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/TN/WATER/42977/2019   (ii). Name of Project for which Forest Land is required : CWSS to Villupuram District Beneficiaries with 60 MLD DSP as source   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Drinking water supply to Villupuram district beneficiaries with setting up desalination plant at Koonimedu as source   (iv). State : Tamil Nadu   (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) : 150000   (viii). Area of forest land proposed for diversion(in ha.): 16   (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): 30
A-2. Details of User Agency
  (i). Name : TAMILNADU WATER SUPPLY AND DRAINAGE BOARD   (ii). Address1 : O/o Executive Engineer, TWAD Board, P.F Division   (iii). Address2 : no.3, GST Road, Tindivanam Po, Villupuram District   (iv). State : Tamil Nadu   (v). District : Viluppuram   (vi). Pin : 604001   (vii). Landmark : Opp. to Tindivanam Railway Station   (viii). Email address : eepftdm@gmail.com   (ix). Landline Telephone No. : 4147-223259   (x). Fax No. : 4147-   (xi). Mobile No. : 9994013391   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State PSU
A-3. Details of Person Making Application
  (i). First Name: Susheela   (ii). Middle Name: NIL   (iii). Last Name: T   (iv). Gender: Female   (v). Designation: Executive Engineer   (vi). Address 1: No.3, GST Road, Tindivanam Po, Villupuram District   (vii). Address 2: Tindivanam Po, Villupuram District   (viii). State: Tamil Nadu   (ix). District: Viluppuram   (x). Tehsil: Tindivanam   (xi). Pin: 604001   (xii). Landmark: Opp. to Tindivanam Railway Station   (xiii). Email Address: eepftdm@gmail.com   (xiv). Landline Telephone No.: 4147-223259   (xv). Fax No.: NIL   (xvi). Mobile No.: 9487750259   (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.Villupuram160
Total160
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Viluppuram160
Total160
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1koonimedu160
Total 16 0
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1sea water intake chamber and PH0.020
2Receiving chamber0.0040
3Flash mixing tank0.0010
4Flocculation tank0.020
5Lamella clarifier0.020
6Sludge Holding tank0.0110
7Thickener0.0710
8Dual media filter0.0060
9Filter house0.2230
10Filtrate collection tank0.1850
11UF permeate tank0.1850
12SWRO Permeate tank0.0250
13Product water storage tank0.4580
14Product water pump house0.0250
15Reject tank0.0960
16Backwash waste collection tank0.0530
17Plant security gate complex0.0060
18Fecl3 storage dyke wall0.0090
19NaOCl storage dyke wall0.0110
20H2So40.0030
21Antiscalant dosing shed0.0040
22Chemical storage room0.0050
23Conference room0.0060
24Lab0.0060
25Membrane storage room0.0040
26Lime stone feed pump shed0.0030
27Co2 storage area0.010
28Lime handling building0.0160
29Administration building0.020
30Canteen building0.0150
31Parking area0.0360
32Sewage treatment plant0.0150
33Offset OTS area2.5930
34Access & internal roads and Hard paved area1.4830
35Green belt area ( as per MoEF & CC requirement ))3.180
36Area required for future expansion4.320
37Caustic storage dyke wall0.0020
38Blower room0.0030
39Instrument Compressor room0.0050
40Workshop0.010
41Outdoor switch yard2.0240
42MRSS 11 KV substation0.0420
43Electrical control building0.0420
44UF building0.3780
45RO building0.3350
46UF feed pump shed0.0030
47SWRO feed pump shed0.0040
48SMBS dosing shed0.0040
Total 16 0
C. Maps of forest land proposed to be diverted
Division 1. : Villupuram
  (i). Area of forest land proposed to be diverted(in ha.) : 16   (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    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).
1.16    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: non availability of alternative land
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 50   (iii). Temporary Employment(Number of person-days): 365
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?: Yes   (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). No. of districts involved for raising Compensatory Afforestation: 1   (iv). No. of patches: Three
District 1. : Viluppuram
  (a). Village: Kattalai   (b). Area(in ha.): 7.09   (c). Copy of KML file of the patch:     View File   (d). Khasra details: Kattalai SF.No 5/1,5/2,5/3,7/1   (e). Present owner: Others   (f). Copy of ownership proof:   (g). Copy of Mou/agreement executed between the Present owner and the User Agency:   (h). Copy of non encumberence certificate for the forest land:
District 2. : Viluppuram
  (a). Village: Kattalai   (b). Area(in ha.): 14.325   (c). Copy of KML file of the patch:     View File   (d). Khasra details: Kattalai SF.No.8/1,8/2,12,36/1,37/1   (e). Present owner: Others   (f). Copy of ownership proof:   (g). Copy of Mou/agreement executed between the Present owner and the User Agency:   (h). Copy of non encumberence certificate for the forest land:
District 3. : Viluppuram
  (a). Village: Karattai   (b). Area(in ha.): 11.055   (c). Copy of KML file of the patch:     View File   (d). Khasra details: Karattai SF.No 107/2,108,109/1,109/2,110/3,110/4,119,120/1,120/2,127,128/3,128/4,135/2,136/1,136/2   (e). Present owner: Others   (f). Copy of ownership proof:   (g). Copy of Mou/agreement executed between the Present owner and the User Agency:   (h). Copy of non encumberence certificate for the forest land:
  (v). Scanned copy of the map of the land identified for creation of Compensatory Afforestation prepared by using GPS ot Total Station:   (vi). Copy of Survey of India Toposheet in 1:50,000 scale indicating location of the land identified for creation of Compensatory Afforestation:
Additional information Details
Documents
S.No Documents
Remarks
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18Map clearly depicting the proposed DSP component wise details is furnished
19Undertaking to effect that the desalinated water will be utilized for drinking water purpose
20additional information/ documents/ clarifications are provided vide The Deputy Inspector General of Forests (Central), Chennai to The Principal Chief Conservator of Forests / Forest Department Chennai Lr.No. F.No.4-TNC061/ 2020 - CHN/ 632, Dated :05.08.2020
21detailed report on quantity of water allocation for each purpose under this scheme / proposal
22Certificate regarding free from encroachment and litigation