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/ROAD/17631/2016   (ii). Name of Project for which Forest Land is required : Balngir-Sonpur section of NH57   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Widening/Strengthening of existing intermediate/2 lane to 2 lane with 1.5m paved shoulder fro 0/0 to 45/750 km of NH57   (iv). State : Orissa   (v). Category of the Proposal : Road   (vi). Shape of forest land proposed to be diverted : Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 15729.74   (viii). Area of forest land proposed for diversion(in ha.): 10.155   (ix). Non-forest land required for this project(in ha.): 8.81   (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 ENGINEER N H DIVISION BALANGIR   (ii). Address1 : OFFICE OF THE EXECUTIVE ENGINEER NH DIVISION GANDHINAGARPADA BALANGIR   (iii). Address2 : NIL   (iv). State : Orissa   (v). District : Balangir   (vi). Pin : 767001   (vii). Landmark : GANDHINAGARPADA   (viii). Email address : eenhbolangir@gmail.com   (ix). Landline Telephone No. : 6652-230477   (x). Fax No. : 6652-   (xi). Mobile No. : 9861096349   (xii). Website (if any) : no   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: ASHOK   (ii). Middle Name: KUMAR   (iii). Last Name: PADHI   (iv). Gender: Male   (v). Designation: EXECUTIVE ENGINEER   (vi). Address 1: NH DIVISION GANDHINAGARPADA BALANGIR   (vii). Address 2: NIL   (viii). State: Orissa   (ix). District: Balangir   (x). Tehsil: Balangir   (xi). Pin: 767001   (xii). Landmark: GANDHINAGARPADA   (xiii). Email Address: eenhbolangir@gmail.com   (xiv). Landline Telephone No.: 6652-230477   (xv). Fax No.: NIL   (xvi). Mobile No.: 9861096349   (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.Subarnapur10.1558.81
Total10.1558.81
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Sonapur10.1558.81
Total10.1558.81
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Kulipali00.427
2Badbahali3.640
3Arjunpur6.5150
4Khari03.838
5mahule01.22
6Medinipali00.134
7Sahajpita01.51
8Bagduli01.681
Total 10.155 8.81
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Bairakhaman RF3.640
2Arjunpur RF6.5150
3Approach road to Kukudajore Bridge03.035022
4Toll Plaza01.93728
5Realignment at Khari03.8376
Total 10.155 8.809902
C. Maps of forest land proposed to be diverted
Division 1. : Subarnapur
  (i). Area of forest land proposed to be diverted(in ha.) : 10.155   (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).
1.10.155    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: No   (a). Reason for not providing such map: existing road to be developed
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 40   (iii). Temporary Employment(Number of person-days): 1500000
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?: 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. : Sonapur  
  (a). Village: Degraded Bairikhaman RF   (b). Area(in ha.): 20.5   (c). Copy of KML file of the patch:     View File   (d). Khasra details: Degraded Reserved Forest   (e). Present owner: User Agency   (f). Copy of Ownership proof: No Data
  (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:
Additional information Details
Documents
S.No Documents
Remarks
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4Forwarding Letter to DFO,SNP.
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10Forwarding letter to DFO
11Approval of demand note for NPV
12compliance for online demand generation