OKLAHOMA DEPARTMENT OF MINES
IMPOUNDMENT CERTIFICATION & INSPECTION
Company Name: / Permit #:
OPDES#: / Expiration Date:
If design was approved via revision, give revision number:
Inspection Date:
Pond # / Location / /4 of / /4 of / /4 of Sec: / Twp: / Rng:
TYPE OF CERTIFICATION & INSPECTION (check one): / Final or Reconstruction Certification / Yearly Inspection
Is this inspection also being used to satisfy the requirements for a quarterly impoundment inspection? (If yes, the inspection date must be within the appropriate quarter for which this report is being used). / Yes / No
Date Construction Started: / Date Construction Finalized:
What is the current primary function of the pond/impoundment?
Discuss any appearance of instability, structural weakness or other hazardous condition and existing or required monitoring procedures and instrumentation, and any other aspects of the structure affecting stability on an attached page.
Depth of Water: / (ft) / Current Elevation of Water:
Constructed elevation of bottom of pond / Designed Sediment storage / ac/ft.
▲Current Sediment Storage / ac/ft. / Designed Storage Capacity(H20 plus Sediment) / ac/ft.
Do spillway(s) meet all design requirements including size, location, and required lining?
If spillway(s) is designed for riprap does the type, size, and placement of the riprap meet the design requirements?
If spillway(s) is designed for a grass lining, is the vegetation in place and capable of meeting design requirements?
In accordance with Section OAC 460:20-43-12 & 14 of the Oklahoma Coal Reclamation Act Permanent Regulations, I hereby certify that the above named water impoundment was inspected at the site of construction and the above report is true and correct and further more that the said impoundment is constructed or within the attached tolerances as designed in accordance with the approved plan and the Oklahoma Coal Reclamation Act Permanent Regulations.
Name of Inspecting Professional Specialist:

Name (print or type)

Signature / Date
Name of Registered Professional Engineer or Land Surveyor:

Name (print or type) ( Professional Engineer Stamp)

Reg. No. / Signature / Date
▲ Not required after watershed meets Phase II standards.
*If inspected by qualified professional specialist under the direction of a P.E. then both specialist and P.E. must sign. A copy of this report shall be retained at or near the mine site. Submit three copies to the Oklahoma Department of Mines - Wagoner Field Office.
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Oklahoma Department of Mines
Acceptable Engineering Tolerances for Pond/Impoundment Construction Certification
DIMENSIONS / ACCEPTABLE TOLERANCE RANGE
Length, width, and depth / -5% to +10% for all ponds/impoundments that exceed a length and width of 200 ft. by 200 ft.
-5% to +20% for all ponds/impoundments that are less than or equal to a length and width of 200 ft. by 200 ft.
All ponds/impoundments must maintain a minimum depth of 5 feet.
Total capacity / -5% to +20%, not to exceed the MSHA 20 acre foot standard
Embankment slopes / +/-5 degrees, 27-degree maximum
Open channel spillway width / -10%, +25%
Sediment storage capacity / -5%
Elevation difference between dewatering device and bottom of emergency spillway channel / -0.5 foot, +1.0 foot
Elevation difference between bottom of emergency spillway channel and top of dam / -0.5 foot, +2.0 foot (1.0 foot minimum freeboard)

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