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/RJ/WATER/26264/2017   (ii). Name of Project for which Forest Land is required : Trambay station Harizan Basti OHSR   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : RCC OHSR of capacity 190 KL proposed at Trambay station Harizan Basti for water supply in the area   (iv). State : Rajasthan   (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) : 176   (viii). Area of forest land proposed for diversion(in ha.): 0.0225   (ix). Non-forest land required for this project(in ha.): 0.06   (x). Total period for which the forest land is proposed to be diverted(in years): 30
A-2. Details of User Agency
  (i). Name : EXECUTIVE ENGINEER PHED CITY DN I AJMER   (ii). Address1 : Near Mahaveer Circle, Nal Godam Ajmer (Rajasthan)   (iii). Address2 : NIL   (iv). State : Rajasthan   (v). District : Ajmer   (vi). Pin : 305001   (vii). Landmark : Near Mahaveer Circle, Nal Godam Ajmer (Rajasthan)   (viii). Email address : ee.phed@yahoo.in   (ix). Landline Telephone No. : 145-2628476   (x). Fax No. : 145-2628476   (xi). Mobile No. : 9414212310   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Ashok   (ii). Middle Name: KUMAR   (iii). Last Name: Yadav   (iv). Gender: Male   (v). Designation: AssistantEngineer   (vi). Address 1: Civil Lines, Ajmer   (vii). Address 2: NIL   (viii). State: Rajasthan   (ix). District: Ajmer   (x). Tehsil: Ajmer   (xi). Pin: 305001   (xii). Landmark: Near Mahaveer Circle, Nal Godam Ajmer (Rajasthan)   (xiii). Email Address: ee.phed@yahoo.in   (xiv). Landline Telephone No.: 145-2628476   (xv). Fax No.: 1452628476   (xvi). Mobile No.: 9413827650   (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.Ajmer Territorial0.02250.06
Total0.02250.06
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Ajmer0.02250.06
Total0.02250.06
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Paharganj0.02250.06
Total 0.0225 0.06
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Const. of RCC OHSR0.02250
2Pipeline laying Jointing work00.06
Total 0.0225 0.06
C. Maps of forest land proposed to be diverted
Division 1. : Ajmer Territorial
  (i). Area of forest land proposed to be diverted(in ha.) : 0.0225   (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.
1.0.0225    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): 0   (iii). Temporary Employment(Number of person-days): 150
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
1Techical Report of project
2Patwari report, Mauka Parcha, Jamabandi ki nakal, Rajasv Naksha
3Undertaking for the use of forest land
4undertaking for payment of NPV CA and other amount
5undertaking for minimum forest land required
6undertaking for forest land not to be changed in any other project
7Muck Disposal plan
8Administrative and Financial sanction of the project
9Area calculation sheet
10Project details ,pipeline design, OHSR design
11Reply of shorcomings raised by forest department
12undertaking for payment of penalty