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/HR/WATER/37822/2018   (ii). Name of Project for which Forest Land is required : Augmentation of Drinking Water Supply Status 80 Nos. villages and Firojpur Jhirka Town   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Proposal for diversion of forest land for laying drinking water pipeline (DI Pipeline) of size, 200, 300, 600mm for supply of drinking water to various village (vill. Ranyala, Agaon, Hasanpur Balonda, Kol gaon, Sakras gao etc.) of district Mewat   (iv). State : Haryana   (v). Category of the Proposal : Drinking Water   (vi). Shape of forest land proposed to be diverted : Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 26300   (viii). Area of forest land proposed for diversion(in ha.): 3.55   (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): 45
A-2. Details of User Agency
  (i). Name : PUBLIC HEALTH ENGINEERING DEPARTMENT   (ii). Address1 : Executive Engineer, Public Health Engineering Division No. 1 Nuh   (iii). Address2 : NIL   (iv). State : Haryana   (v). District : Palwal   (vi). Pin : 122107   (vii). Landmark : NIL   (viii). Email address : eephnuh@gmail.com   (ix). Landline Telephone No. : 1267-271278   (x). Fax No. : 1267-   (xi). Mobile No. : 9467596075   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Faisal   (ii). Middle Name: NIL   (iii). Last Name: Ibrahim   (iv). Gender: Male   (v). Designation: executiveengineer   (vi). Address 1: O/o the Executive Engineer, PHE, Division No. 1, Nuh   (vii). Address 2: NIL   (viii). State: Haryana   (ix). District: Palwal   (x). Tehsil: Palwal   (xi). Pin: 121102   (xii). Landmark: NIL   (xiii). Email Address: sepalwalcircle@gmail.com   (xiv). Landline Telephone No.: 1275-246688   (xv). Fax No.: NIL   (xvi). Mobile No.: 9810082597   (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.Mewat3.550
Total3.550
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Mewat3.550
Total3.550
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Mau Chowk to Sakras0.20440
2Ranyali to Agon0.87920
3Agon to Kolgaon0.56460
4Agon to Doha0.5080
5Agon to Sohalpur0.18640
6Sohalpur to Hasanpur Bilonda0.19280
7Sohalpur to Patkhori0.2640
8Tighra Mod to Kameda0.10460
9Kameda to Firozpur Jhirka0.18640
10Kameda to Sidhrawat0.34480
11Tighra Mod to Ghata Shamsabad0.11480
Total 3.55 0
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Laying of drinking water Pipe line3.550
Total 3.55 0
C. Maps of forest land proposed to be diverted
Division 1. : Mewat
  (i). Area of forest land proposed to be diverted(in ha.) : 3.55   (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).
1.3.55    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: NIL
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 0   (iii). Temporary Employment(Number of person-days): 10
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: Others
Additional information Details
Documents
S.No Documents
Remarks
1Administrative approval
2Checklist
3Layout plan