Pinewood Springs Fire Protection District

Dept. Designator_________

Defensible Space Survey Form

Lot/Address ______________________________

Date ______________________________

Contact ______________________________

Structures

Are trees and brush thinned around structures? Yes___ No___ N/A___

Is the initial 15 feet around structures clear of ALL

flammable vegetation? Yes___ No___ N/A___

Is there a noncombustible “belt” maintained close to

structures? Yes___ No___ N/A___

Are grass and weeds maintained at 6 inches or less if

within 30 feet of structures? Yes___ No___ N/A___

Have branches been removed where they would extend

over eaves of structure roofs or where they are within

15 feet of a chimney? Yes___ No___ N/A___

Are tree branches clear of decks and overhead power

lines? Yes___ No___ N/A___

Are roof gutters and decks cleared of combustible debris? Yes___ No___ N/A___

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Defensible Space

Are trees thinned beyond the initial 15 feet around

structures to a 10 – 12 foot crown spacing? Yes___ No___ N/A___

Has additional space been provided around tree

clumps retained for natural effects? Yes___ No___ N/A___

Have ladder fuels been thinned or removed from

under tree clumps retained for natural effects? Yes___ No___ N/A___

Has ground litter been removed from within the

defensible space? Yes___ No___ N/A___

Is firewood stacked uphill or on contour a minimum

of 15 feet away from structures? Yes___ No___ N/A___

Have tree branches within the defensible space been

pruned to a height of 10 feet above ground fuels? Yes___ No___ N/A___

Other

Has vegetation or other combustible material been

cleared a minimum of 10 feet around propane tanks? Yes___ No___ N/A___

Are brush, weeds and grass maintained within 10 feet

of access and road? Yes___ No___ N/A___

Has slash and debris from thinning been reduced or

disposed of? Yes___ No___ N/A___

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