This form has
been prepared to help the observer in collecting data on
new sinkhole occurrences. These reports, in conjunction
with information from other sources, will provide a
comprehensive data source on sinkhole events.
1.
DATE and time sinkhole was first observed:
Month ______________ Day ____ Year
_______
Time___________am/pm.
2. LOCATION:
LONGITUDE: ______Degrees ______Min
______Sec.
LATITUDE: _______Degrees ______Min
______Sec.
County: ______________________
T____ R ____Section _____,
_____1/4 of _____1/4. 7-1/2 min.
Quad. Name_________________
Name and Address of property
where sinkhole occurred:
____________________________________________________
Phone: (
)__________
3. SINKHOLE DATA: (Circle or fill-in the blank).
SIZE and SHAPE: Are dimensions
measured ____or estimated ____?
Is the sinkhole roughly circular ____
or elongate____?
Sinkhole DIMENSIONS at surface:
LENGTH______ feet;
WIDTH______ feet. DEPTH of sinkhole
below land surface:____feet
Approximate SLOPE of sinkhole walls
when first observed: ______.
(Flat land slopes 0; a vertical wall
slopes 90).
Is there WATER in the sink? ____ Y
____ N.
DEPTH of water below land surface:
_______ feet.
Is LIMESTONE visible in the walls of
the sink? Y____ N____.
Is a CAVERN or cavity visible in the
sink? Y____ N____.
4. CIRCUMSTANCES OF COLLAPSE: How long did it take
for the
sinkhole to
form?________________________________________
Were there any probable TRIGGERING
MECHANISMS, such as: new
construction nearby ___; new
well-drilling nearby ___; blasting
nearby___; heavy loading of the ground
___; heavy rainfall ___; heavy
ground-water pumpage___;
other_________________.
Were there any PRE-COLLAPSE
INDICATORS, such as: ponding of
runoff ___; ground cracks___; tilting
of posts or trees ___; small
preliminary holes ___; turbidity in
nearby well ___; changes in nearby
vegetation (wilting) ___; other___.
Was there any property damage? ____ Y
____N Describe in
COMMENTS, below.
Was sink filled or repaired? ____ Y
____ N.
Is this planned? ____ Y ____ N.
5. TERRAIN CHARACTERISTICS:
TOPOGRAPHY: flat, hilltop, slope,
valley bottom, depression.
Please describe any drainage channels
or structures that are in the
immediate area:
_________________________________________
LAND USE / COVER: cropland, pasture
(or similar), forest, grove,
wetland, suburban (low density), urban
(high density), industrial
SOIL TYPE at the site (eg.: white
clean sand, orange clayey sand,
etc.):
_________________________________________________
Is this sink in line with, or very
near, other recent sinks? ____ Y ____ N
Is this sink in line with, or very
near, older sinks or lakes?
____ Y ____ N. Please explain:
_____________________________________________________
ADD ANY OTHER COMMENTS OR OBSERVATIONS
HERE:
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
PLEASE SKETCH THE SINKHOLE ON BACK OF THIS FORM.
