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/WATER/141926/2021   (ii). Name of Project for which Forest Land is required : Karnataka Urban Water Supply Modernization Project   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : To lay the under ground clear water pipeline for providing the continuous 24x7 water supply in the entire city of Hubballi & Dharwad   (iv). State : Karnataka   (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) : 120800   (viii). Area of forest land proposed for diversion(in ha.): 0.19477   (ix). Non-forest land required for this project(in ha.): 5.2387   (x). Total period for which the forest land is proposed to be diverted(in years): 99
A-2. Details of User Agency
  (i). Name : M/S. LARSEN & TOUBRO LIMITED   (ii). Address1 : Astra Complex, Sirur Park Road, Vidyanagar, Hubballi   (iii). Address2 : NIL   (iv). State : Karnataka   (v). District : Dharwad   (vi). Pin : 580021   (vii). Landmark : NIL   (viii). Email address : satish_yad11@yahoo.co.in   (ix). Landline Telephone No. : 0-   (x). Fax No. : 0-   (xi). Mobile No. : 8953400868   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Dr Gopalkrishna   (ii). Middle Name: NIL   (iii). Last Name: B   (iv). Gender: Male   (v). Designation: Municipal Commissioner   (vi). Address 1: Ward No47, Sir Siddappa Kambli Road, Hubballi   (vii). Address 2: NIL   (viii). State: Karnataka   (ix). District: Dharwad   (x). Tehsil: Hubli   (xi). Pin: 580029   (xii). Landmark: NIL   (xiii). Email Address: mahadev.mahapurush@smec.com   (xiv). Landline Telephone No.: 8362-213878   (xv). Fax No.: NIL   (xvi). Mobile No.: 9241247075   (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.Dharwad0.194775.2387
Total0.194775.2387
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Dharwad0.194775.2387
Total0.194775.2387
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Amminbhavi00.6228
2Kavalgeri00.5181
3Dandikoppa00.2829
4Gongadikoppa00.3535
5Allapura Somapura00.2894
6Navalur00.7864
7Amargol00.4792
8Rayapura0.194770.4568
9Ittigatti00.6091
10Sattur00.1351
11Sutagatti00.6468
12Tarihal00.0584
Total 0.19477 5.2385
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Amminbavi 1219dia MS pipe SY NO 113700.00824291
2Amminbavi 1219dia MS pipe SY NO 109400.03055598
3Amminbavi 1219dia MS pipe SY NO 85500.03540849
4Amminbavi 1219dia MS pipe SY NO 85600.0188591
5Amminbavi 1219dia MS pipe SY NO 85700.01468467
6Amminbavi 1219dia MS pipe SY NO 91300.03670108
7Amminbavi 1219dia MS pipe SY NO 914/100.01839292
8Amminbavi 1219dia MS pipe SY NO 109100.03638323
9Amminbavi 1219dia MS pipe SY NO 914/200.0294541
10Amminbavi 1219dia MS pipe SY NO 91500.01936766
11Amminbavi 1219dia MS pipe SY NO 91600.01345565
12Amminbavi 1219dia MS pipe SY NO 91700.01487538
13Amminbavi 1219dia MS pipe SY NO 91800.01167569
14Amminbavi 1219dia MS pipe SY NO 91900.01133665
15Amminbavi 1219dia MS pipe SY NO 92200.029774069
16Amminbavi 1219dia MS pipe SY NO 92300.024434189
17Amminbavi 1219dia MS pipe SY NO 89300.029674476
18Amminbavi 1219dia MS pipe SY NO 116900.022260095
19Amminbavi 1219dia MS pipe SY NO 891/200.01288352
20Amminbavi 1219dia MS pipe SY NO 891/100.011508289
21Amminbavi 1219dia MS pipe SY NO 89000.03841747
22Amminbavi 1219dia MS pipe SY NO 88500.04731727
23Amminbavi 1219dia MS pipe SY NO 88600.027612689
24Amminbavi 1219dia MS pipe SY NO 88700.033982403
25Amminbavi 1219dia MS pipe SY NO 88400.03617133
26Amminbavi 1219dia MS pipe SY NO 89200.00934479
27Kavalgeri 1219dia MS pipe SY NO 4900.07518212
28Kavalgeri 1219dia MS pipe SY NO 5000.07047794
29Kavalgeri 1219dia MS pipe SY NO 5200.036050547
30Kavalgeri 1219dia MS pipe SY NO 5300.027063868
31Kavalgeri 1219dia MS pipe SY NO 5400.033948499
32Kavalgeri 1219dia MS pipe SY NO 5600.07552116
33Kavalgeri 1219dia MS pipe SY NO 5800.057789368
34Kavalgeri 1219dia MS pipe SY NO 6000.05524233
35Kavalgeri 1219dia MS pipe SY NO 6300.03716726
36Kavalgeri 1219dia MS pipe SY NO 4300.0260637
37Kavalgeri 1219dia MS pipe SY NO 4500.023571756
38Dandikoppa 1219dia MS pipe SY NO 11300.017964882
39Dandikoppa 1219dia MS pipe SY NO 11200.010501764
40Dandikoppa 1219dia MS pipe SY NO 11100.020041502
41Dandikoppa 1219dia MS pipe SY NO 11000.07619924
42Dandikoppa 1219dia MS pipe SY NO 10900.077862655
43Dandikoppa 1219dia MS pipe 0SY NO 10800.080335528
44Gongadikoppa 1219dia MS pipe SY NO 8500.093159716
45Gongadikoppa 1219dia MS pipe SY NO 8600.065333008
46Gongadikoppa 1219dia MS pipe SY NO 5200.097287528
47Gongadikoppa 1219dia MS pipe SY NO 5100.09779185
48Allapura Somapura 1219dia MS pipe SY NO 6600.039292617
49Allapura Somapura 1219dia MS pipe SY NO 6500.04695704
50Allapura Somapura 1219dia MS pipe SY NO 6000.010980658
51Allapura Somapura 1219dia MS pipe SY NO 5900.002284282
52Allapura Somapura 1219dia MS pipe SY NO 5800.003097978
53Allapura Somapura 1219dia MS pipe SY NO 5700.002678416
54Allapura Somapura 1219dia MS pipe SY NO 56/200.00493727
55Allapura Somapura 1219dia MS pipe SY NO 56/100.005984056
56Allapura Somapura 1219dia MS pipe SY NO 5500.009791899
57Allapura Somapura 1219dia MS pipe SY NO 5400.00737412
58Allapura Somapura 1219dia MS pipe SY NO 5300.008336146
59Allapura Somapura 1219dia MS pipe SY NO 49/100.011597287
60Allapura Somapura 1219dia MS pipe SY NO 49/200.0118664
61Allapura Somapura 1219dia MS pipe SY NO 49/300.0294541
62Allapura Somapura 1219dia MS pipe SY NO 4600.057961007
63Allapura Somapura 1219dia MS pipe SY NO 4400.03680703
64Navalur 1219dia MS pipe SY NO 28200.06443879
65Navalur 1219dia MS pipe SY NO28300.0786149
66Navalur 1219dia MS pipe SY NO 29100.0404729
67Navalur 1219dia MS pipe SY NO 29200.026680329
68Navalur 1219dia MS pipe SY NO 29400.087156589
69Navalur 1219dia MS pipe SY NO 32000.095598685
70Navalur 1219dia MS pipe SY NO 31900.065055419
71Navalur 1219dia MS pipe SY NO 32300.058899724
72Navalur 1219dia MS pipe SY NO 32400.048230559
73Navalur 1219dia MS pipe SY NO 32600.023220002
74Navalur 1219dia MS pipe SY NO 32700.007361406
75Navalur 1219dia MS pipe SY NO 32800.02417779
76Navalur 1219dia MS pipe SY NO 33200.060527116
77Navalur 1219dia MS pipe SY NO 33300.024020984
78Navalur 1219dia MS pipe SY NO 33900.081806114
79Amargol 1219dia MS pipe SY NO 39100.083952661
80Amargol 1219dia MS pipe SY NO 38700.11603644
81Amargol 1219dia MS pipe SY NO 31700.06554067
82Amargol 1219dia MS pipe SY NO 31600.025741612
83Amargol 1219dia MS pipe SY NO 31400.012101609
84Amargol 1219dia MS pipe SY NO 31300.011306984
85Amargol 1219dia MS pipe SY NO 31200.020889102
86Amargol 1219dia MS pipe SY NO 31100.007961083
87Amargol 1219dia MS pipe SY NO 31000.022340617
88Amargol 1219dia MS pipe SY NO 31500.113372857
89Rayapur 1219dia MS pipe SY NO 14300.082289246
90Rayapur 1219dia MS pipe SY NO 14000.046622238
91Rayapur 1219dia MS pipe (Road)00.03333187
92Rayapur 1219dia MS pipe SY NO 13800.023005983
93Rayapur 1219dia MS pipe (RoadXX)00.003451851
94Rayapur 1219dia MS pipe SY NO 1000.007730112
95Rayapur 1219dia MS pipe SY NO 900.00790387
96Rayapur 1219dia MS pipe SY NO 800.043280575
97Rayapur 1219dia MS pipe SY NO 1300.053146639
98Rayapur 1219dia MS pipe (RoadXY)00.009410479
99Rayapur 1219dia MS pipe SY NO 300.0535386540.023402236
100Rayapur 250dia MS pipe (Road)00.01301365
101Rayapur 250dia DI pipe SY NO 400.00494065
102Rayapur 250dia DI pipe SY NO 300.0019214
103Rayapur 250dia DI pipe SY NO 200.00497445
104Rayapur 864dia MS pipe SY NO 2500.026712252
105Rayapur 864dia MS pipe (Road)00.010836252
106Rayapur 864dia MS pipe SY NO 300.0918638280.001241856
107Rayapur 1219dia MS pipe SY NO 1100.047637239
108Rayapur 762dia MS pipe SY NO 300.0342820740.001125174
109Sutagatti 762dia MS pipe SY NO 39(1)00.028917138
110Sutagatti 762dia MS pipe SY NO 4500.050872158
111Sutagatti 762dia MS pipe (Road)00.21325122
112Sutagatti 762dia MS pipe SY NO 35(1)00.013871052
113Sutagatti 762dia MS pipe SY NO 35(2)00.022139502
114Sutagatti 762dia MS pipe (RoadXX)00.032618412
115Sutagatti 762dia MS pipe SY NO 27(2)00.010335978
116Sutagatti 762dia MS pipe (RoadXY)00.066293856
117Sutagatti 762dia MS pipe SY NO 1000.015538038
118Sutagatti Village00.038152872
119Sutagatti 762dia MS pipe SY NO 200.012715962
120Sutagatti 762dia MS pipe SY NO 300.027168714
121Sutagatti 762dia MS pipe SY NO 4(1)00.032861064
122Sutagatti 762dia MS pipe SY NO 5(1)00.01483335
123Sutagatti 762dia MS pipe SY NO 117(2)00.018906912
124Sutagatti 762dia MS pipe (Road)00.048419046
125Sattur 762dia MS pipe SY NO 3800.025433586
126Sattur 762dia MS pipe SY NO 3900.017761794
127Sattur 762dia MS pipe SY NO 4100.055525758
128Sattur 762dia MS pipe SY NO 4200.036392814
129Ittigatti 762dia MS pipe SY NO 800.089875974
130Ittigatti 762dia MS pipe SY NO 1400.082647936
131Ittigatti 762dia MS pipe SY NO 1700.093294708
132Ittigatti 762dia MS pipe SY NO 100.0175341
133Ittigatti 762dia MS pipe SY NO 5700.065530998
134Ittigatti 762dia MS pipe SY NO 3500.021444786
135Ittigatti 762dia MS pipe SY NO 3400.035403924
136Ittigatti 762dia MS pipe SY NO 3300.02399928
137Ittigatti 762dia MS pipe SY NO 3100.026048526
138Ittigatti 762dia MS pipe SY NO 3000.015370176
139Ittigatti 762dia MS pipe SY NO 2600.041377152
140Ittigatti 762dia MS pipe SY NO 2300.014909802
141Ittigatti 762dia MS pipe SY NO 2700.041920626
142Ittigatti 762 MS pipe( Village)00.039753378
143Tarihal 762dia MS pipe SY NO3300.0505248
144Tarihal 250dia DI pipe SY NO3300.00675675
145Rayapur 250dia DI pipe SY No 300.015084550.01163955
Total 0.194769106 5.238255283
C. Maps of forest land proposed to be diverted
Division 1. : Dharwad
  (i). Area of forest land proposed to be diverted(in ha.) : 0.19477   (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).
1.0.19477    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 existing PSC laid more than 10 years ago and l
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 4   (iii). Temporary Employment(Number of person-days): 15330
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?: 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
1Authorization Letter
2Certificate for Minimum use of Forerst Land
3Certificate for Undertaking FRA
4Certificate regarding Historical Archeological Places
5Proposed Pipeline from WTP Details - Forest Area
6Statement showing details of Forest Land involved in the Project
7Statement showing details of NonForest Land involved in the Project
8Typical Cross-section for Pipeline Trench
9Under Taking for Non-Violation of Forest Conservation Act 1980
10Undertaking to Pay NPV, Compensatory Afforestation Charges and Other Stipulated Charges
11Details of DGPS points for proposed pipeline
12Geo reference village maps
13Details with non forest area village wise survey nos
14Details with forest area village wise survey nos
15Details with DGPS points in forest area
16As per the Instructions, Correction have been made and complied