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/31054/2017   (ii). Name of Project for which Forest Land is required : Widening of existing 2-lane to 2-lane with 1.5m. wide paved shoulder from Km 0/0 to 81/00 & 93/0 to 119/0 of N.H-157 on EPC mode.   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Widening of existing 2-lane to 2-lane with 1.5m. wide paved shoulder from Km 0/0 to 81/00 & 93/0 to 119/0 of N.H-157 for the year 2016-17 has been approved by the MORT&H, New Delhi vide letter No. RW/NH-12014/24/2016/ORS/P-5 dated 22nd August-2016, Job No. 157-ORS-2016-17-585.   (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) : 28769.75   (viii). Area of forest land proposed for diversion(in ha.): 27.343   (ix). Non-forest land required for this project(in ha.): 34.459   (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 NH DIVISION SAMBALPUR   (ii). Address1 : NH, Division, Sambalpur, BROOK SHILL, Sambalpur.   (iii). Address2 : NIL   (iv). State : Orissa   (v). District : Sambalpur   (vi). Pin : 768001   (vii). Landmark : NIL   (viii). Email address : eenhsambalpur@gmail.com   (ix). Landline Telephone No. : 663-2598462   (x). Fax No. : 663-2548462   (xi). Mobile No. : 8895921156   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Dhyan   (ii). Middle Name: Chand   (iii). Last Name: Nayak   (iv). Gender: Male   (v). Designation: EE   (vi). Address 1: NH Division, Sambalpur, Brook Shill, Sambalpur, Odisha   (vii). Address 2: NIL   (viii). State: Orissa   (ix). District: Khordha   (x). Tehsil: Saheednagar   (xi). Pin: 751001   (xii). Landmark: NIL   (xiii). Email Address: eenhsambalpur@gmail.com   (xiv). Landline Telephone No.: 674-2970994   (xv). Fax No.: 06742564200   (xvi). Mobile No.: 9437639261   (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.Phulbani7.7226.353
2.Ghumusur North19.62128.106
Total27.34334.459
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Kandhamal7.7226.353
1.Ganjam19.62128.106
Total27.34334.459
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Barannata0.1081.618
2Bhetkhol01.714
3Dadapaju1.4810.802
4Jiringipada00.011
5Panishal0.0990.083
6Penjisahi01.154
7Ranipathar00.971
8Phulbani PRF0.8230
9Badakodanda00.556
10Baunsalundi01.04
11Beniguba01.061
12Bhejiput0.4262.829
13Buduli00.051
14Chhedabhumi02.084
15Dadarlunda02.68
16Dhanajayanagar02.058
17Dubduba01.335
18Durgaprasad00.081
19Khariguda04.289
20Mujaguda04.794
21Rambha0.5534.776
22Darpangia RF2.7150
23Galeri RF15.9270
24Russelkonda Reservior00.472
Total 22.132 34.459
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Bhanjanagar Paved Shoulder Chainage 93 km to 119 k19.62128.106
2Phulbani paved shoulder from 6 km to 33 km7.7226.353
Total 27.343 34.459
C. Maps of forest land proposed to be diverted
Division 1. : Ghumusur North
  (i). Area of forest land proposed to be diverted(in ha.) : 19.621   (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).
1.19.621    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. : Phulbani
  (i). Area of forest land proposed to be diverted(in ha.) : 7.722   (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).
1.7.722    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.
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): 500
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? : 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?: 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: Central Govt. Project
Additional information Details
Documents
S.No Documents
Remarks
1Compensatory Afforestation not required for non forest land.
2Comply the EDS.
3EDS has been complied vide this office Letter No. 434 dated 20.02.2020
4EDS has been complied vide this office Letter No. 795 dated 02.05.2020.
5Compliance the EDS raised by MoEF on date 17.05.2021
6Compensatory scheme of Paburia PRF and Talarimaha PRF
7Topo map of CA land of Paburia PRF and Talarimaha PRF
8DGPS map of Paburia PRF
9DGPS map of Talarimaha PRF