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`. <br /> <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name:~,4s ~'.~~,~k,, Date: 63. /¢- QS <br />NPDES ID. No.:CO-0000213 Date Last Inspected: jZ -6"i -off <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #0014 Location:47N16W SEC 31 <br />Mine Name: New Horizon Mine Location:l mi.NW of Nucla, CO. <br />Mine ID No.: CDMG Permit #0008-81 <br />Owners Rep.: R. L. Wade, Mine Manager <br />CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />1. Foundation Preparation (removal of vegetat io stumps., topsoil) Y~ No N/A <br />2. Lift thickness (inches) ~2 /i/~ <br />3. Compaction according to approved plan ~e No N/A <br />4. Burning (specify extend and location) Yea No N/A <br />5. Angle of slope: 3:1 upstream, 3:1 downstream <br />6. Seepage (specify location, color, and approx. volume) <br />a.) From underdrain pipes: Yes No N/ <br />b.) At isolated points on embankment elopes: Yes ~ N/A <br />c) At natural hillside: Yes ®~ N/A <br />d) Over widespread areas Yes NO N/A <br />e) From downateam foundation area Yes ~ N/A <br />f) "Boils" beneath stram or ponded water Yes ~ N/A <br />7. CYdCka or scarps On Crest Yee No N/A <br />8. Cracks or scrape on Slope Yes No N/A <br />9. Sloughing or bulging on slope Yes ~N N/A <br />10. Major erosion problems Yea ~1~-W N/A <br />11. Surface movements in valley bottom or on hillside Yes cQ N/A <br />12. Erosion of toe Yes 13~ N/A <br />13. Water impounded against toe Yes / ~ N/A <br />14. Existing embankment freeboard (feet)~r Feet <br />15. Cracks, bulging, or erosion on upst eam face Yes ~ N/A <br />16. Visible sumps or sinkholes in slurry surface Yea N N/A <br />17. Clogging <br />a) Spillway channels and pipes Yes No N/ <br />b) Decant system Yes No N/ <br />C) Diversion Dit chea Yea NO N/ <br />18. Cracking or crushing of pipes <br />a) Spillway pipes Yes No N/ <br />b) Decant system Yea No N <br />19. Trash racks clear and in plnace I' Yes No N/ <br />~~,f roNO ~GS ~aS~~na off' ~or 'R2 ~UO ~~(EJ~t <br />~s l'~' ~ ) S ~ f Ll <br />F:\Enq\DATA\WP\pond-banks\DAMFORM.wpd <br />