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/8917/2014   (ii). Name of Project for which Forest Land is required : Ramkot to Pattharkot   (iii). Short narrative of the proposal and Project/scheme for which the forest land is required : Constructed Moter Road (3.00 km) Ramkot to Pattharkot, approximate 600 peoples benefited with this Road and easy availability fruits and vegetables.   (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.): 0.63   (ix). Non-forest land required for this project(in ha.): 2.07   (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 WORK DEPARTMENT   (ii). Address1 : PD PWD PITHORAGARH GHANTAKARAN DISTT PITHORAGARH 262501   (iii). Address2 : NIL   (iv). State : Uttarakhand   (v). District : Pithoragarh   (vi). Pin : 262501   (vii). Landmark : NEAR POST OFFICE   (viii). Email address : harishbathyal99@gmail.com   (ix). Landline Telephone No. : 5964-225115   (x). Fax No. : 5964-225115   (xi). Mobile No. : 9412144099   (xii). Website (if any) : NIL   (xiii). Legal status of User Agency : State Government
A-3. Details of Person Making Application
  (i). First Name: Sunil   (ii). Middle Name: Kumar   (iii). Last Name: Kohali   (iv). Gender: Male   (v). Designation: EXECUTIVE ENGINEER   (vi). Address 1: PD PWD PITHORAGARH GHANTAKARAN DISTT PITHORAGARH 262501   (vii). Address 2: NIL   (viii). State: Uttarakhand   (ix). District: Pithoragarh   (x). Tehsil: Pithoragarh   (xi). Pin: 262501   (xii). Landmark: NEAR POST OFFICE   (xiii). Email Address: pwdpithoragarh@gmail.com   (xiv). Landline Telephone No.: 5964-225115   (xv). Fax No.: 05964225115   (xvi). Mobile No.: 9412144099   (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.Pithoragarh0.632.07
Total0.632.07
B-2.2 Details of Districts involved
District wise breakup
S.no District Name Forest Land(ha.) Non-Forest Land(ha.)
1.Pithoragarh0.632.07
Total0.632.07
B-2.3 Village wise breakup
Villages wise breakup
S.no Village Forest Land(ha.) Non-Forest Land(ha.)
1Harali0.632.07
Total 0.63 2.07
B-2.4 Component wise breakup
Component wise breakup
S.no Component Forest Land(ha.) Non-Forest Land(ha.)
1ROAD0.632.07
Total 0.63 2.07
C. Maps of forest land proposed to be diverted
Division 1. : Pithoragarh
  (i). Area of forest land proposed to be diverted(in ha.) : 0.63   (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).
1.0.63    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): 0   (iii). Temporary Employment(Number of person-days): 3000
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
1Land Wise Allignment toposhit
2F.R.A
3Bhoo Arjan Certificate
4G.O.
5joint inspection report
6Minimum Requird Land certificate
7Land schdule
8Land schdule
9detail of lengh &width of project
10Bar Chart with index (counter signed by DFO). (pdf file).
11Compensatory afforestation scheme in Civil and Soyam land (10 years) by DFO
12Certificate regarding suitability of indentified land for Comensatory Afforestation by DFO (10 years) by DFO
13Certificate regarding suitability of indentified land for Comensatory Afforestation by DFO (10 years) by DFO
14Undertaking by the User Agency to bear the cost of Road side /gap filling plantation
15Estimate of 100 trees plantation by DFO
16Felling of Oak trees (if involves, inspection report of the concerning CF has to be provided).
17If felling of trees is not involved, certificate by DFO in this regard.
18If felling of trees is not involved, certificate by DFO in this regard.
19If felling of trees is not involved, certificate by DFO in this regard.
20Certificate of felling minimum trees during the project work.
21Muck disposal cirtificate
22Muck disposal scheme
23Whather project area is a part of National Park or sanctuary and airal distance of the project from National Park or sanctuary signed by DFO.
24No voilation has taken place, FC Act. 1980 reg.
25NOC from local Gram Sabha.
26Certificate- work has not been started reg.
27Geologist Report (Govt. approved Geologist).
28Task Force report.
29Certificate by user agency for complying the condition imposed in Standard Condition
30No historical/monumental or relegeous place will be effected certificate reg.
31Undertakoing regarding no animal will be effected adversely by the project.
32Undertading to provide alternative fuelwood, kerosene or LPG to labours involved in project. (Pdf file).
33Benefited villages/Families/Population Certificate.
34NPV calculation certificate as per Hon'ble Supreem court /MoEF orders by DFO
35Undertaking of payment of NPV, if Hon'ble Supreem Court increses the rates of NPV
36Cost of the forest land and lease rent certificate by DM.
37Certificate of Lease period by user agency
38Demarcation of land to be diverted
39cost beniffite certificate
40praroop 2
41praroop 3
42praroop 4
43praroop 4
44NOC sarpanch and complete FRA with sign and date
45digital maps and google map
46acknowledgement slip
47objection remove point wise
48Pointwise Objection Removed With Letter
49tree list update