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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: <br />NPDES ID. No.: 0000213 <br />Date: It 1 <br />Date Last Inspected: 6 2 . 0 9 <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment #009 Location: SEC 36 <br />Mine Name: New Horizon Mine Location: 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) (!9 No N/A <br />2. <br />Lift thickness (inches) <br />3. <br />Compaction according to approved plan <br />No <br />N/A <br />4. <br />Burning (specify extend and location) <br />Yes <br />N/A <br />5. <br />Angle of slope: 3:1 upstream, 3:1 downstream <br />6. <br />Seepaqe (specify location, color, and approx.. volume) <br />a.) From underdrain pipes: <br />Yes <br />Q <br />N/A <br />b.) At isolated points on embankment slopes: <br />Yes <br />0 <br />N/A <br />c) At natural hillside: <br />Yes <br />N/A <br />d) Over widespread areas <br />Yes <br />N/A <br />e) From downsteam foundation area <br />Yes <br />N/A <br />f) "Boils" beneath stram or ponded water <br />Yes <br />N/A <br />7. <br />Cracks or scarps on crest <br />Yes <br />N/A <br />8. <br />Cracks or scraps on slope <br />Yes <br />10 <br />N/A <br />9. <br />Sloughing or bulging on slope <br />Yes <br />4P <br />N/A <br />10. <br />Major erosion problems <br />Yes <br />40 <br />N/A <br />11. <br />Surface movements in valley bottom or on hillside <br />Yes <br />® <br />N/A <br />12. <br />Erosion of toe <br />Yes <br />40 <br />N/A <br />13. <br />Water impounded against toe <br />Yes <br />QD <br />N/A <br />14. <br />Existing embankment freeboard (feet) sL,.Fo.(. .. 5g.0-'3 <br />10,3 <br />Feet <br />15. <br />Cracks, bulging, or erosion on upsteam face <br />Yes <br />(0 <br />N/A <br />16. <br />Visible sumps or sinkholes in slurry surface <br />Yes <br />N/A <br />17. <br />Clogging <br />a) Spillway channels and pipes <br />Yes <br />® <br />N/A <br />b) Decant system <br />Yes <br />da� <br />N/A <br />c) Diversion Ditches <br />Yes <br />N/A <br />18. <br />Cracking or crushing of pipes <br />a) Spillway pipes <br />Yes <br />N/A <br />b) Decant system <br />Yes <br />® <br />N/A <br />19. <br />Trash racks clear and in place <br />1�p <br />No <br />N/A <br />T�� <br />F: \Eng \DATA \WP \pond- banks \DAMFORM.wpd <br />o � REG T� <br />, <br />,ems • • � \ <br />..r <br />