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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: <br />NPDES ID. No.: 0000213 <br />Date: <br />Date Last Inspected: ( .2 •0 <br />Facility Configuration: Parcel Incised Pond <br />Site Name: Impoundment #011 Location: SEC 1 <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) No N/A <br />2. Lift thickness (inches) <br />3. <br />Compaction according to approved plan <br />(�D <br />No <br />N/A <br />4. <br />Burning (specify extend and location) <br />Yes <br />o <br />N/A <br />S. <br />Angle of slope: 3:1 upstream, 3:1 downstream <br />6. <br />Seepage (specify location, color, and approx. volume) <br />a.) From underdrain pipes: <br />Yes <br />N/A <br />b•) At isolated points on embankment slopes: <br />Yes <br />&D <br />N/A <br />C) At natural hillside: <br />Yes <br />6 <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 />a. <br />Cracks or scraps on slope <br />Yes <br />® <br />N/A <br />9. <br />Sloughing or bulging on slope <br />Yes <br />® <br />N/A <br />10. <br />Major erosion problems <br />Yes <br />N/A <br />11. <br />Surface movements in valley bottom or on hillside <br />Yes <br />N/A <br />12. <br />Erosion of toe <br />13. <br />Water impounded against toe <br />Yes <br />Yes <br />o <br />1 0 <br />N/A <br />14. <br />Existing embankment freeboard (feet) 547-7,6 <br />e T <br />N/A <br />15. <br />Cracks, bulging, or erosion on upsteam face <br />Yes <br />42) <br />Feet <br />N/A <br />16. <br />Visible sumps or sinkholes in slurry surface <br />Yes <br />4D <br />N/A <br />17. <br />Clogging <br />a) Spillway channels and pipes <br />Yes <br />N/A <br />b) Decant system <br />Yes <br />19 <br />N/A <br />c) Diversion Ditches <br />18. <br />Cracking or crushing of pipes <br />Yes <br />N/A <br />a) Spillway pipes <br />Yes <br />® <br />N/A <br />b) Decant system <br />Yes <br />N/A <br />19. <br />Trash racks clear and in place <br />Yes <br />No <br />N/A <br />v� <br />s <br />F: \Eng \DATA \WP \pond- banks \DAMFORM.wpd <br />