20171208 Graham.pdf17120804
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL15CPTJZ Wisconsin Motor Vehicle
Crash Report
Secondary
CrashAmendedCrash Type
DT4000 (Standard Crash)Reportable
TagsSchool Bus Related
NoActive School ZoneGovernment
Property
Trailer or TowedWork ZoneLane ClosureHit and RunOn Emergency
Total Killed
00
Total Injured
00
Total Units
01
Time Notified
11:35 AM
Date Notified
12/08/2017
Time Arrived
11:40 AM
Date Arrived
12/08/2017
Crash Time
11:30 AM
Crash Date
12/08/2017
Investigating Officer/Deputy
SERGEANT GREG RIPCZINSKI
Agency Crash Number
17120804
Primary Crash Document #Document Number Override
6V
L
1
5
C
P
T
J
Z
Additional InformationPhotos
Photos BySGT GREG RIPCZINSKI
Reconstruction ByDiagram
Description
Narrative: I, a sworn law enforcement officer, agree that I have not added any CJIS data in this report.
UNIT #1 WAS SOUTHBOUND ON TANNERS POINT ROAD, AS UNIT 1 NEGOTIATED A DOWNWARD CURVE IN THE ROAD, UNIT STRAYED OFF TRAVEL PORTION OF THE ROAD, COLLIDED WITH THE DITCH LINE AREA AND RAN INTO A POND WHERE IT CAME TO REST.
Structure Type
No Structure
Y Coordinate
5112180
X Coordinate
157178.515625
Longitude
-91.433697301
Latitude
46.077125422
ON TANNINGS POINT RD
462 FT E
OF SHORT RD
IN THE TOWN OF LENROOT
IN SAWYER COUNTY
Location
Crash Time 11:30 AM
Crash Date 12/08/2017Wisconsin Motor Vehicle Crash
Form DT4000 1 of 4
This report does not include any CJIS data.
17120804
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL15CPTJZ Wisconsin Motor Vehicle
Crash Report
Special StudyAccess Control
No Control
Tribal Land
Crash Classification - Jurisdiction
No Special Jurisdiction
Crash Classification - Location
Public Property
Relation To Trafficway
Trafficway - Not On Road
Animal Type
Weather Condition(s)
Cloudy
Environment Factor(s)
Weather Conditions
Roadway Factor(s)
Narrow Shoulder, Low Shoulder, Soft Shoulder
Road Surface Condition(s)
Snow, Ice
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
Reporting Threshold
No
Truck Bus or HazMat
No
Road Grade
Level
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 UseNot ApplicableSpecial FunctionNo Special FunctionMost Harmful Event: Collision With
Immersion, Full or Partial
Total Lanes
2
Speed Limit
55Pre CrashTire
Mark
Direction Of Travel
Southbound
Insurance?
YES
Total HazMat Types
0
Total Trailers
0
Total # Citations Issued
0
Train/Bus # InjuredTotal Occs
1
Operating As EndorsementsVehicle Type
Utility Truck/Pickup Truck
Unit Type
Truck
Vehicle Operating As Classification
D CLASS
Unit Status
In Transit
UN
I
T
01
Unit Summary
Driver Actions
Driver Prior Action Other
Vehicle Factors
Not Applicable
What Driver Was Doing
Going Straight
Vehicle Removed By
OPERATOR
Towed Due To Damage
Not Towed01
Extent Of Damage
Functional Damage
Vehicle Damage
1--Right Front Corner
Initial Contact Point
1--Right Front Corner
Bus UseNot A BusBody Style
TK - TRUCK
Color
RED - Red
Model
F450
Year
2007
Make
FORD
Vehicle Identification Number
92
Country of Issuance
UNITED STATES
St
WI
Plate Type
LTK - Light Truck
License Plate Number
DG99560
VE
H
I
C
L
E
UN
I
T
01
Vehicle
Crash Time 11:30 AM
Crash Date 12/08/2017Wisconsin Motor Vehicle Crash
Form DT4000 2 of 4
This report does not include any CJIS data.
17120804
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL15CPTJZ Wisconsin Motor Vehicle
Crash Report
Driver DistractionsNot Distracted
Failure To Control
VE
H
I
C
L
E
UN
I
T
Address
BONITA SPRINGS, FL 34134 1711, US
IndividualKENNETH LARSON01
VE
H
I
C
L
E
OW
N
E
R
Vehicle Owner
Sequence Of Events
EventDitch01
EventRun Off Roadway Right02
EventImmersion, Full or Partial03
Event
04
Individual
KENNETH LARSON
Insurance Company
NORTHERN CAPTIAL PERSONAL
Policy Holder
UN
I
T
Crash Time 11:30 AM
Crash Date 12/08/2017Wisconsin Motor Vehicle Crash
Form DT4000 3 of 4
This report does not include any CJIS data.
17120804
SAWYER COUNTY SHERIFFS DEPT
15880 EAST FIFTH STREET
HAYWARD, WI 54843
(715) 634-4858
6VL15CPTJZ 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
State: Wisconsin Country: UNITED STATES
Address
HAYWARD, WI 54843 , US
RaceWHITEDate of Birth
07/25/
Sex
Male
Citations Issued
0
DriverDONALD R GRAHAM
IN
D
I
V
I
D
U
A
L
UN
I
T
Injury
Drug &
Alcohol
Individual
Non Motorist
Equipment
Crash Time 11:30 AM
Crash Date 12/08/2017Wisconsin Motor Vehicle Crash
Form DT4000 4 of 4
This report does not include any CJIS data.