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/UP/Pipeline/152749/2022
(ii). Name of Project for which Forest Land is required :
Laying of Water Distribution Line along Mirzapur to Robertsganj Road, (LHS) and proposed Reserved forest land to be diverted in Wyndom Fall, and Madihan Range, Mirzapur Forest Division, under Danti Group of Villages Drinking Water Scheme of Jal Jeevan Mission of Govt. of India, in District:- Mirzapur
(iii). Short narrative of the proposal and Project/scheme for which the forest land is required :
Proposed protected forest land to be diverted for Laying of Water Distribution Line along Mirzapur to Robertsganj Road, (LHS) and proposed Reserved forest land to be diverted in Wyndom Fall, and Madihan Range, Mirzapur Forest Division, under Danti Group of Villages Drinking Water Scheme of Jal Jeeva
(iv). State :
Uttar Pradesh
(v). Category of the Proposal :
Pipeline
(vi). Shape of forest land proposed to be diverted :
Linear
(vii). Estimated cost of the Project(Rupees in lacs) :
20750.93
(viii). Area of forest land proposed for diversion(in ha.):
0.7694
(ix). Non-forest land required for this project(in ha.):
22.6064
(x). Total period for which the forest land is proposed to be diverted(in years):
30
A-2.
Details of User Agency
(i). Name :
STATE WATER SANITATION MISSION
(ii). Address1 :
behind the tehsil officer colony mahuwariya mirzapur
(iii). Address2 :
NIL
(iv). State :
Uttar Pradesh
(v). District :
Mirzapur
(vi). Pin :
231001
(vii). Landmark :
jal nigam compound
(viii). Email address :
shashanks618@gmail.com
(ix). Landline Telephone No. :
0-
(x). Fax No. :
0-
(xi). Mobile No. :
9685668349
(xii). Website (if any) :
NIL
(xiii). Legal status of User Agency :
State PSU
A-3.
Details of Person Making Application
(i). First Name:
Sandeep
(ii). Middle Name:
NIL
(iii). Last Name:
Singh
(iv). Gender:
Male
(v). Designation:
Executive Engineer
(vi). Address 1:
Abav Khand Bhatua Road Nakahara
(vii). Address 2:
NIL
(viii). State:
Uttar Pradesh
(ix). District:
Mirzapur
(x). Tehsil:
Mirzapur
(xi). Pin:
231001
(xii). Landmark:
Ghandhi Ghat
(xiii). Email Address:
jalnigammirzapurswsm@gmail.com
(xiv). Landline Telephone No.:
0-
(xv). Fax No.:
NIL
(xvi). Mobile No.:
7571080264
(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.
Forest Division Mirzapur
0.7694
22.6064
Total
0.7694
22.6064
B-2.2
Details of Districts involved
District wise breakup
S.no
District Name
Forest Land(ha.)
Non-Forest Land(ha.)
1.
Mirzapur
0.7694
22.6064
Total
0.7694
22.6064
B-2.3
Village wise breakup
Villages wise breakup
S.no
Village
Forest Land(ha.)
Non-Forest Land(ha.)
1
Danti
0.23695
4.609385
2
Surywar
0.2208
5.882
3
Newadhiya
0.0966
0
4
Bela
0.03525
0.390251
5
Kotwa Pandey
0.1798
0
6
Kakaraha
0
2.186817
7
Bhagesar
0
3.296735
8
Dewahi
0
3.298019
9
Gahira
0
2.680443
10
Madihan
0
0.26275
Total
0.7694
22.6064
B-2.4
Component wise breakup
Component wise breakup
S.no
Component
Forest Land(ha.)
Non-Forest Land(ha.)
1
Laying of Drinking Water Pipeline
0.7694
22.6064
Total
0.7694
22.6064
C.
Maps of forest land proposed to be diverted
Division 1. : Forest Division Mirzapur
(i). Area of forest land proposed to be diverted(in ha.) :
0.7694
(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.
0.7694
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:
Not Aplicable
E.
Employment likely to be generated
(i). Whether the Project is likely to generate employment ?:
Yes
(ii). Permanent/Regular Employment(Number of persons):
2
(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?:
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?:
Not Applicable
(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 ?:
Not Applicable
(iii) . Reason for not providing Non-Forest Land:
Not Applicable
Additional information Details
Documents
S.No
Documents
Remarks
1
AREA CALCULATION SHEET
2
UNDERTAKING FOR CA DEPOSIT
3
UNDERTAKING FOR ETT
4
FOREST NOTIFICATION
5
LAYOUT PLAN
6
UNDERTAKING FOR LEASE AMOUNT DEPOSIT
7
UNDERTAKING FOR MINIMUM TREE FELLING
8
MUCK DISPOSAL PLAN
9
UNDERTAKING FOR NO SUBSQUENT PROPOSAL INITIATION
10
IRRIGATION NOC
11
PWD NOC
12
UNDERTAKING FOR NPV DEPOSIT
13
PROJECT SANCTION LETTER
14
STANDARD CONDITIONS
15
VAIKALPIK VAN BHOOMI CERTIFICATE
16
UNDERTAKING FOR VANYA JEEV VIHAR
17
UNDERTAKING FOR NOT START WORK BEFORE FOREST APPROVAL
18
Eds
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