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/UK/ROAD/11782/2015   (ii). Name of Project for which Forest Land is required : Goluchhina Srikhet Motor Road KM 08 to Gomri Motor Road   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Construction of Goluchhina Srikhet Motor Road KM 08 to Gomri Motor Road in Someswer constituency,Distt Almora.Construction of Goluchhina Srikhet Motor Road KM 08 to Gomri Motor Road is proposed as a extension of Goluchhina Srikhet motor road the sention lenth of proposed motor road is 1.00 km.   (iv). State : Uttarakhand   (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) : 12.6   (viii). Area of forest land proposed for diversion(in ha.): 0.54   (ix). Non-forest land required for this project(in ha.): 0.36   (x). Total period for which the forest land is proposed to be diverted(in years): 1000
A-2. Details of User Agency
  (i). Name : EXECUTIVE ENGINEER   (ii). Address1 : Provincial Division P.W.D., Almora   (iii). Address2 : Mall Raod Almora   (iv). State : Uttarakhand   (v). District : Almora   (vi). Pin : 263601   (vii). Landmark : Chaughan Pata, Almora   (viii). Email address : eepdalmora@rediffmail.com   (ix). Landline Telephone No. : 5962-2320033   (x). Fax No. : 5962-5962   (xi). Mobile No. : 7533877888   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Vijay   (ii). Middle Name: NIL   (iii). Last Name: Kumar   (iv). Gender: Male   (v). Designation: Executive Engineer   (vi). Address 1: Executive Engineer, Provincial Division, Public works Department, Almora   (vii). Address 2: Mall Road Almora   (viii). State: Uttarakhand   (ix). District: Almora   (x). Tehsil: Almora   (xi). Pin: 263601   (xii). Landmark: Chaughan Pata, Almora   (xiii). Email Address: eepdalmora@rediffmail.com   (xiv). Landline Telephone No.: 5962-230033   (xv). Fax No.: 059622320033   (xvi). Mobile No.: 9456104668   (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.Almora0.540.36
Total0.540.36
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Almora0.540.36
Total0.540.36
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1majholi chak bagdwar0.470.135
2gumori0.070.225
Total 0.54 0.36
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1motor road0.540.36
Total 0.54 0.36
C. Maps of forest land proposed to be diverted
Division 1. : Almora
  (i). Area of forest land proposed to be diverted(in ha.) : 0.54   (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).
1.0.54    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): 12
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: Diversion of forest land up to one hectare
Additional information Details
Documents
S.No Documents
Remarks
1A short narrative and importance of the project
2Administrative and Financial sanction
3Preliminary Joint Inspection report
4Comperative chart showing statement of both alignment or alternate site explored for the proposed project and reasons for their rejection duly countersigned by DFO.
5Certificate from the DM that no alternative suitable non-forest land is available for the project in question and the demand of the forest land for the project is barest minimum.
6Land schedule (for RF signed by DFO and civil soyam, Van panchayat and private nap land signed by DM).
7Category wise (RF,civil soyam, Van panchayat and private nap land, Notified forest land etc.) land length, width and area in Ha
8Bar Chart with index
9Certificate Regarding. suitability of indentified land for Comensatory Afforestation by DFO
10Undertaking by the User Agency to bear the cost of compensatory afforestation duly counter signed by the DFO
11Road side/gap filling plantation estimate
12Undertaking by the User Agency to bear the cost of Road side /gap filling plantation
13Estimate of 100 trees plantation by DFO
14Certificate of felling minimum trees during the project work
15Whather project area is a part of National Park or sanctuary and airal distance of the project from National Park or sanctuary signed by DFO
16If the project area is within 10 Km radius of N/P or Centuary, Comments/No objection certificate of CCF Wild Life has to be provided
17If the Project falling within the National park or Sanctuary, needs recommendation of State Wild Life Board, National Board of Wild Life (NBWL) and permission of Hon'ble Supreme Court/MoEF GoI.
18No voilation has taken place, FC Act. 1980 reg.
19NOC from local Gram Sabhas
20Approved general lay out plan/alignment and estimate from competent authority with name and designation
21Component wise details of construction work.
22Certificate- work has not been started reg.
23Geologist Report (Govt. approved Geologist
24Task Force report
25Muck disposal
26Details of the trees with their scientific name in RF, Civil Soyam, Van Panchayat, Private Notified land and in Nap Land should be mentioned (with valuation of the trees to be felled ) (0-10 dia trees will be mentioned as saplings).
27Felling of Oak trees (if involves, inspection report of the concerning CF has to be provided).
28If felling of trees is not involved, certificate by DFO in this regard
29Item wise details of works
30Certificate by user agency for complying the condition imposed in Manak Shartain
31Certificate by suer agency for complying the condition imposed in geologist report/Task forcex recommendation in hill areas
32No historical/monumental or relegeous place will be effected certificate reg
33Undertakoing regarding no animal will be effected adversely by the project
34Undertading to provide alternative fuelwood, kerosene or LPG to labours involved in project
35Benefited villages/Families/Population Certificate
36NPV calculation certificate as per Hon'ble Supreem court /MoEF orders by DFO
37Undertaking of payment of NPV, if Hon'ble Supreem Court increses the rates of NPV
38Cost of the forest land and lease rent certificate by DM
39Certificate of Lease period by user agency
40Demarcation of land to be diverted
41Compensatory afforestation scheme in Civil and Soyam land
42Undertaking of user agency to bear the cost for dimarcation work
43Non-availability of non-forest land for compensatory afforastation certificate by Chief secretary
44Check list/Fact sheet
45EDS DFO dt 30.07-2016
46as per instruction objection removed
47EDS date 13-7-16 as per instruction objection removed
48EDS DFO 30.07.2016