20072619 gustafson-henk20072619
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0JB3P46 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
01
Total Units
02
Time Notified
02:07 PM
Date Notified
07/26/2020
Time Arrived
02:26 PM
Date Arrived
07/26/2020
Crash Time
02:06 PM
Crash Date
07/26/2020
Investigating Officer/Deputy
DEPUTY NATHAN FREY
Agency Crash Number
20072619
Primary Crash Document #Document Number Override
6VL0JB3P46Additional InformationNONE, PHOTOS
Photos By344
Reconstruction ByDiagram
Description
I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
UNIT 1 WAS TRAVELING EAST ON CEDAR AVENUE. UNIT 1 FAILED TO STOP FOR THE MARKED STOP SIGN AT COUNTY HIGHWAY F. UNIT 2 WAS
NORTHBOUND AND WAS UNABLE TO STOP, STRIKING UNIT 1 IN BETWEEN THE PASSENGER SIDE DOORS. THE OPERATOR OF UNIT 1 WAS ENTRAPPED AND
INJURED. THE OPERATOR AND PASSENGER OF UNIT 2 RECEIVED NO INJURIES.
Crash Time 02:06 PM
Crash Date 07/26/2020Wisconsin Motor Vehicle Crash
Form DT4000 1 of 7
This report does not include any CJIS data.
20072619
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0JB3P46 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Structure Type
NO STRUCTURE
Y Coordinate
5065349.5
X Coordinate
147736.734375
Longitude
-91.521162563
Latitude
45.652150784
ON CTHF NB
36 FT N
OF STONY HILL RD 10
IN THE TOWN OF EDGEWATER
IN SAWYER COUNTY
Location
Special StudyAccess Control
PARTIAL 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
01 - ANGLE
First Harmful Event Location
ON ROADWAY
First Harmful Event
MOTOR VEH IN TRANSPORT
Crash Scene
Intersection Type
FOUR-WAY INTERSECTION
Junction Location
INTERSECTION
Within Interchange Area
NO
Time Scene ClearedDate Scene Cleared
07/26/2020
Time All Lanes Open
04:07 PM
Date All Lanes Open
07/26/2020
Time Initial Lane/Rd Closed
02:20 PM
Date Initial Lane/Rd Closed
07/26/2020
Reasons for Closure
LAW ENFORCEMENT, TOW TRUCK
Closure Type
CLOSURE-ONE DIRECTION
Truck Bus or HazMat
NO
Road Grade
LEVEL
Road Curvature
STRAIGHT
Surface Type
BLACKTOP (BITUMINOUS)
Traffic Control Inoperative/Missing
NO
Traffic Control
STOP SIGN
Traffic Way
TWO-WAY, NOT DIVIDED
Emergency Motor Vehicle Use
NOT APPLICABLE
Special Function
NO SPECIAL FUNCTION
Most Harmful Event: Collision With
MOTOR VEH IN TRANSPORT
Total Lanes
2
Speed Limit
45
Pre CrashTire
Mark
Direction Of Travel
EASTBOUND
Insurance?
NO
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
2
Train/Bus # RecordedTotal Occs
1
Operating As EndorsementsVehicle Type
PASSENGER CAR01 Unit Type
AUTOMOBILE
Vehicle Operating As Classification
D CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITModel
LUCERNE
Year
2007
Make
BUICK
Vehicle Identification Number
10320101 Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - AUTOMOBILE
License Plate Number
Vehicle
Crash Time 02:06 PM
Crash Date 07/26/2020Wisconsin Motor Vehicle Crash
Form DT4000 2 of 7
This report does not include any CJIS data.
20072619
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0JB3P46 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
BIRCHWOOD, WI 54817 , US
Owner Name
0101Driver Actions
FAILED TO YIELD RIGHT-OF-WAY
Driver Prior Action Other
FAILURE TO STOP AT STOP SIGN
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
OTHER
Vehicle Removed ByTowed Due To Damage
TOWED DUE TO DISABLING DAMAGE
Extent Of Damage
DISABLING DAMAGE
Vehicle Damage
01 - RIGHT FRONT CORNER, 02 - RIGHT SIDE FRONT, 03 - RIGHT SIDE
MIDDLE, 04 - RIGHT SIDE REAR, 05 - RIGHT REAR CORNER
Initial Contact Point
03 - RIGHT SIDE MIDDLE
Bus UseBody Style
SD - SEDAN
Color
GRY - GRAY
VEHICLEUNITUNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
MOTOR VEH TRAN OTHER RDWY02
Event
03Event
04Injury
Time of DeathDate of DeathHospital
LAKEVIEW MED CTR
EMS Run #
CFS2007583
EMS Agency Identifier
6000113
Medical Transport
EMS GROUND
Trapped/Extricated
TRAPPED/EXTRICATED
Ejection Path
NOT EJECTED/NOT APPLICABLE
Ejected
NOT EJECTED
Airbag
DEPLOYED-SIDE
Injury Severity
SUSPECTED MINOR INJURY00101 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
07 - LEFT
Row
01 - FRONT ROW
Safety Equipment
NONE USED - VEHICLE OCCUPANT
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
BIRCHWOOD, WI 54817 , US
Race
WHITE
Date of Birth
10/30/
Sex
FEMALE
Citations Issued
2
Driver
ITSafety Equipment
Individual
UNINDIVIDUALCrash Time 02:06 PM
Crash Date 07/26/2020Wisconsin Motor Vehicle Crash
Form DT4000 3 of 7
This report does not include any CJIS data.
20072619
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0JB3P46 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Distracted By
Drug & Alcohol
Individual Condition
APPEARED NORMAL
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
LocationStriking Unit #
Distracted By Action
NOT DISTRACTED
Distracted By Source
NOT APPLICABLE (NOT DISTRACTED)UNITNon Motorist
INDIVIDUAL Violations
DescriptionOPERATE MOTOR VEHICLE W/O INSURANCEStatute Number344.62(1)Issue To?
001
UTC Number
BE65126401
DescriptionFAILURE TO YIELD RIGHT OF WAYStatute Number346.06Issue To?
001
UTC Number
BE65126502
Truck Bus or HazMat
NO
Road Grade
UPHILL
Road Curvature
STRAIGHT
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
MOTOR VEH IN TRANSPORT
Total Lanes
2
Speed Limit
55
Pre CrashTire
Mark
Direction Of Travel
NORTHBOUND
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # RecordedTotal Occs
2
Operating As Endorsements
F - FARM SERVICE CDL
Vehicle Type
TRUCK TRACTOR (SEMI ATTACHED)02Unit Type
TRUCK
Vehicle Operating As Classification
A CLASS
Unit Status
IN TRANSIT
Unit Summary
UNITCountry of Issuance
UNITED STATES
St
WI
Plate Type
TOR - TRACTOR
License Plate Number
Vehicle
Crash Time 02:06 PM
Crash Date 07/26/2020Wisconsin Motor Vehicle Crash
Form DT4000 4 of 7
This report does not include any CJIS data.
20072619
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0JB3P46 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Owner Address
BIRCHWOOD, WI 54817 , US
Owner Name
0202Driver Actions
NO CONTRIBUTING ACTION
Driver Prior Action Other
Vehicle Factors
NOT APPLICABLE
What Driver Was Doing
GOING STRAIGHT
Vehicle Removed ByTowed Due To Damage
TOWED DUE TO DISABLING DAMAGE
Extent Of Damage
MINOR DAMAGE
Vehicle Damage
01 - RIGHT FRONT CORNER, 12 - FRONT
Initial Contact Point
01 - RIGHT FRONT CORNER
Bus UseBody Style
TR - TRAILER
Color
SIL - SILVER (ALUMINUM)
Model
700
Year
2004
Make
MACK
Vehicle Identification Number
84180202
VEHICLEUNITUNITVEHICLE Sequence Of Events
Event
MOTOR VEH IN TRANSPORT01
Event
MOTOR VEH TRAN OTHER RDWY02
Event
03Event
04IndividualInsurance Company
RURAL-MUTUAL-INS-CO-(ATTN:-CLAIMS-DEPT)
Policy Holder
UNITInjury
Trapped/Extricated
NOT TRAPPED
Ejection Path
NOT EJECTED/NOT APPLICABLE
Ejected
NOT EJECTED
Airbag
NON DEPLOYED
Injury Severity
NO APPARENT INJURY00202 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
07 - LEFT
Row
01 - FRONT ROW
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
BIRCHWOOD, WI 54817 , US
Race
WHITE
Date of Birth
03/10/
Sex
MALE
Citations Issued
0
Driver
ITSafety Equipment
Individual
UNINDIVIDUALCrash Time 02:06 PM
Crash Date 07/26/2020Wisconsin Motor Vehicle Crash
Form DT4000 5 of 7
This report does not include any CJIS data.
20072619
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0JB3P46 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Distracted By
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00202Drug 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
LocationStriking Unit #
Distracted By Action
NOT DISTRACTED
Distracted By Source
NOT APPLICABLE (NOT DISTRACTED)
Time of DeathDate of DeathHospital
EMS Run #EMS Agency IdentifierMedical Transport
NOT TRANSPORTED
UNITNon Motorist
INDIVIDUALInjury
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 INJURY00302 Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
09 - RIGHT
Row
01 - FRONT ROW
Safety Equipment
SHOULDER & LAP BELT
On Duty Crash
Driver License Number
STATE: WISCONSIN COUNTRY: UNITED STATES
Address
BIRCHWOOD, WI 54817 , US
Race
WHITE
Date of Birth
03/10/
Sex
MALE
Citations Issued
0
Passenger
ITSafety Equipment
Individual
UNINDIVIDUALCrash Time 02:06 PM
Crash Date 07/26/2020Wisconsin Motor Vehicle Crash
Form DT4000 6 of 7
This report does not include any CJIS data.
20072619
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL0JB3P46 WISCONSIN MOTOR VEHICLE
CRASH REPORT
Distracted By
Drug & Alcohol
Individual Condition
APPEARED NORMAL
Drug Type
00302Drug 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
LocationStriking Unit #
Distracted By Action
Distracted By Source
Time of DeathDate of DeathHospital
UNITNon Motorist
INDIVIDUALCrash Time 02:06 PM
Crash Date 07/26/2020Wisconsin Motor Vehicle Crash
Form DT4000 7 of 7
This report does not include any CJIS data.