Baseline Documentation Report & Acknowledgement of Property Condition

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1 Baseline Documentation Report & Acknowledgement of Property Condition [Property Photo] [#: Property Name] Conservation Easement [Town], New Hampshire [#: Property Name] Baseline Documentation Report Page 1 of 10

2 TABLE OF CONTENTS Cover Page...1 Table of Contents...2 I. Property Information...3 II. History...4 III. Property Description and Conservation Attributes...4 IV. Current Condition...5 V. Attachments...6 A. Maps B. NH Natural Heritage Bureau Report C. Hazardous Waste Review D. Survey Plan E. Photographs F. Legal Information G. Reference Material H. Preparer Resume VI. Works Cited...7 VII. Preparer Qualifications...9 VIII. Preparer Certification...9 IX. Acknowledgement of Property Condition...10 [#: Property Name] Baseline Documentation Report Page 2 of 10

3 I. PROPERTY INFORMATION: Property Address: [Address] Tax Parcel: [Town Map XX, Lot XX] Directions: [Directions to the property from the nearest highway intersection] Property Access: [Describe how to access the property from maintained public roads, non-maintained public roads, private roads, and/or legal rights-ofway] Conservation Easement Deed: [Hillsborough/Merrimack County Registry of Deeds Book: Page: Date: ] Easement Grantor: [Name] Address: [Address] Easement Grantee: Piscataquog Land Conservancy Address: 5A Mill Street, New Boston, NH Executory Interest holder: [Remove if not applicable] Address: [Remove if not applicable] Method of Acquisition: [Donation, purchase, bargain sale, bequest, etc.] Total Acreage: [XX acres, determined by survey/deed/other] Approximate Land Types: [Acres of forest, field, open water, wetlands, etc.] Baseline Documentation Field Visits to the Property: [Date, Name, Title/Position] [#: Property Name] Baseline Documentation Report Page 3 of 10

4 II. HISTORY: Project History [Any pertinent information related to the acquisition of the property; may want to reference and include an attachment of Board minutes/resolutions conveying conservation easement] Property History [Land use history, recent past disturbances] III. PROPERTY DESCRIPTION AND CONSERVATION ATTRIBUTES: [General physical description of the property, including anything that does not fit easily into one of the below categories, such as: topography, terrain, soils, etc.] Hydrological Resources Within the Piscataquog River Watershed: Contains or is adjacent to a brook, stream, river, pond, lake, or wetlands: [GIS datasets to look at: NH Hydrography Dataset; NWI; NRCS Soils (hydric); SPARROW] Overlies public drinking water sources: [GIS datasets to look at: NHDES public water supply, water supply intake protection] Overlies aquifers: [GIS datasets to look at: Aquifer Boundaries/transmissivity] Within floodplain: [GIS datasets to look at: Digital Flood Insurance Rate Maps] Within Headwaters Project I focal area: Other: Ecological Significance Contains rare or exemplary natural communities or habitat types: [GIS datasets to look at: NH Natural Services Network] Contains rare, threatened, or endangered species: Contributes to local and regional habitat diversity: [GIS datasets to look at: NH WAP unfrag] Identified in NH WAP (Tier 1 3): [GIS datasets to look at: NH WAP] Other: [GIS datasets to look at: NH WAP] Landscape Context Adjacent to existing PLC conservation land: [GIS datasets to look at: NH Conservation/Public Lands; PLC_Lands] Adjacent to other private or public conservation land: [GIS datasets to look at: NH Conservation/Public Lands; Website for Identification of conservation lands: Existing link in a greenbelt, wildlife migration corridor, or trail system: [GIS datasets to look at: NH Wildlife Connectivity Model] Other: Recreational, Scenic, and Cultural Resources Recreational value(s): [Existing trails, access] [#: Property Name] Baseline Documentation Report Page 4 of 10

5 Permitted recreational activities: [Such as: hiking/walking, hunting, fishing, nature observation, educational programming, scientific research, snowmobiling, cross-country skiing, horseback riding, none, and/or other] Scenic value(s): [road frontage; working to get scenic byway GIS dataset] Cultural or historic value(s): [working to get historic resources GIS dataset] Other: Working Lands Supports working farm: Contains prime farmland soils: [GIS datasets to look at: NRCS Soils] Supports active and responsible forest management: Contains important forest soils: [GIS datasets to look at: NRCS Soils] Other: IV. CURRENT CONDITION: Current Land Uses and Management [Current land uses and management; any recent land use changes] Structures and Improvements Buildings: [Include use, description, dimensions, and condition] Secondary Structures: [Include any structures accessory to residential, recreational, farm, and/or forestry uses (silos, concrete pads, private utilities, antennae, flagpoles, dams, wells, etc.)] Roads: [Include roads, bridges, major culverts, and farm/woods roads] Public Utilities: [Include poles and lines, wells, pump houses, and underground utility boxes/lines] Cultural Resources: (Include historic or other cultural resources (stone walls, cellar holes, wells, etc.)) Other Improvements: [Include other improvements interpreted in the broadest sense, such as evidence of quarries, dumps, or other disturbances, also include anything that might be grandfathered but might not otherwise be permitted in the CE, such as gravel pits, farm dumps, tree stands, etc.] Exclusion Area(s): [Include brief description of activities and structures in the exclusion area(s) that might affect the conservation easement area] Conditions of Boundaries Corner monuments/pins found: [describe any missing monuments here if applicable] Well-marked blazes: [describe color and extent, mention flagging if present] Areas of Special Consideration Evidence of Recent Disturbances: [Include recent disturbances to the land (timber harvest, road building, erosion, etc.)] Existing Violations: [Any existing violations at the time of baseline documentation?] Other Considerations: [Such as: potential buffer zones or areas of special resource protection] [#: Property Name] Baseline Documentation Report Page 5 of 10

6 V. ATTACHMENTS: A. Maps 1. Locus Map: Property boundary on USGS topographic map at 1:24,000 scale. 2. Protected Open Space Map: Property boundary on aerial photograph, at 1:24,000 scale, showing adjacent or nearby conservation lands, and displaying roads. 3. Tax Map: Property boundary on [Town] Tax Map at [appropriate] scale. 4. Topographic Map: Property boundary on USGS topographic map at a closer scale. 5. Aerial Photograph Map: Property boundary on aerial photograph at a closer scale, showing adjacent conservation lands, and displaying roads. 6. Natural Resources Map(s): [Number and description of Natural Resource maps will depend on the property] 7. Soils Map: Property boundary with USDA-NRCS soil types and classifications. B. NH Natural Heritage Bureau Report C. Hazardous Waste Review 1. NH Department of Environmental Services Map: Map depicting NHDES most current records of hazardous waste on or in the vicinity of the Property (via One- Stop map generator) 2. Hazardous Waste Preliminary Site Evaluation D. Survey Plan: [ Plan Title, as prepared by [Name], LLS #[XXX], dated [Month, Day, Year], and recorded at the Hillsborough/Merrimack County Registry of Deeds as Plan #.] E. Photographs 1. Photography Affidavit 2. List of Photographs 3. Photograph Points Map: Property boundary on aerial photograph showing location and direction of BDR Photographs according to the List of Photographs. 4. BDR Photographs: Printed version as well as an electronic version on a nonrewritable compact disc. F. Legal Information 1. [Such as: Conservation Easement Deed; Title Work; Property Deed; Appraisal; and/or IRS Form 8283] G. Reference Materials 1. Supplemental Information: [Board minutes/resolutions conveying conservation easement, descriptions of ecological features, natural resource inventories, management plans] H. Preparer Resume 1. [Name] Resume [#: Property Name] Baseline Documentation Report Page 6 of 10

7 VI. WORKS CITED: [include natural resources inventories or management plans, if applicable, and other site-specific resources, and remove resources that weren t consulted] Reference Materials Bond, Richard W. and John F. Handler. Soil Survey of Hillsborough County, New Hampshire, Eastern Part. U.S. Department of Agriculture, Soil Conservation Service, Durham, NH, Handler, John F. Soil Survey of Hillsborough County, New Hampshire, Western Part. U.S. Department of Agriculture, Soil Conservation Service, Durham, NH, Mooney, Charles N., H. L. Westover, and Frank Bennett. Soil Survey of Merrimack County, New Hampshire. U.S. Department of Agriculture, Bureau of Soils, Field Operations, NH Fish and Game Department. New Hampshire Wildlife Action Plan. New Hampshire Fish & Game Department, Concord, NH, 2005 (updated 2010). Quabbin-to-Cardigan Partnership. The Quabbin-to-Cardigan Partnership. Retrieved December 21, 2012, from Sperduto, D. D. and Ben Kimball. The Nature of New Hampshire: Natural Communities of the Granite State. NH Natural Heritage Bureau, Concord, NH. Pub. UNH Press, Durham, NH Thorne, Sarah and Dan Sundquist. NH s Vanishing Forests: Conversion, Fragmentation and Parcelization of Forests in the Granite State. Society for the Protection of New Hampshire Forests, Concord, NH, Tiner, Ralph W. Wetland Definitions and Classifications in the United States. National Water Summary on Wetland Resources, U.S. Geological Survey Water-Supply Paper: 2425, 27-34,Washington, D.C., U.S Department of Agriculture, Natural Resources Conservation Service. New Hampshire Soil Attribute Data Dictionary. U.S. Department of Agriculture, Natural Resources Conservation Service, Concord, NH, GIS Data Sources Federal Emergency Management Agency. Digital Flood Insurance Rate Map Database, Hillsborough County, NH. GIS data layer from NH GRANIT, University of New Hampshire, Durham, NH, September [#: Property Name] Baseline Documentation Report Page 7 of 10

8 Federal Emergency Management Agency. Digital Flood Insurance Rate Map Database, Merrimack County, NH. GIS data layer from NH GRANIT, University of New Hampshire, Durham, NH, April NH Audubon Society, et al. New Hampshire Natural Services Network GIS data layer from NH GRANIT, University of New Hampshire, Durham, NH, April NH Audubon Society and NH Fish and Game Department. NH Wildlife Connectivity Model. GIS data layer from NH Audubon and NH Fish and Game Department, Concord, NH, July NH Department of Transportation. NH Public Roads. GIS data layer from NH GRANIT, University of New Hampshire, Durham, NH, September NH Fish and Game Department. New Hampshire Wildlife Action Plan GIS data layer from NH GRANIT, University of New Hampshire, Durham, NH, March NH GRANIT. New Hampshire Conservation/Public Lands at 1:24,000 Scale. GIS data layer from NH GRANIT, University of New Hampshire, Durham, NH, April Quabbin-to-Cardigan Partnership. Q2C Shapefiles. GIS data layer from Quabbin-to- Cardigan Partnership, Concord, NH, U.S. Department of Agriculture, Natural Resources Conservation Service. Soil Survey Geographic (SSURGO) database for New Hampshire. GIS data layer from NH GRANIT, University of New Hampshire, Durham, NH, January U.S. Fish and Wildlife Service. Wetlands: National Wetlands Inventory. GIS data layer from NH GRANIT, University of New Hampshire, Durham, NH, U.S. Geological Survey, et al. Aquifers: Transmissivity. GIS data layer from NH GRANIT, University of New Hampshire, Durham, NH, February U.S. Geological Survey. New Hampshire Hydrography Dataset. GIS data layer from NH GRANIT, University of New Hampshire, Durham, NH, September U.S. Geological Survey. New Hampshire Political Boundaries at 1:24,000 Scale. GIS data layer from NH GRANIT, University of New Hampshire, Durham, NH, November [#: Property Name] Baseline Documentation Report Page 8 of 10

9 VII. PREPARER QUALIFICATIONS: [Example: Allison Gillum, Land Protection Specialist, holds a Bachelor s degree from Skidmore College in Environmental Studies and a Master s degree from the University of Pennsylvania in City and Regional Planning. Allison s current resume can be found in Attachment H.] VIII. PREPARER CERTIFICATION: I hereby certify that I have personally inspected the property that is the subject of this Baseline Documentation Report, and I have personally prepared and reviewed the maps, photographs, and other information contained in this Baseline Documentation Report. [Name, Title] Date: [#: Property Name] Baseline Documentation Report Page 9 of 10

10 IX. ACKNOWLEDGEMENT OF PROPERTY CONDITION: In compliance with Section 1:170A-14(g) (5) of the federal tax regulations, the undersigned accept and acknowledge that this Baseline Documentation Report is an accurate representation of the property at the time of the conservation easement conveyance. The undersigned also acknowledge that they will receive a final copy of this document after all signatures are complete and the Conservation Easement Deed is recorded. IN WITNESS WHEREOF, We have hereto set our hands this day of, GRANTOR(S): By: [Grantor 1] By: [Grantor 2] STATE OF NEW HAMPSHIRE COUNTY OF [HILLSBOROUGH/MERRIMACK] The foregoing instrument was acknowledged before me this day of, 2012 by [Grantor 1 and Grantor 2]. GRANTEE: By: Paula S. Bellemore, Executive Director Duly Authorized STATE OF NEW HAMPSHIRE COUNTY OF [HILLSBOROUGH/MERRIMACK] Justice of the Peace/Notary Public Print Name: My commission expires: The foregoing instrument was acknowledged before me this day of, 2012 by Paula S. Bellemore, Executive Director of the Piscataquog Land Conservancy. Justice of the Peace/Notary Public Print Name: My commission expires: [#: Property Name] Baseline Documentation Report Page 10 of 10

APPLICATION TO AMEND THE FUTURE LAND USE MAP (FLUM) SMALL SCALE

DEPARTMENT OF DEVELOPMENT & PLANNING 825 Ohio Avenue - Lynn Haven, FL 32444 (850) 265-2961 - (850) 265-3478 APPLICATION TO AMEND THE FUTURE LAND USE MAP (FLUM) SMALL SCALE Deadline to submit is 30 days