Archeological Site Inventory Form Former Ketcham Private Graveyard | If checked, this is a Supplemental Form, not in the original surveys.
| Information in brackets [ ] is new or updated information (i.e., not on the original form) | . Images | «» | . People | «» | . Other Documents |
| | | | | Prepared Date: 11/26/2005 | | Submitter | Revised Date: | | | Submitter Name: | | | Submitter Address: | | | Organization: | |
| | | | Identification | | | | 1-Site Name: | Former Ketcham Private Graveyard | | 2a-County: | Suffolk | 2b-Town: | Brookhaven | 2c-Village: | Hamlet of Brookhaven | | 3-Location: | abt 368 South Country Rd. | | About 368 South Country Rd. |
| | | | Ownership | | | 4a-Public Site | 4b-Private Site | | | 4-Present Owner: | 5a-Address: | |
| | | | | | Historic and Architectural Importance | | | «» | | | | | 6- Description, Condition, Evidence of Site | | | | | | | | | | 7- Collection of Material from Site | | | 7a- Surface Hunting | By Whom: | Date: | 7b-Testing | By Whom: | Date: | 7c-Excavation | By Whom: | Date: | 7d-None | | | | 7e-Present Repository of Materials | |
| | | | | | 8- Prehistoric Cultural Affiliation or Date | | | | | | | | | 9-Historical Documentation of Site | | | «» | | | | | | 10- Possibility of Site Destruction or Disturbance | | | «» | | | | | | 11-Remarks | | | «» | | | | | | | 12- Map Location | [If an original form, the source map images were not reproducible.] | | 12a- 7 1/2 Minute Quad. Name: | | 12b- 15 Minute Quad. Name: | | 12c- U.S.G.S Coordinates: | | 12d- D.O.T. Coordinates: (if known): | | Other Maps: | | | | | 13- Photographs | . | | | | | | | Supplemental Material | | | «» | | | | | | Prepared By: | John Deitz |
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