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/46172/2020   (ii). Name of Project for which Forest Land is required : Laying of water pipeline & ancillary works, in forest land, in Bidoli, Amboli, Vadkal & Ulavi villages in Joida taluka of Uttarkannada District, for Irrigation, drinking water & ground water recharge in favour of "Executive Engineer KNNL, Kalasa Project Division Khanapur Belagavi".   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Diversion of 0.555 ha (Revised from 0.6710 ha). forest land under “Lift Irrigation System (Head Works consisting of construction of Jack well cum pump house, Power supply, rising main, delivery chamber & Gravity mains) in joida taluka of uttar kannada 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) : 1501   (viii). Area of forest land proposed for diversion(in ha.): 0.671   (ix). Non-forest land required for this project(in ha.): 0.0218   (x). Total period for which the forest land is proposed to be diverted(in years): 30
A-2. Details of User Agency
  (i). Name : EXECUTIVE ENGINEER KNNL KALASA PROJECT DIVISON BELAGAVI   (ii). Address1 : Shivaji nagar Khanapur Belagavi   (iii). Address2 : NIL   (iv). State : Karnataka   (v). District : Belgaum   (vi). Pin : 591302   (vii). Landmark : NIL   (viii). Email address : eekpdkhanapurf@gmail.com   (ix). Landline Telephone No. : 8336-222163   (x). Fax No. : 8336-   (xi). Mobile No. : 9448340481   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Nagesh   (ii). Middle Name: NIL   (iii). Last Name: C H   (iv). Gender: Male   (v). Designation: Executive Engineer   (vi). Address 1: Shivaji Nagar Khanapur Belagavi   (vii). Address 2: NIL   (viii). State: Karnataka   (ix). District: Belgaum   (x). Tehsil: Khanapur   (xi). Pin: 591302   (xii). Landmark: NIL   (xiii). Email Address: eekpdkhanapurf@gmail.com   (xiv). Landline Telephone No.: 8336-222163   (xv). Fax No.: NIL   (xvi). Mobile No.: 9741901116   (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.Dandeli Wildlife0.5550.0206
Total0.5550.0206
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Uttara Kannada0.5550.0206
Total0.5550.0206
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Ulavi0.04950.0206
2Amboli0.33680
3Vadkal0.0890
4Bidoli0.07990
Total 0.5552 0.0206
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Approach channel0.0070
2Risining main0.27550
3Gravity main0.17130.0086
4Gravity sub main-1/10.03440
5Gravity sub main-1/20.01630.012
6Jckwell cum Pumphouse0.040
7Foot Bridge0.00450
8Delivery Chamber0.00160
9Electrical line0.00450
Total 0.5551 0.0206
C. Maps of forest land proposed to be diverted
Division 1. : Dandeli Wildlife
  (i). Area of forest land proposed to be diverted(in ha.) : 0.555   (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.
1.0.053    View File
  (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).
1.0.502    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): 1   (iii). Temporary Employment(Number of person-days): 300
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? : Yes   (a). Whether Project or a part thereof is located within a Protected Area ? : Yes   (b). Status of approval of the Supreme Court : Approval under cons   (ii). Status of approval of the Standing Committee of National Board for the Wildlife(NBWL) to the Project : Application under process   (a). Date of submission of proposals : 04 Jan 2021   (b). Current status : NIL
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?: No   (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) . Reason for not providing Non-Forest Land: Diversion of forest land up to one hectare
Additional information Details
Documents
S.No Documents
Remarks
1Administrative approval of the project
2copy of Undertaking to that, all corners of forest area will be marked with temporary stone piller for verification by the forest officers.
3Copy of Clarification note : This Project is not related to any other projects, submitting consolidated FC proposal.
4Copy of Undertaking to bear the NPV and CA charges by UA
5Copy of Undertaking to the Submitting of FRA certificate from Jurisdictional DC.
6Copy of RTC's of Forest land to be diverted.
7Copy of Geo referenced map (Zoomed) SC 1: 3690)break-up
8This file contains, Clarification note on the Purpose, Diameter and Depth of pipeline to be laid.
9GPS readings of the project
10Copy of village wise & Sy.No wise forest & non forest area break-up
11This file contains Component wise break-up and Details of Patches & segments of forest & non forest area of the project.
12Detailed project report.
13compliance to EDS Raised by the DCF Dandeli
14Layout of plan showing jackwell and approach channel
15This file contains Component wise break-up and Details of Patches & segments of forest & non forest area of the project.
16Structural GAD and plan showing jakwell and approach channel