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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLIIRRY IMPOIINDMENTS <br />Inspectors Name:~~ ~~~~__ Date: ~,q~ (4~.c~G <br />NPDES ID. No.:CO-0000213 Date Last Inspected:,,g_ho,,.C~ <br />Facility Configuration: Total Incised Pond <br />Site Name: ImDOUndment #009 Location:47N16W SEC 36 <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 v <br />egetation, stumps.,'topaoil) Ye <br />NO <br />N/A <br />2• Lift thickness (inches)- ~Z , ~~ <br />3- Compaction according to approved plan <br />Ye <br />No <br />N/A <br />4• <br /> <br />S Burning (specify extend and location) <br />Yes <br />No <br />N/A <br />- Angle of slope: 3:1 upstream, 3:1 downstream <br />6• Seepage (specify location, color, and approx. volume) <br /> a•) From underdraia pipes: <br />Yes <br />~~ <br />N/A <br /> b•) At isolated points on emban]®ent slopes: Yes 17d N/A <br /> c) At natural hillside: <br /> <br />d) Over widespread azeas Yes ® N/A <br /> <br />e) Fras dowasteam foundation area Yes ~ N/A <br /> <br />f) 'Boils" beneath strain or ponded water Yea N~ N/A <br /> <br />7- <br />Cracks"or scarps on crest Yes NCB N/A <br /> <br />B• <br />Cracks or scraps on slope Yes ® . N/A <br />9• Sloughing or bulgin on sl <br />g o~ Yes ® N/A <br /> <br />10. <br />Major erosion problems Yes ~ N/A <br /> <br />11. <br />Surface movements in valley bottom or oa hillsid Yes ~ N/A <br /> <br />12. e <br />firosion of toe <br />Yea <br />~ <br />N/A <br /> <br />11• <br />Hater impounded agarnst tce Yee <br /> <br />YeS ~ <br />t-~ N/A <br /> <br />N/ <br />14. Existing embankment freeboard (feet) , / \9 A <br /> <br />15. <br />16 <br />Cracks, bulging, or erosion on upateam face e <br /> <br />Yes <br /> <br />~ Feet <br /> <br />N/A <br />. <br />17 Visible su s or sinkholes in slur <br />~ ry surface Yes ~ N/A <br />. Clogging <br /> a) Spillway channels and pipes <br />Yes <br />~ <br />N/A <br /> h) Decant system <br />Yes <br />~ <br />N/A <br /> <br /> <br />18 <br />- c) Diversion Ditches <br />Yes <br />~ <br />N/A <br />. Cracking or crushing of pipes <br /> a) spillway pipes <br /> <br />b) Decant system Yea ~ N/A <br />19. Trash racks clear and is place Yes ~ N/A <br /> \ Ye <br />o ~d i s l7 r p,0.......!ST No N/A <br /> ~' OQ; <br />EW IS <br />, <br />F,9 <br /> ~ ~ <br />G <br />~ <br />~;o <br />F:\Eng\DATA\NP\pond-baxilcs \DAMFORM.wpd <br />Lj_ /~, oG <br />