HomeMy WebLinkAbout038-1018-30-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 563846 0
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Bruss, Ma Alice Coles Star Prairie, Town of 038-1018-30-000
CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown/Range/Map No:
13 ryN 1 03.31.18.65B
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ~Z Benchmark
`e 2w~ Z$dc~ 2 ZS l63 -65 /4z, B
Dosing Alt. BM
Aeration Bldg. Sewer
473 ".3Z
Holding n1 0-:5 St/Ht Inlet Q7 C-3
St/Ht Outlet
TANK SETBACK INFORMATION S Q(r~
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic
Z G Z7 Zs 7o 73.
Dosing Header/Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP/SIPHON INFORMATION
Manufacturer DeP ^and St Coyr4 l~ / 7 .55 14j - S
Model Number t_ o
TDH Lift Friction Loss System Head JTFt
Forcemain Length Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYS O P/L BL WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION T e Of System: J CHAMBER OR
76 UNIT Model Number:
DISTRIBUTION SYSTEM
Header/Manifold Distribution a Size ]xHole Spacing Vent to Air Intake
Pipe(s)
Length Dia Length is Spacing
SOIL COVER x Pressur stems Only xx Mound Or At-Grade Systems y.
Depth Over Depth Over xx Depth of _ xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges [E Yes 0 No ❑ Yes [g No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / /
Location: 1198 CTH "H" New Richmond, WI 54017 (Gov't Lot 3 3 T31 N R18W) metes & boounds Lot / Parcel No: .31.18.656
1.) Alt BM Description
2.) Bldg sewer length
- amount of cover I-
Plan revision Required? 0 Yes No f~ I
Use other side for additional informatXn
Date Insepctors Si ature Cert. No.
SBD-6710 (R.3/97)
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~r+aru~T County
1 °a Safety and Buildings Division
®S 201 W. Washington Ave., P.O. Box 7162 St. Croix
a P Madison, Wl 53707-7162 Sanitary Permit Number (to be filled in by Co.)
Sanitary Permit Application ,TrSaaronNumber
In accordance with SPS 383.21(2), Wis. Adm., submission of this form to the appropriate governmental yt~9j Na
is required prior to obtaining a sanitary • Application forms for state-owned POWTS are submittek Project Ad if different than mailing address)
the Department of Safety and Prof si . Personal information you provide may be used for s..gdary I'9g Co.
T
purposes accordance with th s. 1 (in), Stats.
S,,^^~~' 'e, WI 54026
`°K
1. Application Iaforma ' t All Information
sse
' ti'el #
Property Owner's Name
V
N
Mary Alice Coles Bruss 038-1018-30-000
Property Owner's Mailing Address Property Location
2345 9d' St. C J t~
City, State Zip Code Phone Number Govt. Lot
NE v., SE 1/., section 3
St. Paultvffi 55110 (651738-7600 (circle one)
II. of Building (check all that apply) Lot # T 31 N; R 18 E or W
or 2 Family Dwelling - Number of Bedrooms 2 Subdivision Name
Na
Block # Na `
11 PubliclCommerciai -Describe Use
Na ❑ City of
❑ State Owned - Describe Use CSM Number ❑ Village of
Na ❑ Town of Star Prairie
Ta~..
III. Type of Permit: (Check my one box on line A. Co a 1'
A. ❑ New System ❑ Replacement System Treatm t/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
Move existing holding tank
❑ Permit Transfer to New List P~cv" Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber
Before Expiration Owner A U Iq tw ki
IV. iype of POWTS System/Component/Device: Check all that apply)
won'-Prres~mid In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound >24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
koldi T ~ ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis rsal/Treat ent Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
300 Gpd Na Na Na Na
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units S~
New Tanks Existing Tanks g tom'
Septic or Holding Tank 2,500 2,500 1 Wieser Concrete X
Dosing Chamber I- P
VIL Responsibility Statement- ,the undersign 4 assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's ignattue MP/MPRS Number Business Phone Number
James K. Thompson MPRS 30021 715 248-7767
Plumber's Address (Street, City, State, Zi ode)
340 Paulson Lake Lane, Osceola, WI 54020
VIII. County/Department Use Only
ta,lproved n Permit Fee Date Issued Issuing t Signature
II~ASSf~+PP J Given Reason for Denial $ 65( ' ZL~~3 '
VL Conditions of Approval/Reasons for Disapproval
Al nr-r1reA4e.-j1.$
-5 6le.. d0- IQe_
Attach to complete plans for the system and submit to the Co ty tm~ on paper not less thaq S 1/Z z 11 Inc in size
3 < Z00o r~k4urbdv,cfz h),g L. yea
SBD-6398 (R. 11/11)
CONCRETE HOLDING TANK DESIGN
Single Tank Option
INDEX AND TITLE SHEET
Project Bruss 2 bedroom Residential Holding Tank
Owner Mary Alice Coles Bruss
Address 2345 9th St., St. Paul, MN 55110
Site Address: 1198 Co. Rd. H, Star Prairie, WI
Legal Description NE1/4 SE1/4, Sec. 3, T. 31 N., R. 18 W.
Township Star Prairie County St. Croix
Subdivision Name Na Lot No. Na
Parcel ID Number 038-1018-30-000
Plan Transaction ID Number
Index and title sheet Page 1
Holding tank specifications Page 2
Site plan Page 3
Maintenance and contingency plan Page 4
Holding Tank Servicing Contract Page 5
Holding Tank Agreement Page 6
WaranV Deed Page 7
Attached Soil Evaluation Report Page 8
Designe James Thompson
Signature s-- Phone No. (715) 248-7767
License Number Dept of SPS Credential #30021 Date 07/08/13
Designed pursuant to:
Holding Tank Component Manual For POWTS
SBD-10571-P (R.6/99)
Version 4.0 (04/03) Page 1 of 8
HOLDING TANK SPECIFICATIONS
2 Number of bedrooms
0.0 Non-residential estimated flow (gpd)
2000.0 Minimum holding tank volume required (gal)
2500.0 Proposed holding tank capacitty, (gal)
Wieser Concrete Tank Manufacturer
WILP 2500HO Tank model number
JH Rhombus Alarm manufacturer
SJE 1011421 Alarm model number
Tank Dimensions and Data Tank Anchor Calculations
X for round tank 24827 Ibs Weight of tank and cover
38.0 Liquid depth below inlet invert (in) 1.50 Safety factor
26.0 Maximum de th of soil cover (ft) 31238 Ibs Weight of anchor required
56.0 Height (in) Outside E2 Soil cover req. for anchor or
183.0 Length (in) Dimensions 7.7 yd' Concrete counter weight
101.0 Width (in) Only
HOLDING TANK CROSS SECTION
manhole cover with
locking device and finished vent cap
junction warning label grade
box
a4- min-I 1-
12" min.
24 in.
conduit Manhole and vent locations vent pipe
18"min.
12 0 in. building sewer
service inlet
blind plug alarm on Note: All tank joints, and
to seal joints between tank
outlet openings and piping are
Electrical as per 26.0 in. sealed watertight. All
NEC 300 pipe and vent materials
and Comm 16 comply with Comm 84.
3 in. bedding under tank. Tank is anchored as necessary to negate buoyancy.
Project: Bruss 2 bedroom Residential Holding Tank
Transaction Number: Page 2 of 8
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HOLDING TANK MANAGEMENT PLAN
This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and
maintained according to Comm 83, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10571-P
6/1111999), and the St. Croix County Sanitary Ordinance.
1. This POWTS is designed to accommodate an estimated domestic wastewater flow of 500.0 gpd.
2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in
the attached Holding Tank Servicing Contract and Maintenance Agreements.
3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet
(at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to
empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code.
4. At each service event, the service provider should visually inspect the condition of the tank, risers and
manhole cover(s) and verify that the alarm system functions and manhole locking devices are present.
Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions
shall comply with the county sanitary ordinance and Comm 83 and 84 Wis. Adm. Code.
5. All service events or inspections of this POWTS shall be reported to the county within 10 business days.
6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be
removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes
tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes
a failing POWTS and may result in issuance of correction orders or a citation by the county or state.
7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards
for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue
of a person from the interior of the tank may be difficult or impossible.
8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank
may be installed in the same location (a new sanitary permit is required for such a replacement). Con-
nection to municipal services would also be considered at this time if they are deemed available to the
property.
9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in
accordance with Comm 83.33 Wis. Adm. Code.
10. If there is a problem with, or question about this installation, the following persons should be contacted:
a. Installer James K. Thompson Phone: (715) 248-7767
b. Service Provider Powers Liquid Waste Management Phone: (715) 246-5738
c. Co. Zoning or Health Dept. St. Croix Co. Zoning Dept. Phone: (715) 386-4680
11.
Project: Bruss 2 bedroom Residential Holding Tank
Transaction Number: Page 4 of 8
i
SEPTIC or HOLDING TANK SERVICING CONTRACT
Contract Date
D -W 12 This contract is made between the
Tank O ner(s) Name(s) and PWper's Name
pw~J Lr' 4<,7d uh5~
/ ~Le &18,5 46/u SS ~-E
We ac owledge the installation of (a) se tidh>olding tank(s on the following property:
(Provide legal description): Cc~. & fj 1,0/ O
/I ~ 5E Sic. 3 T:31 . i S -no. o Sfe~ Ara ci S~. cro,9 Co. LL;(
0 3 oii~- - c2;b
1. The owner agrees to file a copy of this contract with the local governmental unit (St. Croix County
Planning & Zoning Department) to document maintenance by a certified septage servicing operator as
required in Comm 83.52(lxc)2. Wis. Adm. Code and the approved Component Manual.
2. The owner agrees to have the septic/holding tank(s) serviced by the undersigned pumper and guarantees to
permit the pumper to have access and to enter upon the property for the purpose of servicing the
septic/hold ng tank(s). The owner agrees to maintain the access road or drive so that the pumper can
service the septic/holding tank(s) with the pumping equipment. The owner further agrees to pay the
pumper for all charges incurred in servicing the septic/holding tank(s) as mutually agreed upon by the
owner and pumper.
3. The pumper agrees to submit to the local governmental unit (St. Croix County) a report for the servicing of
the septic/holding tank(s) on a monthly basis. The pumper further agrees to include the following in the
monthly report:
a. The name and address of the person responsible for servicing the septic/holding tank;
b. The name of the owner of the septic/holding tank;
c. The location of the property on which the septic/holding tank is installed;
d. The sanitary permit number issued for the septic/holding tank (if known);
e. The dates on which the septic/holding tank was serviced;
f. The volume in gallons of the contents pumped from the septic/holding tank for each servicing;
g. The disposal sites to which the contents from the septic/holding tank were delivered.
4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a
change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a
new service contract with the local governmental unit named above within ten (10) business days from the
date of change to this service contract-
Owner(s) Name(s) (Print) Owner's Signature(s) Subscri and sworn to me on this date:
QCl/~
Q7,Y ,Tedpy's Date
Ca~eS ~/GCS ,
Pumper's Name (Print) Pumper' Si rra re otary Public Signature
C
-S
Pumper's egist ton Number Commission Expiration
.s a ~'8
8 1 7 0 2 7 3
Tx: 4140061
Document Number Document Title- 982623
St. Croix County BETH PABST
Holding Tank Agreement REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
Permit Number - 07/19/2013 09:56 AM
a Alice.- ep&.5 u EXEMPT
2
REC FEE:
Na (Owner) Typed or printed PAGES: 30.00
: 2
being duly sworn , states, under oath, that:
1. He/she is the owner/part owner of the following parcel of land
located in St. Croix County, Wisconsin, recorded in Volume -
Page - Document Number'196 St. Croix County Register
of Deeds Office: Gov. L Recoidi Area
A parcel of land located in the of the:~ (o Sf Section Name and Return Address
~3 T_-31 N - R 1,Y _ W, Town of
St. Croix County, Wisconsin, being 35F0`~"'<
r'z~ ~r'e~ ~o~a c~/• Sao
duly described as follows (include lot no. and subdivision/CSM or
detailed legal description): 03F- /0/8'-
Parcel Identification Number (PIN)
Agreement Date;, u ~-Sl O' .z013
We acknowledge that application is being made for the installation of (a) holding tank(s) on the above described property or that continued use of
the existing promises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property I
cannot now be served by a municipal sewer, or any other type of private onste wastewater treatment system as permitted under Ch. Comm 83,
Wis. Adm. Code, or Ch. 145, Wis. State.
As an Inducement to the county to issue a sanitary permit for the above-described property, we agree to do the following:
I.. Owner agrees to conform to all applicable requirements of Ch. Comm 83, Wis. Adm. Code relating to holding tanks. if the owner falls to have
the holding tank property serviced in response to orders issued by the governmental unit or the Department of Commerce to prevent or abate
a human health hazard as described in s. 254.59, State., the governmental unit (Town) may enter upon the property and service the tank or
cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current
services rendered. The charges will be assessed as prescribed by s. 66.0703, Slats.
2. The owner agrees, pursuant to s. Comm 83.54 (2), and Comm 82.40(3)(0), Wis. Adm. Code, to have a water meter installed in the structure.
The water meter shall be installed by a plumber authorized by the Department of Commerce to make such installations, with said installation
complying with State regulations and manufacturers specifications. The owner agrees to be financially responsible for the purchase,
installation, maintenance, and repair of the water meter, and agrees to allow the governmental unit or the Department of Commerce to enter
the above described property on a regular basis to read and/or Inspect the water meter.
3. Owner agrees to pay alt charges and costs incurred by the governmental unit or county for Inspection, pumping, hauling, or otherwise
servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank.
The governmental unit shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In
the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and charges may be placed
on the tax roil as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law.
4. The owner, agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code, to have the holding tank serviced and to
file a copy of the contract with the governmental unit. The owner further agrees to file a copy of any changes to the service contract, or a
copy of a new service contract, with the governmental unit within ten (10) business days from the date of change to the service contract.
5. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the county on a semiannual
basis a report detailing the servicing of the holding tank. The governmental unit or county may enter upon the property to investigate the
condition of the holding tank when pumping reports and meter readings may indicate that the holding tank Is not being properly maintained.
6. This agreement will remain in effect only until the county office responsible for the regulation of private onsite wastewater treatment systems
certifies that the property is served by either a municipal sewer or a private onste wastewater treatment system that complies with Ch. Comm
83, Wis. Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this
agreement in such manner which will permit the existence of the certification to be determined by reference to the property.
7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shall submit this agreement
to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will permit the existence of the
agreement to be determined by reference to the property where the holding tank is installed.
Owner(s) Name(s) - Please Print bscribed swom to before me on this date:
C'o%s ,~~uss a ,t3 ~
Note ' ne s Signature s) ary Publ
Govemmen nit Official Name. Title - Please Print
-74 7
vem on al ignature Draft by.
' it
V G r r
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on nfonnation you provide maybe used for secondary purposes Fcy.L a .04(1)(m)1
"THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE"
y fT4ft information must be completed by submifter document title. name & return address. and EW (N required). Other information such as the
granting clauses, leaga/ deacrlpbon, etc. may be placed on this Arst page of the document or may be placed on additional pages of the
document Note: Use of this cover pea& adds one pace to your document and 32,00, to the nsoordi w fee. Wisconsin Statutes. 59.517.
it
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8060218
Tx:4044021
QUIT CLAIM DEED 958060
BETH PABST
REGISTER OF DEEDS
Document Number Document Name ST. CROIX CO., WI /
THIS DEED, made between Donald R. Coles and Nancy A. Coles, husband 06/12/2012 11:00 AM
and wife, as joint tenants ("Grantor," whether one or more), and Mary Alice EXEMPT#: 8
Coles Bruss and Peter Otto Bruss, wife and husband, as survivorship marital REC FEE: 30.00
property ("Grantee," whether one or more). PAGES: 2
Grantor quit claims to Grantee the following described real estate, together with
the rents, profits, fixtures and other appurtenant interests, in St. Croix County,
State of Wisconsin ("Property"):
See attached legal description.
T/
Name and Return Address
ti P2~c~ ~ Q~}e~ 3ruS:s
V~1ri.~T,L'G~-cam l~.e NUS t t~
038-1018-30-000
Parcel Identification Number (PIN)
This ~S fir • homestead property.
(is / is not)
Dated this / day of ~ q v\ e , 2012.
(SEAL) Y (SEAL)
* * Donald R. Coles
(SEAL) /Z ~ (SEAL)
* * Nancy A. les
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
authenticated on ) ss.
.Y- COUNTY )
9- c9-C,
Personally came before me on this day of. 2p 12,
TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Donald R. Coles and Nancy: 0le5; hu•b'd;
(If not, and wife, to me known to be the person(s) wl}4"i gAtted t J
authorized by Wis. Stat. § 706.06) going instrument and acknowledged the •~11*tie.
THIS INSTRUMENT DRAFTED BY: * U;
Robert L. Loberg Notary Public, State of Wisconsin '.tom
Loberg Law Office sw/A-W1,1 My Commission (is permanent) (expires: 4,
(Signatures may be authenticated or acknowledged. Both are not necessary.)
*Type name below signatures
QUOT5L IM DEED FORM NO.3-2003. ,
I
i
A parcel of land located in Government Lot 6 of Section 3, Township 31 North, Range 18 West, Town of Star
Prairie, St. Croix County, Wisconsin, further described as follows:
Commencing at the intersection of the East line of Section 3, Township 31 North, Range 18 West with the
North line of County Trunk Highway "H"; thence West to a point 210 feet on the North line of said County
Trunk Highway "H"; thence North to the South shore of Cedar Lake; thence East along the said south shore of
Cedar Lake to the East line of said Section 3; thence South along said Section line to the point of beginning;
EXCEPTING THEREFROM the following described parcel: Commencing at a point on the North line of
County Trunk Highway "H", which said point is 110 feet West of the intersection of the East line of Section 3,
Township 31 North, Range 18 West with the North line of said County Trunk Highway "H"; thence West along
the North line of said County Trunk Highway "H", a distance of 100 feet; thence North to the South shore of
Cedar Lake; thence East along the South Shore of Cedar Lake to a point directly North of the point of
beginning; thence South to the place of beginning.
-
T01T CLAIM DEED FORA NO. 3-2003
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2332
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 2
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations
Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction
and St. Croix
percent slope, scale or dimemsiore, north arrow, and location and distance to nearest road. Parcel I.D.
18-30-000
Please print all information. Rev By Date
Personal information you provide may be used for secw4ary purposes (Privacy Law, s.15.04 (1) (m)).
Property Owner Property Location
Ma Alice Coles Bruss Govt. Lot 1/4 1/4 S 3 T 31 NR 18 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
2345 9th Street na na Na
~41L ~
City State Zip Code Phone Number J City _J Village a Town Nearest Road G/
Saint Paul i MN 55110 651-738-7600 Star Prairie 1198 Co. Rd. H f I~"1
New Construction Use: l Residential / Number of bedrooms Code derived design flow rate 300 GPD
M' Replacement J Public or commercial - Describe:
Parent material Glacial Till Flood plain elevation, if applicable unknown
General comments
and recommendations: Holding tank required - insufficient area available to site mound POWTS. See attached site plan.
Boring # -I Boring
WJ Pit Ground Surface elev. 97.05 ft. Depth to limiting factor 23° in. SoA Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots . N#1 ~'E
in. Munsd Qu. Sz. Cont. Color Gr. Sz. Sh.
1 0-7 10yr3/2 none sl 2fgr mvfr cs 2vf,f 0.6 1.0
2 7-23 7.5yr4/3 none sl 1csbk mvfr Cw 1vf,f 0.4 0.7
3 23-30 7.5yr4/6 f2f 7.5yr5/8 sl Om mfr Cw - 0.2 0.6
4 30-51 7.5yr4/6 f2f 7.5yr5/8 Ifs Osg ml - - 0.5 1.0
T
Saturated flow observed at 43".
`Effluent #1 = BODS> 30 < 220 mg/L nd TSS >30 <1150 mg/L ' Effluent #2 = BOD <30 mg/L and TSS 1.30 mg/L
CST Name (Please Print) igna re: CST Number
James K. Thompson 3602
Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane, a, WI 54020 6/18/2013 715-248-7767
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