20191029 nordback19102916
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0F1BQ6T WISCONSIN MOTOR VEHICLE
CRASH REPORT
Secondary
CrashAmendedCrash Type
DT4000 (STANDARD CRASH)Reportable
TagsSchool Bus Related
NOActive School ZoneGovernment
Property
Reporting
ThresholdTrailer or TowedWork ZoneLane ClosureHit and RunOn Emergency
Total Killed
00
Total Injured
00
Total Units
01
Time Notified
04:07 PM
Date Notified
10/29/2019
Time Arrived
04:45 PM
Date Arrived
10/29/2019
Crash Time
99:99
Crash Date
10/29/2019
Investigating Officer/Deputy
DEPUTY CALEB JORSTAD
Agency Crash NumberPrimary Crash Document #Document Number Override
6VL0F1BQ6TAdditional InformationPHOTOS
Photos ByDEPUTY JORSTAD
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON OCTOBER 29TH, 2019 AT APPROXIMATELY 1607, I DEPUTY JORSTAD WITH THE SAWYER COUNTY SHERIFF'S OFFICE WAS DISPATCHED TO
SISSABAGAMA ROAD IN THE TOWNSHIP OF SAND LAKE FOR A VEHICLE THAT HAD STRUCK A TREE. WHILE EN ROUTE, I WAS ADVISED BY DISPATCH
THE DRIVER WAS NO LONGER ON SCENE. I ARRIVED ON SCENE AT APPROXIMATELY 1647, WHERE I OBSERVED A SILVER CHEVY TRAILBLAZER IN
THE DITCH THAT HAD IMPACTED A TREE. I SEARCHED THE AREA AND HAD NO CONTACT WITH ANYONE IN THE AREA WHO COULD HAVE BEEN
DRIVING THE VEHICLE. I THEN PHOTOGRAPHED THE CRASH AND WAITED FOR A TOW TRUCK TO REMOVE THE VEHICLE. I WILL BE ATTEMPTING TO
MAKE CONTACT WITH THE OWNER OF THE VEHICLE.
Crash Time 99:99
Crash Date 10/29/2019Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
19102916
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0F1BQ6T WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5081080
X Coordinate
149728.203125
Longitude
-91.507041708
Latitude
45.794307882
ON SISSABAGAMA RD
0.40 MI N
OF CRANBERRY DR/ CTHF WB
IN THE TOWN OF SAND LAKE
IN SAWYER COUNTY
Location
Special StudyAccess Control
NO CONTROL
Tribal Land
Crash Classification - Jurisdiction
NO SPECIAL JURISDICTION
Crash Classification - Location
PUBLIC PROPERTY
Relation To Trafficway
TRAFFICWAY - ON ROAD
Animal Type
Weather Condition(s)
CLEAR
Environment Factor(s)
NONE
Roadway Factor(s)
NONE
Road Surface Condition(s)
DRY
Light Condition
DAYLIGHT
Manner of Collision
NO COLLISION W/VEHICLE IN TRANSPORT
First Harmful Event Location
SHOULDER RIGHT
First Harmful Event
DITCH
Crash Scene
Intersection Type
NOT AN INTERSECTION
Junction Location
NON-JUNCTION
Within Interchange Area
NO
Truck Bus or HazMat
NO
Road Grade
LEVEL
Road Curvature
CURVE LEFT
Surface Type
BLACKTOP (BITUMINOUS)
Traffic Control Inoperative/Missing
NO
Traffic Control
NO CONTROL
Traffic Way
TWO-WAY, NOT DIVIDED
Emergency Motor Vehicle Use
NOT APPLICABLE
Special Function
NO SPECIAL FUNCTION
Most Harmful Event: Collision With
TREE
Total Lanes
2
Speed Limit
35
Pre CrashTire
Mark
Direction Of Travel
EASTBOUND
Insurance?
UNKNOWN
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
1
Train/Bus # RecordedTotal Occs
1
Operating As EndorsementsVehicle Type
(SPORT) UTILITY VEHICLE01 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITExtent Of Damage
DISABLING DAMAGE
Vehicle Damage
12--FRONT
Initial Contact Point
12--FRONT
Bus Use
NOT A BUS
Body Style
4H - HATCHBACK 4 DOOR
Color
SIL - SILVER (ALUMINUM)
Model
TRAILBLAZE
Year
2004
Make
CHEVROLET
Vehicle Identification Number
32930101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
UNITVEHICLECrash Time 99:99
Crash Date 10/29/2019Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
19102916
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0F1BQ6T WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
BIRCHWOOD, WI 54817 , US
Owner Name
0101Driver Actions
UNKNOWN
Driver Prior Action Other
Vehicle Factors
UNKNOWN
What Driver Was Doing
NEGOTIATING CURVE
Vehicle Removed ByTowed Due To Damage
TOWED DUE TO DISABLING DAMAGE
VEHICLEUNIT Sequence Of Events
Event
DITCH01
Event
TREE02
Event
03Event
04Injury
Distracted By
LocationStriking Unit #
Distracted By Action
Distracted By Source
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABLE
Ejected
NOT EJECTED
Airbag
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00101 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
1--FRONT SEAT-LEFT SIDE (DRIVER/MOTORCY
Safety Equipment
RESTRAINT USE UNKNOWN
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
BIRCHWOOD, WI 54817 , US
Race
WHITE
Date of Birth
10/08/
Sex
MALE
Citations Issued
1
Driver
UN Individual
Non Motorist
Safety EquipmentITIDUALINDIV
Crash Time 99:99
Crash Date 10/29/2019Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
19102916
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0F1BQ6T WISCONSIN MOTOR VEHICLE
CRASH REPORT
Drug & Alcohol
Individual Condition
NOT OBSERVED
Drug Type
00101Drug Test ResultsDrug Test TypeDrug Test Given
TEST NOT GIVEN
Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given
TEST NOT GIVEN
Suspected Drug Use
NO
Suspected Alcohol Use
NO
To/From SchoolAction Other
Action
Prior Action
UNITINDIVIDUAL Violations
DescriptionFAILURE OF OPERATOR TO NOTIFY POLICE OF ACCIDENTStatute Number346.70(1)Issue To?
001
UTC Number
BE60920701
Crash Time 99:99
Crash Date 10/29/2019Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.