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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />(,t4ll &6r-i4fe- <br />Inspectors <br />Name: Date : <br />NPDES <br />ID. No.:CO- 0000213 Date Last <br />Inspected: li <br />4-ia,'L,A 2Ul <br />Facility <br />Configuration: Total Incised Pond <br />Site <br />Name: Impoundment #0015 Location:47N <br />16W SEC 36 <br />Mine <br />Name: New Horizon Mine Location:l <br />mi.NW of Nucla, CO. <br />Mine <br />ID No.: CDMG Permit #0008 -81 <br />Owners <br />Rep.: Rick Wolney, Mine Manager <br />CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />1. <br />Foundation Preparation (removal of vegetation, stumps., topsoil) <br />`Yes No <br />N/A <br />2. <br />Lift thickness (inches) <br />3. <br />Compaction according to approved plan <br />/Yes� No <br />N/A <br />4. <br />Burning (specify extend and location)_ <br />Yes (7.) <br />N/A <br />5. <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 No <br />N/A <br />b.) At isolated points on embankment slopes: <br />Yes No <br />N/A <br />c) At natural hillside: <br />Yes No <br />N/A <br />d) Over widespread areas <br />Yes No <br />N/A <br />e) From downsteam foundation area <br />Yes No <br />N/A <br />f) "Boils" beneath stream or ponded water <br />Yes N <br />N/A <br />7. <br />Cracks or scarps on crest <br />Yes No <br />N/A <br />8. <br />Cracks or scraps on slope <br />Yes (No <br />N/A <br />9. <br />Sloughing or bulging on slope <br />Yes No <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 />Yes _Z. <br />N/A <br />13. <br />Water impounded against toe <br />Yes LNS` <br />N/A <br />14. <br />L -7 <br />Existing embankment freeboard (feet) �� ) / ( <br />I O, I t <br />Feet <br />15. <br />Cracks, bulging, or erosion on upsteam face <br />Yes No <br />N/A <br />16. <br />visible sumps or sinkholes in slurry surface <br />Yes No,' <br />N/A <br />17. <br />Clogging <br />a) Spillway channels and pipes <br />Yes No <br />N1` <br />b) Decant system <br />Yes Z, <br />N/ <br />C) Diversion Ditches <br />Yes No <br />N/A ) <br />18. <br />Cracking or crushing of pipes <br />a) Spillway pipes <br />Yes No <br />;N /A <br />b) Decant system <br />No <br />19. <br />Trash racks clear and in place^ <br />N <br />F : \ENG\ DATA \WORD \POND - BANKS \DAMFORM.DOCDOC <br />l <br />