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/150514/2021   (ii). Name of Project for which Forest Land is required : Proposed Forest Land to be Diverted for Laying of Water Distribution Line along different roads, under Gulara, Tilaitha, Bachawali and Budpura Village Group Drinking Water Scheme of Jal Jeevan Mission of Govt Of India, in District:- Jhansi (UP).   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Laying of Water Distribution Line along different roads, under Gulara, Tilaitha, Bachawali and Budpura Village Group Drinking Water Scheme of Jal Jeevan Mission of Govt Of India, in District:- Jhansi (UP).   (iv). State : Uttar Pradesh   (v). Category of the Proposal : Drinking Water   (vi). Shape of forest land proposed to be diverted : Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 51441.53   (viii). Area of forest land proposed for diversion(in ha.): 6.6873   (ix). Non-forest land required for this project(in ha.): 4.0551   (x). Total period for which the forest land is proposed to be diverted(in years): 30
A-2. Details of User Agency
  (i). Name : UTTAR PRADESH WATER SUPPLY AND SANITATION MISSION   (ii). Address1 : U.P. JAL NIGAM COMPOUND, 6- RANA PRATAP ROAD LUCKNOW U.P.   (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. : 91-0522-2239428   (x). Fax No. : 91-   (xi). Mobile No. : 9454502163   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Nitesh   (ii). Middle Name: Pratap   (iii). Last Name: Singh   (iv). Gender: Male   (v). Designation: EE   (vi). Address 1: OFFICE OF THE EXECUTIVE ENGINEER CONSTRUCTION DIVISION, U.P. JAL NIGAM (RURAL) JEEVANSHAH, GWALIOR ROAD JHANSI U.P.   (vii). Address 2: NIL   (viii). State: Uttar Pradesh   (ix). District: Jhansi   (x). Tehsil: NIL   (xi). Pin: 284001   (xii). Landmark: NIL   (xiii). Email Address: sengar.nitesh232@gmail.com   (xiv). Landline Telephone No.: 0-   (xv). Fax No.: NIL   (xvi). Mobile No.: 9473942725   (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 Jhansi6.68734.0551
Total6.68734.0551
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Jhansi6.68734.0551
Total6.68734.0551
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Parichha0.370
2Gulara0.22250
3Palhari0.10
4Pahari Buzurg00.193
5Baral0.20
6Chakarpur0.0640.062
7kargawan0.30
8Simrawari0.0560
9Semri0.40
10Girari00.062
11Amargarh0.1630
12Digara0.50
13Dhawani00.181
14Karguwan0.30.086
15Tilak Nagar0.1040
16Gharmau00.5013
17Gormachhiya0.40.116
18Baragaon0.640.2375
19Bachaoli Buzurg0.080
20Kolwan00.3332
21Banguwan0.40
22Barua Sagar0.3250.102
23Ghughuwa0.1610
24Khailar0.8370.1229
25Raksa0.090.055
26Dhikoli0.1260
27Khari00.0483
28Dagarwaha0.0240.111
29Neguwan00.2
30Baruapura0.078250.093
31Dongri0.0750.0528
32Math0.015250.1071
33Bajna0.07850.0785
34Baijpur0.0210.0361
35Ullu Gaon00.1534
36Baghaura0.0210.1859
37Manpur0.0560.086
38Babina0.0630.1177
39Chirgaon0.41680.4265
40Rasina00.3069
Total 6.6873 4.0551
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Laying of Drinking Water Pipeline6.68734.0551
Total 6.6873 4.0551
C. Maps of forest land proposed to be diverted
Division 1. : Forest Division Jhansi
  (i). Area of forest land proposed to be diverted(in ha.) : 6.6873   (ii). Nature of the Project: Linear   (b). No. of Segments : Eight
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).
1.2.0523    View File
2.0.886    View File
3.2.04    View File
4.0.119    View File
5.0.021    View File
6.0.021    View File
7.1.301    View File
8.0.247    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: No Alternative
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): 10000
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?: 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 ?: Yes   (a). Reason Category: CA Will be raised on degraded forest land as well as on land provided by User Agency   (b). Degraded forest area on which CA has to be raised by forest department(in ha.): NIL   (c). Area of non-forest or Revenue forest land required to be provided by User Agency for raising Compensatory Afforestation(in ha.): 0.408   (iii) . Reason for not providing Non-Forest Land: Linear or 'strip' plantation declared as protected forest along with road/rail/canal sides for widening or expansion of road/rail/canal
Additional information Details
Documents
S.No Documents
Remarks
1FOREST NOTIFICATION
2PROJECT SANCTION LETTER
3UNDERTAKING FOR FRA
4UNDERTAKING FOR CA DEPOSIT
5UNDERTAKING FOR ETT
6UNDERTAKING FOR MINIMUM TREE FELLING
7STANDARD CONDITIONS
8UNDERTAKING FOR VANYA JEEV VIHAR
9UNDERTAKING FOR NOT START WORK BEFORE APPROVAL
10MUCK DISPOSAL PLAN
11UNDERTAKING FOR LEASE RENT
12VAIKALPIK VAN BHOOMI CERTIFICATE
13UNDERTAKING FOR NPV DEPOSIT
14AREA CALCULATION SHEET
15LAYOUT PLAN
16UNDERTAKING FOR NO SUBSQUENT PROPOSAL INITIATION FOR SAME AREA
17NHAI NOC
18RAILWAY NOC
19UNDERTAKING FOR NHAI AND IRRIGATION NOC