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/UK/ROAD/16816/2015   (ii). Name of Project for which Forest Land is required : Construction of Ghatora to Jhar Sirtoli Motor Road   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : The Project consist of the Construction of 1.500 Km. Motor Road form Ghatora to Jhar Sirtoli in Pati Block of Champawat District Under Mukhya Mantri Gram Sadak Yojana. This Road will be connected by the village Haldukhark, Jharsirtoli & Kapdi tok & the population of around 100 people will get the b   (iv). State : Uttarakhand   (v). Category of the Proposal : Road   (vi). Shape of forest land proposed to be diverted : Linear   (vii). Estimated cost of the Project(Rupees in lacs) : 37.8   (viii). Area of forest land proposed for diversion(in ha.): 0.97   (ix). Non-forest land required for this project(in ha.): 0.54   (x). Total period for which the forest land is proposed to be diverted(in years): 100
A-2. Details of User Agency
  (i). Name : PUBLIC WORKS DEPARTMENT   (ii). Address1 : PWD office Lohaghat   (iii). Address2 : distt champawat   (iv). State : Uttarakhand   (v). District : Champawat   (vi). Pin : 262524   (vii). Landmark : PWD   (viii). Email address : eepwdlohaghat@rediffmail.com   (ix). Landline Telephone No. : 5965-234525   (x). Fax No. : 5965-234525   (xi). Mobile No. : 9997612578   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Bhuwan   (ii). Middle Name: Bhaskar   (iii). Last Name: Pande   (iv). Gender: Male   (v). Designation: Assitant Engineer   (vi). Address 1: C.D. PWD Lohaghat   (vii). Address 2: NIL   (viii). State: Uttarakhand   (ix). District: Champawat   (x). Tehsil: Lohaghat   (xi). Pin: 262524   (xii). Landmark: uttrakhand   (xiii). Email Address: eepwdlohaghat@rediffmail.com   (xiv). Landline Telephone No.: 5965-234525   (xv). Fax No.: 05965234525   (xvi). Mobile No.: 8979315093   (i). Copy of documents in support of the competence/authority of the person making this application to make application on behalf of the User Agency: No Data
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.Champawat0.970.54
Total0.970.54
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Champawat0.970.54
Total0.970.54
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Baramtora tok Kaphli0.970.54
Total 0.97 0.54
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1Road Cutting0.770.36
2Muck Disposal0.20.18
Total 0.97 0.54
C. Maps of forest land proposed to be diverted
Division 1. : Champawat
  (i). Area of forest land proposed to be diverted(in ha.) : 0.97   (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).
1.0.97    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: Yes   (a). Copy of map indicating location of alternative examined:
E. Employment likely to be generated
  (i). Whether the Project is likely to generate employment ?: Yes   (ii). Permanent/Regular Employment(Number of persons): 100   (iii). Temporary Employment(Number of person-days): 300
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
1Copy of documents in support of the competence/authority of the person making this application to make application on behalf of the User Agency.
2Copy of Survey of India Toposheet indicating boundary of forest land proposed to be diverted.
3Scanned copy of the Geo-referenced map of the forest land proposed to be diverted prepared by using GPS
4Google Map of the proposed site showing legal status of the proposed land and alternative examined for the project with legend. (kml file)
5Note containing justification for locating the Project in forest land
6Certificate by DM- Forest Right Act-2006(in MoEF revised prescribed form
7If non-forest or Revenue forest land is required to be provided by User Agency? A Copy of ownership proof and No Objection Certificate
8A short narrative and importance of the project..
9Administrative and Financial sanction
10Preliminary Joint Inspection report (by user agency, forest department, revenue department etc.)
11Comperative chart showing statement of both alignment or alternate site explored for the proposed project and reasons for their rejection duly countersigned by DFO.
12Comperative chart showing statement of both alignment or alternate site explored for the proposed project and reasons for their rejection duly countersigned by DFO.
13Comperative chart showing statement of both alignment or alternate site explored for the proposed project and reasons for their rejection duly countersigned by DFO.
14Comperative chart showing statement of both alignment or alternate site explored for the proposed project and reasons for their rejection duly countersigned by DFO.
15Certificate from the DM that no alternative suitable non-forest land is available for the project in question and the demand of the forest land for the project is barest minimum
16Category wise (RF,civil soyam, Van panchayat and private nap land, Notified forest land etc.) land length, width and area in Ha.
17Bar Chart with index (counter signed by DFO).
18Copy of Mou/agreement executed between the Present owner and the User Agency.
19Cost benefit anylises (in more then 5.0 ha. Land diversion cases)
20Certificate regarding suitability of indentified land for Comensatory Afforestation by DFO
21Road side/gap filling plantation estimate (by DFO
22Undertaking by the User Agency to bear the cost of Road side /gap filling plantation (by user agency)
23Estimate of 100 trees plantation by DFO ( less then 1.0 ha. cases )
24Details of the trees with their scientific name in RF, Civil Soyam, Van Panchayat, Private Notified land and in Nap Land should be mentioned (with valuation of the trees to be felled ) (0-10 dia trees will be mentioned as saplings). (pdf file) Tree count.
25Details of the trees with their scientific name in RF, Civil Soyam, Van Panchayat, Private Notified land and in Nap Land should be mentioned (with valuation of the trees to be felled ) (0-10 dia trees will be mentioned as saplings). (pdf file) Tree count.
26Details of the trees with their scientific name in RF, Civil Soyam, Van Panchayat, Private Notified land and in Nap Land should be mentioned (with valuation of the trees to be felled ) (0-10 dia trees will be mentioned as saplings). (pdf file) Tree count.
27Details of the trees with their scientific name in RF, Civil Soyam, Van Panchayat, Private Notified land and in Nap Land should be mentioned (with valuation of the trees to be felled ) (0-10 dia trees will be mentioned as saplings). (pdf file) Tree count.
28Felling of Oak trees (if involves, inspection report of the concerning CF has to be provided).
29Certificate of felling minimum trees during the project work.
30Muck disposal scheme (in prescribed format)
31Muck disposal scheme (in prescribed format)
32Muck disposal scheme (in prescribed format)
33Muck disposal scheme (in prescribed format)
34Whather project area is a part of National Park or sanctuary and airal distance of the project from National Park or sanctuary signed by DFO
35No voilation has taken place, FC Act. 1980 reg.
36NOC from local Gram Sabhas.
37Certificate- work has not been started reg.
38Geologist Report (Govt. approved Geologist)
39Task Force report.
40Certificate by user agency for complying the condition imposed in Standard Condition
41Certificate by user agency for complying the condition imposed in geologist report/Task force recommendation in hill areas
42No historical/monumental or relegeous place will be effected certificate reg. (by DM/DFO)
43Undertakoing regarding no animal will be effected adversely by the project.
44Undertading to provide alternative fuelwood, kerosene or LPG to labours involved in project.
45Benefited villages/Families/Population Certificate.
46NPV calculation certificate as per Hon'ble Supreem court /MoEF orders by DFO
47Undertaking of payment of NPV, if Hon'ble Supreem Court increses the rates of NPV (by user agency)
48Cost of the forest land and lease rent certificate by DM.
49Demarcation of land to be diverted.
50Praroop-2
51Praroop-2
52Praroop-3
53Praroop-4
54Land Schedule of R.F. & Civil Land
55Hard copy Submission letter
56GEO reference Map
57Hard Copy Submitted Paper