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NPDES ID <br />PERIODIC INSPECTION FORM <br />V WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Name: Trevor 5J/ <br />a1-- Date: 20 /(%V 2013 <br />No.:CO- 0000213 Date Last Inspected: 2--?,449 20 3 <br />Facility Configuration:Incised Pond <br />Site <br />Name: Impoundment #012 Location:47N16W Sec <br />36 <br />Mine <br />Name: New Horizon Mine Location:2 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) <br />es <br />No <br />N/A <br />2. <br />Lift thickness (inches) <br />3. <br />Compaction according to approved plan <br />( e <br />No <br />N/A <br />4. <br />Burning (specify extend and location) <br />Yes <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 />N/A <br />b.) At isolated points on embankment slopes: <br />Yes <br />N/A <br />C) At natural hillside: <br />Yes <br />0 <br />N/A <br />d) Over widespread areas <br />Yes <br />N <br />N/A <br />e) From downsteam foundation area <br />Yes <br />1 <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 />o <br />N/A <br />8. <br />Cracks or scraps on slope <br />Yes <br />N <br />N/A <br />9. <br />Sloughing or bulging on slope <br />Yes <br />No <br />N/A <br />10. <br />Major erosion problems <br />Yes <br />No <br />N/A <br />11. <br />Surface movements in valley bottom or on hillside <br />Yes <br />N <br />N/A <br />12. <br />Erosion of toe <br />Yes <br />N <br />N/A <br />13. <br />Water impounded against toe <br />Yes <br />o <br />N/A <br />14. <br />p <br />Existing embankment freeboard (feet) S b 1 � � � �� 1 • %-f <br />1 �, <br />Feet <br />15. <br />Cracks, bulging, or erosion on upsteam face <br />Yes <br />IQ <br />/DTtY1 <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 />® <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 />60 <br />N/A <br />19. <br />Trash racks clear and in place <br />No <br />N/A <br />WLS+ <br />d�'hL� kaS been &1Q-a z j% 0"+/. w25+ <br />/ (Yes <br />Glt T'L� <br />f <br />Iwl��— I,y1d <br />PdVt d <br />-e—en f -e- Pa1'rPJ akd 2L+' 4al-( <br />cu(v -ert <br />;viI4f ;yfo <br />0 v., OC k a S b R- e'q a- � J e J. Po h l r 5 Yt o+ (,` � 5 L � ci Ir Gt 1 �► G1 <br />F: \ENG\ DATA \WORD \POND - BANKS \DAMFORM.DOCDOC ✓ J/ <br />