Wetlands Violation - Initial Complaint Form | Enforcement | New England

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Wetlands Violation - Initial Complaint Form

Date:

1. Complainant

Name:
Address:

Phone #:

2. Location of Suspected Violation

Street:
Town:
State:

What is the nearest intersection, street, waterbody or other landmark?

3. The Activity

a)	Is there a discharge of dredged and/or fill material into wetlands or waters?	Yes NO
b)	Is the activity ongoing?	Yes NO
c)	What is the approximate area of filled wetlands or waters?	acres or square feet
d)	Is mechanized landclearing taking place?	Yes NO
e)	If the answer to d) is yes, what is the approximate area of land that has been cleared through mechanized landclearing?	acres or square feet
f)	When did the activity begin?

4. The Parties Involved

a) Landowner's

Name:
Address:

Phone #:

b) Contractor's

Name:
Address:

Phone #:

5. Other Information

a) Do you know if local, state or other federal authorities are involved? If yes, explain:

b) Do you have maps, photographs and/or names of other individuals who might have additional information?

6. Other Comments

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