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.1? <br />v <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name : _R Date: CA ?Z- OS <br />NPDES ID. No.:CO-0000213 Date Last Inspected:?p, <br />+?UB <br />Faci lity Configuration: Parcel Incised Pond <br />Site Name: Impoundment #0013 Location:47N16W SEC 36 <br />Mine Name: New Horizon Mine Location:1 mi.NW of Nucla CO. <br />Mine ID No.: CDMG Permit #0008-81 <br />Owne rs Rep.: R. L. Wade, Mine Manag er <br /> CIRCLE OR WRITE IN APP ROPRIATE RESPONSE <br />1. <br />2 Foundation Preparation (removal of vegetation , stumps., topsoil) Ye No N/A <br />. Lift thickness (inches) <br />3. Compaction according to approved plan <br />4. Burning (specify extend and location) <br /> <br />5. <br />Angle of slope: 3:1 upstream, 3:1 downstream Yes ® N/A <br />6. Seepage (specify location, color, and approx. volume) <br /> a•) From underdrain pipes: <br /> Yes ® <br />b.) At isolated points on embankment slopes: <br />Yes ® N/A <br /> <br />c) At natural hillside: N/A <br /> <br />d) Over widespread areas Yes Q?P N/A <br /> <br />e) From downsteam foundation area Yes (D N/A <br /> <br />f) "Boils" beneath stram or ponded water Yes ? N/A <br />7. Cracks or scarps on crest Yes ®o N/A <br /> <br />8. <br />Cracks or scraps on slope Yes ® N/A <br /> <br />9. <br />Sloughing or bulging on slope Yes ® N/A <br /> <br />10. <br />Major erosion problems Yes ® N/A <br />11. Surface movements in valley bottom or on hillside Yes <br />Yes ? N/A . <br />N/A <br />12. Erosion of toe <br />13. Water impounded against toe Yes I? N/A <br /> <br />14. <br />Existing embankment freeboard (feet) Yes ? <br />) <br />' N/A <br />15. Cracks, bulging, or erosion on up <br />steam face 7- <br />Yes <br />Yes Feet <br />N <br />A <br />16. Visible sumps or sinkholes in slurry surface / <br />17. Clogging <br />Yes <br />N/A <br /> a) Spillway channels and pipes <br /> <br />b) Decant system Yes ? N/A <br /> <br />C) Diversion Ditches Yes ?I N/A <br /> <br />18. <br />Cracking or crushing of pipes Yes ® N/A <br /> a) Spillway pipes <br /> <br />b) Decant system Yes ® N/A <br /> <br />19. <br />Trash racks clear and in place Yes ® N/A <br /> Ye No N/A <br />'r o. u o ? W c. r . t? o vv? ?.?0 R ` G/S <br /> Oe;• 'EW 's • TF <br /> <br /> <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />.M <br />V io