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/MH/IRRIG/15702/2015   (ii). Name of Project for which Forest Land is required : Surewada Lift Irrigation Scheme   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Construction of Surewada LIS include Pump House, Rising Main, Delevary chamber, Main Canal and its Distributory System   (iv). State : Maharashtra   (v). Category of the Proposal : Irrigation   (vi). Shape of forest land proposed to be diverted : Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 6858.658   (viii). Area of forest land proposed for diversion(in ha.): 37.512   (ix). Non-forest land required for this project(in ha.): 74.811   (x). Total period for which the forest land is proposed to be diverted(in years): NIL
A-2. Details of User Agency
  (i). Name : Irrigation Department   (ii). Address1 : Gosikhurd Lift Irrigation Division Ambadi (Bhandara)   (iii). Address2 : Tehsil : Bhandara Dist. : Bhandara   (iv). State : Maharashtra   (v). District : Bhandara   (vi). Pin : 441924   (vii). Landmark : Irrigation Colony, Ambadi (Bhnadara)   (viii). Email address : glidwrd@gmail.com   (ix). Landline Telephone No. : 7184-252801   (x). Fax No. : 7184-252801   (xi). Mobile No. : 9892079437   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Rajesh   (ii). Middle Name: Govind   (iii). Last Name: Patil   (iv). Gender: Male   (v). Designation: Executive Engineer   (vi). Address 1: Gosikhurd Lift Irrigation Division Ambadi (Bhandara)   (vii). Address 2: Tehsil : Bhandara Dist. : Bhandara   (viii). State: Maharashtra   (ix). District: Bhandara   (x). Tehsil: Bhandara   (xi). Pin: 441924   (xii). Landmark: Irrigation Colony,Ambadi (Bhandara)   (xiii). Email Address: glidwrd@gmail.com   (xiv). Landline Telephone No.: 7184-252801   (xv). Fax No.: 07184252801   (xvi). Mobile No.: 9892079437   (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.Bhandara35.28372.301
2.Gondia WL0.650
3.Gondia(Nagpur)1.5792.51
Total37.51274.811
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Bhandara35.93372.301
1.Gondia1.5792.51
Total37.51274.811
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Surewada0.076.2
2Matora0.4231.854
3Saleheti0.8421.346
4Saleheti Hamesha0.1950
5Koka Range, Comp. No. 164, Koka WLS0.650
6Injewada4.4171.622
7Yetewahi00.622
8Surpewada0.7337.436
9Koka7.5693.218
10Sonkund3.2593.864
11Palora2.3838.366
12Kesalwada4.3082.177
13Yelkazari3.5542.186
14Lendezari4.0482.307
15Kisnapur04.313
16Kardi2.3022.054
17Navegaon0.911.706
18Dongardeo0.274.06
19Borgaon00.61
20Mundhari Bk.00.666
21Panjra00.835
22Kanhalgaon01.556
23Mundhari Kh.00.645
24Dudhara00.37
25Dhiwarwada04.574
26Jambhora03.248
27Khadaki02.881
28Bonde03.585
29Khedepar1.5792.51
Total 37.512 74.811
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Canal37.51274.811
Total 37.512 74.811
C. Maps of forest land proposed to be diverted
Division 1. : Bhandara
  (i). Area of forest land proposed to be diverted(in ha.) : 35.283   (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).
1.35.283    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:
Division 2. : Gondia(Nagpur)
  (i). Area of forest land proposed to be diverted(in ha.) : 1.579   (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).
1.1.579    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:
Division 3. : Gondia WL
  (i). Area of forest land proposed to be diverted(in ha.) : 0.65   (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).
1.0.65    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): 100   (iii). Temporary Employment(Number of person-days): 5000
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?: Yes   (a). Copy of Cost-Benefit analysis:
H. Status of Environmental Clearance
  (i). Whether the Project requires Clearance under the Environment (Protection) Act 1986 ? : Yes   (a). Status of the Environmental Clearance to the Project: EC application yet to be submitted
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 : Application yet to b   (ii). Status of approval of the Standing Committee of National Board for the Wildlife(NBWL) to the Project : Application yet to be submitted
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 ?: No   (iii). No. of districts involved for raising Compensatory Afforestation: 1   (iv). No. of patches: One
District 1. : Bhandara
  (a). Village: Dighori   (b). Area(in ha.): 76   (c). Copy of KML file of the patch:     View File   (d). Khasra details: 113,114   (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:
M. Hydel/Irrigation/Multipurpose Project
  (i). Installed power generation capacity of the Project(in MW): 0   (ii). Total command area of the Project(in ha.): 5000   (a). Copy of the approval of competent authority to the Catchment Area Treatment Plan (CAT Plan):   (b). Copy of the approved CAT plan:
Additional information Details
Documents
S.No Documents
Remarks
1FRA
2DIGHORI CA LAND TOPO SHEET 1:50000
3CA Land Encumberence MoU Between user Agency CA Land Owner
4DIGHORI OWNERSHIP
5CAD PLAN
6ECOSENSETIVE ZONE MAP 1:50000
7INDEX MAP
8Map Showing The Compensatory Afforestation Land dighori
9MAP SHOWING THE ALTERNATIVE ALIGNMENT 1:50000