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<br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />~'lA n O~~ . <br />Insp ectors Name : ~« ~~~\~ Date : ~ _~ _ ~ 4. <br />NPDE S ID. No.:CO-0000213 Date Last Inspected: 1n-3- O~V- <br />Faci Lity 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 /> <br />Mine ID No.: CDMG Permit #0008-81 <br />Owne rs Rep.: R. L. Wade, Mine Manager <br /> CIRCLE OR WRITE IN APPROPRIATE R ESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps., topsoil) ~, No N/A <br />2. Lift thickness (inches) IZ ~ uc.~_ <br />3. Compaction according to approved plan ~ Ye No N/A <br />4. Burning (specify extend and location) Yes ~ <br />~ <br />`,7+ 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 <br /> b.) At isolated points on embankment slopes: Yea N~ N/A <br /> c) At natural hillside: Yes ~ N/A <br /> d) Over widespread areas Yes ^ <br />~ N/A <br /> e) From downateam foundation area Yes N/A <br /> f) "Boils" beneath stram or ponded water Yes ~ N/A <br />7. Cracks or scarps on crest Yee ~ N/A <br />8. Cracks or ecrapa on elope Yes ~ N/A <br />9. Sloughing or bulging on slope Yes ~ N/A <br />10. Major erosion problems Yea N~ 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 • ~ <br />N N/A <br />14. Existing embankment freeboard (feet) ~ __ Feet <br />15. Cracks, bulging, or erosion on upsteam face Yea No N/A <br />16. Visible sumps or sinkholes in slurry surface Yes ~ N/A <br />1'1. Clogging <br /> a) Spillway channels and pipes Yes No <br /> b) Decant system Yes No <br /> <br />c) Diversion Ditches <br />Yes <br />No ~ <br />`~" ' <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 ®N <br />/ i•,f ~VFa <br />l,.Xl~'~r Ih ~TIOw~ ~COw. \rYr•~4~1 w. <br />wGs p~ e.S ~9 Mrc~ -~ . -~~--. ~~~tt ~ev-w. <br />F:\Eng \IIATA\WP\pond-banks\DAMFORM.wpd <br />- ~. 'r' <br />