Summary of Lead Service Line Inventory - Sackett Lake Estates (NY5230003)

I. System Information

Water System Name Sackett Lake Estates
PWS ID Number NY5230003

II. Contact Information for Owner / Licensed Operator of Record Completing the Form

Contact Name SH Water Company
Contact Phone Number 845-573-9100
Contact Email Address roko13@aol.com

III. Summary of Inventory

Total Number of Service Lines in the Distribution System 27
Total Number of Identified Service Lines 1
Total Number of Lead Service Lines 0
Total Number of GSLRR 0
Total Number of Non-LSL 1
Total Number of Unknown Service Lines 26
Service Lines Lead GSL or GSLRR Non-Lead Unknown
PWS - Side Service Lines 0 0 GSL 27 0
Customer - Side Service Lines 0 0 GSL 1 26
Total Number of Service Lines in the Distribution System 0 0 GSLRR 1 26
Service Line Identification Methods
Identification Methods PWS- Side SLs Customer-Side SLs
Historical Records 26 0
Field Inspection 1 1
Customer Identification with Photo or other Verification NA 0
Excavation 0 0
Sequential Sampling 0 0
Statistical Analysis/Predictive Model 0 0

IV. Inventory Availability - The inventory must be available to public

If 50,000 customers or greater: Posting the inventory online water system's website. Address:
If under 50,000 customers: Explain how to access the inventory

V. Certifications

By submitting this form, I have verified and certify the information listed in this form is true and accurate to the best of my knowledge and belief.

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Name
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Title

Date