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).
Name_MV_Report
Page 1
1/6/2011
9.
Describe compliance with the Forest Stewardship Plan recommendations. Is the landowner following the
Forest Stewardship Plan?
10. Are the terms of the Conservation Restriction being upheld?
11. Any follow ups needed?
12. 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.
13. ___ Ground photographs
__Maps ____ Illustrations
__ Aerial photographs
Name of Monitor (please print):
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 of Landowner (please print):
Signature of Landowner:
Date:
Address:
Telephone:
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 #, JPEG #
Azimuth:
Description:
Name_MV_Report
Page 3
1/6/2011