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/WATER/119894/2021   (ii). Name of Project for which Forest Land is required : Patwadh Group of Villages Water Supply Scheme – Construction of Intake works consisting of a jackwell and related facilities, 1.20 km pipeline is to be laid underground and a Water Treatment Plant are to be constructed at Village Kanach in Kaimur wild life divsion Mirzapur,district sonbhadra   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Intake works consisting of a jackwell and related facilities, 1.20 km pipeline is to be laid underground and a Water Treatment Plant are to be constructed in Kaimur wild life divsion Mirzapur,district sonbhadra   (iv). State : Uttar Pradesh   (v). Category of the Proposal : Drinking Water   (vi). Shape of forest land proposed to be diverted : Non Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 7115   (viii). Area of forest land proposed for diversion(in ha.): 6.4325   (ix). Non-forest land required for this project(in ha.): 0   (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 AND SANITATION MISSION NAMAMI GANGE AND RURAL WATER SUPPLY DEPARTMENT UP GOVERNMENT   (ii). Address1 : 6 Rana Pratap Marg UP Jal Nigam Compound   (iii). Address2 : NIL   (iv). State : Uttar Pradesh   (v). District : Lucknow   (vi). Pin : 226001   (vii). Landmark : NIL   (viii). Email address : ed.swsmup@rediffmail.com   (ix). Landline Telephone No. : 522-2239448   (x). Fax No. : 522-2237709   (xi). Mobile No. : 7007071001   (xii). Website (if any) : www.swsmup.org   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Mahendra   (ii). Middle Name: NIL   (iii). Last Name: Singh   (iv). Gender: Male   (v). Designation: Executive Engineer   (vi). Address 1: 6 Rana Pratap Marg UP Jal Nigam Compound   (vii). Address 2: NIL   (viii). State: Uttar Pradesh   (ix). District: Lucknow   (x). Tehsil: Lucknow   (xi). Pin: 226001   (xii). Landmark: NIL   (xiii). Email Address: ankurbajpai.swsm@gmail.com   (xiv). Landline Telephone No.: 0-7007071001   (xv). Fax No.: NIL   (xvi). Mobile No.: 7007071001   (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.Kaimur Wild Life Division Mirzapur6.43250
Total6.43250
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Sonbhadra6.43250
Total6.43250
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Kanach6.43250
Total 6.4325 0
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Treatment Plant60
2Pipeline0.30
3Jackwell Quarter0.10
4Jackwell to Intake chamber pipeline0.030
5Intakewell Chamber0.00250
Total 6.4325 0
C. Maps of forest land proposed to be diverted
Division 1. : Kaimur Wild Life Division Mirzapur
  (i). Area of forest land proposed to be diverted(in ha.) : 6.4325   (ii). Nature of the Project: Non Linear   (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.
1.6.4325    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:
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 10   (iii). Temporary Employment(Number of person-days): 350000
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? : Yes   (a). Whether Project or a part thereof is located within a Protected Area ? : Yes   (b). Status of approval of the Supreme Court : Application yet to b   (ii). Status of approval of the Standing Committee of National Board for the Wildlife(NBWL) to the Project : Application yet to be submitted
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. : Mirzapur
  (a). Village: Sagara   (b). Area(in ha.): 6.4325   (c). Copy of KML file of the patch:     View File   (d). Khasra details: 28/1mi   (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
1Site Photograph
2Linear Strip Plan of Kanach
3Cross Section Raw Water Rising Main
4Land Schadule
5Certificate of Project Cost
6Certificate of Employment
7Certificate for Nations Wild Life Sanctuary
8Joint Inspection Report
9Calculation of NPV
10Undertaking for Eco Sensitive Zone
11Undertaking for Reserved Forest
12Bio Diversity Impact Assessment not Applicable
13Certificate for compliance of each proposal.
14Certificate for NPV Payment
15Certificate for Compensatory afforestation
16Undertaking for any legal issue under judiciary.
17Certificate related to protect Rare and Endangered specific species.
18Memorial Area Certificate
19Undertaking for Mitigation Measures
20Certificate for Non Availablity of Alternative Land
21Certificate for Beneficiaries and Village
22Certificate related to Task Force Planning Commission
23Certificate related compliance of directives of Ministry of Environment & Forest and Supreme Court
24Information on the Project undertaken by the proponent agency in the past in the protected area
25Abstract of Trees affected
26Abstract of size of 55 Trees affected
27Lease duration certificate
28Certificate regarding not to start construction work till final approval
29Certificate related to compliance of GO VIP-23_14-2-2019-190G_2018 dated 28Jun19
30Undertaking for the compliance of FRA certificate
31Project Sanction Letter
32Response to DFO's letter No. 3019_331 dt 29 May 21
33Respose EDS Raised on the date 28_5_22021
34Undertaking for Van Swaroop
35Certificate related to compliance of 1972 (or revised) Act
36Certificate related to compliance of non violence of Forest Conversion Act 1980 and Wild life Protection Act1972 (or revised)
37Manak Sharte
38Undertaking For Paying Revised NPV cost
39Gazette Notification of forest department
40Respose EDS Raised on the date 04_08_2021
41Certificate of suitability for compensatory afforestationonidentifiednon-forestland
42REPLY EDS
43EDS REPLY 22-09-2021
44Muck disposable plan Letter
45Wild life time line
46map of the land identified for creation of Compensatory Afforestation prepared by using GPS or Total Station
47Muck Disposable Plan
48Punargrahan Adesh
49SDM CERTIFICATE
50GEO REFRENCE MAP OF CA LANDS AND DFL
51Upiyogta Pramanpatra
5212 Years Plantation Estimate
53Status of wild life clearence
54Reply To ED raised on 19-04-2022