CWMTF Project Number_________________

Property Name______________________________________Date of visit___________

Parcel number_______________________________________County_______________

Monitor(s) name and affiliation______________________________________________

Were owners or representative present?_________

Owners’ or representatives’ contact information _____________________________

_____________________________

Are there any changes in the property? (examples: construction, dredging or filling, new
trails, timber harvest, evidence of trespass, trash, any observed natural alterations
including, but not limited to, flooding, fire, insect infestation, etc).

Are these changes consistent with the terms and conditions of the easement?

If any reserved rights have been exercised, please describe and attach photos.

BOUNDARIES

Are boundaries clearly marked?

OBSERVATIONS AND COMMENTS (Attach map with sites marked and photos)
Include change in neighboring land use or concerns expressed by landowner.

RECOMMENDED ACTIONS OR ACTIONS TAKEN DURING VISIT

To the best of your knowledge and observation, is the land owner complying with the
conservation easement?

Signature of monitor(s) __________________________________________________
Signature of monitor verifies that the information on this form is accurate and that a copy of the report has been provided to the landowner.

Signature of landowner or representative____________________________________
Signature of landowner or representative is optional.

Signature of landowner certifies that the landowner is aware of the monitoring report, but does not necessarily agree with the content.