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/GA/ROAD/19984/2016
(ii). Name of Project for which Forest Land is required :
FDP:NH-17, Goa
(iii). Short narrative of the proposal and Project/scheme for which the forest land is required :
Four Laning of existing NH-17 from Km 475.040 to Km 611.000 in the state of Goa on BOT (Toll) basis under NHDP-III (Patradevi to Pollem Section on NH-17)
(iv). State :
Goa
(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) :
333100
(viii). Area of forest land proposed for diversion(in ha.):
29.836
(ix). Non-forest land required for this project(in ha.):
146.844
(x). Total period for which the forest land is proposed to be diverted(in years):
100
A-2.
Details of User Agency
(i). Name :
PUBLIC WORKS DEPARTMENT
(ii). Address1 :
The Executive Engineer, WD.Div.VII(NH),Public Works Department,13-A,C Type, Govt.Qtrs,Patto, Panaji-Goa
(iii). Address2 :
NIL
(iv). State :
Goa
(v). District :
North Goa
(vi). Pin :
403001
(vii). Landmark :
Govt. Qtrs, Patto
(viii). Email address :
ee7-pwd.goa@nic.in
(ix). Landline Telephone No. :
832-2438332
(x). Fax No. :
832-
(xi). Mobile No. :
9370694540
(xii). Website (if any) :
NIL
(xiii). Legal status of User Agency :
State Government
A-3.
Details of Person Making Application
(i). First Name:
Ulhas
(ii). Middle Name:
NIL
(iii). Last Name:
Kerkar
(iv). Gender:
Male
(v). Designation:
Executive Engineer
(vi). Address 1:
Works Division,VII(NH), Public Works Department,Patto Panaji
(vii). Address 2:
NIL
(viii). State:
Goa
(ix). District:
North Goa
(x). Tehsil:
Tiswadi
(xi). Pin:
403001
(xii). Landmark:
Govt.Qtrs, Patto
(xiii). Email Address:
ee7-pwd.goa@nic.in
(xiv). Landline Telephone No.:
832-2438332
(xv). Fax No.:
NIL
(xvi). Mobile No.:
9370694540
(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.
North
0
68.0475
2.
South
29.836
78.7965
Total
29.836
146.844
B-2.2
Details of Districts involved
District wise breakup
S.no
District Name
Forest Land(ha.)
Non-Forest Land(ha.)
1.
North Goa
0
68.0475
1.
South Goa
29.836
78.7965
Total
29.836
146.844
B-2.3
Village wise breakup
Villages wise breakup
S.no
Village
Forest Land(ha.)
Non-Forest Land(ha.)
1
Torxem
0
4.9675
2
Tamboxem
0
1.69
3
Uguem
0
3.66
4
Poroscodem
0
3.61
5
Amberem
0
1.51
6
Pernem
0
8.88
7
Virnora
0
1.01
8
Dargalim
0
6.22
9
Colvale
0
6.44
10
Mapusa
0
4.28
11
Bastora
0
1.11
12
Guirim
0
3.11
13
Socorro
0
9.91
14
Salvador-Do-Mundo
0
0.27
15
Pilerne
0
0.89
16
Penha-De-Franca
0
2.47
17
Morambi-O-Pequeno
0
0.48
18
Murda
0
1.96
19
Cujira
0
3.62
20
Calapor
0
1.96
21
Cortalim
0
0.6874
22
Nagoa
0
0.8503
23
Verna
0
0.3812
24
Dramapur
0
2.2
25
Sirlim
0
0.76
26
Chinchinim
0
1.0466
27
Cuncolim
0
19.489
28
Bali
0
13.24
29
Bendordem
0.136
6.95
30
Cordem
2.587
5.94
31
Padi
10.966
0.8
32
Canacona
6.695
3.71
33
Nagorcem Palolem
0.431
8.85
34
Barcem
8.68
6.702
35
Loliem
0.341
7.19
Total
29.836
146.844
B-2.4
Component wise breakup
Component wise breakup
S.no
Component
Forest Land(ha.)
Non-Forest Land(ha.)
1
Road
29.836
146.844
Total
29.836
146.844
C.
Maps of forest land proposed to be diverted
Division 1. : South
(i). Area of forest land proposed to be diverted(in ha.) :
29.836
(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.
29.495
View File
2.
0.341
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:
Up-gradation of 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):
500
(iii). Temporary Employment(Number of person-days):
1095
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?:
Yes
(a). Copy of Cost-Benefit analysis:
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:
Central Govt. Project
Additional information Details
Documents
S.No
Documents
Remarks
1
Administrative approval
2
Initial Social Impact Assessment report
3
MOEF circularexempting EIA
4
MOEF circularexempting NOC from gramsabha
5
Cost benefit Analysis
6
Project Description
7
Minimum Demand for forest area certificate
8
Net Present Value Certificate
9
Toposheet D43B13
10
Toposheet D43B14
11
Toposheet D43B15
12
Toposheet D43B16
13
Toposheet D43C4
14
Toposheet D43I1
15
Form I & XIV Bendordem 46
16
Form I & XIV Cordem 42
17
Form I & XIV cordem 23
18
Form I & XIV cordem 24
19
Form I & XIV Padi 12
20
Form I & XIV Padi 10
21
Form I & XIV Padi 7
22
Form I & XIV Padi 1
23
Form I & XIV Barcem 23
24
Form I & XIV Barcem 37
25
Form I & XIV Barcem 114
26
Form I & XIV Canacona 103
27
Form I & XIV Canacona 105-6
28
Form I & XIV Canacona 106-1
29
Form I & XIV Nagorcem Palolem 199
30
Form I & XIV Loliem 229
31
Index Map of the project Road
32
Document Verification Certificate
33
Form A of FDP
34
Check list
35
Archeological Importance certificate
36
Compensatory Afforestation certificate
37
Cost of felling of trees certificate
38
Unqualified commitment certificate
39
No violation of FCA 1980
40
Exemption of EIA Certificate
41
Certificate of No Objection from GramSabha
42
Typical Cross Sections of the Road
43
Social Impact Assessment report
44
Forest Area statement
45
Non-Forest Area statement
46
Forest Cadastral plans
47
Undertaking for Submission of FRA Certificate
48
Replies to observations of REC and Cost benefit analysis
49
Compliance to REC recommendations
50
Compliance letter to DCF(M&E)
51
Compliance to the observations raised
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