State Agriculture Development Committee

							          State Agriculture Development Committee
     Easement Restriction Compliance Inspection Report

Applicant / Owner: _____________________________________
Farm’s Common Name: _____________________________________
Address: ______________________________________________
          ______________________________________________
          ______________________________________________
Phone:    ______________________________________________
Farmer/Contact: ________________________________________
Farmer/Contact Phone: __________________________________
Date of Inspection: ____________________________________
Acres: _________________________________________________
Type of Operation: ____________________________________
Program: _______________________________________________
Date Closed: ___________________________________________



Blocks and Lots
County:_____________________________
Municipality: ______________________
Blocks:_____________________________
Lots: ______________________________

County:_____________________________
Municipality: ______________________
Blocks:_____________________________
Lots: ______________________________



New Owner Information
New ownership? YES   NO   UNKNOWN

Name: ______________________________
      ______________________________

Address: ___________________________
         ___________________________
         ___________________________

Phone:   ___________________________
Fax:     ___________________________


Date of Transfer: __________________


Deed Reference: Book:     Page:

Is current owner aware of Restrictions? YES   NO   UNKNOWN
Has a copy of the Restrictions been provided? YES  NO   UNKNOWN
Existing Structures:    _______________________ _______________________
_____________________   _______________________ _______________________
_____________________   _______________________ _______________________


Exceptions:
Acres: ________________________________
Location: _____________________________
Severable
Non-Severable
County:________________________________
Municipality: _________________________
Blocks: _______________________________
Lots: _________________________________


Lease Agreements: Yes    No
Describe:________________________________________________________
________________________________________________________________

Non Ag Uses: Yes      No
Describe:____________________________________________________________________
_____________________________________________________________________________


Describe any major Use changes:________________________________________
______________________________________________________________________________


Have any of the following activities occurred on the premises?
Removal of sand, gravel, loam, rock, peat, etc. YES    NO   UNKNOWN
Trash accumulation, dumping YES   NO    UNKNOWN
Construction of roads, parking lots, swimming pools, tennis courts
utility lines, conduits, etc YES   NO    UNKNOWN
Has Division of the Premises been Granted? YES     NO  UNKNOWN
Date Granted: _______________________
Division of the Premises into two or more lots YES    NO   UNKNOWN
Is a copy of the Deed on File? YES    NO   UNKNOWN
New Structures? Yes     No
Description & Location _______________________ ______________________
_____________________   _______________________ ______________________

Approved RDSOs: ________
Used RDSOs: ____________
Available RDSOs: _______

Explanations:________________________________________________________________
_____________________________________________________________________________

Use of Farmland
Land Use Percentage (approximate):

Cropland ________%
Pasture _________%

Orchard _________%

Woodland ________%

Wetland    ________%

Other(s) ________%

Total Acreage _______________


Has a National Resource Conservation Service (NRCS) Farm Conservation Plan been
prepared? YES   NO   UNKNOWN

Has a Forest/Woodlot Management Plan been prepared? YES                 NO   UNKNOWN

Did the SADC/State Soil Conservation Committee approve soil and
water conservation project(s) on the Premises? YES   NO   UNKNOWN

Observation of Farm Condition: ____________________________________________
___________________________________________________________________________

Is the Premises in compliance with the deed of easement? Yes                 No

Are there any other problems or situations associated with the
Premises that should be noted? YES   NO   UNKNOWN
(encroachment, trespassing, municipal regulations, etc.)

Describe: __________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________


Landowner’s Comments: ________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

Inspector’s Comments: ________________________________________________________
_____________________________________________________________________________

Weather Conditions: _________________________________________________________

Describe Bordering Properties: ______________________________________________

Inspector: __________________________________________________________________

Signature: __________________________________________________________________
Date: _______________________________________________________________________

S:\Stewardship of Preserved Farms\Form Letters\Monitoring form for web.doc