Provide as much of the requested information as possible. You may want to print a hard copy of the form, fill it out at your convenience, then fill out the electronic form. Some of the data are essential for your report to be useful. The more completely and accurately you can answer the questions on the form, the more valuable your report. The three most important points for reporting cover-collapse sinkholes are (1) be certain the feature you are reporting is a cover-collapse sinkhole, (2) be sure you can pinpoint where it is located, and (3) you must know to the nearest month when it happened. If you know the coordinates of the location (latitude and longitude from a map or GPS receiver), please provide that information as well. Remember, the Kentucky Geological Survey would like to have reports on collapse sinkholes with a diameter as small as 1 foot, just as much as for the larger ones.

REQUIRED INFORMATION

Name of person reporting sinkhole:

Representing (yourself, the homeowner, your employer, etc.):

Date collapse sinkhole was visited or reported (day/month/year):

Date cover collapse occurred (day/month/year):

County of cover collapse:

Directions to cover collapse (driving directions in relation to easily identifiable landmarks):

For example:

• From Munfordville, take Ky. 357 north 6 miles; 100 feet north of highway between Frenchman Knob Road and Brown Road
• 500 feet due east of Mt. Pleasant Church in Wilmore

ADDITIONAL INFORMATION

Identification Numbers: (for use by investigating professional)

Field , AKGWA* , or Other

* Assembled Kentucky groundwater database well or spring identification number.

Feature Location

7.5-minute quadrangle:

Latitude of sinkhole: degrees; minutes; seconds

Longitude of sinkhole: degrees; minutes; seconds

Elevation (in feet): ; at datum : ; determined with

Property Owner

Name

Street

City , KY

Zip code

Telephone

Feature History

Any property damage? Yes or No

If yes, please describe damage:

Any evidence of prior collapse? Yes or No

If yes, please describe evidence:

Any buried trash exposed by collapse? Yes or No

If yes, please describe the source of the trash (e.g., domestic, construction, agricultural, etc.):

Any service lines exposed (water, sewer)? Yes or No

If yes, please describe the type of lines exposed:

Was there a reviously existing depression? Yes or No

If yes, did it hold water? Please describe the circumstances when water was present (e.g., always, only after major storm, farm pond, etc.):

Weather conditions during prior month (e.g., heavy rain, dry, freezing, etc.):

Feature Dimensions (estimate if necessary)

Short axis: length feet; azimuth degrees

Long axis: length feet; azimuth degrees

Depth (undisturbed ground level to minimum depth visible): feet

Average or typical wall slope: degrees

Hydrogeology

Bedrock visible? Yes or No

If yes, identify formation or member

Soil name or type:

Water visible? Yes or No

If yes, identify direction of flow (e.g., north, south, east, west)

Cave entrance visible? Yes or No

Comments (Describe unusual or extenuating circumstances, history of the collapse, or any relevant detail)

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