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z, c tv ) u'k3 <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: <br />NPDES ID. No.:CO- 0000213 <br />Date : 2-% /l, yo- o he/- 2 v 13 <br />Date Last Inspected: 7 .ct Gl3 <br />Facility Configuration: Cross Valley Pond <br />Site <br />Name: Impoundment #007 Location:46N15W SEC <br />6 <br />Mine <br />Name: New Horizon Mine Location:l <br />mi.NW of <br />Nucla, CO. <br />Mine <br />ID No.: CDMG Permit #0008 -81 <br />Owners Rep.: Rick Wolney, Mine Manager <br />CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />1. <br />Foundation Preparation (removal of vegetation, stumps., topsoil) es <br />No <br />N/A <br />2. <br />Lift thickness (inches) <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 No <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 />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 />N/A <br />7. <br />Cracks or scarps on crest <br />Yes <br />N/A <br />8. <br />Cracks or scraps on slope <br />Yes <br />JNo <br />N/A <br />9. <br />Sloughing or bulging on slope <br />Yes <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 />N/A <br />12. <br />Erosion of toe <br />Yes <br />N/A <br />13. <br />Water impounded against toe r <br />r� <br />Yes <br />f <br />N/A <br />14. <br />Existing embankment freeboard (feet) Ip �'j � - 1l b � � <br />t-5 <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 />N/A <br />17. <br />Clogging <br />a) Spillway channels and pipes <br />Yes <br />N/A <br />b) Decant system <br />Yes <br />No <br />N/A <br />c) Diversion Ditches <br />Yes <br />o <br />N/A <br />18. <br />Cracking or crushing of pipes <br />a) Spillway pipes <br />Yes <br />N <br />N/A <br />b) Decant system <br />Yes <br />o <br />N/A <br />19. <br />Trash racks clear and in place <br />Yes <br />No <br />N/A <br />P() <br />S IS h t)+ J'o 5 C4 a r cJ i h9 <br />F: \ENG\ DATA \WORD \POND- BANKS \DAMFORM.DOCDOC <br />