0.0280
54Gungucha0.0255450
55pargaspura, jamuniya gond0.207360
56Hanota Sagar0.06540
57jaisinagar, khamariya0.2167450
Total 4.24122 0
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Laying of Pipe line under RoW width 0.5 mtr1.608280
2Laying of Pipe line under RoW width 1 mtr0.01470
3Laying of Pipe line under RoW width 0.9 mtr1.254150
4Laying of Pipe line under RoW width 0.8 mtr0.473440
5Laying of Pipe line under RoW width 0.7 mtr0.261380
6Laying of Pipe line under RoW width 0.65 mtr0.253630
7Laying of Pipe line under RoW width 0.6 mtr0.375640
Total 4.24122 0
C. Maps of forest land proposed to be diverted
Division 1. : Sagar South(T)
  (i). Area of forest land proposed to be diverted(in ha.) : 4.24122   (ii). Nature of the Project: Linear   (b). No. of Segments : Two
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).
1.1.30395    View File
2.2.93727    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: Work has been proposed along with 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): 250   (iii). Temporary Employment(Number of person-days): 450
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? : 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 ?: Not Applicable   (iii) . Reason for not providing Non-Forest Land: Public utility projects (excluding mining and regularization of encroachments) involving less than 20 hecatres of forest land implemented by Govt. Departments in hill districts and in other districts having forest area exceeding 50% of the total geographical area
Additional information Details
Documents
S.No Documents
Remarks
1CA Certificate
2NPV Certificate