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/34491/2018   (ii). Name of Project for which Forest Land is required : Adhichunchangiri Water Supply Project   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Providing Drinking Water Supply to Adhichunchangiri & 128 other Habitations in Nagamangala Taluka of Mandya District.   (iv). State : Karnataka   (v). Category of the Proposal : Drinking Water   (vi). Shape of forest land proposed to be diverted : Hybrid   (vii). Estimated cost of the Project(Rupees in lacs) : 15462.96   (viii). Area of forest land proposed for diversion(in ha.): 0.977   (ix). Non-forest land required for this project(in ha.): 7.127   (x). Total period for which the forest land is proposed to be diverted(in years): 99
A-2. Details of User Agency
  (i). Name : EXECUTIVE ENGINNER RDWSD MANDYA   (ii). Address1 : Rural Drinking Water and Sanitation Department, Division office, Bannur Road, Mandya   (iii). Address2 : NIL   (iv). State : Karnataka   (v). District : Mandya   (vi). Pin : 571401   (vii). Landmark : Bannur Road   (viii). Email address : raghumgh7@gmail.com   (ix). Landline Telephone No. : 8232-222365   (x). Fax No. : 8232-   (xi). Mobile No. : 9900040392   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Ramkrishna   (ii). Middle Name: NIL   (iii). Last Name: Ramkrishna   (iv). Gender: Male   (v). Designation: ee   (vi). Address 1: Rural Drinking Water And Sanitation Department, Division Office, Bannur Road, Mandya   (vii). Address 2: NIL   (viii). State: Karnataka   (ix). District: Mandya   (x). Tehsil: Mandya   (xi). Pin: 571401   (xii). Landmark: Bannur Road   (xiii). Email Address: raghumgh7@gmail.com   (xiv). Landline Telephone No.: 8232-222365   (xv). Fax No.: NIL   (xvi). Mobile No.: 9900040392   (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.Mandya0.9777.127
Total0.9777.127
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Mandya0.9777.127
Total0.9777.127
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Halalu - Sy No-220.0920
2Yadavanahalli - Sy No-330.03340
3Doddenahalli - Sy No-730.08680
4Kabbanakere- Sy No-210.0370
5Yellekoppa - Sy No-92/P130.6740
60 to 128 Habitations in Nagamangala Taluka07.125
7Vaderahalli - Sy No 730.05270
Total 0.9759 7.125
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1WATER TANKS AREA (80m(L) x 50.0m(W))0.40
2PIPELINE AND ROAD (575m(L) x 6m(W))0.27460
3PIPE LINE LAYING @ HALALU VILLAGE, SY NO 22 - (9200.0920
4PIPE LINE LAYING @ YADAVANAHALLI VILLAGE, SY NO 330.03340
5PIPE LINE LAYING @ DODDENHALLI VILLAGE, SY NO 73 -0.08680
6PIPE LINE LAYING @ KABBANAKERE VILLAGE, SY NO 21 -0.0370
7PIPE LINE LAYING @ VADERAHALLI, SY NO 73 (527m(L)0.05270
Total 0.9765 0
C. Maps of forest land proposed to be diverted
Division 1. : Mandya
  (i). Area of forest land proposed to be diverted(in ha.) : 0.977   (ii). Nature of the Project: Hybrid   (a). No. of patches : One
Patch wise details
Patch No. Area of Patch(in ha.) Kml File of PatchesTo view KML file on google the same may be downloaded and then open if in google earth install in your computer.
1.0.4    View File
  (b). No. of Segments : Six
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).
1.0.2746    View File
2.0.092    View File
3.0.033    View File
4.0.087    View File
5.0.0527    View File
6.0.037    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 ?: No
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?: 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
1GO
2Self Authorization letter
3Undertaking
4Topo Sheet
5Google Map with GPS Readings
6Village Map with GPS Readings
7Concept Note of Project
8Hydraulic Flow Diagram.
9Location on Topo Sheet.
10Habitations Details
11NON FOREST LAND DETAILS
12COMPALINECE REPORT
13Compliance -2
14Doddenhalli - Map
15Halau - Map
16Kubberakare - Map
17Vaderahalli - Map
18Yadavanahalli - Map
19Dodenahalli Village Map
20Halalu Village map
21Kubbenakere Village map
22Vaderahalli Sy No 73 - Topo
23Yadavenhalli Village Map
24Project Area Details
25Yadanahalli Sy No 33 Topo
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