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PERIODIC INSPECTION FORM <br />WATER, SEDIMENT, OR SLURRY IMPOUNDMENTS <br />Inspectors Name: Date: 2-7 Glutei 2o) 3 <br />NPDES ID. NO.:CO- 0000213 Date Last Inspected: O ,�uky 1v13 <br />Facility Configuration: Total Incised Pond <br />Site Name: Impoundment 4008 Location:46N15W SEC 6 <br />Mine Name: New Horizon Mine Location:l mi.NW of Nucla, CO. <br />Mine ID No.: CDMG Permit 40008 -81 <br />Owners Rep.: Rick Wolney, Mine Manager <br />CIRCLE OR WRITE IN APPROPRIATE RESPONSE <br />1 <br />3 <br />4 <br />5 <br />0 <br />7. <br />8. <br />9. <br />10 <br />11 <br />1� <br />13 <br />14 <br />15 <br />16 <br />17 <br />18 <br />19. <br />Foundation Preparation (removal of vegetation, stumps., topsoil) <br />Yes <br />No <br />Lift thicl:ness (inches) <br />Compaction according to approved plans <br />No <br />Burning (specify extend and location) <br />Yes <br />Cdo' <br />Angle of slope: 3.1 upstream, 3:1 downstream <br />Seepage (specify location, color, and appro::. volume) <br />a.) From underdrain pipes: <br />Yes <br />102 <br />b.) At isolated points on embankment slopes: <br />Yes <br />No <br />c) At natural hillside: <br />Yes <br />PIo <br />d) Over widespread areas <br />Yes <br />No <br />e) From downsteam foundation area <br />Yes <br />N <br />f) "Boils" beneath stream or ponded water <br />Yes <br />No <br />Cracks or scarps on crest <br />Yes <br />N <br />Cracks or scraps on slope <br />Yes <br />No <br />Sloughinq or bulging on slope <br />Yes <br />eN <br />Maior erosion problems <br />Yes <br />Surface movements in valley bottom or on hillside <br />Yes <br />N <br />Erosion of toe <br />Yes <br />No <br />Water impounded against toe <br />Yes <br />No <br />/ <br />E::isting embankment freeboard (feet) �it`•h' �%�v' �f <br />fok- <br />Cracks, bulging, or erosion on upsteam face <br />Yes <br />L <br />Visible sumps or sinkholes in slurry surface <br />Yes <br />�3� <br />`l:�'" <br />Clogging <br />a) Spillway channels and pipes <br />Yes <br />N <br />b) Decant system <br />Yes <br />c) Diversion Ditches <br />Yes <br />N <br />Cracking or crushing of pipes <br />_ <br />a) Spillway pipes <br />Yes <br />V <br />b) Decant system <br />Yes <br />J <br />Trash racks clear and in place <br />';es <br />No <br />1 k `r <br />d itG i�c �! • 5 L �lilr�, �t <br />r <br />G: \DATA \WP \pond- banl:s \DAMFORM.doc <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />Feet <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />N/A <br />-z.e 04-t5\-*-5V *to -P <br />