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/KA/ROAD/120467/2021   (ii). Name of Project for which Forest Land is required : 4 L of Addahole (Near Gundya) to Bantwal Cross Section (Pkg-01) from Design Km. 255.140 to Design Km. 270.270 of NH-75 (Old NH-48)   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Diversion of 2.5315 Ha additional forest land for Four-Laning of the Bangalore-Mangalore section of NH-48 (New NH-75) from Design Chainage Km 255.140 to Km 270.270 passing through reserve forest stretch of Four laning of Addahole (Near Gundya) (Existing Chainage Km. 263.000, Design Chainage Km. 255.   (iv). State : Karnataka   (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) : 40600   (viii). Area of forest land proposed for diversion(in ha.): 2.5315   (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): 100
A-2. Details of User Agency
  (i). Name : NATIONAL HIGHWAYS AUTHORITY OF INDIA PIU MANGALORE   (ii). Address1 : National Highways Authority of India, Project Implementation Unit, Door No.3-29, Bethel, Tharethota, Near Pumpwell, NH-66, Mangalore   (iii). Address2 : NIL   (iv). State : Karnataka   (v). District : Mangalore   (vi). Pin : 575005   (vii). Landmark : Near Pumpwell   (viii). Email address : nhaimang@gmail.com   (ix). Landline Telephone No. : 8244-264499   (x). Fax No. : 8244-254499   (xi). Mobile No. : 7259924698   (xii). Website (if any) : www.nhai.gov.in   (xiii). Legal status of User Agency : Central Government
A-3. Details of Person Making Application
  (i). First Name: Naveen   (ii). Middle Name: J   (iii). Last Name: S   (iv). Gender: Male   (v). Designation: SiteEngineer   (vi). Address 1: National Highways Authority of India, Project Implementation Unit, Door No. 3-29, Bethel, Tharethota, Near Pumpwell, NH-66, Mangalore   (vii). Address 2: NIL   (viii). State: Karnataka   (ix). District: Dakshina Kannada   (x). Tehsil: NIL   (xi). Pin: 575005   (xii). Landmark: Near Pumpwell   (xiii). Email Address: nhaimang@gmail.com   (xiv). Landline Telephone No.: 8244-264499   (xv). Fax No.: 08244254499   (xvi). Mobile No.: 7259924698   (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
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
1InprincipleFP/KA/ROAD/2019/2011F.No.8-78/2013-FC159.8159.806 May 2014
2InprincipleFP/KA/ROAD/9361/2013F.No.4-KRA 973/2013-BAN3.4833.48309 Oct 2015
3ApprovedFP/KA/ROAD/19004/20124-KRC1074/2015-BNG33.1833.1823 May 201608 Aug 2017
Total 196.463 196.463
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.Mangalore2.53150
Total2.53150
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Dakshina Kannada2.53150
Total2.53150
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Ichalampady Sy No 951.31870
2Rekya Survey No 510.12950
3Rekya Survey No 690.67720
4Rekya Survey No 530.40610
Total 2.5315 0
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
14 lane Carriageway1.680
2Shoulder0.60
3Utility Corridor0.120
4Drain0.1314960
Total 2.531496 0
C. Maps of forest land proposed to be diverted
Division 1. : Mangalore
  (i). Area of forest land proposed to be diverted(in ha.) : 2.5315   (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).
1.2.5315    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: Alignment Approved by NHAI HQ
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 30   (iii). Temporary Employment(Number of person-days): 100
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?: Not Applicable   (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: Not Applicable
Additional information Details
Documents
S.No Documents
Remarks
1Alignment Approval conveyed by Competent Authority
2Crossection for Component wise break up
3Executive summary of Project
4Project Approval
5Details of Forest Land proposed for diversion
6No work Undertaking
7Undertaking Boundary Pillars
8undertaking for NPV and CA
9RTC copies of Sy No 69
10RTC copies of Sy No 95
11RTC copies of Sy No 51
12RTC copies of Sy No 53
13RTC copies proposed land
14Compliance to EDS raised by MoEF
15Compliance to EDS raised by MoEF&CC and REC Site Inspection
16Revised Compliance to EDS by Nodal Officer based on MoEF&CC EDS
17Reply to EDS raised by IRO based on 69th REC meeting dated 01.03.2023