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i~ <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />'--~~ ~ -~ <br />Inspectors Name : ~s ~„ ,~-,~ Date : ~ Z - o~( - 04- <br />NPDES ID. No.:CO-0000213 Date Last Inspected: 9 - 4- O L}- <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #0014 Location:4 7N16W SEC 31 <br /> <br />Mine Name: New Horizon Mine Location:l mi.NW of Nuc la, CO. <br />Mine ID No.: CDMG Permit #0008-81 <br />Owners Rep.: R. L. Wade, Mine Manager <br /> CIRCLE OR WRITE IN APPROPRIATE R ESPONSE <br />1. Foundation Preparation (removal of vegetat io <br />n, stumps., tops oil) Y~ No N/A <br />2. n <br />Lift thickness (inches) ~ ~. i Nc~ <br />3. Compaction according to approved plan 0 No N/A <br />4. Burning (specify extend and location) Yea No N/A <br />5. Angle of elope: 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 slopes: Yea No N/A <br /> c) At natural hillside: Yes ~ N/A <br /> d) Over widespread areas Yea Q° N/A <br /> e) From downsteam foundation area Yee doh N/A <br /> f) "Boils" beneath stram or ponded water Yea ~ N/A <br />7. Cracks or scarps on treat Yes ® N/A <br />8. Cracks or scraps on elope Yes ® N/A <br />9. Sloughing or bulging on slope Yea ~ N/A <br />10. Major erosion problems Yea ~ N/A <br />11. Surface movements in valley bottom or on hillside Yes ®N N/A <br />12. Erosion of toe Yes ~l N/A <br />13. Water impounded against toe Yes ~ @ N/A <br />14. Existing embankment freeboard (feet) ~ Feet <br />15. Cracks, bulging, or erosion on upsteam face Yes ~ N/A <br />16. Visible sumps or sinkholes in slurry surface Yes N N/A <br />17. Clogging <br /> a) Spillway channels and pipes Yes No <br /> b) Decant system Yes No <br /> c) Diversion Ditches Yes No /A <br />18. Cracking or crushing of pipes <br /> a) Spillway pipes Yes No /N~J~. <br />= <br />~ <br /> b) Decant system Yes No ~ <br />NL <br />AJ(~ <br />19. Trash racks clear and in place Yes No N/A <br />p,~r,~ \.u7a'J de5lgNoa ~or ~~ ~001~t~ '~J-2+~~"! <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />)~_o~,o~ <br />