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1 <br />?V <br />PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name:) G? Date: <br />C1? e wn U? <br />NPDES ID. No.:CO-0000213 Date Last Inspected:-JO T? n.1-108 <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #0014 Location:47N15W 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 APPROPRIATE RESPONSE <br />1. Foundation Preparation (removal of vegetation, stumps., topsoil) Ye No N/A <br />2. Lift thickness (inches) <br />3. <br />4 Compaction according to approved plan <br />• Burning (specify extend and location) <br /> <br />S. <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 /> <br />b.) At isolated points on embankment slopes: Yes ? N/A <br /> <br />c) At natural hillside: Yes ? N/A <br /> d) Over widespread areas Yes ? N/A <br /> e) From downsteam foundation area Yes N/A <br /> <br />f) "Boils" beneath stram or ponded water Yes Q <br />? N/A <br />7. Cracks or scarps on crest Yes ® N/A <br />8. Cracks or scraps on slope Yes ? N/A <br />9. Sloughing or bulging on slope Yes @ N/A <br />10. Major erosion problems Yes N9 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. <br />is Existing embankment freeboard (feet) Yes ® N/A <br />Feet <br />. Cracks, bulging, or erosion on uP <br />steam face. es <br /> <br />16. <br />Visible sumps or sinkholes in slurry surface <br />Y <br />Yes <br />® <br />N/A <br />17. Clogging Yes ??1 N/A <br /> a) Spillway channels and pipes <br /> <br />b) Decant system Yes No (jJ1P <br /> <br /> <br />c) Diversion Ditches <br />Yes <br />No ED <br />is. Cracking or crushing of pipes Yes ® N/A <br /> a) Spillway pipes <br /> <br />b) Decant system Yes No <br />19. Trash racks clear and in place Yes No N/ <br /> Yes No N <br /> <br />F:\Eng\DATA\WP\pond-banks\DAMFORM.wpd <br />bo qEC./"' <br />00" <br />EWIS • F <br />U.0 <br />bq . o$ <br />? 10NAt