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/UK/ROAD/10146/2015   (ii). Name of Project for which Forest Land is required : Bhandeli Bend (Thalisain) To Jakhola Motor Road, KM 9.500 Under PMGSY   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Bhandeli Bend (Thalisain) To Jakhola Motor Road in Thalisain Block will connect the habitation Jakhola village. the total population of Jakhola village is 271.   (iv). State : Uttarakhand   (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) : 712.5   (viii). Area of forest land proposed for diversion(in ha.): 4.75   (ix). Non-forest land required for this project(in ha.): 4.504   (x). Total period for which the forest land is proposed to be diverted(in years): 100
A-2. Details of User Agency
  (i). Name : PMGSY BAIJRO   (ii). Address1 : Executive engineer PMGSY (ID) Baijro H.Q-Satpuli Pauri Garhwal   (iii). Address2 : NIL   (iv). State : Uttarakhand   (v). District : Pauri Garhwal   (vi). Pin : 246172   (vii). Landmark : Sakti Filling Petrol Pump   (viii). Email address : eepmgsybaijro@rediffmail.com   (ix). Landline Telephone No. : 1386-273344   (x). Fax No. : NIL   (xi). Mobile No. : 8475825023   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Lalit   (ii). Middle Name: Kumar   (iii). Last Name: Dhariwal   (iv). Gender: Male   (v). Designation: Assistant Engineer   (vi). Address 1: Executive Engineer PMGSY (I.D.) Baijro H.Q.-Satpuli   (vii). Address 2: NIL   (viii). State: Uttarakhand   (ix). District: Pauri Garhwal   (x). Tehsil: Satpuli   (xi). Pin: 246172   (xii). Landmark: Sakti Filling Petrol Pump   (xiii). Email Address: eepmgsybaijro@rediffmail.com   (xiv). Landline Telephone No.: 1386-273344   (xv). Fax No.: 01386273344   (xvi). Mobile No.: 9412968402   (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.Garhwal,Pauri4.754.504
Total4.754.504
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Pauri Garhwal4.754.504
Total4.754.504
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1jakhola4.754.504
Total 4.75 4.504
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Reserve Forest0.90
2Van Panchayat3.220
3Civil Soyam0.630
4Naap Bhoomi03.8
5Muck Disposal00.704
Total 4.75 4.504
C. Maps of forest land proposed to be diverted
Division 1. : Garhwal,Pauri
  (i). Area of forest land proposed to be diverted(in ha.) : 4.75   (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).
1.4.75    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): 0   (iii). Temporary Employment(Number of person-days): 35000
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?: 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. : Pauri Garhwal
  (a). Village: Jakhola   (b). Area(in ha.): 9.54   (c). Copy of KML file of the patch:     View File   (d). Khasra details: 2438, 2440   (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:
Additional information Details
Documents
S.No Documents
Remarks
1fect sheet
2Report
3Authority Letter
4Part I Filled by User Agency
5Part II Filled by DFO
6Part III Filled by CF
7Administrative Aprovel
8Joint Inspection Report
9Site Inspection Report
10Topo sheet
11Geo Refrence map
12Report for Essential of Road
13Alternative Alignment on Google
14Per forma between compression of 2 alignment
15Certificate Reg. No alternate Alignment
16Land schedule
17Length and Width of Land
18Bar Chart
19No Work start Certificate
20Effective No of Trees
21Valuation of Effective No of Trees
22Detail of Actually cutting of Tres
23Fall of Oak tress
24No of trees effected in project
25Certificate regarding falling of Minimum No of tress
26Certificate regarding project not a part of National park or airport
27Certificate regarding project not in 10 km radius of National park or airport
28Certificate regarding consent from supreme court
29No objection Certificate of effected villagers
30Cost benefit ration
31Geologist Reort
32application of suggestion given by geoligist
33Task Force Certificate
34Standard condition regarding Certificate
35Certificate regarding non availability of Temple etc
36Certificate regarding No harm for forest animals & botanical trees
37Certificate regarding cooking gas, kerosene oil for labours
38Details of benefitting villages peoples families in habitation
39Compensatory afforestation scheme in Civil and Soyam land (10years)
40Certificate for suitability of indentified land for Comensatory 10 Afforestation
41Topo sheet MAP OF CA
42Geo Ref map CA.pdf
43No objection certificate from landowner
44Bond between landowner and department
45Muck disposal plan
46NPV Certificate
47Deposit of NPV certificate
48Certificate regarding deposition of pillar cost
49Certificate regarding lease period
50No breach certificate of forest protection act 1980
51Environmental approval from GOI and forest ministry
52Digital map
53Reply of R.O. EDS Point No 1 GIS Map of Road
54Reply of RO EDS Point No II Revised Administrative Approvel
55Reply of RO EDS Point No IIIDetails of EffectiveTrees
56FRA
57revised CA Toposheet
58revised CA GIS Map
59Compliance latter dt 05-12-2017
60Reply of EDS Dated 5 Sep 2018