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<br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: ~¢ ~ ~,~ Date: p~, -~~~ ~ c~`t <br />NPDES ID. No.:CO-0000213 Date Last Inspected :pg _IZ -O'l <br />Facil ity 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 APPROPRSATE RESPONSE <br />1. Foundation Preparation (removal of vegetation, stwspa., topsoil) Ye No N/A <br />2. Lift thickness (inches) <br />3. Compaction according to approved plan Ye No N/A <br />4. Burning (specify extend and location) Yea [~ 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 <br /> b.) At isolated points on embankment slopes: Yes ~ N/A <br /> c) At natural hillside: Yes @ N/A <br /> d) Over widespread areas Yes Q N/A <br /> e) From downsteam foundation area Yes ~ N/A <br /> f) "Boils" beneath strain or poaded water Yes 0° N/A <br />7.~ Cracks or scarps oa crest Yes ® N/A <br />E. Cracks or scrape oa elope Yes t~t~ N/A <br />9. Sloughing or bulging on slope Yes ® N/A <br />10. Major erosion problems Yes ~ N/A <br />11. Surface movements in valley bottom or on hillside Yes ® N(A <br />12. Erosion of toe Yes ~ N/A <br />13. water impounded against toe Yes ®' N/A <br />14. Existing embankment freeboard (feet) 3 Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes ~ N/A <br />16. Visible sumps or sinkholes in slurry surface Yes I~o N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes No <br /> <br />b) Decant system <br />Yes <br />No ~ <br />~'.".l~' <br /> C) Diversion Ditche9 Yes NO <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes No <br /> b) Decant system Yes No <br />19. Trash racks clear and in place Yes No ~~r <br />)-(~nP ~5 ~Y~. <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />S~T~°~ <br />