20171209 Olson Pacholke.pdfSAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6X Wisconsin Motor Vehicle
Crash Report
Secondary
CrashAmendedCrash Type
Private Property/Parking LotReportable
TagsSchool Bus Related
NoActive School ZoneGovernment
Property
Trailer or TowedWork ZoneLane ClosureHit and RunOn Emergency
Total Killed
00
Total Injured
00
Total Units
02
Time Notified
06:37 PM
Date Notified
12/09/2017
Time Arrived
06:57 PM
Date Arrived
12/09/2017
Crash Time
06:37 PM
Crash Date
12/09/2017
Investigating Officer/Deputy
DEPUTY NICOLE RIPCZINSKI
Agency Crash Number
17120907
Primary Crash Document #Document Number Override
6V
L
1
3
1
B
Q
6
X
Additional InformationNone, Photos
Photos ByN. RIPCZINSKI
Reconstruction ByDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
ON DECEMBER 9, 2017 AT APPROXIMATELY 6:37 PM I, DEPUTY RIPCZINSKI WAS DISPATCHED TO THE PHILLIPS 66 GAS STATION IN THE VILLAGE OF WINTER FOR A REPORT OF A PROPERTY DAMAGE ACCIDENT. I ARRIVED ON-SCENE AND MET WITH THE OPERATORS. MR. OLSON ADVISED THAT
HE WAS THE OPERATOR OF THE FORD TRUCK AND MR. PACHOLKE WAS THE OPERATOR OF THE MITSUBISHI. MR. OLSON STATED THAT HE AND
MR. PACHOLKE WERE BACKING UP AT THE SAME TIME, STATED THAT THERE WAS ONE VEHICLE IN THE STALL BETWEEN THEM. MR. OLSON
STATED HE LOOKED IN HIS MIRROR AND THOUGHT HE SAW THE ROAD BEHIND HIM, DID NOT SEE MR. PACHOLKE BACKING UP, HOWEVER THEY
WERE BACKING UP AT THE SAME TIME AND COLLIDED. MR. OLSON STATED HIS BACK UP SENSORS DID NOT GO OFF AND DID NOT ALERT HIM OF
MR. PACHOLKE BACKING UP. I NOTED THAT THERE WAS SNOW ON BOTH BACK ENDS OF THE VEHICLES WHICH MAY HAVE BEEN THE ISSUE WITH THE SENSORS. BOTH OPERATORS STATED THEY WERE SEATBELTED IN AND WERE TRAVELING AT A VERY SLOW RATE OF SPEED, LESS THAN 5
MPH AS THEY WERE BACKING UP. BOTH PARTIES EXCHANGED NAMES AND INSURANCE INFORMATION. THERE WAS MINIMAL DAMAGE TO EACH
VEHICLE. MR. PACHOLKE HAD DAMAGE TO THE REAR DRIVERS SIDE PORTION OF THE VEHICLE, AND MR. OLSON STATED THERE WAS VERY
MINIMAL DAMAGE TO THE BUMPER OF THE REAR PASSENGER SIDE OF THE TRUCK, WHICH HE STATED WAS OWNED BY HIS GIRLFRIEND. THE
VEHICLES WERE DRIVEABLE. PHOTOS WERE TAKEN AND CASE NUMBER GIVEN TO THE OPERATORS. NO FURTHER INFORMATION. END OF
Crash Time 06:37 PM
Crash Date 12/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 1 of 7
This report does not include any CJIS data.
REPORT.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6X Wisconsin Motor Vehicle
Crash Report
Structure Type
House/Building
Y Coordinate
5082339
X Coordinate
188408.5625
Longitude
-91.01145203
Latitude
45.824148643
ON 6574 CTHW
167 FT NOF STH70 WB
(HOUSE/BUILDING 6574)
IN THE VILLAGE OF WINTER
IN SAWYER COUNTY
Location
Special StudyAccess Control
No Control
Tribal Land
Crash Classification - Jurisdiction
Private Property
Crash Classification - Location
Private Property
Relation To Trafficway
Non Trafficway - Parking Lot
Animal Type
Weather Condition(s)
Clear
Environment Factor(s)
None
Roadway Factor(s)
None
Road Surface Condition(s)
Snow
Light Condition
Dark/Lighted
Manner of Collision
07--Rear To Side
First Harmful Event Location
In Parking Lane or Zone
First Harmful Event
Motor Veh In Transport
Crash Scene
Intersection Type
Not an Intersection
Junction Location
Non-Junction
Within Interchange Area
NO
Reporting Threshold
No
Truck Bus or HazMat
No
Road Grade
Level
Road CurvatureSurface Type
Blacktop (Bituminous)
Traffic Control Inoperative/Missing
NO
Traffic Control
No Control
Traffic Way
Parking Lot or Private Property
Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Motor Veh In Transport
Total LanesSpeed LimitPre CrashTire
Mark
Direction Of Travel
Not On Roadway
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
1
Operating As EndorsementsVehicle Type
Passenger Car
Unit Type
Automobile
Vehicle Operating As Classification
D CLASS
Unit Status
In Transit
UN
I
T
01
Unit Summary
Extent Of Damage
Vehicle DamageInitial Contact Point
5--Right Rear Corner
Bus UseNot A BusBody Style
PK - PICKUP
Color
BLK - Black
Model
F150
Year
2013
Make
FORD
Vehicle Identification Number
A51455
Country of Issuance
UNITED STATES
StPlate Type
AUT - Automobile
License Plate Number
LB9840
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 06:37 PM
Crash Date 12/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 2 of 7
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6X Wisconsin Motor Vehicle
Crash Report
Driver DistractionsNot Distracted
Driver ActionsNo Contributing Action
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Backing
Vehicle Removed By
OPERATOR
Towed Due To Damage
Not Towed
VE
H
I
C
L
E
UN
I
T
01
Minor Damage
5--Right Rear Corner
Address
MARSHFIELD, WI 54449 , US
IndividualKATHERINE S WINIARCZYK01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
Event
02
Event
03
Event
04
Individual
KATHERINE WINIARCZYK
Insurance Company
PROGRESSIVE-UNIVERSAL-INSURANCE-COMP
Policy Holder
UN
I
T
Crash Time 06:37 PM
Crash Date 12/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 3 of 7
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6X Wisconsin Motor Vehicle
Crash Report
Individual Condition
Appeared Normal
Drug Type
Drug Test ResultsDrug Test TypeDrug Test GivenTest Not Given
Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given
Test Not Given
Suspected Drug UseSuspected Alcohol Use
Action Other
IN
D
I
V
I
D
U
A
L
UN
I
T
Action
To/From SchoolLocationPrior ActionStriking Unit #
00
1
01
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 Injury
IN
D
I
V
I
D
U
A
L
UN
I
T
Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
1--Front Seat-Left Side (Driver/Motorcycle/Bicycl
00
1
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
01
ber
: UNITED STATES
Address
MARSHFIELD, WI 54449 , US
RaceWHITEDate of Birth
06/15/
Sex
Male
Citations Issued
0
DriverTANNER G OLSON
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 06:37 PM
Crash Date 12/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 4 of 7
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6X Wisconsin Motor Vehicle
Crash Report
Reporting Threshold
No
Truck Bus or HazMat
No
Road Grade
Level
Road CurvatureSurface Type
Blacktop (Bituminous)
Traffic Control Inoperative/Missing
NO
Traffic Control
No Control
Traffic Way
Parking Lot or Private Property
Emergency Motor Vehicle UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Motor Veh In Transport
Total LanesSpeed LimitPre CrashTire
Mark
Direction Of Travel
Not On Roadway
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
1
Operating As EndorsementsVehicle Type
Passenger Car
Unit Type
Automobile
Vehicle Operating As Classification
D CLASS
Unit Status
In Transit
UN
I
T
02
Unit Summary
Driver DistractionsNot Distracted
Driver ActionsNo Contributing Action
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Backing
Vehicle Removed By
OPERATOR
Towed Due To Damage
Not Towed
VE
H
I
C
L
E
UN
I
T
02
Extent Of Damage
Minor Damage
Vehicle Damage
7--Left Rear Corner, 8--Left Side Rear
Initial Contact Point
7--Left Rear Corner
Bus UseNot A BusBody Style
UT - SPORT UTILITY VEHICLE
Color
RED - Red
Model
OUTLANDER
Year
2012
Make
MITSUBISHI
Vehicle Identification Number
07125
Country of Issuance
UNITED STATES
St
WI
Plate Type
AUT - Automobile
License Plate Number
665AJL
VE
H
I
C
L
E
UN
I
T
02
Vehicle
Address
RICE LAKE, WI 54868 , US
IndividualEDWARD L PACHOLKE02
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventMotor Veh In Transport01
Crash Time 06:37 PM
Crash Date 12/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 5 of 7
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6X Wisconsin Motor Vehicle
Crash Report
Event
02
Event
03
Event
04
Individual
EDWARD PACHOLKE
Insurance Company
SAFECO-INS-CO-OF-ILLINOIS
Policy Holder
UN
I
T
Crash Time 06:37 PM
Crash Date 12/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 6 of 7
This report does not include any CJIS data.
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL131BQ6X Wisconsin Motor Vehicle
Crash Report
Individual Condition
Appeared Normal
Drug Type
Drug Test ResultsDrug Test TypeDrug Test GivenTest Not Given
Alcohol Test ResultsAlcohol Test TypeAlcohol Test Given
Test Not Given
Suspected Drug UseSuspected Alcohol Use
Action Other
IN
D
I
V
I
D
U
A
L
UN
I
T
Action
To/From SchoolLocationPrior ActionStriking Unit #
00
2
02
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 Injury
IN
D
I
V
I
D
U
A
L
UN
I
T
Tint ComplianceEye Protection
Helmet ComplianceHelmet Use
Seat Position
1--Front Seat-Left Side (Driver/Motorcycle/Bicycl
00
2
Safety Equipment
Shoulder & Lap Belt
On Duty Crash
02
ber
State: Wisconsin Country: UNITED STATES
Address
RICE LAKE, WI 54868 , US
RaceWHITEDate of Birth
01/21/
Sex
Male
Citations Issued
0
DriverEDWARD L PACHOLKE
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 06:37 PM
Crash Date 12/09/2017Wisconsin Motor Vehicle Crash
Form DT4000 7 of 7
This report does not include any CJIS data.