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/39353/2019   (ii). Name of Project for which Forest Land is required : Water Supply Project for 399 Villages and 395 Dhanies of Blocks Kushalgarh and Sajjangarh, District – Banswara, Rajasthan.   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Water Supply Project for 399 Villages and 395 Dhanies of Blocks Kushalgarh and Sajjangarh, District – Banswara, Rajasthan.   (iv). State : Rajasthan   (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) : 79835   (viii). Area of forest land proposed for diversion(in ha.): 16.4546   (ix). Non-forest land required for this project(in ha.): 164.1214   (x). Total period for which the forest land is proposed to be diverted(in years): 99
A-2. Details of User Agency
  (i). Name : PUBLIC HEALTH ENGINEERING DEPARTMENT, DIVISION - I BANSWARA   (ii). Address1 : Office of the Superintending Engineer, Public Health Engineering Department   (iii). Address2 : Project Circle - Banswara   (iv). State : Rajasthan   (v). District : Banswara   (vi). Pin : 327001   (vii). Landmark : Near Pratap Circle   (viii). Email address : phed.kushalgarh@gmail.com   (ix). Landline Telephone No. : 2962-242480   (x). Fax No. : 2962-   (xi). Mobile No. : 7230034047   (xii). Website (if any) : www.phedwater.rajasthan.gov.in   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Kuldeep   (ii). Middle Name: Singh   (iii). Last Name: Chauhan   (iv). Gender: Male   (v). Designation: Engineer   (vi). Address 1: Office of the Assistant Engineer, Public Health Engineering Department, Project Division-I, Banswara   (vii). Address 2: Housing Board Colony, Near Pratap Circl, Banswara,   (viii). State: Rajasthan   (ix). District: Banswara   (x). Tehsil: Banswara   (xi). Pin: 327001   (xii). Landmark: Near Pratap Circle   (xiii). Email Address: phed.kushalgarh@gmail.com   (xiv). Landline Telephone No.: 2962-242480   (xv). Fax No.: NIL   (xvi). Mobile No.: 7230034047   (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.Banswara Territorial16.4546164.1214
Total16.4546164.1214
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Banswara16.4546164.1214
Total16.4546164.1214
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Kundla khurd0.06221.8425
2Navakhera0.40722.4983
3Ghatigara0.04111.789
4Gardiya0.07291.5023
5Jeerakot0.06251.8652
6Heja bhavji0.11311.8853
7Kala khoonta0.02151.525
8Bhamri0.17791.7425
9Padla Mokha0.08544.4983
10Padla Katara0.18741.689
11Chuna Khan0.08135.3023
12Padla Barkiya0.0261.6652
13Balasindoor0.06721.3853
14Andeshwar0.96721.725
15Macha0.07241.9425
16Itala0.14492.7983
17Tambesara0.37120.689
18Tima Mahuri0.14241.7023
19Tidiyadev0.04881.1652
20Kasumba0.05650.9853
21Khundani hala0.15041.525
22Goda0.08891.7425
23Ganeshpura0.13030.7983
24Khrod Chatra0.05581.589
25Pandwal Lunja0.02150.5023
26Patriya0.01660.4952
27Somji Para0.06861.1853
28Biya para0.04211.025
29Karmi0.41781.7425
30Rasodi0.05571.9983
31Koya Nawapada0.10521.389
32Bawarkot0.11731.6023
33Basdi0.13742.5652
34Suliya Malpura0.06251.7853
35Ramgadh0.03981.925
36Chapri0.05911.5425
37Gartara0.04921.8983
38Chor Dugor0.28492.289
39Hathiyadeli0.07222.9023
40Bhuripada0.15711.555
41Taleti0.09331.9652
42Kotariya0.09932.9853
43Amlipara0.30332.825
44Galdhar0.10913.3425
45Nathpura0.02951.6983
46Nishnawat0.12172.789
47Sooraj kund0.13553.8023
48Bijori0.4742.6632
49Sinsagra0.10753.3853
50Umarjhonka0.57793.825
51Ratanmal0.45423.5423
52Bhimpura0.50272.7853
53Banseri0.29171.6793
54Khunta0.29283.6652
55Bijalpur0.45272.4843
56Balachuna0.0475.325
57Khajuran0.72223.2925
58Barla ki rel0.11471.6683
59Fera dongri0.11431.589
60Jogrimal0.06782.5023
61Talaipara0.20493.2652
62Kundiya0.19942.1253
63Haloopara0.10872.625
64Andok0.10642.8223
65Kherli0.01691.7682
66Bassi0.06951.489
67Piplon0.06354.2023
68Umarjhonka 20.02872.4242
69Potaliya0.1672.5852
70Ugamnapara0.18752.524
71Haldupara0.01822.9432
72Bharoda30.9023
73Fatehpura1.60421.7652
74Kundla kala0.18591.1853
75Bortalab0.04111.425
Total 16.4546 164.1214
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Laying of Pipeline (1.0 m)6.969585.3945
2Laying of Pipeline (1.5 m)1.91639.8025
3Laying of Pipeline (2.0 m)1.130513.504
4Approach Road Area0.14790
5Transmission Line (33 kv)1.459312
6WTP30
7Pump House (50 x 70 mtr)0.74.9
8CWT0.00360.4752
9PSP0.00120.1584
10VTC0.00160.6368
11OHSR (25 x 25 mtr.)1.1257.25
Total 16.4546 164.1214
C. Maps of forest land proposed to be diverted
Division 1. : Banswara Territorial
  (i). Area of forest land proposed to be diverted(in ha.) : 16.4546   (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).
1.16.4546    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: Laying of Pipeline along the road
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 233   (iii). Temporary Employment(Number of person-days): 463500
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?: 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. : Banswara
  (a). Village: Guwari   (b). Area(in ha.): 16.4546   (c). Copy of KML file of the patch:     View File   (d). Khasra details: 181/96   (e). Present owner: Others   (f). Copy of ownership proof:   (g). Copy of Mou/agreement executed between the Present owner and the User Agency:   (h). Copy of non encumberence certificate for the forest land:
  (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
1Administrator and Financial Sanctions.
2Project Report.
3UNDERTAKING FOR USE OF FOREST LAND
4CERTIFICATE FOR MINIMUM USE OF FOREST LAND
5UNDERTAKING FOR CONSERVATION OF FLORA FAUNA DURING PIPE LINE
6UNDERTAKING FOR FRA CERTIFICATE
7UNDERTAKING FOR NO CHANGES IN STATUTORY POSITION OF DIVERTED FOREST LAND
8UNDERTAKING FOR NO OTHER FEASIBLE ALTERNATIVE
9UNDERTAKING FOR PAYMENT OF ANY OTHER COST AND CONDITION
10UNDERTAKING FOR PAYMENT OF COST OF COMPENSATORY AFFORESTATION
11Undertaking for Use of Any Material From Forest Land
12UNDERTAKING FOR PAYMENT OF NET PRESENT VALUE OF
13Component Wise Area Calculation Sheet.
14Details of Permanent Employment to be generated.
15EDS Reply Letter dated 26.03.2019.
16Bar Chart Status.
17Khasra Map and Jamabandi.
18Segment Wise Area Calculation Sheet.
19DPR Report.
20CROSS SECTION MULTIPLE PIPE.
21EDS Reply Letter Dated of 17.06.2019..
22Village Wise Area Calculation Sheet.
23Georeferenced Toposheet Map Total Alignment 50000 scale.
24Georeferenced Digital Map Total Alignment 50000 scale.
25Georeferenced Digital Map zoom view Segment 1 to 156 all.
26MOEF EDS Reply Letter dated 16.07.2020.