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Z.e 7,1 o v Zak <br />Inspectors Name: <br />NPDES ID. <br />PERIODIC INSPECTION FORM <br />SEDIMENT, OR SLURRY IMPOUNDMENTS <br />No.:COG- 850062 <br />V, �, <br />Date: 20 &o K 20/ 3 <br />Date Last Inspected: 7 rtu 20i3 <br />Facility Configuration: Partial Incised Pond <br />Site <br />Name: NHN Impoundment #001A Location:SEC <br />25, 47N 16W <br />Mine <br />Name: New Horizon North Mine Location:2.4 <br />mi.NW <br />of Nucla, <br />CO. <br />Mine ID No.: CDMG Permit: C- 2010 -089 <br />Owners <br />Rep.: Rick Wolney, Mine Manager <br />CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />1. <br />Foundation Preparation (removal of vegetation, stumps., topsoil) <br />Yes <br />No <br />N/A <br />2. <br />Lift thickness (inches) 10, % <br />3. <br />Compaction according to approved plan <br />Yes <br />No <br />N/A <br />4. <br />Burning (specify extend and location) <br />Yes <br />(.Y <br />N/A <br />5. <br />Angle of slope: 3:1 upstream, 3:1 downstream <br />6. <br />Seepage (specify location, color, and approx. volume) <br />a.) From underdrain pipes: <br />Yes <br />No <br />N/A <br />b.) At isolated points on embankment slopes: <br />Yes <br />N/A <br />c) At natural hillside: <br />Yes <br />Q <br />N/A <br />d) Over widespread areas <br />Yes <br />N/A <br />e) From downsteam foundation area <br />Yes <br />N/A <br />f) "Boils" beneath stream or ponded water <br />Yes <br />No <br />N/A <br />7. <br />Cracks or scarps on crest <br />Yes <br />No <br />N/A <br />8. <br />Cracks or scraps on slope <br />Yes <br />N/A <br />9. <br />Sloughing or bulging on slope <br />Yes <br />® <br />N/A <br />10. <br />Major erosion problems <br />Yes <br />N/A <br />11. <br />Surface movements in valley bottom or on hillside <br />Yes <br />No <br />N/A <br />12. <br />Erosion of toe <br />Yes <br />N/A <br />13. <br />Water impounded against toe <br />Yes <br />�I <br />N/A <br />14. <br />/ u / <br />Existing embankment freeboard (feet) 5 6 4� S V �• S <br />(�" <br />Feet <br />15. <br />Cracks, bulging, or erosion on upsteam face <br />Yes <br />N/A <br />16. <br />Visible sumps or sinkholes in slurry surface <br />Yes <br />No <br />N/A <br />17. <br />Clogging <br />a) Spillway channels and pipes <br />Yes <br />N�c <br />N/A <br />b) Decant system <br />Yes <br />No <br />N/A <br />c) Diversion Ditches <br />Yes <br />No <br />N/A <br />18. <br />Cracking or crushing of pipes <br />a) Spillway pipes Yes N/A <br />b) Decant system Yes N/A <br />19. Trash racks clear and in place es No N/A <br />�0- -buy 1fi r►�1n +s 0�' Ea5-f- - Wz S t (Ie��' -; aq <br />0- w ra v e l + r ru- <br />; <br />a <br />F: \ENG\ DATA \WORD \POND - BANKS \DAMFORM.DOCDOC <br />