.13 Property Owner Notification of Tree Removal (M-689) SAMPLE.pdf
PDF 269 KB Posted
- Attached to
- Tree Trimming Stump Removal Services
- Solicitation number
- 6100065310
- Issued by
- Washington County, Pennsylvania
About this file
This is a Property Owner Notification form (Form M-689) issued by the Pennsylvania Department of Transportation (PennDOT) to inform abutting property owners of tree removal work scheduled within PennDOT's Right-of-Way. The form serves as an official notification mechanism related to tree trimming and stump removal services contracted by PennDOT in Washington County and other areas under PennDOT's jurisdiction. The notification identifies the contractor performing the work, the specific property information including owner name, address, county, state route, and segment location, and requests property owner preferences regarding the disposition of resulting materials. Property owners are asked to indicate whether they want the resulting wood, whether they desire a load of wood chips if available, and whether wood chips may be blown onto their property. The form includes spaces for property owner signature and contact person information, with three copies distributed among PennDOT, the contact person, and the property owner.
The form requires completion in blue or black ink with typed or printed information and does not imply property owner agreement or disagreement with the tree removal work being performed. Contact information for PennDOT District Roadside Units across all twelve districts is provided, allowing property owners to obtain additional information. This notification form is part of PennDOT's standard procedure for tree trimming and stump removal contracts, which are designated as Small Business Procurements restricted to DGS-certified small businesses. Waste composition including chips, mulch, leaves, and branches is primarily hauled away and disposed of, though fly chipping may be performed if specifically required and instructed for particular projects.
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Text version
This notification is to inform you, the abutting property owner, of the tree work that will take place within the PennDOT
Right-of-Way. If you should require additional information, please contact the PennDOT Roadside Unit indicated at the bottom of this form.
This work will be performed by Contractor: _______________________________________________________ .
Property Information:
Owner Name:_ ______________________________________________ County:________________________
Address:_ __________________________________________________ State Route:_ ___________________
__________________________________________________________ Segment:_____________ Left or Right
Telephone:__________________________________________________
1. Do you want the resulting wood?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . o Yes o NO
2. Do you want a load of wood chips if any are available?. . . . . . . . . . . . . . . . . . . . . . . . . o Yes o NO
3. May the resulting wood chips be blown on your property?. . . . . . . . . . . . . . . . . . . . . . . o Yes o NO
* Property Owner Signature:_________________________________________ Date:_______________
Contact Person:_ _________________________________________________ Date:_______________
* The property owner's signature does not imply that he or she agrees or disagrees with the work being performed.
PennDOT District Roadside Units
WHITE - PennDOT YELLOW - Contact Person PINK - Property Owner
M-689 (8-08) Sample
ProPerty owner notification of tree removal PleaSe tyPe or Print in blue or black ink all information o District 1-0 • (814) 678-7147 o District 2-0 • (814) 205-1192 o District 3-0 • (570) 368-4224 o District 4-0 • (570) 963-4048 o District 5-0 • (610) 871-4139 o District 6-0 • (610) 205-6753 o District 8-0 • (717) 787-7600 o District 9-0 • (814) 696-7226 o District 10-0 • (724) 357-2833 o District 11-0 • (412) 429-4954 o District 12-0 • (724) 439-7374
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