Please print this form and mail it to:
Jim Currens
Kentucky Geological Survey
currens@uky.edu
308 Mining and Mineral Resources Bldg.
University of Kentucky
Lexington, KY 40506-0107
Provide as much of the requested information
as possible. 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* |
: |
| Contact Email: |
(required) |
| 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 previously 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)
|
| If your browser or server is not configured to use this form, please report
this information directly to Jim Currens at 859.323-0526. |
