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J' • <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: ~ « ~, ,~pltq Date• ~(, ~~ > o-c <br />NPDES ID. No.:CO-0000213 005 Date Last Inspected :o R-)Z-~ 1 <br />Facil ity Configuration:Incised Pond <br />Site Name: Impoundment #012 Location: 47N16W Sec 36 <br />Mine Name: New Horizon Mine Location: 2 mi.NW of Nucla , CO. <br />Mine ZD No.: CDMG Permit #0008-B1 <br />Owners Rep.: R. L. Wade, Mine Manager <br /> CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps., topsofl) ® No N/A <br />2. Lift thicloesa (inches) <br />3. Compaction according to approved plan ~ No N/A <br />4. Burning (specify extend sad location) Yea ~ NJA <br />5. Angle of slope: 3:1 upstream, 3:1 downstream <br />6. Seepage (specify location, color, and approx. volume) <br /> a.) From underdraia pipes: Yes NO N/A <br /> b.) AC isolated points oa embankment slopes: Yes ® N/A <br /> c) At natural hillside: Yes Q1~ N/A <br /> d) Over widespread azeas Yes ~ NIA <br /> e) From downsteam foundation area Yes ~ N/A <br /> f) •BO11s' beneath strain or ponded water Yes ~ N/A <br />7. Cracks or scarps on crest Yes ~ N/A <br />S. Cracks or scraps on slope Yes ~ N(A <br />9. ~ Sloughing or bulging on elope ~ Yes ~I~. N/A <br />10. Major erosion problems ~ Yea ® N/A <br />11. Surface movements is valley bottom or on hillside Yes ® N/A <br />12. Erosion of tce ~ Yes ® N/A <br />13 .' Water impounded against tce Yes Q~ '' N/A <br />14. Existing embankment freeboard (feet) <br />~ <br />Peet <br />15. Cracks, bulging, or erosion on upsteam face Yea ® N/A <br />16. Visible sumps or sinkholes in slurry surface Yea ~ N/A <br />17. Clogging <br /> a) Spillway ebannels and pipes Yee ~ N/A <br /> b) Decant system Yes ~ N/A <br /> c) Diversion pitches Yes ~ N/A <br />is. Cracking or crushing of pipes <br /> a) Spillway pipes Yes ~ N/I+ <br /> b) Decant system Yes ® N/A <br />19. Trash racks clear and is place ~ No N/A <br />R)~~ 15 ~r~ <br />fQ 7 >~ <br />b~~~ o~ <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd ''(~~• ~, <br />