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THIS FORM IS VALID FOR 6 MONTHS FROM DATE RATIFIED
ADOPTED: 5/19/2008
OFFICE OF
CONSERVATION COMMISSION
Owner/Applicant Name: ________________________________________ Date: __________
Project Location: __________________________________________ Map_____Parcel_____
Mailing Address: _____________________________________________________________
Phone: _________________________ Email / Fax: _________________________________
Contractor/Representative: _______________________________ Phone: _______________
Other Contact Information (if necessary): __________________________________________
PROJECT DESCRIPTION: (Attach additional pages if necessary. Include photos and a site
plan if available.) _____________________________________________________________
___________________________________________________________________________
TOWN OF BREWSTER
1657 MAIN STREET
BREWSTER, MA 02631
PHONE: (508) 896-4546 conservation@brewster-ma.gov
ADMINISTRATIVE REVIEW FORM
DESCRIPTION OF RESOURCE AREA AFFECTED: (Coastal Bank, Land Subject to Flooding, Salt
Marsh, Beach, Dune, Vegetated Wetland, Inland Bank, Lake, Pond, River, Stream, Bog, Swamp, etc.)
___________________________________________________________________________
1. Site Access Authorization form is included? Y / N
2. Will the proposed work take place within 50 feet of any resource area? Y / N
3. Is excavation by machinery required? Y / N
4. Will there be disturbance to the ground? Y / N
5. Is removal of vegetation proposed? Y / N
6. Is regrading proposed? (Addition or removal of soil?) Y / N
7. Is tree removal proposed? Y / N
• If so, how many? ____
8. Is pruning of trees proposed? - If so, please supply photo Y / N
9. Is planting proposed? - If so, please supply a plan including species Y / N
10. Is removal of poison ivy or other nuisance or invasive species proposed? Y / N
• If so, please explain on an additional sheet
11. Is the use of herbicides proposed? Y / N
For office use only:
Site Inspection Date: ____________________ Date Ratified: ________________
Additional Filing Required: ________________ Approval:____________________
Conservation Administrator Comments:
Office Use:
Date Received:
Fee Paid: __________
Revised: May 2008
TOWN OF BREWSTER
CONSERVATION COMMISSION
SITE ACCESS AUTHORIZATION FORM
Date: _________________________________
Project: _______________________________________________________________
Location: ______________________________________________________________
Property Owner: ________________________________________________________
I (we) hereby authorize the individual members of the Brewster Conservation
Commission and its agents to enter upon the referenced property for the purpose of
gathering information regarding the application filed with the Commission pursuant to
the Wetlands Protection Act (M.G.L. Ch 131, s. 40) and/or the Brewster Wetlands
Protection Bylaw (Chapter 172).
Additionally, if an Order of Conditions is issued for the project, I (we) grant permission
for Commission members and the Commission’s agents to enter the above referenced
property for the purpose of inspecting for compliance with the Order of Conditions.
This site access authorization is valid until a Certificate of Compliance is issued by the
Conservation Commission.
Authorized Signature: ______________________________ Date: ________________
Please Print Name: ________________________________
If other than owner, please state whether tenant, agent, or other: __________________
Mailing Address: ________________________________________________
________________________________________________
________________________________________________
Phone: __________________________ Email: __________________________
Cell: __________________________ Fax: __________________________