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/OR/IRRIG/40723/2019   (ii). Name of Project for which Forest Land is required : Khairibhandan Barrage Project   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Khairibhandan Barrage project is Barrage project on river Khairibhandan is tributary to Baitarani River in Baitarini basin. The barrage will be constructed at Village Analabeni in Jashipur Block of Mayrubhanj District (Lat 21O 57’ 59” N and Long 86O 03’ 32”E). The barrage scheme will irrigate 6950 h   (iv). State : Orissa   (v). Category of the Proposal : Irrigation   (vi). Shape of forest land proposed to be diverted : Hybrid   (vii). Estimated cost of the Project(Rupees in lacs) : 18387   (viii). Area of forest land proposed for diversion(in ha.): 26.444   (ix). Non-forest land required for this project(in ha.): 265.775   (x). Total period for which the forest land is proposed to be diverted(in years): 99
A-2. Details of User Agency
  (i). Name : EE, MAYURBHANJ INVESTIGATION DIVISION   (ii). Address1 : O/o The Executive Engineer   (iii). Address2 : Mayurbhanj Investigation Division, Udala, Mayurbhanj   (iv). State : Orissa   (v). District : Mayurbhanj   (vi). Pin : 757041   (vii). Landmark : Infront of Mendakhai School   (viii). Email address : eemid.udala@rediffmail.com   (ix). Landline Telephone No. : 6795-232236   (x). Fax No. : 6795-   (xi). Mobile No. : 9437136524   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Bajinath   (ii). Middle Name: NIL   (iii). Last Name: Hembram   (iv). Gender: Male   (v). Designation: Executiveengineer   (vi). Address 1: O/o The Executive Engineer   (vii). Address 2: Mayurbhanj Investigation Division, Udala, Mayurbhanj   (viii). State: Orissa   (ix). District: Mayurbhanj   (x). Tehsil: Udala   (xi). Pin: 757041   (xii). Landmark: Infront of Mendakhai School   (xiii). Email Address: eemid.udala@rediffmail.com   (xiv). Landline Telephone No.: 6795-232236   (xv). Fax No.: NIL   (xvi). Mobile No.: 9437136524   (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.Karanjia26.444265.775
Total26.444265.775
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Mayurbhanj26.444265.775
Total26.444265.775
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Khaladi05.985
2Anlabeni03.319
3Jashipur5.78338.661
4Ankulpur04.953
5Jamda01.21
6Badsole07.738
7Kankadani02.622
8Padmapur07.653
9Bhandaripasi00.878
10Maudi03.1
11Itamundi1.3648.693
12Sanajunapasi0.9359.806
13Bedakudar0.0241.53
14Manada06.706
15Biunria02.724
16Tingiria0.6526.71
17Panashi0.0280.089
18Kulundi04.739
19Purunia03.194
20Bisida0.3933.516
21Dhangidipasi00.972
22Bhramarapasi02.206
23Bhanjakia01.801
24Bhagabandha0.0936.329
25Mamudipani02.42
26Tilakoti0.2155.196
27Papada0.0932.246
28Riteisahi0.174.298
29Aktapal1.3561.514
30Tikarapada2.3438.952
31Jamada0.77.532
32Begunia00.574
33Nebda0.1057.673
34Khandabandha0.1097.754
35Rugudi1.5015.897
36Kadodiha0.5145.832
37Palasagadia1.9355.997
38Hatibindha05.512
39Chaturanjali0.4257.345
40Godhimara0.1172.096
41Bhaliadiha0.0122.582
42Tingria0.6560.227
43Bhramaraposi0.0571.926
44Badaterenti1.573.363
45Pandarsila0.3369.437
46Sarubali03.541
47Kakharupanha01.234
48Naupanha05.095
49Jamdapal02.598
50Patua0.2022.031
51Sukruli04.415
52Beguniabindha03.245
53Bodamtaila01.194
54Pandabhila02.493
55Khiching0.0085.313
56Gharaikudar01.109
57Bhramarapasi RF3.010
58Kusurbida RF1.7380
Total 26.444 265.775
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Ponding065.819
2Main Canal26.444199.956
Total 26.444 265.775
C. Maps of forest land proposed to be diverted
Division 1. : Karanjia
  (i). Area of forest land proposed to be diverted(in ha.) : 26.444   (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.
1.26.444    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    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): 25   (iii). Temporary Employment(Number of person-days): 300000
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 ? : 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? : Yes
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. : Kalahandi
  (a). Village: Latiaguda   (b). Area(in ha.): 26.444   (c). Copy of KML file of the patch:     View File   (d). Khasra details: 153, 167   (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.): 6950   (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
1
2Compliance as per EDS raised by your office vide letter no 7459, Dt 30/11/2019
3Compliance as per DFO letter no. 7663 dt 7.12.2019