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/140781/2021   (ii). Name of Project for which Forest Land is required : Diversion of 2.4346 ha of forest land for improvement of existing Road from Pathapalya to Polanayakanapalli via Singappagarapalli, Kamasanapalli, Gummallapalli Villages (CH: 3.219km to 4.285KM and Ch: 7.2KM to 8.929 Km) Mittemari & Pathapalya [H], Bagepalli [T], Chikkaballapura [D] in favour of the Executive Engineer, Project Division (PMGSY),Chic   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Diversion of 2.4346 ha of forest land for improvement of existing Road from Pathapalya to Polanayakanapalli via Singappagarapalli, Kamasanapalli, Gummallapalli Villages (CH: 3.219km to 4.285KM and Ch: 7.2KM to 8.929 Km) Mittemari & Pathapalya [H], Bagepalli [T], Chikkaballapura [D] in favour of the   (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) : 1120   (viii). Area of forest land proposed for diversion(in ha.): 2.4346   (ix). Non-forest land required for this project(in ha.): 11.9871   (x). Total period for which the forest land is proposed to be diverted(in years): 50
A-2. Details of User Agency
  (i). Name : EE PMGSY CHIKKABALLAPURA (KRRDA)   (ii). Address1 : Venugopalaswamy temple road, Behind New middle School   (iii). Address2 : NIL   (iv). State : Karnataka   (v). District : Chikkaballapura   (vi). Pin : 562101   (vii). Landmark : NIL   (viii). Email address : pmgsycbp@gmail.com   (ix). Landline Telephone No. : 0-   (x). Fax No. : 0-   (xi). Mobile No. : 9448407946   (xii). Website (if any) : online.omms.nic.in   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Nagaraja   (ii). Middle Name: Lingapura   (iii). Last Name: Kempegowda   (iv). Gender: Male   (v). Designation: Executive Engineer   (vi). Address 1: #441, IDSMT Layout, APMC back door, chikkballapur-562101   (vii). Address 2: NIL   (viii). State: Karnataka   (ix). District: Chikkaballapura   (x). Tehsil: NIL   (xi). Pin: 562101   (xii). Landmark: NIL   (xiii). Email Address: pmgsycbp@gmail.com   (xiv). Landline Telephone No.: 0-   (xv). Fax No.: NIL   (xvi). Mobile No.: 9448084264   (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
1ReturnedFP/KA/ROAD/140781/2021KFD/HoFF/A5-4(GFL)/8/2021-FC, E-4878130.99450
Total 0.9945 0
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.Chikkaballapura2.434611.9871
Total2.434611.9871
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Chikkaballapura2.434611.9871
Total2.434611.9871
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Forest Sy No 51 of Singappagarapalli Village0.28850
2Forest Sy No 26 Kamasanapalli Village0.01890
3Forest Sy No 51 of Singappagarapalli Village0.34870
4Forest Sy No 23 of Gummallapalli Village0.30520
5Forest Sy. No 51 of Singappagarapalli Village0.07690
6Forest Sy No 26 Kamasanapalli Village0.00480
7.Forest Sy No 51 of Singappagarapalli Village0.09340
8.Forest Sy No 23 of Gummallapalli Village0.08150
9Forest Sy No51 of Singappagarapalli Village0.0770
10.Forest Sy No 26 Kamasanapalli Village0.00560
11Forest Sy.No 51 of Singappagarapalli Village0.09210
12Forest Sy No 23. of Gummallapalli Village0.0810
13Forest Sy No 51 -of Singappagarapalli Village0.17340
14-Forest Sy No 23 of Gummallapalli Village0.15230
15Sy No 51 of Singappagarapalli Village0.14420
16Sy No 26 Kamasanapalli Village0.00910
17Forest Sy No 51 of Singappagarapalli Village0.17480
18Forest Sy No.23 of Gummallapalli Village0.15270
19Forest-Sy No.51 of Singappagarapalli Village0.14430
20Forest- Sy No. 26 Kamasanapalli Village0.01020
21Kamasanahalli Sy No. 8700.0456
22Kamasanahalli Sy No.100.1634
23Kamasanahalli Sy No. (V)00.13015
24Kamasanahalli Sy No.8500.0171
25Kamasanahalli Sy No.6600.12445
26Kamasanahalli Sy No.6500.0589
27Kamasanahalli Sy No.6300.17195
28Kamasanahalli Sy No.6200.1843
29Kamasanahalli Sy No.4500.361
30Kamasanahalli Sy No.6100.0798
31Kamasanahalli Sy No.6000.16245
32Kamasanahalli Sy No.5900.1596
33Kamasanahalli Sy No.5800.32775
34Kamasanahalli Sy No.5000.2622
35Kamasanahalli Sy No.4600.08835
36Kamasanahalli Sy No.3300.0513
37Kamasanahalli Sy No.3400.10355
38Kamasanahalli Sy No.3600.0912
39Kamasanahalli Sy No.3900.06365
40Kamasanahalli Sy No.4100.0608
41Kamasanahalli Sy No.4000.01425
42Kamasanahalli Sy No.4200.1064
43Kamasanahalli Sy No. 4100.1121
44Singappagarapalli Sy No.5300.69635
45Singappagarapalli Sy No.5500.09785
46Singappagarapalli Sy No. (V)00.0703
47Singappagarapalli Sy No.2600.22515
48Singappagarapalli Sy No.3100.0703
49Singappagarapalli Sy No.3000.12445
50Singappagarapalli Sy No.2900.0646
51Singappagarapalli Sy No.2800.03515
52Singappagarapalli Sy No.5200.798
53Singappagarapalli Sy No. 5300.1539
54Gummalapalli Sy No.2200.84835
55Gummalapalli Sy No.1900.1007
56Gummalapalli Sy No.7600.1216
57Gummalapalli Sy No.7500.3496
58Gummalapalli Sy No.2900.02375
59Gummalapalli Sy No.7000.07125
60Gummalapalli Sy No.7100.0513
61Gummalapalli Sy No. (V)00.1786
62Gummalapalli Sy No.6800.06745
63Gummalapalli Sy No.6700.0399
64Gummalapalli Sy No.6900.15295
65Gummalapalli Sy No.3800.1672
66Gummalapalli Sy No.6400.03135
67Gummalapalli Sy No.5500.24985
68Dugginayakanapalli Sy No.2400.35815
69Dugginayakanapalli Sy No.1900.33535
70Dugginayakanapalli Sy No.7500.1026
71Dugginayakanapalli Sy No.7300.04275
72Dugginayakanapalli Sy No.7100.0247
73Dugginayakanapalli Sy No.7000.076
74Dugginayakanapalli Sy No.6300.3211
75Dugginayakanapalli Sy No.5600.0323
76Dugginayakanapalli Sy No.6200.02185
77Dugginayakanapalli Sy No. 5600.08455
78Poolakuntlapalli Sy No.3600.1273
79Poolakuntlapalli Sy No.3800.21185
80Poolakuntlapalli Sy No.4100.0589
81Polinayakanapalli Sy No.22500.05415
82Polinayakanapalli Sy No.22400.1102
83Poolikakuntlapalli Sy No.4600.3439
84Polinayakanapalli Sy No.22300.0627
85Polinayakanapalli Sy No.21800.0494
86Polinayakanapalli Sy No.21500.0095
87Polinayakanapalli Sy No.21600.02185
88Poolikakuntlapalli Sy No. 5200.0266
89Poolikakuntlapalli Sy No. 5300.0665
90Poolikakuntlapalli Sy No. 5400.04465
91Poolikakuntlapalli Sy No. 4500.07695
92Poolikakuntlapalli Sy No. (V)00.09595
93Poolikakuntlapalli Sy No. 6200.37145
94Polinayakanapalli Sy No.15900.0304
95Polinayakanapalli Sy No.16000.03515
96Polinayakanapalli Sy No.11400.0665
97Polinayakanapalli Sy No.16100.1862
98Polinayakanapalli Sy No.11200.04275
99Patapalya Sy No. 200.08645
100Patapalya Sy No. 19000.02185
101Patapalya Sy No. 18900.08645
102Patapalya Sy No. 17200.25935
103Patapalya Sy No. 17100.08455
104Patapalya Sy No. 15200.10925
105Patapalya Sy No. 14600.08645
106Patapalya Sy No. 15300.0304
Total 2.4346 11.9871
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Forest Drain LHS0.25670
2Forest Drain RHS0.25580
3Forest Shoulder LHS0.48110
4Forest Shoulder RHS0.480
5Shoulder Both Side - Non Forest Land04.7318
6Carrage Way -Non Forest Land04.7318
7Drains- Non Forest Land02.5235
8Forest Carriage Way0.9610
Total 2.4346 11.9871
C. Maps of forest land proposed to be diverted
Division 1. : Chikkaballapura
  (i). Area of forest land proposed to be diverted(in ha.) : 2.4346   (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).
1.2.4346    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): 5   (iii). Temporary Employment(Number of person-days): 200
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: Two
District 1. : Chikkaballapura
  (a). Village: Singappagarapalli   (b). Area(in ha.): 1.7524   (c). Copy of KML file of the patch:     View File   (d). Khasra details: Sy No.53   (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. : Chikkaballapura
  (a). Village: Devala varapalli   (b). Area(in ha.): 0.6822   (c). Copy of KML file of the patch:     View File   (d). Khasra details: Sy No.62   (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
1Tender Approved Copy of Project
2Boundary stone letter
3Cross section of road
4Guard stone temporary
5Nodal officer
6Admin Approval of Project
7Justification and along with Alternative Alignment Map
8Proposed Forest Land - RTC Copy
9Proposed CA Land - RTC Copy and Tahasildar Order Copies
10Entire Alignment with Survey Number and Village Wise Forest and Non Forest Land details
11GPS Co Ordinates
12Undertaking for payment of CA and NPV
13Undertaking for payment of NPV
14Village Wise and Survey Number and area wise breakup details
15Component Wise Breakup Forest and Non Forest details
16Assistant Commissioner, Revenue Dept letter
17CA Suitability Certificate
18Entire Alignment RevisedMap
19Plain Map With Zoom View Revised Map
20Detailed Project Report- DPR
21Proposed CA - Plain Map and Google Maps