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z,.0 1,4 o cl -t-0 l-� <br />PERIODIC INSPECTION FORM <br />, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: I-eyor <br />NPDES ID. No.:CO- 0000213 <br />�2 Date:- 2 D /V,y_ 2 D% 3 <br />Date Last Inspected: 2 7 A46 2o) 3 <br />Facility Configuration: Total Incised Pond <br />Site <br />Name: Impoundment #009 Location:47N16W SEC <br />36 <br />Mine <br />Name: New Horizon Mine Location:l mi.NW <br />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) <br />es <br />No <br />N/A <br />2. <br />Lift thickness (inches) <br />3. <br />Compaction according to approved plan <br />De <br />No <br />N/A <br />4. <br />Burning (specify extend and location) <br />Yes <br />To <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 <br />N/A <br />c) At natural hillside: <br />Yes <br />No <br />N/A <br />d) Over widespread areas <br />Yes <br />N/A <br />e) From downsteam foundation area <br />Yes <br />o <br />N/A <br />f) "Boils" beneath stream or ponded water <br />Yes <br />0- <br />7. <br />Cracks or scarps on crest <br />Yes <br />� <br />N/A <br />8. <br />Cracks or scraps on slope <br />Yes <br />No <br />N/A <br />9. <br />Sloughing or bulging on slope <br />Yes <br />I� <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 />o <br />N/A <br />12. <br />Erosion of toe <br />Yes <br />o <br />N/A <br />13. <br />Water impounded against toe // / 6 <br />q q 3. <br />Yes <br />IL <br />� <br />6 <br />N/A <br />Feet <br />14. <br />Existing embankment freeboard (feet) b 5 <br />15. <br />Cracks, bulging, or erosion on upsteam face <br />Yes <br />o <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 />N/A <br />c) Diversion Ditches <br />Yes <br />N/A <br />18. <br />Cracking or crushing of pipes <br />a) Spillway pipes <br />Yes <br />No <br />N/A <br />b) Decant system <br />Yes <br />N/A <br />1199. <br />racks clear and in place <br />Yes <br />No <br />N/A <br />CC <br />S1 `f- <br />CTrash[ <br />5 0 t j � (,64c4 w i z A4 d, +e-4 5 Rave- bo-e- ' <br />( <br />Ltka� <br />POK � i 5 IJr/ <br />F: \ENG\ DATA \WORD \POND- BANKS \DAMFORM.DOCDOC <br />