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/41019/2019   (ii). Name of Project for which Forest Land is required : Diversion of 5.724414 Ha of forest land for work of “Widening to Two Lane with Paved Shoulders from km 24.600 to km 70.063 (45.463kms) of Mudigere - Kadur Section of NH-173 on EPC mode in the State of Karnataka” Job No. KNT-NH-173-2017-18-873   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Widening of the existing Intermediate lane to Two lane paved shoulder section from km 24.600 to 70.063( Muguthihalli to Kadur) to accommodate the increasing traffic improve socio economic status in the region and enhance the safety of road user   (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) : 29730.382   (viii). Area of forest land proposed for diversion(in ha.): 5.724414   (ix). Non-forest land required for this project(in ha.): 116.294286   (x). Total period for which the forest land is proposed to be diverted(in years): 99
A-2. Details of User Agency
  (i). Name : NATIONAL HIGHWAY DIVISION HASSAN   (ii). Address1 : Office of the Executive Engineer National highway Division Ground floor, PWD circle office, Hassan   (iii). Address2 : NIL   (iv). State : Karnataka   (v). District : Hassan   (vi). Pin : 573201   (vii). Landmark : PWD Circle Office, N R Circle   (viii). Email address : eenhhassan@gmail.com   (ix). Landline Telephone No. : 8172-297402   (x). Fax No. : 8172-   (xi). Mobile No. : 9620149825   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: D   (ii). Middle Name: NIL   (iii). Last Name: Archana   (iv). Gender: Female   (v). Designation: EE   (vi). Address 1: Office of the Executive Engineer National Highway Division, Ground Floor, PWD Circle Office, Haasan   (vii). Address 2: NIL   (viii). State: Karnataka   (ix). District: Hassan   (x). Tehsil: Hassan   (xi). Pin: 573201   (xii). Landmark: PWD Circle   (xiii). Email Address: eenhhassan@gmail.com   (xiv). Landline Telephone No.: 8172-297402   (xv). Fax No.: NIL   (xvi). Mobile No.: 9620149825   (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.Chikkamagalur5.724414116.294286
Total5.724414116.294286
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Chikmagalur5.724414116.294286
Total5.724414116.294286
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1FS No. 59, 60 & NFS Sy .no of Dasarahalli (Mentio0.15440.0942
2FS No. 59, 60 & NFS of Devarahalli (Mentioned in1.14230.3322
3FS No. 118 & NFS Sy .no. of HaleLakya (Mentione0.35081.2276
4FS No. 112 & NFS Sy .no. of Hiregowja (Mentione0.83880.1364
5FS No.302 Brahmasamudra (Mentioned in Table)0.11390
6FS No. 74, 744 & NFS Sy .no. of Sakrepatna (Menti3.0045141.57144
7FS No.1 of Yemmedoddi (Mentioned in Table)0.11970
8Non Forest Land Villages0112.9324
Total 5.724414 116.29424
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Toll plaza2.8947536370.825
2Drain to ROW010.360250767
3Carriageway0.89548673437.321713266
4Paved Shoulder0.38122949712.360070503
5Earthen Shoulder0.45929577611.332304224
6Paved Parking01.55816
7Utility Corridor0.05506146119.773778539
8Slope0.28811007910.861464921
9Drain0.7491562211.90154378
Total 5.723093404 116.294286
C. Maps of forest land proposed to be diverted
Division 1. : Chikkamagalur
  (i). Area of forest land proposed to be diverted(in ha.) : 5.724414   (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).
1.5.724414    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: The alignment of project highway is located almost
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 60   (iii). Temporary Employment(Number of person-days): 400000
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 ?: Yes   (a). Reason Category: CA Will be raised on degraded forest land as well as on land provided by User Agency   (b). Degraded forest area on which CA has to be raised by forest department(in ha.): 6.98   (c). Area of non-forest or Revenue forest land required to be provided by User Agency for raising Compensatory Afforestation(in ha.): 6.98   (iii). No. of districts involved for raising Compensatory Afforestation: 1   (iv). No. of patches: One
District 1. : Chikmagalur
  (a). Village: Melinahuluvathi   (b). Area(in ha.): 6.98   (c). Copy of KML file of the patch:     View File   (d). Khasra details: Sy No 27 of Melinahuluvathi   (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
1MoRTH Sanction Letter for Estimated cost of the Project
2LA 3D-Gazette Notification - Village Wise Breakup
3Typical cross section of road pertaining to forest land acquisition
4Comprehensive Project Maps
5GOI Project Sanctioned
6RTC Sy 27 of Meluhulvathi
7UNDER TAKING FOR NPV PAYMENT & UPWARD REVISION OF NPV
8UNDER TAKING FOR CA charges
9UNDER TAKING FOR Boundary demarcation on the ground level
10UNDERTAKING FOR CERTIFICATE OF COMPLIENCE UNDER RECOGNITION
11CERTIFICATE FOR MINIMUM USE OF FOREST LAND.
12FOREST LAND GPS COORDINATES
13Right of way as per the forest Notifications
14Forest and non forest land details
15Village and Sy No wise Forest and non forest land details
163A Gazzete notification copy
17Complaince letter dt-03-01-2022
18CA land revenue sketch.
19Ministry of MoEF order
20ADLR letter for ROW of the road both chikamagluru and Kadur taluk
21Component wise area
22under taking letter.
23Complaince letter
24MOEF Circular for exemption of cost benifit analysis