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/46525/2020   (ii). Name of Project for which Forest Land is required : For construction of Raising & Gravity Main Pipeline, Storage & Distributor Tank, Inspection path in forest land, Bellatti, Devihala, Etagi & other Villages for providing drinking water and recharging ground water to fill 20 tanks in Shirahatti (T), Gadag (D) under Shirahatti Lift Irrigation Scheme in favour of the EE, SLI Division, KNNL, Mundaragi.   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Diversion of 0.8311 ha of forest land in Bellatti, Devihala, Etagi, Alagilawada, Nadigatti, Tangod, Majjuru, Hosuru & Chabbi Villages for construction of Raising & Gravity Main Pipeline, Storage & Distributor Tank, Inspection path for providing drinking water and recharging ground water to fill 20 t   (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) : 13706   (viii). Area of forest land proposed for diversion(in ha.): 0.8311   (ix). Non-forest land required for this project(in ha.): 48.8716   (x). Total period for which the forest land is proposed to be diverted(in years): 99
A-2. Details of User Agency
  (i). Name : MANAGING DIRECTOR, KNNL, DR.B.R. AMBEDKAR VEEDHI, BANGALORE   (ii). Address1 : Executive Engineer, Singataloor Lift Irrigation Division No-1, Karnataka Neeravari Nigam Limited, Mundargi, Gadag District.   (iii). Address2 : NIL   (iv). State : Karnataka   (v). District : Gadag   (vi). Pin : 582118   (vii). Landmark : Near Hudco Colony, Mundargi   (viii). Email address : eeslidmdg@gmail.com   (ix). Landline Telephone No. : 8371-262174   (x). Fax No. : 8371-262174   (xi). Mobile No. : 9916146827   (xii). Website (if any) : www.knnlindia.com   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Srinivasaraddi   (ii). Middle Name: Basavaraddi   (iii). Last Name: Malligwad   (iv). Gender: Male   (v). Designation: EE   (vi). Address 1: Executive Engineer, Singataloor Lift Irrigation Division No.1, Karnataka Neeravari Nigam Limited, Mundargi, Gadag District.   (vii). Address 2: NIL   (viii). State: Karnataka   (ix). District: Gadag   (x). Tehsil: Mundargi   (xi). Pin: 582118   (xii). Landmark: Near Hudco Colony Mundargi   (xiii). Email Address: eeslidmdg@gmail.com   (xiv). Landline Telephone No.: 8371-262174   (xv). Fax No.: 08371262174   (xvi). Mobile No.: 9916146827   (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.Gadag0.831148.8716
Total0.831148.8716
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Gadag0.831148.8716
Total0.831148.8716
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Alagila Wada Sy No.260.03840
2Nadigatti Village Sy No.540.06840
3Etagi Village Sy No. 1990.02310
4Etagi Village Sy No.1890.00450
5Etagi Village Sy No. 1890.02370
6Etagi Village Sy No.1870.0360
7Etagi Village Sy No.1860.01620
8Etagi Village Sy No. 1850.02070
9Etagi Village Sy No.1910.0060
10Etagi Village Sy No.1980.0010
11Etagi Village Sy No.2110.02970
12Etagi Village Sy No.2120.02790
13Etagi Village Sy No.2140.02270
14Etagi Village Sy No.1890.00090
15Etagi Village Sy No. 18800.005
16Tangod Village Sy No.220.00390
17Devihala Sy No.1680.0440
18Devihala Sy No. 1680.01440
19Devihala Sy No.1680.04110
20Devihala Sy No.320.01020
21Devihala Sy No.500.03530
22Devihala Sy No.490.00660
23Devihala Sy No.480.01510
24Devihala Sy No.1200.015
25Chabbi Sy No.3490.02580
26Chabbi Sy No.3480.0260
27Chabbi Sy No.3470.01370
28Chabbi Sy No.190.02740
29Chabbi Sy No.200.02340
30Majjuru Sy No.100.0220
31Majjuru Sy No.110.0230
32Majjuru Sy No.200.00350
33Bellatti Sy No.690.01460
34Bellatti Sy No. 690.010
35Bellatti Sy No 690.01760
36Bellatti Sy No.710.03070
37Hosuru Village Sy No.70.04480
38Bellatti Sy No.500.0188
39Bellatti Sy No.23300.0181
40Bellatti Sy No.8400.0067
41Bellatti Sy No.8200.002
42ITAGI VILLAGE Multiple Sy No.02.4788
43TEREDAHALLI VILLAGE Multiple Sy No.00.6981
44MEVUNDI VILLAGE Multiple Sy No.01.8919
45KERIKOPPA VILLAGE Multiple Sy No.02.2157
46TANGOD VILLAGE Multiple Sy No.02.6912
47ALAGILAWADA VILLAGE Multiple Sy No.01.0927
48HOSUR VILLAGE Multiple Sy No.01.8919
49VADVI VILLAGE Multiple Sy No.03.8446
50TARIKOPPA VILLAGE Multiple Sy No.01.5884
51NARAYANAPURA VILLAGE Multiple Sy No..01.7098
52BELLATTI VILLAGE Multiple Sy No.03.1263
53DEVIHALA VILLAGE Multiple Sy No.03.0453
54CHABBI VILLAGE Multiple Sy No.05.8276
55MAJJURU VILLAGE Multiple Sy No.01.0522
56NADIGATTI VILLAGE Multiple Sy No.01.295
57KUDRALLI VILLAGE Multiple Sy No.01.8211
58BATTURA VILLAGE Multiple Sy No.02.7216
59SHETTIKERE VILLAGE Multiple Sy No.01.4771
60HULIGERABANA VILLAGE Multiple Sy No.01.295
61BASTIBANA VILLAGE Multiple Sy No.01.1736
62ADRIKATTI VILLAGE Multiple Sy No.01.4367
63HIREBANA VILLAGE Multiple Sy No.00.8499
64PETABANA VILLAGE Multiple Sy No.02.155
65DESAIBANA VILLAGE Multiple Sy No.00.9004
66SHIGLI VILLAGE Multiple Sy No.00.5261
67Etagi Village Sy No.1990.05880
Total 0.8311 48.8716
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Raising Main [Tangod village]0.00390
2Raising & Distributary Main0.0440
3Road from Tank to Existing CC Road0.04110
4Raising & Distributary Main00.015
5Gravity Main [Chabbi Village]0.13830
6Gravity Main [Chabbi- Village]0.02650
7Gravity Main [Bellatti village]0.01460
8Raising Main Pipeline [Bellatti Village]0.04830
9Storage/Distributor Tank [Bellahatti]0.010
10Storage/Distributor Tank [Devihalla]0.01440
11Gravity Main Pipeline [Devahalli Village]0.06720
12Raising Main-Pipeline [Bellatti Village]00.0369
13Gravity Main Pipeline -[Bellatti Village]00.0087
14Raising Main Pipeline0.03840
15Gravity Main Pipeline0.06840
16Raising Sub-Main Pipeline0.02760
17Gravity Main Pipeline-10.02370
18Gravity Main Pipeline-20.07890
19Raising Main-20.11740
20Raising Main-10.02270
21Distributary Chamber0.00090
22Raising Main Pipeline [Hosur Village]0.04480
23Gravity Main Pipeline [Patta Land]00.005
24For Laying of pipe line048.806
Total 0.8311 48.8716
C. Maps of forest land proposed to be diverted
Division 1. : Gadag
  (i). Area of forest land proposed to be diverted(in ha.) : 0.8311   (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).
1.0.8311    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): 2   (iii). Temporary Employment(Number of person-days): 30
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
1Project Report
2Work Order Agreement
3Entire Alignment, KML, Auto Cad Drawing, GPS Co-Ordinate in Excel Format send to E-Mail
4Plain Map [Seven Villages]
5Undertaking for Temporary Stone Pillar
620 Meter Interval GPS Reading Co-Ordinates
7Copies of RTC of Forest area proposed for diversion
8Individual Survey Number Wise Non-Forest Land details
9Village Wise Non Forest Land details
10Google Maps [7 Villages]
11Undertaking for Payment of NPV and Compensatory Plantation Charges
12Entire Alignment Map
13Entire Alignment map