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/155109/2022   (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 Sala Group of Villages Drinking Water Scheme of Jal Jeevan Mission of Govt. of India, in District:- Jhansi and Jalaun.   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Proposed forest land to be diverted for Laying of Water Distribution Line along different roads, under Sala Group of Villages Drinking Water Scheme of Jal Jeevan Mission of Govt. of India, in District:- Jhansi and Jalaun.   (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) : 51271.078   (viii). Area of forest land proposed for diversion(in ha.): 5.5287   (ix). Non-forest land required for this project(in ha.): 9.5404   (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: A   (ii). Middle Name: K   (iii). Last Name: Gupta   (iv). Gender: Male   (v). Designation: Executive Engineer   (vi). Address 1: OFFICE EXECUTIVE ENGINEER U.P. JAL NIGAM KALPI ROAD   (vii). Address 2: NIL   (viii). State: Uttar Pradesh   (ix). District: Jalaun   (x). Tehsil: NIL   (xi). Pin: 285001   (xii). Landmark: NIL   (xiii). Email Address: eeoraidiv@gmail.com   (xiv). Landline Telephone No.: 0-   (xv). Fax No.: NIL   (xvi). Mobile No.: 9473942726   (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 Jhansi0.7561.7101
2.Forest Division Orai4.77277.8303
Total5.52879.5404
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Jhansi0.7561.7101
1.Jalaun4.77277.8303
Total5.52879.5404
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Erach0.0060.177
2Dikoli0.751.2171
3Sala00.316
4Girthan0.2710.2565
5Baghaura00.4422
6Bhua0.29210
7Kukargaon00.1205
8Ajnari0.700580.3178
9Magrayan00.1221
10Mohammdabad0.43340
11Kusumiliya0.37920
12Kahta00.4613
13Barsar00.227
14Mohana0.19750
15Badagaon0.30920
16Dakore00.6484
17Goran00.8569
18Aindha00.2184
19Pachokhara0.320040.0834
20Seorhi00.5213
21Ait0.54730
22Mawai Ait00.4238
23Pirona0.19840.4137
24Somai0.42420
25Jakhauli00.4056
26Birguwan Khurd00.968
27Pindari00.3025
28Bilayan0.04880
29Basob00.2125
30Sei0.090
31Paretha00.2458
32Konch0.239980
33Darhi0.3210.5826
Total 5.5287 9.5404
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Laying of Drinking Water Pipeline5.52879.5404
Total 5.5287 9.5404
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.) : 0.756   (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).
1.0.756    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. : Forest Division Orai
  (i). Area of forest land proposed to be diverted(in ha.) : 4.7727   (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).
1.4.7727    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 Alternate
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): 2000
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 ?: No   (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
1UNDERTAKING FOR CA DEPOSIT
2UNDERTAKING FOR ETT
3UNDERTAKING FOR FRA
4UNDERTAKING FOR MINIMUM TREE FELLING
5MUCK DISPOSAL PLAN
6UNDERTAKING FOR NPV DEPOSIT
7PROJECT SANCTION LETTER
8STANDARD CONDITIONS
9VAIKALPIK VAN BHOOMIM CERTIFICATE
10UNDERTAKING FOR VANYA JEEV VIHAR
11UNDERTAKING FOR NOT START WORK BEFORE FOREST APPROVAL
12FOREST NOTIFICATION
13AREA CALCULATION SHEET
14NHAI NOC
15LAYOUT PLAN
16UNDERTAKING FOR PWD NOC
17EDS REPLY LETTER