MOUNT GRACE LAND CONSERVATION TRUST MONITORING REPORT Conservation Restriction Name: Date of Inspection: Location: Project #: Current owner(s): Address (es): Telephone: Email: Local contact if different from owner: Method of monitoring visit: [ ] Ground [ ] Aerial List all persons attending the monitoring visit: Landowner contact prior to the monitoring visit: [ ] Yes Method of contact: [ ] Letter [ ] Telephone [ ] No [ ] Other (please specify) Was landowner present for inspection? 1. Describe the nature and methods of the site visit. 2. Current land use: list and describe any changes in land use since last inspection. 3. List man-made alterations since the last monitoring visit and any man-made alterations not documented in the field notebook or baseline documentation (i.e. construction, dredging, filling, timber harvest, clearing of fields, etc.) Describe the activity or alteration, noting the extent, location, purpose and individual responsible (if known). Take measurements of the scope of the activity, if applicable. Attach maps, photographs, and illustrations if helpful. 4. List natural alterations (flooding, fire, insect infestations, ice damage or other changes). Note location and nature of changes. Attach maps, photographs, and illustrations as helpful. 5. Describe the results of any interaction(s) with the landowner or other people having use of the land. Indicate any plans or potential future activities mentioned. 6. Inspector comments: list any other observations or comments, management needs, information requests, etc. 7. Is there any knowledge of the property being transferred, leased or sold? Are the reserved rights being activated? 8. List areas in need of discussion or review (depositing/dumping, wetland alteration, excavation, residential structures, tree or shrub removal, agricultural structures, residential structures, woods roads or trails). 9. Any follow ups needed? Name_MV_Report Page 1 1/6/2011 10. Please indicate the number of attachments to this report. Be sure to sign and date all materials, and provide a description or map showing where on-site photographs were taken and path walked. 11. ___ Ground photographs __Maps ____ Illustrations __ Aerial photographs 12. Name of Monitor (please print): 13. Signature of Monitor: Date: Address: Mount Grace Land Conservation Trust, 1461 Old Keene Road, Athol, MA 01331 Telephone: 978-248-2043 Email: wansleben@mountgrace.org Name_MV_Report Page 2 1/6/2011 Photographs from Conservation Restriction Monitoring Visit to the Name of CR Location, Massachusetts Date Tom Wansleben-Stewardship Biologist Mount Grace Land Conservation Trust Photo point Azimuth: Description: Name_MV_Report Page 3 1/6/2011