NTSB Preliminary Report

·-·:·-:-;.;::-;--.·::-:-·::.;::::·::::::::::::::;:: ::::::::::::::::::::::::::::::::::::::: j:t::::::..: :·:::· NTSB Form 6120.19A (1-84) This form supersedes NTSB Form 6120.19(Rev. 1-83) i Page2 NTS8 Accident Incident Numb.er National Transportation' Safety Board PRELIMINARY REPORT AVIATION ACCIDENT/INCIDENT M I A 9 0 F A 1 3 5 Na. 'atfve (continued) an NOB approach a missed approach was initiated. Shortly after power was applied for the missed approach the right engine fire warning activated. The right engine vas shut down, per the pilot's checklist. At this time, it was also noted that the lo~ voltage light was-illuminated~ The airplane would not climb after the right engine was shut down, and he verified that he had "cleaned up the airplane." The ai~~lane would not maintain level flight, and while descending through 600 feet they entered the clouds. They broke out of the clouds at 150 to 170 feet anj flew toward a field. The student asked if he should extend the gear and the instructor stated no. Touchdown in the field was made and the airplane nosed over. A small postcrash fire occurred in-the left engine compartment. Examination of the airplane after the accident by FAA inspectors indicated the landing gear was extended and locked at touchdown. The landing gear handle was in the up position and the flaps were extended to 10 degrees. The right propeller was in the feathered position and the left propeller was in the normal flight position with no rotational damage. The investigation continues. (Anach additional pages if necessary.} CROCKETT. ;soo ORLANDO, FL lnvestlgator(s) Assigned 85 nves NTSB Form 6120.1QA {1-84) Thia form auper~ NTS8Form1120.18(Rev. 1-B:l) Page3 '~ ~ ! ! I I t- i 'i lI I I11 t '~ i! !! I! i! i ! N .-i tional Transporta lion Safety Board ACCIDENT FILE CONTENTS i"\( .l ___--~-· ()j __:::._., \( .l II ·\\l\11<1'-' l :". l ! R.\ \1 li ) ·\ I H Cl t\\ ,\ ~ ,\\·\RI~! PIP! l !Nl R •\ll R.0.-\D ~--------------~---------- 1' !) I ., l 11 I\ .\ I I t ) '- l l I ·\ ( ( 11 ) I ', l i I I I \I "' ) DELAND. FLOR.IDA CESSNA T303; N4973V S··-28-90 MIA-90-F-Al35 1. Accident File Contents, STSB Form 6120 3 2. J. • Factual Report, Aviation Accident/Incident, NTSB form 6 1 2 0 • 4 w I S u p p l e m.e n t s " A , B , E , I , H , a n d S " Pilot/Operator Aircraft Accident Reports, NTSB F0r~ 6120.1/2w/Attachments 4. Sheriff's Department Report 5. 6. 7 • 8. 9. 10. ll. Airplane Maintenance Records Excerpts from Cessna T303 Information Manual Telephone Conversatiun Slip - Cessna Aircraft Postaccident Fire Warning Tests Release of Aircraft Wreckage, NTSB Statement of Party Representatives Investi.g3.tion Photographs (14) w/~egati~es (4) Form 6120.15 to NTSB 3 .J _":"l I L T -r- • FACTUAL REPORT AVIATION ACCIDENT/INCIDENT National Transportation Safety Board Washington, D.C. 20594 • NTSB Form 6120.4 Instructions Unless otherwise stated in the instructions 0r on the form, all da~a fields must be completed. Each data field requires either a direct entry or the entry of one or more x!s in appropriate blocks that best describe the mishap cir12umstances. Multiple entry fields may require two or more responses. Enter all applicable responses in multiple entrv fields. When the selections offered are inappropriate, a two digit "other'"' code shall be entered in the space that follows the word "other." Do not make additional remarks in the margins as the automated data processor is not programmed to a.ccept them. Any iraformation which is needed to outline the sequence of events which preceded the occurrence, to support probable cause dett:mination or which is pertinent to crashwor·thi- ness studies should be addressed in the narrative r~port. "Other'' Codes 01 02 03 04 05 06 07 08 09 10 11 12 Limited access to and/or limited time available at site. Aircraft not recovered/missing. Part/component not recovered/not located. Aircraft too badly damaged to determine. Part/{~omponent too b9.dly damaged to determine. In formation not pertinent to accident/incident. Applicable personnel could not provide information or information not avail9ble to applicable personnel. Applicable personnel would not provide information. Not installed. Records not locs ted/not available. Information not entered on NTSB Form 6120.1. See narrative-rep~ ~plements The following accident scenarios are provided to assist investigators in selecting the report forms which should supplement the basic NTSB Form 6120.4. 1. A Ces;na 172 collided with a snowbank during landing· goa.round at e..n airport. Weather was not a factor. The pilot said there was no powerplant or control malfunction. The pilot and one passenger received minor injuries. The pilot had recently been certificated as a private pi lot. Complete supplemental for ms F (Training and Proficiency), Q (Airport) .itnd S (O+~cupar..: list). A "Limited'' investigation should be completed. 2. A PA-31, being operated by two pilots under- FAR 135, crashed into a tower while being vectored to intercept the localizer at the destination airport. The PA-31 struck the tower while being operated at an assigned altitude. Flight was in IMC. The!'e were two fatal injuries and three se1\'iol.J3 injuries. CFR personnel responded and treated the injured. This accident requires an onscene investigation. Thus supplement A (Wreckage documentation), R (Cockpit documentation) and I (Crash kinematics) are required. Supple- ments E (Second pilot), F (Training and Proficiency) and U are required because of the two pilot FAR 135 operation (even though proficiency may not be at issue). S is neede·d to list the occupants; T, to documer.t the CFR activity and P, to cover the possible ATC involvement. a (Meteorology) is required to document the weather conditions. topies of supplements K and L w~uld be req.uired to document injury/tox:colugy and seat/restraint damage information, respectively. -~ ...,(__ Nation~1I Transportation Safety Board FACTUAL REPORT AVIATION I' NTSB AccirlenVln<ident Numb« M 1 I !A19 l0 IFJ_:i_!l . __ I__ X f\c:de;·~: i X ".-~~:: 2 ·· JJ· ln·1es~11;atic1n • . . I r·:c :Jer· c :' . . ;: ·"- ,\ = ·· ·· J • -·--·-----·----·--.---------,..-------------.--~--..·---- --,-------- 4 Aircraft Registra!ion t~umber 5 Flight Number :,~~rc<:~:/;:'.~,'~/:~:1~~\'~S:~l 6 Ai; craft Registration Number l!? ~"' ''"_··r.:>=r- N4 9 7 3 v A Otlier and flt ·10 for otlicr ,vcr,1f1 8 Nearest City1Place 9 State 10 Zip Code 1 Fus: 5 nu1n: .:rs 01111 11 Accident Sile Elevaticn 32720 5 -28-90 ~D 0803 EDT 1.--_ _::.._::..:::._:...::._________J_______::...:;_:._____-:--~-:---:---:--:--:---:--:--:-------'--·-==~----·--------- 16 Narrative Statement of Facts, Conditions and Circumstances Pertinent lo the Accident/Incident HISTORY OF THE FLIGHT On Hay 28, 1990, at 0803 (all t. imes eastern daylight time), a Cessna '1'303~ N4973V, registered to and operated by Embry-Riddle Aeronautical University,, nosed over while making a forced landing near Deland, Florida, following los~ of electrical power and shutdown of the right engine due to a fire warning. Instrument meteorological conditions prevailed at the time and an instrumE~= flight rules clearance had been received. The airpla2e was destroyed, and t~= commercial-rated flight instructor and private-rated dual student rece.i.-;e.= minor injuries. The flight originated at Daytona Beach, Florida) on ::-'"3y :23, 1990 at 0715. The flight- was a dual ins~.fructional flight con-ducted in accordance wi:..:: Federal Aviation Regulation 14 CFR Part 141. The instructor pilot stated tn~: during taxi to take off at Daytona Beach, the right alternator fail ligb:. illuminated. He noted electrical system load was below 30 amps. During pr..:: takeoff checks, the light went out and remained out. The flight departed wi!:::. the dual student flying the airplane. They received radar vectors to t1:"~ Deland non directional beacon (NDB). The right alternator fail light agab illuminated. ·The instructor noticed that no circuit breakers were open a~:: that total electrical system load was less than 30 amperes. They shut down t~~ right alternator by turning off the control switch. The flight entered holding at the Deland NDB and after four comp le::= holding patterns, perf armed the NDB approach to nmway 30 at the Delan.: Municipal Airport. Upon reaching the missed approach point, the dual stude::r: applied climb power and initiated a missed approach. The right engine fir:= warning activated at this time and tne electrical system low voltage lig:tt ..,23. Additional Persons Participating in this AccidenVlncident lnvesligation 1 Name. address. aff1ilar1on. Conrmue on page 2 if necessai,y, · Ken Crockett, FAA, FSDO, Orlando, FL Jack Haun, ERAU, Daytona,. FL L'ale Carter, Continental Engines, Mobile, AL Joe f oole, ERAU, Daytona,, ;,::L Rick Basco, Cessna Aircraft, \Iii chi ta, KS A. C. Tucker, ERAt;, Daytona, Fl. Lyle Sunderland, E~~U, Daytona, FL James Teski, ERAU, Daytona, FL 17 Date (Nos. for M, D. Y) 18 Agency 10-22-90 NTSB (MIA) NTSB Form 6120.4 (Rev. 1-84) Investigated By: 19 Name/Signature .-t«;_;:J J JEFFREY L. KENNEDY I j / P.x;;: r I •·------~-------·----- National Transportation Safety Board FACTUAL REPORT _ AVIATION NTSB Accident1 lncider;t Number also noted to be illuminated. The instructor pilot took control of airplane. Upon climbing to 700 feet, the right engine was shut down secured per the emerg~ncy checklist. the and The ai rpl.ane would not cl irnb or maintain a 1 t itude after the right engine shut down even though full power was applied on the left. e:igine. The instructor v·erified that they had placed the landing gear and wing flap handles to the retracted posit ion. He did not remember hearing t':le landing gear retract or noricing what the landing gear light indications ~ere. They broadcast a mayday call on the Deland unicorn frequency, Daytona Beac~ Approach frequency, and on the emergency frequency 121.5. They also placed emergency code 7700 in the transponder. As the flight descended through 600 feet, it entered a local area of lo~ clouds. The student was asked to restart the right engine at this time. All controls were set for the start; however, when the stdrter switch ~as engaged the engine would not turn 6ver. As the flight descended through 150 feet, the ground became vi.sible and the instructor fle\11 to\llard a field in preparation for a forced landing. The student asked if the landing gear should be lowere~ and the instructor said no due to the low airspeed. As the airpla~e touched dow~ in the field,· they realized the--±am::ttng gear was dow~.--As the airplane rolled out, the nose landing gear bogged down ·in the soft dirt and the airplane nosed over. The occupants exited the airplane through the left rear cabb d0or, As they exited, they no tee! that the right engine fire warning t,v<.is still sounding and that a small fire had begun in the area of the left eng:ne. After approximately 20 minutes, a sheriff's department helicopter arrived· at the scene. The helicopter had been launched by the Daytona Beach Approach Control after receiving the emergency code 7700 on radar. PERSONNEL INFORMATION The pilot-in-command flight instr.1ctor holds a commer;:£al pilot certificate wl th airplane single engine land, airplane mult 5-engine land, and instrument airplane ratings. This pilot holds a flight instruccor certificate with airplane single engine land, airplane multi engine land, and inst ruraent airplane ratings. Information furnished by the operator indicates this pilot had accumulated 1,520 total flight hour~, 100 flight hours in the Cessna T303, and 930 flight hours as a flight instructor. This pilot holds a second-class medical ce~tificate, issued on rebruary 23, 1990, with the limitation that correcting lenses be worn while exercising the privileges of the certificate. This pilot recei•1ed a biennial flight review in accordance with Federal aviation regulations on September 20, 1989. Attach add1tJ0n3/ pages as necessary (Page 2a 2D. 2:. ate.. ~TSB Fenn 6120.4 (Rev. 1-84) ?ci~2 --- .r-- I National Transportation Safety Board FACTUAL REPORT AVIATION NTSB Ac:ciderild!"lcl~nt Number _~l I I I A I s I 0 I F I A l ~ !A.;i._l Hi Nam1llv11 Sta!emenl ol F.1cle, Cond!!!on& end Clrcumslancfi?~ Pertinent lo lhe Accidenl./lnc!denl (con/1nusd) The dual ~.tud2nt holds a private pilot certificate with ~irplane sing,1-=- engine land and airplane multiengine land ratings. Information furnished b~• the operator indicated this pilot has accumulated 183 total flight hours, wit~ 48 flight hours in the Cessna T303. This pilot holds a first-class medica.::. certificate, issued on April 24, 1990, with no limitations. This pilot received a biennial flight review in accordance with Federal aviatic= regulations on August 21, 1989. For additional p2rsonnel information, see <lat~ fields 87 through 1~5 of this report, Supplement E, and att~chments. AIRCRAFT INFORMATION The airplane was a Cessna Aircraft Company model T303, serial Ko~ T30300285, registration No. N4973V, manufactured on June 15, 1984. Tb~ airplane was eq ulpped wi.t h L:!ledyne Continen ta 1 TS I0-520-AE, 250-hor sepoi.:e: engines. Logbook records indica i:.ed the airpl2.ne had accumulated 2, 542 tot a.: flight hours. The airplane received a phase six inspection in accordance witi the Embry-Riddle Aeronautical University approved airplane inspection progran on May 17, 1990, 42 flight hours be.fore the accident. The left and rig·r:.= engines had accumulated 4,352 total hours, with 445 flight hours sine-== overhaul. For additional airplane information i:>ee data fields 39 through 70 0: this report. WEIGHT AND BALANCE INFORMATION Postaccident calculations indicated the airplane weighed 4,848 pounds a: the t!me of the accident. The center of gravity was located at 151.0 inches aft of the datun. The weight and balance condition was within allowable limit~ for the airplane. METEOROLOGICAL INFCRMATI~N The Daytona Beach Regional Airport 0831 surface weather observation was: clear skies, visibility 12 miles, temperature 79° F, dewpoint temperatur= 73° F, winds 150 degrees at 6 knots, and altimeter 29.76 inHg. Daytona Bea~~ is located 15 miles east of the accident site. The pilot-in-command stated that at the time of the accident a low cloU: layer which extended from 150 feet to 600 feet above the surface was prese2= in the area around the Deland Municipal Airport. COMMUNICATIONS The f lightcrew slated that during t~e descent for the forced landing the! attempted to transmit a mayday ca.11 on the Deland Airport unicorn frequency, Daytona Beach Approach Control Frequency, and the emergency frequency 121.S. Allach add1t1ona1 pages as necessary (Page Za. 2D. 2c_ 8: National Transportation Safety Board FACTUAL REPORT AVIATION INTSB Aoc;d,,;;;;ncldonl Numb<< -----·- ,______...~ I I A I 9_l_!l£j_;~~_l~JU __ _ 16 N:malivt Sl~lemenl ol Facb, Condilicnlil and Circumtill'lnces Perllnenl lo the Acc!denVlncldenl (contmued) They also put the emergency code 7700 5n the air traffic control transponder. :fone of the voice calls were received by ground stations. The code 7700 frc~ the trans ponder was recei.ved by the Daytona Beach Approac:-i Control, whi.:":1 notified search and rescue. After the accident, the No. 1 communir:ations radio was found set :::o frequency 122. 8, the Deland unicorn frequency. The No. 2 communic:at ions r.:i1.E:. was found set ~o frequency 125.35, the Daytona Approach fr~quency. The transmit selector was set to the No. 2 communications radio. WRECK.A.GE AND IMPACT INFORMATION The airplane came to rest inverted in a field a.pp roxiaiate ly 3 !Iii le.s eas:: of the Deland Muqfcipal Airplane. rn site examination of the crash sit2 wa..:; conducted by a Federal Aviation Administration ainrnrtbiness inspector. Trac:<S caused by the three main landing gears ot the airplane extended frora west to east for approximately 50 feet. At this point the airplane was lying inverted with th~ nose pointing tc the west. All components of the airplane were fou~ri attached or lying adjacent to the airplane. The airplane structure and flight control systems were intact with no evidence of failure or malfunction. The left ~ropeller was fou.nd. in a low _p.itc.h_setting w.!.th chordwise scratches a~ross the face of the blades. Each blade was bent aft slightly ac the outboard ends. The right propeller was found in the feathered positi0e. One blade was free to rotate in the hub. The right engine showed no evidence to indicate the occurrence oE a f lr~ in the engine area or of excessive heating which would have caused activation of the right engine fire warning. The left engine had sust:1ined minor fir,:: damage to the accessory area as a result of a postcrash fin:~. The main ciL."cuit breaker panel had five circuit breakC!rs open after t~1e accident. They were, the left bus isolation, right" bus isolation, bus tie, landing gear indicator, and air conditioning compressor breakers. The landi~g gear handle was found in the landing gear retracted position after the accident. The landing gears were found extended and locked. The flap contr0l handle was found in the flaps 10° position and the wing flaps wer~ found i~ the lQO position. The flap handle was damaged during the accident. Detailed examination of the air plane, sys terns, and engL1es, '"1'35 accomplished by the NTSB after recovery of the airplane. Examination of t::.c eng~ne assemblies, ignition systems, and fuel systems, revealed no eviden=e :0 indicate precrash failure or malfunction. The left and right starter motors operjated normally and rotated their respective enginec:;. The wiring circuits for !the starters had normal continuity after the accident. Attach add1t1onal pages as necessary ( Pagr: 2a. 2b. 2'4-. 3>;;:r; L..----------~------~----~~----~----------~----------_,.~--_..~ PAn~? ~ i National Transportation Safety Board FACTUAL REPORT AVIATION •NTSB Accldtnl/lncld~n! Number ]'. .________.._~__, _,_I~1_._l_AillJLi.Il-LiliLJ....=:_·J._ L-1r--~_N_e_rr_a1-1.,.-e-S_!_al_e_rn_e-nt_o_l_F_~-ct-111 .-C-o_n_d_ll_lo_n_a-a-nd---C-lr-cu-m--11-t-lln'-c""'."e-s-=0 --=-ert~e nt to the Accide n!/ I nci de nl (continued) The right engine fire warning loop with ln the engine 1~om~rnrtment ..-::..::> separated in the accident. The wiring for the system tested normal after t~ accident. The left engine fire warning system wiring tested normal after t:::i::: accident. The left and right al te rnato rs we re tested on a test bench after ::,::: accident. The left alternator was intact and had normal output of 28 volts 3=.:: 95 amperes. The right alternator case was cracked and the drive sh&fc was be=t as a result of impact -damage. This alternator put out normal voltage-- and :•J amperes before the test drive belt slipping off the ber~t drive shaft. A2.l alternator circuitry was tested - -and fo1~nd to have continuity after tze accident. The alternator control units were tested by installation on anot~e~ airplane and were fouqd to operate normally. Examination of the aft s lde of the ma ln ci re ui t bI:"eaker panel reveal=:d that an electrical power supply jumper wire between t~o strips of the left b~s was burned. This wire ~as found to have been caught between the breaker pan:L chassis and the protective liner on the airplane structure. Furtb£:c examination revealed a chaffing mark on the wire insulation in which wiri~~ wlth arching damage was exposed. Arching damage was present on the ground,:<l metal chassis of the bI:"eaker panel at the point the damaged wire w2s found ::::i rest on the panel. T_l!e left pJ.lot ~rm _rest also had sl_iKhLsoot damage i.n_~~ area that is adja~ent to the burned wire on the pa~el. The flap operating motor was tested after the accident and found to dra~ 2 amper~s with no load on it< The flap motor and flap control circu:!.try h::..:i continuity after the accident. The gear operating motor was found . to dra'-7 5 amperes unloaded. The gear motor. and control circuitry was found to ha-.e coPtinuity after the accident. The left bus isolation, right bus isolatio:i, and bus tie circuit breakers were tested after the accident. Each was found :o open when a load of between 50 and 60 amperes were placed on them. T~e batce~ was found to have leaked all electro lite after the accident and couJ.d not :::e tested. MEDICAL AND PATHOLOGICAL INFORMATION The flight instructor and dual student received minor injuries as a result of the accid~nt. FIRE A postcrash fire erupted in the area of the left engine turbocharger which was rest ihg in dry 6 ras s after the accident. This fire caused damage to r::e: engine acdessory area of the left engine. ! .... -.-.-. -- - ~· .,...,.. .. Attach addlf1onal pages as necessary f Pa?f 2a. 2b. 2=- JD,r: ) - v ,~ / Pace:;;: • - lNTSB Accident/lncld~nl Number N~tlonal Transportation Safety Board FACTUAL REPORT AVIATION .. ' l---------~~-!_._I_____.. Il_A__..!_~-_L~j_lj__:WJ..2.LlJ~~l.-16_N_111_n_~·--11v-e-:S~.t-a1-e·m--e-n-t0-:f~F=-ec-1=-,~.c=-on-d7'."ll:-:-lo-·n-,-.-n-:-d-:C:71r-c-um.__!!I !~&-ncei P 1;; rt I.ire n I to thr: Acclde nVI nclde nt (cont 1n ued) ~ TESTS AND RESEARCH The Pilot's Operating H~ndbook for the Cessna T303 states under section 3, c::i.c::-gency procedul'."es, electrica1 poi,..7 er supply m.ilfunctions, that: "due to component tolerances and . lov slgr1a.l levels, it may be normal for one ALT OFF light to be illuminated when the total load on both alternators is less than 30 amps." The handbook states in section 7, airplane and system descriptions, that: "a 50 amp :]iain bus tie and 60 amp isolation circuit breakers are incoq:;orated into the electrical system to automatically. isolate the main bus bars from the battery supply current in the event of a fault of one or the other of the main buses. In such a case, the bus tie c i rcul t breaker, la be led bus ti.e, would first become overloaded and open the circuit connecting the main bus bars together. If the fault remained uncorrected, the isolation circuit breaker of the affected bus bar would open, disconnecting that bus from battery supply. Without b;:tttery current, the ACU of the affected mai:i. bus shuts down the respi:..~tive alternator, prt~venting further damage to the main bus system until correction of the fault." ~ Wiring diagrams for thP. Cessna T303 indicate that power for the engine start~r motors, flap operating motor, and 18n~ing gear motor, are supplied by the left ancl right main bus systr::~. As described above if the bus isolatiou. breaker is open, no electrical po~er is supplied to the main bus system. This would pr2vent electrical power from reaching the engine starter motors, flap operating motor, and landing gear operating motor. Performance char ts 1 .::ontained in the Cessna T303 information manual i. ~die a ted that for the c.ondi t ions present at the time of the accident, the airpJ.ane should have a rate of climb of 170 feet per minute with one engine shu~ down, landing gear retracted, and flaps retracted. The charts do not give fig1ires for r2te of climb degradation jo to exter.ded landing gear and flaps. The instructor on N4973V stated after the right engine was shutdown, the airplane descznded at appcoximately 200 feet per minute. (See attached excerpts from the Cessne T303 information manual.) After the accident Embry-Riddle Aeronautical University personnel reported that on two previous occ3sions Cessna T303 airplanes operated by the university ex9~rienced false Eire warnings due ::o ~lectrical system malfunctions. T~ey stated, in occurr~nces in which the bus tie circuit breaker opens and a bus isolation circuit breaker opens the engine fire warning for a.•T~D r- .::1?n A 10-•• 1_aA1/ I .O.ttach add111ona/ pages as necessary (Page?.:;. i!J. 2c. '1.ltc: /3 ~2 3- 1 I National Transportation Safety Board FACTUAL REPORT AVIATION b--.~------~~~--~----~~~--~--~--'-'~LltLL.LlJLJ.E_J~ '1 h 1~ IHi Nam1tlve Statement of f&tcb, Conditions and Clrcum1!ance11 Pertinent to the 1'ccldenUlnclderil (continued) the respective side of the airplane ·(that is left bus, left engine fire warning) will activate. After the accident, this was simulated on thr~e other Cessna T303 airplanes. (See attached report on Post Ace ident Fi re Warning Tests and statements from flightcrews on the two previous occurrences.) Cessna Aircraft Company engi11eer.s were notified of this false fire i,.;arning occurrence. They were able to simulate the false fire warning occurrence using a Cessna. T303 airplane at the factory. They further.- identifierJ. the cause of the ~alse •rnrning and the need for a diode tcJ be installed in the fire warning s:rstem to prevent the occurrence during times of electrical- system malfunction. Examination of the maintenance records for Nf+973V revealed that the last recorded time the main ciri:uit breaker panel was pulled loose from the airplane side wall was on January 4, 1990, 443 flight hours before the accident. ADDITIONAL INFORMATION The airplane wreckage was released to: Embry-Riddle Aeronautical University Regional Airport - ~- - Daytona Beach, Florida 32014 'l Attach add1t1onaf pages as necessary (Page 2a, 2b. 2c. etc.) "--------------~··~--~----_..:.~~--------~--------------~~------~--~--~~/----~~~=E-- N TS B Farm 6120.4 (Rev 1-841 /, PaQe 2 • ----- ·- -- NTSB Accident/Incident Number National TransP-orta!ion Safety Board FACTUAL REPORT AVIATION Airport/ Approach/Landing l nformatlon 24 n Not applicable (Go to block 39) 25 Airport Name 26 Airport Identifier 30 VFR Approech/landlng (Multiple entry) - 1 None 2 .___ Traffic pattern 3 '---- Straight-in 4 ,__ Valley/terrain following 5 .___ Go around 6 ..___ Touch and go ,__ 7 Full stop '---- 8 .__ Stop and go 27 Accident Location 1 ~Off airport/airstrip 2 ~-~ O;i airport 3 L__J On airstrip A Other 28 Dl1t11nce From Airport Center (Nearest SM) ---------SM A Other 31 Type Instrument Approach Flown (Mwtiple entry) 1 n None 12 --1 LOA 2~-~-;-ADF/NOB 13LJ ASA 3 'SDF - 14HPAR 4 -~ VOR/TVOR _ 15 I Sidestep 5 _ __J VOR1DME 16 n Visual - 66 I T AGAN 17 [l C:ontact 7 -~I LS-complete 18 =1 Circling 29 Direction From Airport ____ "mag A Other 32 Runway Used ldenllllftf' 32__ A Ott·,er 33 tmJ Length _Feet A Other 34 Runway Width -1flLL Feet 9 Simulated forced landing 10 ~ Forced landing 11 _ Precautionary landing A Other 8 -j I LS-localizer 19 LJ Practice 9 tJ~- ILS-backcourse A Other 10 1 RNAV A Other li-35--A-lrpo_'1_E_141Y_a_tlo-n·------- I Vt'\ 36 R~ay/Landlng Surface 1 Macad.Jm I ~- 2 Asphaii --3-~ Concrete .__ 4 Gravel ~ 5 Dirt 6152'.1 Grass/tur1 7 Snow .__ 8 Ice ---- 9 Water ~ 10 Metal/wood ~- A Other i---- 11 MLS 37 Runway/Landing Surface Condition I ~§-: ::covernd ~4 Snow-dry 5 L Snow-wet I 6 H Snow-crusted 7 H Snow-comp~cted 8 B' __ Vegetation - 9 Water-calm 1O Water-choppy I _Q....l,...L_ Ft. MSL A Other 11 n Water-glassy f--,12 L-1 Rubber deposits 13l 1Soft 14 ~Rough 15 f-----1 Slush covered 16 l_JHoles A Othe~ If accident occurred during approach, departure or on airport, see instructions for completing Supplement Q. Aircraft Information 39 Aircraft Manufacturer 141 St1rlal No. 142 Certii1c.<1ler: "Aa1·mum I I ' Gros .. w/ e~/gs --- 1 7:30300~_ - 40 Aircraft Model/Serles I I T I A Other A Other Cf 5.SNA 30~ '--__:~~;;;__..;..J~~~~~~~L-~~-----=-~""-~~~~~_l_.~~~--~~~~~~~-1-~~-.-~~~~~-----t 43 Typo of Aircraft 44 Type Airworthiness Cei1ificale I Mult1ni'c entry J I45 Home Sullt 1 ~Airplane 5 BBlimp/dirigible Standard Spacial 1 [J Yes 2 Helicopter 6 Ultralight 1 1 ~Normal 5 ~Restricted A Other 2 ~No 3 Glider 7 Gyroplane 2 Utility 6 Limited A Other 4 Balloon A Specify 3 Acrobatic 7 Provisional ___ 4 l __ Transport 8 Special flight _J' 9 J Experimental ...._________.....__.,.--..-_ _____.___ NTSB Form 6120.4 (Rev 1-84) )/ Page 3 I I National Transportation Safet~" Board FACTUAL REPORT- AVIATION craft Information (continu:d_J ______________ landing Gear (Multiple entry) NTSB Accident lnc:idenl Number n Tricycle-fi~ed 4 Jl T.:iliwneel-a!I retract3b.e 7 h: Hull 10 F---Ski 13 [J High Skid L __ j k2~' Tricycle-retractable 5 rl Tatlwheel-retractable mains 8 H Float 11 Ski/wheei 3 Ta1lwheel-all !1xed 6 I Amph1b1an 9 Emerg. float 12 ·--Skid A Ottier 48 tJo. of S11i1t13 49 Siai! W1.1r~lng Syate~ !FR Equlppe~1- 51 Icing Certification/Equipped 152 Engine Type ---- -:;-;;~,-r-- 1 ,"~~es _JI ~ ~ ~:' ;)!q~c~~,'.?~ . ~ X ::~;~;:~:::~~=~:;~,~i:~~" 20 No A Other 2, ; Not CP.rt1f1ed 31 Turbo prop A Other 3 ~Equipped I 4 Turbo iet 4 :~j Not Equipped I 5 \ , Turbo !an If no~ Engine powered. goto block 59 SJ Engine Manufacturer .A Omer l 6 ~Turbo stiatt A Other _I_5_4_E_n_g_i_n.._e_M_o_d-.e--!-a_n_d_S_e_r-ie-s~---r55Englne Rated~ Sii Number ol Engines 8 ______ L~s. Plrust f., Other L. r:;i:o - s ~ C-/f E.tl A -2!2.fi5- Horsepower --~- CoNllAJEN//T ISL o-5¢0-A.£ c Other 1------~--+---E-n~g-!n_e_T_..lm-e---r-----="------0.----~--.j,___~- ·--_---.-,---C-T_l_m_e_S_ln~c-e-M-.a_j_o_r-----r-~~ If 3 or more ) A Total Time j 8 Time Since lnspec11on 0 I D Other _(_H_o_u_ns_____,i--------...-· -----------;.'--- verhaul r;,-Engine•lo:--+--~~~52__ +--=~ :.;) __ I____ '-fuj5.5 -~--~--~ Jsa fng<neNo." J35'J. J . -'TJ.. - / j ~~~ r--5-9-.-T-yp_e_M_a_l_nt_e_n_a_n_c_e-Program I 60 Typ'l! of las! ·;n:spe~---· 61 Date Lasi Inspection fl62 Time Since ms.pectlon enrer Supp. C 1 I_] Annual 1 1 [ __ '.Annual Performed _j;)___ Hours 2 ~Ma11ufacturer's lnspect1on Prog~am 2 l . .,; 100 hcur (Nos 'or r..• O Y) A Other 3 I 1 Ocher approved inspection program (AAIP) 3 l)<. .A.AIP __:i_:_J_?__-__'j_Q___ 4 ' Continuous airworth1nes::; 4 [ ____, Contiriuous airworthiness ,t., Otrier 63 Airframe Total Time A Other A Other ~~Hours ~----..------~-""----_,..~----~- A__2!_h~e_r_______-4 64 Source oi M&lntenance lnformallon · 65 Hazardous Materlal11 E: mer:;ency Lo 1 2 A B r -j on Alrcratl Toansm1l!er 1ELT1 Yes No Other 1 Tach 4 _ . Logoco1<s Flec0rds 2 JFligh; 5 I Estimate 1 ~No 67 ln!ltalled 3 L j Hobb5 6 t::2iPilol. 0p3ra!o• Report A (Type) ____ _ A Other B Othtr 66 Required 1D Yes Operated 2QSJ No Alclt>d In loc._a_tl_o_n-t-'y_--,,~--- 66 Hazardous Material Splll/Fecior i-·---A, Other of accider.t site / ""' t--~~-~---~~~--~-~-----..._~-~-~~----------~- ~~---~......-~....___.._.~-- Owner/ 0 perator Information 71 Regl1tered Aircraft Owner Name £frJ(!J. ~" -R.ZD D l-f A E'-0"''°' L4/Z:Cf}-l. 73 Operator of Aircraft 1! _ :same as registered owner A Name: B dba C Other NTSB Form 6120.4 1Rev 1-84) I L-{r.JL'U£L5.l1i I I Tf74 Add res:; A B Other 1Rsar.ie as registered owner 75 Operator Cenlffcat9 No. A Other b Operator Designator Code J } -'1 Page 4 ........ ~.-.................................................................................................................................................... _. National Transportation Safety Board FACTUAL REPORT AVIATION NTSB A«ident; l.Cdenl ,,,.;;;;;,---, Owner/Operator Information (continued) ,l!i L llf 1'1 IOL;:-11'111 / !-~15 y n Operator Status of This Aircraft ~ xowner 2' i Lessee 3 ! Renter Type of C~rtificate(s) Held 4; j Borrc:.,.,,er 5 ,__ J Unauthorized A Other 80 Air Carrier Operating Certificate (Check all appl1cable1 78 Piiot Status of This Aircraft i !'owner ~ 2 i Lessee 3 l •Renter 4; Borrower ,._ __ __, 5 Ur.aumonzed 6 Y Emoioye-e ./X A C:ther 79 None~ So to bioc.k: 8.3J 81 Operating Certificate 82 0p€rator Certificate 1 '. Flag camer1jomest1c (121) 4 [ . Large hel1co'11er (127) Other operator or - large aircraft _ 1 Roto~ratt~x~erna1·1oad operator (133) 2 ~J Agn~ltural a,rcratt (137) 2 • Supplemental 5 f 1Commuter air earner 3' All cargo (418) 6 l ! On-demand air taxi·---''---------- ___..,..___________________--! Regulation Fiight Conducted Under 83 Regulation Flight Conducted Under 1n .. -._- 14 CFR 91 {only) ·------110 r -) 14 CF~ 137 /- 2 14 CFR 910 4Rl14 CFR 105 5 14CFR121 3i 14CFR103 6 1.: :FR 125 I Type of Flight Operation Conducted 7 r~ Bi 9 14 CFR 127 14 CFR 133 14 CFR 135 1 ~ 014 CF;: 129 rFcreign i'lag) A Specify f (Complete 84a. b, c ONLY if flight was a revenue operation conducted under 121, 12.5, 127, 129. 135) 84a 84b 84c 1 n Domestic 2 [~International if=---s-ctoeduiecr--- · f----· 1 : ~ Passe1ger 2 _-____J Cargo 3 ! Passenger/cargo ___, 2, Non-scheduled ~~-~---~~---~----~-~-~-----~------~-----'"~-~-------~-~J-M_a_i_lr.-~o_n_t_ra_c_t_O_N_L_Y--11 I (Co~mp/B:.ul~ssionae:saslONLY if 84a, b. c is not applica:I~'. ) jExecutive/corporate 5 l Aenal application _ 'Instructional (lncludmg air camer trammg) 6 ' Aenal observation First Pilot .Information 87 Name (Last, First. Initial) 88 Piiot Certificate No. 7 l - Other work use 8 l Public use . 9 i Ferry TO [ Positioning A Specitv ___ R8/?L14N°J 0!:CHAEI 0. _l_J0~_bj____ 89 Str~I Addresa t::_o. 13c_x----=-Ia=-'-1-=~_.._7__ A Other A Other A Other 9CI City ~1 State 92 Date of Birth (Nos. for M, D, Y) 93 Age 94 Sex D~'i'ro/Vfi I~___ 1 9- /- 6 b _2-3 Yrs 1 !><JMale A Other I A Other A Other 21] Female ~~--~~'~F_L_-L--~~--+-~-~~~---495 Se,t Occupied 96 Principal Profession I 1 b1Left ' 1 ~Pilot-civilian 71·--~ Doctor/dentist 2 Right ai '.Police I 2 : Pilot-military I ~, 31 ~Student 3 ~_JCenter 3 I Other-military ~ Aircraft mechanic 1Of ·Clergy 40Front 4 ~-- 11 r·- .Teacher 5 Rear 5 Business ....____ 12r iEngineer A Other 6 Lawyer NTSB Form 6120.4 (Rev. 1-84) 13 f_ lFarrner/rancher 14LJRet1red A Cther 97 Certlflcate(sl 1 Mult1p1e entry J 1 nSt~de-it "'l_-~ Fl'.ght Enpin'Jer 2 , : Private 7 , M1!1tary I r-.--- 3 ComITercial 8 None 4 t't"";ne Tmnsport 9 5Fo<eign S ~ Fligh• rostmctc• A Othe< J Pc:.ge 5 • National Transportation Safety Board FACTUAL REPORT AVIATION First Pilot Information (continued; , ',.1u1t1oie rn 1 ·1· - tic''"',,· 0ri- ,,121 98 Ratings-Airplane . I \n.stru~1ieo~·'.eRa11ng 1· 1Q) Instructor Rating1s) 2 X S1ngie c>:1g11;e .1110 3 x· ~.1u;:1er:i,;1ne ..w0 ...: . 'S11 1 :]le ,~ntJ1nt 1 ... t~J 114 Correc1ing Lenses 1Muif;p/e e.ntr; , . Ne! required 127 Instructor 128 This Make/Model 129 Last 90 Days -------- ----·--- -~·- 130 Lasl 30 Days ~~~~~-~~~-+-H.~· 131 Last 24 Hours 132 Landings-Last 90 Days 136 139 All Aircraft ____ Day A Other J / Seatbelt Available 1 Yes 2 No A Other Shoulder Harness Used 1~Yes 2 1 No A Other 133 Landings-last 90 !Jays All Aircratt ,X D.,,.~1.,\'lu L ,. , j..,,_, c 3 · He!:copter 1~'7 Sealbel' Used I 1 P4Yes2! No A Other I 140 Autopsy Perlormf:d I This pliot) l 1 !XJ Yes A Other 2. ·No ~Jone ')X' I c;- - 1.. /-\1rp ane ._:: 3 X. Airplane~":: Hf~l1cco~~?1 Gvroplc.. _ 138 Shoi.:der Harness Av&ilBll'!! ~~Yes 2, No .:!. ..::•tr1e1 141 Toxicology Ps1a-m~c! I--;-.;; ::,10!) ~~Yes :. :ithe; 21 1 No ·-------------- NTSB Accidenl/lnc.dent Number National Transportation Safety Board FACTUAL REPORT AVIATION f'I 12 119- I tJ 0 ~/cl fl IL __? ?l Piiot Information (~ntlnued) 142 Penicn at Controls 143 Simulated ln1trument FllQht 144 VI_~~-~ Restricting Device Used 145 Second Plbl 1, Yes 1 ~ Polol ;n command 2 t . Second pilot 4 BNon-p1lot 5 No one 1SJ_Yes 21 No 2XN0 1~ Yes 1 :.::;;--:,Ete sec~ d p10·~,;:;.rne --- 3 , Both pilots A Other A Other A Other 2i No Flight Itinerary Information ·---155 Last Departure Point (Mu/t1pla entry) ~57 Destination (Mult1p/e entry) 158 Flight Pan Flied ( 1V'...1lt1pi'8 tn-, 1 U Same as accident/incident location or 1 Same as a::C:1aent/1nc1dent 1ocat10,1 or 1 i-- ~:ine A Airport 1dent1fier D 8 8 2 X :...ocal ft1ght 2 , ~ual F•:cr7 ?ult>!: .. - B City/Place 0f}'{toNft 6E1CH- 3 X ~-:strurr:~;: :::: ::;'it;::_.'-"" -- A Airport ldent1f1er ~ C State !=- L. D Other .,,, . 8 C:ty1Fiace 4 ,;:1111FR - . 156 Time of Departure c State 5 CJmpa:-1y ··,<;;:CR) OZL5 - fa. Time C Cther D Otr.er 6 '-l111tarv ·VF=' - 8 Time Zone ~L A Other- 159 Type of Cle!!ramce 160 Airspace 1 None 6! l VFR on top 1 M.,uncontrolled a Stage II TRSA 15 > . '.,,.iarn1n; ~ ·• -- I 2 VFR 7 Cruise 2 . ! Controlled 9 Stage II! TRSA 16 ~- . F~R 93 1--~- ... ' f-- .~ 3l Special VFR 8' Tr2ffic Advisory I 3 I __ A"port "•Ifie a<ea 10 Proh1b1ted area L___ ·Spec1a' .:w;:::rf':c an: ... ' 4~1FR 9 VFR Flight 4 . : Control zone 11 Restricted area A Cttler 5 \__J Special IFR Following I 5 '-1 A"port advoso'y a<ea 12 _Millta1y Operating t.:ea (MOA1 ,A. Other 6 ; Fos1t1ve controi area 13 Student Jet Trnin:n:; Area - - -~-7 r-· ITerminal control '!~ea -- ---~- ,~ Demo Area 161 Control ArH 162 Route 116.'l Las! T"io Wa-: Comr:-u.maucr.s 1 r=g. None 1~None 7 j VA route (military) Es:::1.'.llished 2 Victor air...,ay 2 1 Standard instrument departure 9: i IA route (:nil1tary) I 1~c-ne 3 ~~Jet airway 3 B Standa'd te,m;nal an;,.1 g· ISA mute (m;lita<y) I 2 '·.!Yes 4 RNAViOMEGAJLCRAN ll'C 10 . _. Refueling route (military) A ;:acil1t;· Identifier 4 tj Control airway Olhe' _ -1 /Jft6 :-;-o£,._£f..5 Colored airway 5~ Direct A A Other 6 1 IProfile Di:;scent B Otr.er Aircraft Loading Information 164 Fue1 on Board at l.&keoff (Multiple entryj 165 Fuei '7ype11 ( Mu/f1ple entry J 1 ~Estimated 1i80.187 5 Ke.osene 9[ Mt•ture 2~100 low lead ,.. 2 L_J Verified 6 JP 3. 4. 5. 6 1G A i..:~rnor~·•c ,_ A _Gallons or 3! 100/130 7 Jet 0. 11: An:i-1ce .:!.Cd1l!'•'B C:"o=!: i •.-:cwr1j ------------ B __J~----- ___ Pounds c Other 166 Aircraft Waight at Takeoff r Mu//1pie entry.i 1 • At or below max cert. ross takeoff wa1g'1t ~ g 2 L_,,; Abo. ve niax ce11ified gross takeoff wei~ ht 3 ~ Estimated 4 · : Verified A Other 168 Aircraft W'E!lght at Accident (Mu/!1pie entry) 1 ~: Same as takeott 2 At er below max cert. gross takeoff weight 3 . Above mzx certified gross takeoff weight 4 . Estimated 5 Verified A Other r 4[ 1i5i145 a Jet a A Other 1m Aircraft CG at Takoofl 1Mu11ole enrryi ' / 3'.rr:ct':EC 1 Within li1T11ts Si x2 Exc&eded fwd l1m1t 3 Exceeded aft 'im1t 4 Exceeded later;il lim·1 169 Aircraft CG at Accident (M1... ::iole er:7rv · 1 -~l Same 2.s takeoff - 2 )(: W1th:n lirn1:s 6 zs:~~arep 3 Exceeded fwd limit 7 ~~~·'e~' 4 Exceeded aft limit 5 : Exceeded lateral l1m11 p •National Trar.sportation Safety Board FACTUAL REPORT AVIATION NTSB Accidel'IUlnti2nt Number Aircraft Loading Information (continued) 170 Load Descrii;tion, :.1ulr pie enrry J 1 X None 3 Cargo 2 , Passengers -l , Towing gl:der 5 j Towing banner ·Other e' t'"rnal 1:~- 8 I Parachutrsts Water Chemical Livestock l ~ -~] Jllega .:::=-i;c A. C~er We-ather Information 180 S?urc_e of Weather BriP.ling 1 .~ruir•ple entry, 181 Method ot Srieting Mul'1p1e :::on-:ry, 182 - 1 · ·No record of br1ef1nq ·Go ro oicc~ 18.J, u 'Company __ -1 - 2 ~\lat1or 1 a1 VVeatner Ser,•cc 1i'<VVS• 7 X Comrncrc1al weather !:Rrv1ce ~11 l:- ::eson ~;Kl Te-'2-",,-;;e J F!1gt1t Service S;a11on 8 ; TV radio weatr.er -l PATWAS \Pilor ,lutomated Tei WX Answering Svc) 9 __ _J M111tary 5 , VRS 1Voice Response Sysiem 1 Completen~ss o! Weather briefing r-- 1 I Wedti;er not pertinent 2XFu11 3 · , Part1al-l1m1red by pilot 4 Part1a: --l1m1ted oy briefer looecaster A Ott-1Pr A Other 183 Investigator"s Source o: Wealher Information 1 ~li P1lo: 1Go ro block 1851 2' _ Witness rGc ro block 1BE-1 3 ~Weather nb~ervat1on fac1:11y I 184 )r 1~:::-~:_.1hor.r:i J. l..._;,-j ;._-c:?.it raa1: ~1 :=:[_IT. ---=id10 _!, Othe· Weather ObservC1tim Facility .A. lde~:1f1er -D~--- B T1rr,e of obser..c.."lon _ 9 23 J__ ::::---=: ~0 C Ele.at1on _ --it/J- -- ·e-e. !v~SL D 01-:;,:.anre from a-cident "'- ~ /5 ·..·..: E C1r-ect1on frorn :::cc1der1t :o"·~e _~.:'.'.a. ;iag:r7 185 Basic Weather Con-ditions at Accident Site t-86-Conditions of Light 187 ~§~y/Lo~:::.:ud Cond•On -188.-t:...owes1~r~ 1 · I Visual Meteorc,:o•;i1ca1 Cond1t1011s <VMCJ 1 ~'[)awn - ~11.C~ 2 _ -.j_ Daylight ,-- 2 X. 1 nstr~Jment r;ietecrolcg1cal C0r.C:tt1or1s I IMC1 ~I 30-r~ r--~ A Other 189 Visibili!y ( dec;mals ! 190 Temperature 192 1~ ]'1 A __ SM F 8 RVR Feet A Other c RVIJ SM 191 Dew Point 0 Other 73 c 3 •Night i0ark1 3; Thin br·::>ken 4 L-. :Night (8rigt1t) 5 L_JDus~ ~ L Thin 0'•-t:rcast 5 · Partial obscuration A Other Wind (From) : . I 193 1 Variable A is·cp Magnetic 8 Cther A _________ Feet AGi._ B Otr1er ~[j~s~:~ 2 [~ Light and Va'.1able A _(a Kts 194 G® 1 Nort:: A - -- ___ Kts. B Other _:: : ll.::' 0 '.:'.lSt ...: LJ c;:-s..-Jed ..r... ~er A 3 Otne Ii95 - .Altimei!!" Seti ng- ')._CJ_~c . Hr;J A 01he 196 Density ~tttude J /,....r/i't Fe~ -l1l'----:- .....~~~~~~~~~~-1.~~A~O~th~e_r~~~'--~~~~~~·~~~~~~~-8-(_J_th_e_r~~~~.1...-~~~~"""!"~~--'~~_.;.A~·O_rr=-~~~~- 1 198 Type o1 Precipitation ·99 I t tt I er croon 197 Restriciions to Visibility 1 iXJ None 2 r1Haze1H) JL Dust10} 4 f.--- Smuke (K) st' Fog :Fi 6 Ice fog (IFJ 7 ~- Ground log (GF1 Bl,_ Blowing spray 18Y) I 9 f--- Blowing dust d30: 10~ Blow111g snow 1BS~ ~low,ng <and IBNI NTSB Form 6120.4 !Rev 1-841 1~None1 Go lo fJlock 200 1 10( ~Snow pellets (S~l " 1°Fer.:si ~oh' e;:;;;n I 2r R;i,'l!R: 11: )Snowqra1ns!SG1 2 --~~~::::· 2 :: I 3 f-J S,iow IS) 12 l __JFreezing drizzle- 1ZLJ 3 l~=-i~a·Jy "1 . JHail !Al 13 [ -1 Ice crystals (IC. A c~- 8 , S ·Rain st1uwers 1RWI 14 __ j Ice pellet shower (!PW! 6 r Freezing r;11ri 1Zf~} A Otrier r----- 7 ~--- Snow sr1c1wer 1 SW) 8 ~ Dr1ulP. ill g L_j Ice pellets !IP\ National Transportation Safety Board FA.CTUAL REPORT AVIATION NTSB Accident. incident Number .,......._.------~-~----------------·-v....,,_,._'71z.lcJ L~Ll(_zJ~ldlLJ;:2.1_ Accident Information Aw::ralt Damage -1201 Aircraft Fire , 1~ None ,w-·~No:1e 2 > ~ l\il1nor 2 J ln-t1,,1t-: .1 :>(__ Destro1,ed ;1, Other 200 202 1(J ~:er ce 1\-.,:~es ~1 c1es Curnr111:~rc1.o.·, bldg J' _ __, Subst.1r~t1a1 J 1' On gr~)Ur1L1 'Jl't<1c1e1-01 11 c:-er ;::rope·'.v --------~------..,_~~----------------.----------·---------------~----~~--~----~--~~·--- 204 ln1ury Index 1 ,\losr cr.:·cal r·1ur~· 1 1 None 2 X.Mmor J --- 1 .1 'F.H;ll ----------------------.........--------r-------..---~-H-~-o-r-~--N-~-n-e-~l.--·-T-o-~~a-1-.._,.. 1 ,---~---------~--~--------~-------·~-~ ~------·-------~-~~-~-~~-~~-~-~,-~~~W 211 c~ssn~~tton ! -!:--'-._ . ~'1 , 1 ,L-"':'1..L U S Reg1s.,2re'J .:..rcr,1t: ~Jn U S __ -- lnjmy S1.1mmary A B 1 Er,ter on1y one 0191! per 01ocK 1 Fatal Serious 205 First Pilot I 206 Co-pilot I Terr1tor1es Jnd P::sses:::ions_ ur I J 1nrernat1cw.'1! '/',':;.:es I 207 Dual Student I ! r 208 Check Pilot I ' I I ?-- i I: C' f' F -4----r-- ~ ;__J _, __, .-.2g.~:cred r=-1rcrai. on O•l;1;:' -+--!---+--+--+-...__~----+---, ! So11 I 209 Flight Engineer i I 210 Cabin Attendants I i 211 Other Crew I I ! 212 Passengers I ! T 213 TOT AL ABOARD I ~ I I I __ !~ I 214 Other A:rcraft i 1- i--t+t215 Other Ground 216 GRAND TOTAL I -- ~--- I I ~ I Part Failure/Incorrect Part 220 Part Failure/Malfunction/ A.-blr1p/,- erwy ! 1 Norie 2 ~ Part component :i 1 3 Part component :12 4 ]Pait component ::J A Other A Part/Component 111 - 3 _ _ ; US Rey1s:E-red ,~·re rat: opera tee::- _; Foreign C;:iera!cr 4 ~Foreign Reg1sterN l•ircral! on U:: ____ Soil Tem:or•es c:.r Pos.o;:ess1ons -- 6__ l-.111itary A:rcraft ~ ~Aircraft r~c~ Re91s:erec 221 Incorrect Fart ( Mulr.-p1e en:r y .' 1 1 1t'>Jone 2 :-J Part component :11 3 ! Part cornronent ;;2 B Part/Component 112 4 ?art compcner.: < A O!l"er ----~~-------------------------~~- C Pan.· Componerr.=l .,_22_2__P_art__N_am__e _________________~~4_/>i_._._P~.£-~~--hl~Z~£~£~----+-----------------------+-----------------~·--~ ~2_2_3_A__TA__c_o_de----~--------~-t--_.....d~~~'.5---=t!/J~--------------+-----·~--------------------+--·------------------·~ 224 Manufacturer C f.S...> "V ~ 225 Mfg. Part# rJ /r.J 22E Mfg. Model ti /V/ /9 227 Serial# ;V/A- _22_a_P_o_rt_c_o_n_d_it_io_n_________c;..Hl}Ff=E D / c,, Wμ"' 4 E ~ 229 T oaal Time "). C::. LI- 'do .....--~--------------------+---~'-"-+,.,...-~---~-----;r-----------~---------~------------------~ 230 TSO ;J IA 231 TSI l.:f'Y ~ 232 Cycles Total U(\) V. ~2_3_3_C~y_cl_e_s_s_1~_c_e_O_v_e_rh_a_u_l~~~~+-~~~"'-:&.;A/~./.~'._._!1~~~---~-r--~~~~~---~~--~-+---~--~~~~--~~-~ 234 Cycles Since Inspection U/V /(. 235 Service Difficulty Report or Malfunction/Defect Report Submitted 236 Bo-gu1 Part 10Yes 21><1 No 1 ["__]Yes 2 ·_J No ---· 1[ l Yes 2[jNo I 1 [_-~Yes ----~--~ - No 1[-= Yes ·--.., - ;Ne - -- - a..,, ......... National TranaportaUon S~faty Board FACTUAL REPORT AVIATION Engine #1 s.rial No. 2 Engine #2 S:trtm No. S Superct\5rger ln•talled ~5¢:1 5'Jlf3/¢ 1 D Yes A Other .\ O:her 2 S No A Other 4 Turbochll!'ger lnlta~ 1 iJ Yes 2 0 No I NTSB Acc1dent!lnceenl Numbe-r 5 Propeller lbnufac:U'er ~ A Oth~r 6Pr~ Model 'Si1riti 3.etJ;c.~ A Other 1-~~~------~--'--~~~--~--~~--~~------~--~~---- ·~--~---"~~------~--'~~--~~~ 7 Propeller Type ( MuU:ple er.try) 5 Ground Adjusl:ab!e/variablE: p1tc.h Alrt:rsl!STOL ~.~~ 1 0 Wood 2 tEI Metal 6 0 Aeversable 1 D Yes 7 D Full automatic 'eathermg 2 S "'° 3 0 Composite 8 ~ Ft;ll man:..al fea~enng A Ot!"e- 4 Constantspeed-controlla._b_le_;..p_it_c._~_-..A_O~t-~-eTr-:-~"."-:'':'""'":'--~--~-~----r--~·~--~----....L--~~------...........,...,.,.._ Landing Gou 9 N~!Tall 10 Lett Main Poaltlon• 1 0 Up 1 D Up (If fixed gear, 2 j8 Down 2 ~ Do·""n go to block 12) 3 0 l~termed1ate 3 0 lntermed1at"'! A Other A Other Control Surface Po•Ulons 12 Lett Trailing Edge r:iap , D Up A Extended -1¢_ oeg. 8 Other Trim Tab Poalilona 16 Lett Aileron (Multiple entryj 1 0 Not Installed 2 ©Neutral 3 D Up 4 0 Down A ___ deg B Other 13 Right Tra.iiing Edge Flap 1 0 Up A Exte~ed 1¢-- deg B Other 17 Right Allero" 1 0 Not Installed 2 ~ Neutral 3 D Up 4 0 Down A __ deg. B Otrer 11 Righi Main 1 0 U? 2 5(1 Dowi 3 0 lntermed1at•: A Other For Rotorcrah ::r Balloon accide-:ts.. go to biock 20. 14 ~ Br:wae --~ 15 Spoiler 1 ~ Not installed I 1 ~ No-t lns:ale:: 2_0 Stoaed 2 0 Stowed 3 0 Depo.,ed I 3 0 Cep!o•Rd A Other 4 0 ()eplo~o :.~·r.lc1·,c.: 18 Rudder 1 0 No! installed 2 ~ NeL..-:ral 3 0 Lett 4 0 R1gr.: A ___ !leg B Q!her j A Other j 19 Elovator.rStoi~ j Fluddenator 1 ~ N€"1.Jtr<:1I 2 0 Up 3 D 0cwri A ___ deg. B Other Cargo Restraint 20 Csrgo Restraint Installed ( Mu::1p/e entry J 1~1 Carg. o Restnilnt U!led f Multiple entry,1 22 CariO Restraint Fal!E-d 1tl',.,·t ;:;Je en System , a None fGo to block. 26) , 0 None (Go to block 26) , D None 2 0 Cargo net 2 0 Cargo net 2 0 Cargo net 3 0 Straps/tie down I 3 0 Straps/lie doWT1 3 0 Straps/tie cown A Otner I A Other A On--er Computed Weight and Balance Information- Complete when weight and/or cemer of gravity lt.mitat10ns are eiceedecr accident flight. (Otherwise go to block 32) Takeoff 26 Weight 27 Center of Gravity __ Lbs A ___ % MAC or B ___ Inches Accldeni 26 CG Range (Multiple entry J 1 0 At takeoff weight 2 0 .A.t max gross v.€1ght 29 Weight 30 Centfi of Gravity 31 CG Range (Multiple entry) _.-- Lbs A ·---% MAC or 1 0 A! takeott \'retght A B ___ Inches 2 0 At max gross weight B A -- _ % tJAC to --· % MilC cc __ lncies to __ Inches --~MACto __ %MACor __ Inches to __ Inches 32 Fuel On B~AIAccldt 1 D Estirnae: 2 D Verifiec A T otaf gailors ___ _ B Ottier -----------------------------------------------...i..--~~~,_.--..-..._:~~ •. FuelT1nk1 33 Lett Wing National Transportatlrr1 Safety Board FACTUAL REPORT AVIATION B Gallons C 2 3 E Verified Other Win Bladder Metal Other y/ NTSB Accldent/lnc:denl Number y l 34 Right Wing / '- ! l------+--=--'''1---+----!----t-'----t----+--+---4---+..i:-...i.-+--~4--+-------4-·--t- I35 Lelt Tip 36 Right Tip I! ·~+-~~~-t-~~-+~~-+---~~--i~~--i~~--+~___,1~~-1-~~+-~~+-~~+-~--~1--~1·~- 37 Fuselage ~ 38 (Specify! 41 Fuel Found In # 1 Engine I Multi pie entry) 42 Fuel Found In #2 ~ngine r Multiple entry J ~ D None 7 C!'.J Filter(s) 1 D None 7 0 Ftlter(s) 2 ~ Lines 8 00 Selector valve 2 ~ L1r:e5 8 ~Selector valve 3 IZJ Gascolator· stra111er 9 @ Fuel manifold·sp1der 3 0 Gascolator.'strainer 9 D Fuel manifold s:ica 4 ~ CJrburetor. fuel iniector 10 D Accumulator tank .: D Carburetor'fuel in:ector rn 0 t..ccumulator t:;;k 5 '8:J Engine driven pump S 0 Engine driven pump 6 ~ Au)(iltary iue;_.pump A Other ___._§-0---AH-)(lliary fuel pump -A-O:her 43 Flight Control•, 44 Airframe/Structure, Evidence of ln-F!ighl Sepanttlon/Fallure 45 Propeller, EYidence I 4S Evidence or ( Ml'1:1 pie entry) of In-flight Operational Failure 1 [&None 7 0 R1gr.t stab/elevator Separation/Failure or Malfunc!lon 2 0 Helicopter (Complete Supp. Gj 8 0 Verl1cal fin rudder l 0 Yes (Mulriple entry) 3 0 General disintegration 9 0 Canard 2 ~ No 1 ~ None 4 D Le:l wing 10 D Powerplant A om~· 2 D Pitch conirol 5 lJ Right wing 11 0 Sabin, cargo dour 3 D Roll control 6 O Lett stab/eleY'ator A Other Powerplanl.. E~rc or ln-Fllgh1 Mechanio Malfunct~ 1 0 Yes 2 ~No A Other 4 0 Yaw control 47 Fuel, EvlC'1ence of Improper G,..de or Cont11mlnatlon 48 O!i, Evidence of Improper G,..de or Conta~ A Other ( Muitiple entry) 1 ~None 2 0 Improper grade 3 0 Contamination A Other Emergency locator Transmitter (ELn Information 52 EL T Model No. D/? E1-r 8 .. I 51 EL T Manu:acturer Do&IJ)E ez~,y A Other A Other (Multiple entry) 1 ,El None 2 0 Improper grade 3 D Contamimocn A Other S5 ~mpacf El T location(~) r Multi pit: e~,1 1 0 Cockpit 2 0 Cabin 5 0 Raft 53 EL T Battery Type 1 ~Alkaline 4 0 Nickel 5 0 L1th1um 54 EL T 9atte6 E1ptralion Date rNos tor M. D. Y) - ~3<!'-9¢ 3 0 Tailcone 4 ~ Empen:-:age 6 0 Surv1.aJ !'<11 A Other 2 0 Cadmium 3 0 Nicad A Other A Other 56 EL!.T-Reason tor Nonelhtctlvene11/fallure (Mult1ple entryJ 1: a Operated effectively 6 D Battery 1nstallat1on incorrect 2 D lnsufftc1ent G's 7 0 Incorrect battery 3 0 Improper 1nstallat1on 8 0 Fire damage 4 0 Battery dead 9 0 Impact damage s'D Battery corroded 10 D Anter.na broken/disconnected 110 12 D 13 D 14 D 1s D Water sucmers1on 1s D Test s.at1sfactorily alter accdenr Un;~ not armed 11 D Signal d1rect1on a.tereo::.,, terrau Shielded by wreckage 1a D Packing device still 1ns:aifed Shielded by terrain 19 D Remote switch oH Internal failure A Other National Transportation Safety Board FACTUAL .REPORT AVIATION •NTSB Acc1dE"nl/lnc1denl Number 2 Cockplt/lnstrumilnt P•MI Destroyed 1 0 Yes (Go lo btoci.11 Cockpit Instrument Indications-Enter direct in appropriate category Flight Instruments Hem Read1ng.:Settmg Comm/Nav Equipment Item Frequency 'Remark NTSB Form 61/20.4 Supplement B (1-84J I i Engine/System Instruments Item Miscellaneous Item Remarh ------; ,/, National Transportation Safety Board N~SB Accident lnc1d~nl Number FACTUAL REPORT AVIATION 3 N1nigalional EqulpmenUDisplays Installed I Multiple entry! 1 J2'] OMNI Head(s) 7 0 LORAN Omega INS 2 ~ Glide slope 8 EJ' DME 3 j4_ HSI 9):?1, AOF 4 0 Flight director 10 J5&_ Marker beacons 5 0 RMI A Other 6 ~ RNAV 4 Autopilot 1 0 Not installed 2 0 Engaged 3 ~Not engaged A Other 5 Dlgll1d Ehtclronlc/ Nav/Com Dl1play1 1 0 Not installed 2 ,'.R'J Installed A CHher 6 Primary AllimcterType 1 0 Counler-poi-,er 2 0 Drum-pointp- 3 ~.. 3-pointer 4 0 2-pointe~ A. Other 1 Slandby ~.ltimeter lni;talled 1 W,. Yes 8 Radar Altimeter ln1talled 1 0. Yes 9 Tran1ponder 10 Attitude Indicator ln~led. ,,.. 2 D No 2 ~No A Othe1 A Other 11 Attllude lndlcat~r Power Source (Mult1pte entry) 1 & Pressure vacuum system 20 Pressure vacul1171 system-with backup power ~ource 3 0 Electrical d C Standby 1nd1cator w1H1 a!te•na!t: pow('• source A Otrier 14 Type Weather Radar/[)etecllon Equlpme11t r Multiple an try) I 0 Storm scope 2 0 Black and -...-rn!e radar Electrical/System Switches Switch/Item 25 Avionics Master Not ln~talled 1 0 Not installed 2 0 Installed-not used 3 0 Installed-used 4 3 lnstalled-used-P..ltilude encoding A Other 12 Type ol Stall Warning Indicator 10 None 20 Visual light 30 Visual· gauge 4~ Aural sD St1ckshCiker 3 ® C::olor 1arla.r ~ ~ ~:' .• A Omer • I13 Weather Radu/Oel•ctlon Equtpn•nl iO Not installed 20 Installed-on 3~ Installed-off 40 Installed. on/off unk.r.ow-: A Other 28 Pile.I Heal ----, 29 Ice Di!leclion -a 30 Propellu Delce/Anti-l_c~---~------+-------+-~c...,-----~-----+-------~~~~-~--~~~-~~--~~-~- 31 Wlnd1hleld Deice _ 32 Windshield Anti-Ice ________..________..._ 33 Airframe D~ce 36 Cabin Air/Fan -------1 37 Cabin Heater ___f 38 Air Condlllonlnv I39 C&bin Pressure A:tilude ·------+---------- -------+--------·---------------11-40 Cabin Pre ..ure Tl!mperature ----1 41 Crew 0.1ygen I 42 Cat>ln/Pa11enger Oxygen : J 45 laxl Llgh._1_1________~-----~-~--·-+---.,__--+-------+---·----·----·----· ··-·----------1 46 Landing Ll~hll 47 Rotating Beacon NTSB Form 6120.4 Supplement B (1-84) I -, / PagE>.: National Transportation Safety Boa~d · FACTUAL REPORT AVIATION NTSB AccldenVlncld.,nt Number 3 2 Not On 011 Other P 0 rtinent Setting Remark "' ~j___ln_s_1a_11_e_d_t--------i---~--+------1-~---~-~-~·~--~~--~~~~4 A Switch/Item 1t-4-S_S_t_ro_b_e_s~----~____J~ ) 11---4-9-N-av_i_g-at-io_n_L_lg_h_ts___ I ~ 50 l;islrul'l"'ent Panel Lights f ._5_1_c_oc_k_p_1.v__s_to_r_m_Ll_g_h_1s___-+------+--~-----1-~-:---+------+-------~--------------~ 52 Cabin Lights X ~ 53 EL T Remote J ------·J I56 0 Engine Control Positions Not Pertinent rGo to bi.:c- 551 ngine Controls-No. 1 Engine 57 Throllle Position 58 Propeller 59 Mixture 160 Carburetor Heel iO Not installed 10 Nol installed 1 0 Not installed 1 tia Not ins121lle-:j 20 Full forward 20 Full increase (low pitch) 20 Full rich 20 Fuil on 30 M1drang.c 30 Midrange 3 0 Midrange 30 Fart1al 4 f4 Idle 40 Full decrease IH1gh pitchl 4 ~ Idle cutoff 40 Off A Other 5 ~Feather A Other A Ct her A Other E1 Alte.nate Air 62 Cowl Flaps 63 Magneto Switch Position 64 Throttle Friction 1 0 Not installed 1 0 Not installed 1 0 Not installed 1 0 l\l::>i insta!lec: 2 0 Open 2 0 Open 2 ~Both 2 0 T.ghl 3 ~_Closed 3 ~ Closed - 3·0 Left ~Loose 4 D Midrange 4 0 Midrange 4 0 Right A Other A Other A O:ner 5 0 Off 6 0 Start A Other Engine Controls-No. 2 Engine 65 0 Engine Control Positions Not Pertinent rGo :.:=•ock 74_, 1 1----~~~~·~~~~--~~~~~~~~~-r-~~~--~~~~~·-.--~~~~~~~·--___J 66 Throttle Position 1 0 Not installed 2 0 Full forward 3 0 M1l~range 4 Ql Idle A 01her 70 Al:ernate Air 1 0 Not installed 2 0 Open 3 ~ Closed 4 0 Midrange A Other 57 Propeller 1 0 Nor installed 2 0 Full increase (Low pitch) 3 0 Midrange 4 0 Fuli decrease (High r1tch) 5 ,8J Feather A Other 71 Cowl Flaps 1 0 Not installed 1 2 0 0!"en 3 ~ Closed 4 0 Midrange A Other NTSB Form 6120.4 Supplemef11 B (1-84) ! 68 Mixture 69 Carburetor Heat 1... 1 0 Not instal1ed 1 i.'J. r-.. ot installeo ) 2 ® Full rich 2 0 Full on I3 0 Midrange 3 0 Partial 4 0 Idle cutofl 4 0 OH 1 A Other 72 Magneto Switch Position 1 0 Not installed 2 0 Botti 3 0 Lett 4 0 i~1ght 5 ~Off 6 D Start A Ot~er A Other 73 Throttle Friction i 0 Not mslalled 2 0 1'"1g:it 3 ~ Loose A Ot~er I Nat!on&I Transportation Safety Board FACTUAL REPORT AVIATION NTS'S Accldent/lncld.3nl Number Landing Gear Controls/Indicators, Flight Controls/Indicators, and Fuel Selectoro/Pumps 74 Landing Gear Control 75 Landing Gear Indicator 76 Trailing Edge Flap Syt1tem 77 Trailing Edge Flap 78 Trall'ng Edgt~ F~ 1 0 Nol installed 1 D Not mstalled 1 0 Not installt:1 Contro! I lndlca!or 2 ~ Up 2 0 Up ~ 0 Manual 1- 0 No-: installed J 1 0 No!. in~tei1ea 3 0 Down 3 ~ Down .:; ca Elec!nc 2 D Up 2 D Up d. 4 0 Off 4 0 Trans11:unsafe 4 0 Hydraulic A Down -J-'P-- 11eg A Down _Jc+-,:ieg. A Other A Other A Other B Other 6 Ott1er 1-~--~~--~~--~--+-----------------~~.........-.,.-~-------~--~~----....--J.--~--~~~---- 79 Speed Brake Control ao Spoiler Control 81 Dual Controls 82 Throwover Control Y1>kll/Po11t!on 1 ~ Not lilo.talied 1 C8J Not installed 1 D N01 ins ''~ed 1 ~ Not installed 2 0 Stowed 2 D Stowed 2 ~ Installed 2 0 Left 3 0 Deployed 3 0 Deployed A Other 2. 0 Right A Other A Other .a 0 lntNmed:ate A Other 1---------~------~----+-~~--~--------~-----i~~------~~------4----~- .83 Elev/Siab 7riA1 Control (Multiple entry) 1 0 Not 1n~talled ? ~ Manual 84 Elev/Slab TMm lndicatcr 1 0 Not in5:alled 2 0 Up 3 0 Down 85 Aileron Trim Control ( Mult.'Ple entry) 1 ~ Nol installec 2 Q Manual 66 Aileron Trim ln.:::licator 137 Rudder Trim lndi:::Jior 1 0 Not installed 1 0 Ni.YI ins!.Jiie:: 2 0 Left 2 D Left I 3 D Right ' 3 D Righi 3 }Bl Ele~tric A Other 4 ,C:?l Neutrai A Other A O\ner l 3 0 Electric t--~--- J_ 4 (Zl l\ieutral I 4 ~ Neu:rai ,, 0111er I μ. Cith.:_______ , 13& fuel Selector Posilio.'l(s) (Multiple entry) 89 f'•.Jel Boos! P•Jm~. Engine ~1 ~ 1 C Left main 7 0 Forward ~13 ){On-engine 1:1 1 D Not nstalled I 2 0 R1g~1t main 8 0 Aft 14 0 Off-engine #1 2 0 On - -- i3 0 Both 9 0 External tank 15 0 On-en91ne #2 ~ D 0 H1gr-1 ! 4 0 Lefl auxiliary 10 0 Between tan'<.s 16 ~ 011-en~;ine 112 .. Low j 5 0 Right auiul1ary 11 0 X-leed left to r;~1r.! A Other 5 J&l Ott I l-·--6-0~c-e_n-te_r_________1_2__,0_x_-_1_ee_d_r._g_h__! _to-.e-ft-------,-:-::-=-:----.::---:·-~--·-A._o_i_h_€_;·---··---·------j 90 Fuel Boost P!Jmp, Engine #2 91 Fuel Transfe1· Pump 92 Primer, Engine- #1 93 Primer Engine 1r2 t 1 0 Not installed 1 El Not installed 1 ~ i>iot installed i ,g) Noi rns.!al:ed f_ 0 D 2 0 Locked 2 0 L ~ 2 On 2 Off ocl<ec i· 0 '·) 3 0 Unlccked "'0 3 High A On( __ ta:il<. to~-- Ian" -' Unlocked 4 0 Low B Other A Other A Other ~ s ca 011 ! A Other ------·--J NTSB Form 6120.4 Supplement B (1-t\4) i ; ! J_ I i: ~. lj NTSB Acciden!.llncident Numter National Transportation Safety Board Second Pllol Responsibilities FACTUAL REPORT AVIATION 1 0 Copilot 2 ~ Dt.1al student 3 D Safety pilot 4 D Check pilot 5- D None (Pilot-Rated Passenger) A Other 2 Name (Last. First. tn1rial) 3 t>ilot Certificate No. 4 Slreel Address FoL><fAT>/ 5 I~ ? Z 3 ~-11___l.__ _ A Other 5 Cily D~1'rvNf7 i!:,£1}-c H A O!her 10 Seat Occupied (Multiple entry) 1 Ci[. Left 4 0 Front 2 0 Right 5 0 Rear 3 D Cer.ter A Other 12 Certlficate(s) (Multiple entry) 1 0 Student 2 t3}. Private A Other FL Principal Profession 1 0 Pilot-civilian 2 D Pilot-military 3 0 Other-military 7 0 "11l1tary 8 D None A Other 1 7 Dale of Birth (Nos. ior M. D. Y) /D-;t,Lf -6 I A Other 9 ~x 1,@ Male 2 0 Female 8 Age 88A Other 4 0 Aircraft mecha:oic 7 0 Ooctor/dentis: 10 0 Clergy 13 0 Farmer1Rar<:her 14 0 Retired 5 0 Business 8 0 Police 6 0 Lawyer 9 ~ Sludent :3 Ratlnga-A.lrpli:noit (Multipla entry) 1 0 None 11 0 Teacher 12 0 Engineer A Other 14 RolorcrafVGllaer/l TA (Multiple 6ntq) 1 ~None 2 ~· S!ngle engine land 2 [j Helicopter 3 0 Commercial 9 D Foreign 3 l2J Muitiengine land 3 0 Gyroplane 4 0 Airline Transport A Other 4 0 Single engine sea 4 D Airship 5 D Flight Instructor 5 0 Multiengine sea 5 D Free balloon 6 0 Flight Engineer 6 0 Glider ____ -- 15. Instrument Rating 16 Instructor Rating(::i) (Multiple t:nlry) 17 Ground lnstrucior ~8 Type Rating/Endorsement Tit.Js (Multiple entry~ 1 ~ None 5 0 Gyroplane 1 0 Basic Aircraft 1 ~ NonP. 2 D Airplane SE 6 0 Glider 2 0 Advanced 1 D Yes 2 D Airplane 3 D Airplane ME 7 0 Instrument airplane 3 0 Instrument 2 Qg No (Go to block 20) 3 D Helicopter 4 0 Helicopter 8 0 Instrument helic,_i::..;..>-i_1e_r_,___4.;...:;:~=-.;...;N.;;.o._ne~----_...._A_._O_t_h_e_r-------------1 19 Month~ Since Check/Endorseme!"lt 20 Biennial Flight Review ~ 21 Months Since La'Jt BFR 122 BFR (or equivalent} Aircraft Make.!Uodet Thlt Aircraft 1 C!?J Yes __'j___ Months I A Make CE<..>""'!1 - 2 D No A Other B Model I 7J., . A Other A Other . C Other 23 Medical Certificate 1 24 Medical Cer!!!icate Validity 25 Date of ust Medic.;;i (Nos. for D. L( Yj 1 0 None 1 f,iJ Valid medical-no waivers/limitations 5 0 No medical certificate 2 ~ Class 1 2 0 Valid med1cal-w1th waivers/:1i!iitations A Other Lf -(j. i --1 dJ 3 0 Class 2 3 0 Non 'lalid medical for this fiight A Other 4 D Class 3 4 0 Expired A Other 26 Medlc~I Llm!tdlon 1 I&] None 2 0 Vision A Specify ___ _ B Other 27 Medlcal Wal'fu 1 Iii None 2 0 Vi:;ion 3 0 Hearing A Specify -------J- 8 Other 28 Ststemeni of Demonstrated A~ility 1 0 Yes 2 1&1 No A Other 29 Correctln~ LenJa (Mu/tip/a entry I 1 ~ Not required 2 0 Required ~o be in poss6:>S1on 3 0 Required, not in possession 4 D Required to b.9 worn 5 0 Required, not worn 6 0 Worn a~ t.ime of accident a....~---~--------..________________-'--------------------~~----"~-:..A:....:Oth~e~r------------·---~--~ 33 Source of P,llol Time 1 D Pilot Log 3 0 FAA 2 0 Company 4 181 Pilot/Operator Report NTSB Form 6120.1 Supplement E (1-a41 5 0 Investigator's Estimate 6 0 Fiela1iv9 7 0 Othsr Person A Other Page 1 National Transportation Sat ety Board NTSB A~ldenVlncldent Numbt.'f' flJghtTlme 35 Total Time 36 Pllol In Command (PIC) 37 lnstrucl.or 38 This Make/Model 39 last 90 ri&ys 4-0 last 30 Days 41 last 24 Hours FACTUAL REPORT AVIATION r~s -I ?-[ d-/ 13 Airplane Mull! Engine Night Actual Simulated Rotorcralt Glider l/ g }Cf !f 6D - 5 !:J ~I I~ 42 Landings-Last 30 Days-- All Aircraft-Day 43 landings-Last 90 Days-All Aircraft-Night : ~~:~·;;-Lwl ~ o~s-Tuts Mtte/M-- 1 1 1 A Other A Other / 47 S.etbelt UIOd ~ 45 Landings-Last SO Days-This Make/Model- 46 Sutbelt Av.ll•ble Night 1 ~Yes 1 ~Yes 2 0 No 2 []No -- -A orner I I -- - A Other A Other 50 Autopsy Perfonn9d-(This Pi.'otJTSi- Tox-lc_ol_og_y_P_•_r1_or.MU- (This Pilot) 1 [] Yes . I 1 [] Yes 2 [Z No I 2 ~No A Other A Other .ca Shoulder Heinnt AHiia~I" 49 Shoulder Htimeu Und 1 ~ Yes 1 '8J Yes 2 0 No 2 D No A Other A Other I jNTSB Form 6120.4 Supplement E (1-84) d~ Page 2 I ---------------------~~--------------------------.-.. National Transportation Safety Board FACTUAL REPORT AVIATION NTSB Accident/Incident Number · 1 Accident Site Geographic Coordinates--Latltude (Multiple entry) 2 Accident Site Geographic Coordln3tes-Longltude (Multiole entry) 1 ®,North A ~deg. ~minutes B Other 1 D East A _.¢..EJ_ deg. _lL_ minutes 2 0 South 3 Impact Sequence-r Number m sequence. Multiple entry. 1 1 0 None 7 ~ d..Grcund 2 0 Rock face 8 0 Dirt bank 3 0 R1g1d struciure 9 0 Scrub tree 4 0 Rocks to 1· diam 10 0 Trees. limbs to 6 .. diam. 5 0 Rocks 1·-2· d;am 11 0 Trees,llmb::. 5--_9· d•am 6 D Rocks > 2' d1.:im 12 0 Trees 11mbs 9·-1r diam 4 Terrain at Principal Impact Foint (Multiple entry j 1 0 None - 6 0 Packed snow 2 0 Wei cult1v.:ited so.I 7 0 Loose sriow 2 0 IJry cu1t1vated soil 3 0 Concrete 4 0 Dry packed clay 9 0 Asphalt ::i D Boggy swampy 10 0 Loos" rock Princip&il lmp~ct Kinematics S Airspeed At Impact I Enter direct or m::irk estimated range) ~ 0 0-15 € 0 75-90 11 0 210 plus knots 2 ~ V.iest B 13 0 Trees/limbs 12" diam. and up 14 0 Frangible approacn aid 15 0 Non-frangible approach aid 1E 0 Submerged obstacle 11 D Vehicle - 1s D Aircraft 11 0 Ory sod 12 ~Wet sod 13 0 Water ;4 0 Tundra 15 0 Dirt 16 0 Rock 17 D 1r;e 18 0 Mud 19 D Sand A Other Other 19 D Runway light 20 0 Water 21 D Wire 220 Pole 23 0 S11ow bani'. A Other 6 Flight Path Ang'e rEnter dtrect or mark estimated range) 1 D Up 6 D 15-20 11 D 60-90 2 0 15-30 7 0 90-120 A __ Knots 2 g Down 7 0 20-25 A ___ Degrees 3 filJ0-45- -- -~B- D 120-150 B Other 3 ~ 0-5 8 0 25-30 - B Other 4 )Q. ·+s-60 9 D 150- 1so 4 D 5-10 9 D 30-45 5 D 60-75 10 D 1so-210 5 D 10-1s 10 D 45-60 7 Pitch Altitude Al Impact I Enter dlfect er mark f:511matea range.) -~~~-~~~--~~---~~~~~~~~-- , ~tch0A~:~:de ~;An~W•t;"o~ ~ ~ ~ ~ ~'eU~ngteW~Honrnn 8 2 0 Up 0 75 0 60 D 45 D 20 D 15 D 0 0 15 D 30 D 45 D 60 0 75 D or Other A ___ Dl:!g. ~\~~~~~~PP jl- ff~ 90 0 75 0 60 D 45 D 3o D 15 D o tgJ 15 l{J 30 D 45 D 60 0 75 0 90 D a Roll At1itude At Impact (Enter dtrect or mark estimated ro.nge) Aircraft Rolled Left Aircraft Rolled Right Roll 1 0 u;ft ~ 't ~ ~ ~ iJI- ,._ ;JV .,, ·f f B 2 0 Right D 105 0 120 D 135 D 1so D 155 D 1so D 165 0 150 0 135 D 120 D 105 D I or Other A ___ Dag. )~ Ir Ir ;(. ~ ~j~ ~ ~ ~ ~ ~ ~ 90 0 15 0 60 D 45 D 3o D 1s D o 15 0 3o 0 45 D oo 0 15 D 90 D NTSB Form 6120.4 Supplement I (1-84) Page.1 I National Transportation Safety Beard INTSB AccidenL'lnci£•~nt_ Number ·FACTUAL REPORT AVIATION 9 Yaw Attitude at Impact (Enter direct or mark estimated range.) 1 0 r~ose left 2 0 Nose right A Deg 10 Terrain Angle 1 ~Level /1. Up B Cown C Othe; deg deg ,----1 or A1rcraf1 Y;1w-=d Left Aircr3ft Yawed Right B Other 9o D 1s D e.o D 45 D 30 D 15 0 o,Rl is 0 Jo D 45 D 60 D 1s 0 9o0 11 Principal Impact Ground Scar Length I ;2 Principal lr·pact Ground Scar Depth 13 Fuselage Totally Destroyed 1 ~None A feet B Other 1 ~None A inches B Other i 0 Yes 1Go to blocJ< 36) 2 ~Ne ·A Other 14 Cockpit Damage 1 Mulrwte entry J 15 FWD Cabin tJamage !Multtple enrrv! 16 AFT Cabin Darr..age{Mu::10/P. entry) 1 D DesW•yed 2 0 Colla;:;sed 3 ~ Pa•t collapser. 4 0 Distorted 5 0 Bumt 6 0 Intact 7 D None 1 D Destroyed 5 D Burnt 1 0 Dest; ..iy~ 5 ~.Burnt 2 lJ Coli?.p:...ed 6 0 'nti'ct 2 D Ccllapsea 6 D Int.Jct 3 0 Pan collapsed 7~ None 3 0 Part co!l2';:i~,ed 7;R( Non~ A Other 4 D Distorted A Other 4 D D1stortee A Other l 17 Fuseiage Split 18 Fuselage Split Behind Seat :i 19 Fuselage Collapse /Est1matedJ 20 Fuselage CrUSh ______..,. 1 ~No rGo to bfc,;k 19) 2 0 Long1tudin;;;I 3 0 Circumferent1c:I A Othe, ~pproved Exit O_ata __ _ I IExit LOC< .on 1 Door 21 Codtpit-Lett 22 Cockpit Righi 23 1L y 21 1R 2S 2L 26 2A 27 3L ---· 28 JR 29 4L JC 4R 31 SL 32 SR 33 SL 34 SR A Other A Type o! Exit I w,nJ 3 Hal::h x ·-- i 1 ffSB Fo:-m 6i20.4 Supplement I (1-84) ! 8 1 Other Yes ¢q - <139 )( x I 1 ~-None 1 ;8.[ None A Horizontal ----- inches A Horizor.ra1 ·----inches B Vertical ·- -- inches 8 Vertical ___ inches C Other C Other c E G Operable Fire Damage Impact Damage I I I2 D 1 2 F 1 2 .{ No Other Yes No Other Yes No Other I - x x x X' . . I ----· - l f I =8·- I Page 2 ) /"'/' J/ I -1 r I ·. National Transportation Safety Board Crash Site Pian/Elevation FACTUAL REPORT AVIATION ....--~----- INTSB Acciderillincioe;~ n .... -;:!; .. r I -- amaa:wllllMf....-a~..,. 36 Sketch of Crash Site-Show d1stnbut1on of ma1or cc.'71ponents. fire area. obstacles strr ;c.'-;. occuoants. and r.1aqner•c nor.. Sketch is ··1JO T :: ::::..4-.E ~----- 5o '----~ Plan View Elevation View - 2£&1idd\W!. 1' ~ N II I I NTSB Form 6120.4 Suoolement I i1-a41 ~- - P: National Transportation Safety Soard NTSB AccidenL'lnciC~nt H~nber FACTUAL REPORT AVIATION ype of Seilrch Conducted I Mull1ple entry I 4 Search Agency Notified 1 ~Air 3 0 Sea A 5-e' 8--9¢ rNcs for M. o. .,. , B eg ¢ b L.xal time 2 0 Ground ~ 0 !nfcirrnal A Other C Other 5 Aircraft/Occupants LocalN A g¥:,~; :Q ! Nos. for M. 0. Y; B · b._ Loc:ii t1i11e 7 Civ~iATrPalrol Involved in earch 1 0 Yes 2 ®No e Military or C~l Guarcl t:erso~ r~o,xi 1 0 Yes 2 ~No C 0\her 9 Distress Cali Transmitted 1Mult1ple entry J 1 D t-..ione transn111ted 2 ~ Prior to accident 3 0 After impact, accident A Other A OthE;r p, Other a I .eceive 11 Method of Locating Accident :iilfl rMi.,Jt1pla e...,-;;:;-;------- 1Muli1ple entry J I 1 0 EL T 2 ~ Prior to accident 3 0 VHF radio S;-;';"10ke/t11'!: 3 0 After impact accident 4 0 UHF radio S 0 SAR satellre A Other 5 ~ Visual s1gt-.ting of wreckage 9 ~A J'C ccm;~ ~-ate 6 r2?l Visual sighting of cccupants A OthetJ" 1 D t~one received ~ D HF radio 7 0 "'':!i-t..a~ sur!'n;:rr!:.gna 1...-2-C_o_n_d.i 0 t-io_n_o~f-A-ir-cr-a--~-..,....__.-es_c_u_e_1l'v_1_u_ll-,p-lc-.-e-n-tr_y_J 13 Weather: ~~ 1 ~ Lccated al;ve 6 D Able to assist with locating Most Sew)!i"e T~'Wii D Chill COl"3rlruon CUm<J ~ 2 Located deceased ? 0 Left scene-successfully located -a J Ll Located alive-died later 8 0 Lett sceri.e-uns~cce~stul in finding aid A Terrrc:IE:-r.:hure -~L_.- E e Wine.. chi!! ta.:'-r.:71' F 4 0 Died awaiting rescue 9 0 Left scene-unsuccessful in finding a1d--O•ed later 5 0 Located ail•1e::_1rapped .A Other 5----------~----....;;------------------~;;_~~--------------------------~----------~--'I-.~.~----~~~-~·~-~ C Otre- Fire Fighting 16 ral None Conducted (Go to block 31) I" F;<edghUng Unit Notllied 18 Flnil Firefighting Unit 19 Firefighting Unit• 20 firefighting Units A..oi1i~'?.d 121 F!reE.i:t~e:aj (Ncs. for M. D. YJ Arrived Responding Evacuation ....:"..:3· ~~~ l1T A Local time (Multiple entry) 1 0 Yes -··---·-- 10 Airport 20 No .0.. 0'.hel B -----·Local time A Other 2 0 Municipal A Ot!'ier c Other 3 0 Military A Other --A Avaliable c Use<l Firefighting Agents I I ----·- 1 Yes 2 No B Other 1 'res 2 t..io a i:tner I ·---- 22 Protein Foam l I I 23 Dry Chemical I I -r-- 24 Carbon Dioxide I - . 25 AFFF (lit-:: Wat2r) ------ 26 Wate. 25 (Specify) I I - ,.., National Transportation Safety Board FACTUAL REPORT AVIATION Sesrch and Rescue, Firef!~~tlng 1 Medical Treatment 31 Medical Units R~sponding r Doctor or para1ned1c Ir Mul!1pl1:: entry 1 1 0 NonP. provided 2 0 Airport 3 ~ Mun1c1pal 4 0 Other paramedics 5 0 Military - A Other •NTSB AccidenUll"cident Number 35 Search and RescOJ·!, Firefighting, Mediic"..al Trealmem1 Unilo; Hunuete-d 1 0 Yes /Complete items 36-51 J 2 ~ ~.lo A Other Search and Rescue F1ref1ghting Med1ccil Treatment Units l..._H_a_m_P__er_e_d_b_Y__________________-r--1_s_e_a-rc-h-ar-1d_R_e_sc_l_1e--r---2-F•-re_f_Jg_n_'_""_g___ 3 Medica: TTE::mei~t ~~~~_~_~_tt_'---------------~~------~~~~~~~~:~~--------±------37 Terrain 41 Obstacles 42 Trainin9 of Personnel 43 Other Vehicles 44 Tralfic 45 Coordination Problem 46 Inadequate Emergency Plan/Planning 47 Command Problem 48 Communication Problem 49 Equipment Unable on Terrain SO Did Not Adhere to Emergt:ncy Plan 51 (Specify) NT~R l=nr,,, f\120_4 SuooiP-ment M 11-R.:11 Pac; 2 3 4 5· 6 7 8 9 11 12 13 14 15 16 17 18 19 20 23 National Transportation Safety Board FACTUAL REPORT AVIATION Address 1C1ty & State) NTS~ Form 6120.4 Supplement S (1-84) f I f NTSB Accidenl/lncidenl Number E Non- G Passenger Occupant FA.A 4 Fatal 3 Ser'Ous i I =age riATIONAL TRANSPORTATION SAFETY 80ARO P,LOT /Of>ERATOf\ AJRCAAFT ,.CODE NT RE?ORT This Form To S.. UMd For Reporting Ctvil Aircraft Accld1nt1 Involving Commerc!1I ind General Aviation Aircraft Nffr"'K'I Ctty l1"'1•ce. lt.11•. Zlip Code Dtrtt of 4oc~t Loe.al Tlm• Zone ll-t'vatlon At A..ccldMt Soft. AC oc~l kO f"1M~ Dr:i..A-NJ-;-F'-",,_~J1e. os-=-2..1-90 ~DH~~~ ·· cnT ~~~ H Thi Acc•c:lent Occurred Or. Appro11ch. lall'.lotl O• Within 3 Miles 01 An Airport. Complete The Follcwin'1 lnformali;;------·---·-- fro..t,lm>ty To A.Jrp-ort: 1.0 On Airport 3 0 Withinil2Mile S.O W1thin1 Mile 8. 0 Within 2 Milu 7.0 W1thin3 Mile~ 8. 5Q Beyond 3 Milu 2.0 W1th•n 1'4 Mile i.0 Within ~4 Miie Airport Name Airport ldent ,.Q<.c..,dcr.-tf (;}'-C."'~ 6PP At~tt>M D~L~~tVll-T/Jr~~ DcO 5. Condition: Sood P'haM Of Ope ration: 1.0 S11nding 2.0 Taxi ~-~ 3. O T1keoff • D Clirr.b - .~·-= 5. 0 Cruis.a 7. fJ Approach 9. O HovertMu1euver 6. 0 De~c:ent e.o· L•nding io. OA!titude ()I In-Flight Occ1Jrrenctt~ ~t >.J "·· "-... .:l ..._'C.t~•·/· )""?pm·, 2f.aa1-'-·,._,-.. -~cu:..!.Li., :c.. ~~-°*' -· ~.::i.~-9-;; ii:~ ~lrtration, Mar\ A!rcrah. Mani.rflicturer ~rcraft Type!Mod•I IS•rial Number C.rt Mu·~ /'l L/'173 v Typis Of Aln:ratt 1. ~ Airpla:-ie 2. G Helicopter JO Glider 4 C Balloon undi:igGHr 1. O T~ocycle-Fixed 2.~ Tricycle--Retractable 2.Q._Tailwheel-Fixed Stall Werning Syw1•m lns11n•d I i.~ Yes 2 C No En~ir.e Manufacturer T3D.3 I 002...8"..S- Sl7S"- Tl'l>t Of Alrworthineu C.rttfic.at• 5. O Blirhp'Darigible 1. S Normal S. O Restricted Am tt-.:r !-u &rt i.o vi$ 6. O Ultralight 2. 0 Utiliry 6. O Limited 7. O Gyroplene 3.0 Acrobatic 7.[J Experimental 8 Specify------ '·D Transport 8 Specify ------ • O Teilwheel-Retractabie 5. O T1ilwheel--Retract1ble Main' 6 :J Amphibian ----rjF?! ~quippe-d ~ngine Type 7.0 Skrd 8.QSkiWh~I 9. Specify i [j:_ Yes 1 0 Reciprocat ng~arburetor 3. O Turbo Prop 5 O T...,-:c;1H'I 2 CJ No 2. Rf'ciprocat1ng-·Fuelln1ected 4.:J TurboJet 6.~ ii,:-:,.:Sn~f'. --~=------'--~-=...__ __;-,.-__;::._____:_______-=;__..--________;=-------·--- Engine Mode!/S.riH r; __ Engino R..t.c:S Power ~/O-~l.o-A~ \Lt.-FT) - fi?.tf · .( I 1. ~Horsepower L -;...s10-s-z...a-1'1;;: ~" AF..J I· . 2. ___ Lbs Thrust Type Of Fire htingui1hir1; S~temUMCI 1. [XJ None 2. Specify -------· E_.!:g i_!" e I1 I ----+--------·----4,___..___ ion Tim~~~- ine No 1 Hours Hours Ho ine No ] --t--~"-'r....a.._,x.:____:.H~o~u~r~s-4---=~~-=-----H..;;..o_u~rs-+-~__.'-=--'--~~ --+-----------11--------Ho.;...u_r..;;..s-+----- Hours Ho ine No 3 ------ine No 4 Tr.;ie or Maint•nanc:e Pr°'iram 1. 0 Annual 2. 0 Manuf&t:turer'' ln,pection Program 3 0 Other Approved lnipection Program (AA!P) 1 4 ~Continuous Airworthiness 5 S crf Emerg..ncy El T ManufK!unH Loc.1t o~ Trana.rnrtur (El n, R.gin•re-d Airtjratt Own., Hours Hours Ho -~--~--------'-~....:;_-L----------------~-~------ Type Of l.a11 ln&p.C1ion i.o Annual 2.Q 100Hour 3.0 AAIP 4 ~Continuous Airworthiness Datt Lan ln & p+c< iOT h-rf twl"r O!i-11-'"iD _tMiJ Time Since Lnt lna:-ec)l-,n _ L,12-D - Ho1 .A.irfr11T.e Total T1rr~ ~.SC., ;.z.. 2. >fo1 ~1Ytr_!l,,JJ14 ~~e~~::=.t.!A~~~~~r-~L::..::~.:.-=-+-.;_::=t-~~~~~~~~~--~~~~~~o-p.r•tor Of Aircraft Addrna 1. ~Same A' Registered Owner 1 ; ~ame LOBS 1. li:J S•me AJ. Regi,tered 0-,...ner 2. -------------· I Oper1tor ICt'1if1c.-te Numb9rl P\.lrpoN Of Alght And T~ Of ~tlon "-eul1111on flight Conductor '-M6er ()p.rator Authority 1.0FAR 91 (ontyl 4.QFAA 121 7.0F"' 13.l fMl.2J fM.m FAR 121. 12'1. 127. ta. 1J "'1vonve ~ ~- QFlotorcrah E)(li•n1il lo11d · LOScht1d;.,iiltd 2.0FARi10 l5.QFAR125 10FAR135 1.0Domntic 3.QFAR 103 6.QF.A\A 129 5OFAR137 2.QFla~ i...:,~rpo:::!..:....:..:N:.:..:...:~rri-r-t---...:....::=----------=::;__----1 3 0 Suppl~merllll 1.0Per1on1I 6 OAeri1I ObHrvltion f..Aflll} 2. 0 Non S.:-hl'!dul!l"j JODomut1c '· 0 lnt•m1tion11I 5 OPrineng9r 2.0Buaineu 7.00thtrWortUH 3~nstr"ction1I , 8. 0 Public UH 4. O becu1iv•'Corpor ate II. 0 Forry 15. O Aerial Aoplication 10. 0 Positioning fA!lill •OOnO.man~ 5 OCommuter 7. 0 Large Aircr1'h f.AB...W ID Foreign 6 OCargo 7. Specify C.rtMlcate(t) 1.0Stu<1ent 2.QPrivtte 3.~ommercial 'QAirline Tran1port 5.~·Fhght Instructor 6 O Fhwhl Engine-er 7.0Military 8 OForeign l.ONone 10 Specify -------- ft.ltlng(al 1.0 None 2.~Single Engine Lind 3. O Single Engine Su •. · Mult1engine Land 5. Multi en ine Su 6 O Helicopter 7.0 Glid,1r 8 O Free Balloon 9 O Airship 10 G ro lane T~ Ratlnga/Student EndorNm1nt1 /V.01'-·c ~lc.111 c.rttflc.etc 1. O None 20Ct1n1 o.g,... Of Injury 1.0 None 2.~ Minor 3. Lf Serious •O Fatal 01t1 Of Lart M.dleal ~.t(ciau 2 •.o ~less3 (M/D/Y S..t°"upi9d 1.0 Lett 2_gR1ght 3.0 Center tQ Front 5.[) Rur lnrtrurnent Rating(&) 1 0 None 2~Airp!ane 3 0 H•licopter Instructor R1tln9(1) 1 O None 2._QQ Airpl:n: S E 3 ~ Air~lane M E •. O Helicopter 5. Glider IFR .llrcref'l ~gt Instrument A.irp'~ne 7.0 Instrument H~te' I~ Ground lnS"trut"'~ 9 Specify _____, Dste Of li1nrilal Fli9ht Review Or Equlval•n1 (MIO/YI 07 /20 s-q ·1. M111i:e ·-p~er Sevn1·,y-Je__ 2. Model · 444-1$?0 _ Peraon At Control a At lime Of-Aceident SHtkl"IA.~~- 1 ~Pile! In Command 3. O Both Pilots 5 :::::J NoOne 1.J;&Yes 2 0 Second Pilot '· O Non-P1101 2 0 No SNtS.tt UMd 1.}21 Ves 2.0 No ihoutder Harr.-.. Avaiable Shoulder Hunn.a UNd Souree Of Pilot Fli9ht Time Information 1 BJ Pilot Logbook •· O Company 1 t2. Yu 2 d No 2 O Operators Esti1.11te S. Specify ----- 3 O FA.ft. R;coros 1.ig Yes 2.Q No Airpl11ne Instrument R" htTime Actual S1mul1ted kotorcra~ Glider Tote! Time 2Co zoo Pilot In Command (P1CI Instructor This Make'Model List 90 Da s l.111 )() 01 ' Second P'Uot Anponalbllh• Al The TlrM Of Aoddent 1. O Co-Pilot 2. ~Dual Student 3. D Safety Pilot • 0 Chtd. Pilot 5. O None (Pilot-Rated Panenger I P'Uot Hime ! "'°' Cefttt\ute No. t:eru: ;~, h:.J 'io-ris 512733201 C.rt!fklte{a) 1 OSludent l t'.Z(Priv1te I . 3 OCommercial •· O Airline :rrenapon 5 0 Flight ln1!ructor 6 OFlight EnginHr PMtiontll'ly &....1.4.;...i_--1...lo<.~~:.lo<...f-1..l-.!.....L.L...::-~~..J+r_..:;;_L USA 9 None 7. 0 Military 8 OForeign 1o SDec1f-t ----·---...., ...--7 ~ --, btl"'l1) 1.0 None J.&, Single Engine Lind - J. O Single Engine SH 4.JS. l~uh11ngiro1 Ltnd I. Muttitn int Su Typo A.l11f'lilt!ltwodent En6ortem1nb None. Medal c.rt tfic.111 1.0 Non• 2. ··oua' 3.0 Cl1112 4.0 Clan l I. O Helicopter 7.0 Glider I. 0 FrM 81!1oon 1.0 Air1hip 10 D Gyropl1n.- Dtt1 or Lnt Med:~l (MtDIY) 4-/zcr/?o Degret ~ Mjviy 1.~Nont 2.tJ Minor 3.0 Serious •.o Fa111 hat Wt VMd L@' Yes 2.0No ~lMnt Rati"l(I) 1._gJ· Noni 2.0 Alrpl1n1 3. 0 Hehtopl1r 3.0 C•nter 4.0 Front •~~(•) · 1.~No~ 2. O Airplane SE 3. D Airpl1n1 M E. 4. 0 H91icopt1r 6. Glider 6.0 Rur I. O lnltr\l~~l'MI 7.0 ln1tn1~~ter 1.0 Groundl"'~ I. S~ty ----· ~~::::...=:~--~~+-=::.L.:----+..i=t..:...---+-_:;~-+-_.=-~+...L..:....L~+.J..t!-'JL..--t-!...!..L.-'--+-__:::_~--+-~~__;;.~o -+--!...ci~-+-~~-+-~---+-~~-+--=---+..(;.{.-W-----4_...&.L-~~;.._--+.-~~-;Q___ List 24 Houri () ! /'\ Pnsenger - Non- -·-Non---- Crew Revenue Re ... enue Occu ant i-=2~---·---+-----t-----~---------+---+---4-----+--~· ~3--------i----t-------------+----~----+---1-------4---I-------- ' ~5-----~--+-----t------~----+---+---+----+-----+---+------~· 6. La11 Oep.airture Poirot lime or 09par1urs Destination Aight Plan Ried 1. A;•pon ID ~ 1. Tome D70Q 1 A;,pon ID ~~ 1.Q None • !:) vn<1fR 2. City'Plm L ~ Bi:id1 2 City.'Placetic 2 o·vFR 5 0 C:m~.,y (VFF 3 State Ft 2. Tim~ Zone f0s-k((\ 3. State Fl. 3. IFR 6 O llihU"'f IVfRl " W•athef Wu lnwotved. St.ate " Weett.Of 8r~ng Wn CY.rtainecl OT " WH'thOf Reporb Wen °*=k.cS And How tl Wu ~ Cc:nr,~ wx ~ ATi.5 ~~!~Board At l.M1 Tali.&;Of'f ---- Gallons or __.li.....C_Q.___ Pou rid' °"""' '-nlcel. " Ar-.y, ~r To b.p.,11.1r• ~J1n-e louos 04 Wir.sttler lnfomrstk>n {Pllot/Oplr11or, Wuth1r ObMrvstk>nl Bl o+ tfl Co/~1 Wio rid !! IMl9'Type 1. 0 80117 ! 0 115'1A5 5.Q Jct A 7. Specify ----- 12 S: 100low Leed 3 tJ 100 130 6 0 Automotive V9.lblltty 1. 0 Dawn 3 0 Ou1lr. 5. 0 Dirt Night _j_ M1~11 '1. ti Daylight • 0 Bright Night 7!_ lk y IL.ow.st Clo\fd Co Mlh:lon 1.0 C111r "Hg - 2. 0 'e1n1rtd ---F111 AGL ~- 0 lrolltn ___ Ftet AGL ••.p( Ovl~ll f 5 Q FHI AGL I. O 1111.,,ial Ob1cur11ion I. O Oblcurr1d Wind :rrlofmatlon P-a),'V.· 1. DI rectlon __.....;;.{_~'__.,__.!...J..__ T~"Hlph.etJon ~OfP'"'~~n 2. Valoclty --- KTS 3. Gu11t --- KTS 1.Q l~ht 3 0 Huvy 12.0 Mod1r111 4. S1>1c!fy __ 3. O Mod1re11 4.0 S1v.,r11 5. 0 h1r1m1 0. 0 Clwr Air 7. D In Cloud& DeogrN Of Alrcr1Pt D1m191 1.0 None 2 O Minor 3. 0 Sub<••n•i•I •. ~ 0.ll•oy•d. r ~ YH I 2.0 No 3.0 ln-F"ligi':t 4.BJ..OnGr~d 0...Crlptlon Of Ocma90 To Alrcrttl And 0th~ ..,operty i.o No 2.~ Yes L;st The N arr.e Of The p,..,_ Manuhcturer. Part No .. Sera I No A.1C3 Descr be The Fa.lure .., 1" .. 1.•·ll'i If Collison Accident Occurred. Com lete The Ir.formation For Other Aircraft R.gi_~ratio11 mark Aircraft Manuf&C1urer _ Airc:ratt Type/Model Pilot Name Addrns Asa irta n ::e Recni v.c:t ToulTime OnP;,11 ___ Hours ---~rs O.VrHOf~r.1f1..Dama ;s 1. O Destroyed 3 O M1f:O 2. O Substantial 4 O N~ l'ilot C.rtific:.11t1 No. 1. 0 O\Jts1de Pf!rson(s.) 2. O Au::1l1ary Li~htinQ 3 0 Slide 40Aope 5 O ladder 6. ~specify -P1lo.+ /s-tuoe1-+ Mttthod Of E.ah (State A.pproxi~t• Number (); Pa~on1 Using Each Of The f=ollowingl 1 Main Door _x.._ 2 Auxiliary Door __ 3. Emer~cincy Exit __ n.endatloft ~ Cou6d TWa Acrident ....... ...,. ~----------..---------- Operator ·Owner S"fety Recommendation IOpt1on&I Ent'j') ·' / '9.f bdl Addttlonal ~ht et.. M.mber, la...,.,_ Of C.Wh An..nentt Comp4111 TM hl$ow\nt 'tnformatlon: flMMI 1M CertM\N11 lto. iiiirOf>I TI:Q C..'3'ute(1) 1.Q ltudent 3. 0 Comrn1rcl1I I. D P:li~ht lnatrut"tor 7. O For1lgn 2.0 F"rlv1i1 4. O A.lrllns Tr11n11port tl.O Fligl'itEnglnnr •. 5P4tlfy - P\.l:tlner.tir.dorMrntnb Tot.Ill Fl~h\ Tims '11-sht Timt Th~ .&.;,;i4~t Name FM Certifkatt No. Addrtu In<. - ~te{1) 1.Q Student 3. 0 Comm1rci1I 5. 0 Flight Instructor 7.0 Foreign 2.0 Privti!e •. D Airline Tr1nsport 6. O Flight Enginoer 8. Specify -'--·---------- -·9'aUn;a:EndorMmenb Total R~M Tlmt Flight lime Thi1 .l.::::iOent ... IFAA C.rtH1..to No. Ncmt Addrn.a - - 'Th-- I ~ - C.rtlfic.et•(•) 1.0 Student 3 0 Commercial 5 O Flight Instructor 7.0 Foreign 2.0 ?rivatE 4. O Airline Tr1nspon 6. O Flight Engineer 8. Specify Ratir.Q1/Endorwm•nt1 _t' A;ght Time Right Time This.&;raaf'I - - - I I I .1 -I ~ 1 _,..- ~----------------------~------------~------------------..---------------------- Describe Wh•' O«ur~ In Chronological Ordtr. TM Circum1t1nc.1 lHdin; To The A.ctidtnt And TM Naturw Oi The A.ctid.-nl Oncrlbt Th,e Terrain And lnclud11 A Skt,ch Of Wrtc:klgt Oi1tribu,ion If Pertinent -'ntch (:'l1~1 ShH11 tf More Sp1c1 I' Nttdtd Si•'• Poin' Oi C:.p.&nu~. T1rn1 Of Dtpenurt. IM1nd~ Do11in11ion And S1rvic11 Oblt:!ii"l9'd. Ott• Of This Report NT6B Accki1n1 No. RevW-Wtd Dy NTH Offlc:e loui..d At /??~ ~J 6 ~U,~A I i N1m1 Of lnv"tlee1or a'} // -/ I J .b.R'u,,_ ).- !:: A - /\ .../~ 6-15-'li PilJ'T AtiilS)Rl' -----· .. _, . ,, .. < . } tlAT~ OF J I ruu ~ M1clrae T~n J?a+>tanQ BIRTH Q°t/01/h ~ Atoru:ss 3?D:&:>x (Olla7 ~a~c~, Etc= 3Z.IZD TZLE?HCNz :i Q4 p• 7 ~ 7 ... Ql34= Pnm crRTil'ICATE -- ~t)'Jea:.ra-l , Fltfjh+ J!;jSt'1"uc0- rnm ~RT ..~ t3;z-5243& l MTDiGS ASM£L- IA c~~ BIT~~IAL FLIGHT REVIEW DATE_ 9/20/8~ ~ . DATE .!. CLASS OF LAS'l' MEDICAL_ c:::>2.j2.3 /% {2(}o).D:J.HDIER~};_ ( 17~5- I) OCCUPAT!ON__813~~ IV1.s+ruc+o.r- . PAST 90 ~ '!'O'fAL FLIC-;IT TIME 15"00 Tot.AL PIC/OR SOLO j300 . MYS - )GOi?f'P'"c~ J DC E:C.EST Di AVIA'rIO~, su.:H .~s suslli'ZSS, PLEASLr.:\E, -ooMMERclAL Croniea~ TYPE OF AIRCRAFT FLOHN \12 t \J_Zeb, MZ<?ZPA2<3J..4Q±bm~~ t Sl. Pfl44::1'60, - ; • CT~ I 4Ch8'0 ~-.J ' il' YOU ARZ A STUDENT PILOT, GIVE rnsTRU.:l'OR 's NAME AND ADD?.ZSS -~- AIRCRAFT DiFORMATION rrE!ITIFICA'rror; NUMBER f\JH73V >-'AXE Ce:ssc-a __ YOUR TOUL FLIGHT TD<iE -- -~~DEL" -trvsdder 303 Ill THIS MAKE/r-DDEL-:_ JZ.0 h...-s - ---~ - owNt~·s NAHE~1bv:u ... K\02\e Acv=c.,)&\J+ LJn•~tlv I~--·-~ I O\filE:1' s ,ADDPF:::.s ~or\?>. I 81tp:.-± ...~fun'!\. "Beacb 1 3 k Cl I :1: REMARKS PBRT.ADHlKi TO OCCURRENCE (Coo.ti.nue oo rever3e} ---- ~~~~ ~- lJAu,J N~~~~ J~~.. ~z~ ~ ~ ~ f.ui~;;#-~1 ~,,, /Z/, ~ 11d't ~'-f' ~ j:Yu.c:uzf -~I u_ra,o, c-t1 ~ d 2 ~~ _c;( lvcU:J ~.4 ~ ~ v,.Ad_ oL~ ~~J~ 4/ll. . . Statement Given by MichaeL J. Rapuano CFI, Multiengine & Instrument Airplane About 0655 was when I .went through the gate on the ramp naybe a little bit after 0700. It was around that time frame. nalkec out to the aircraft and started my pre-flight of the airplane J checking ~11 you usually cover on 2 preflight, fuel, oil, gear, the control surfaces and the overall view of the airplane to make sure its untied, unchecked. Then when I crawled through the cabin I could only get the discrepancy boan:. since it was right there saw that over the weekend it had a problen, with the power of the aircraft, powerless on both engi~es. Made note of it, crawled in the airplane, noted the MEL item of the aircraft, none of them havjng to do with situation tha~ was going to occur. We, uh, me and my student ~ere talking abou= the activities we had to go through that day, with some extr:.:. training flights on a failed pre-prog and there was one inconplete item that was done and that was an NDB approach and he failed the single-engine landing. Told the student what we would probably de is go out to, uh, we were talking about going to ·New Smyrna and hol-5. and that was when I called Operations to find out if they still hac that car show or the airplane show down .in New Smyrna, we decided to go to DeLand and that was also when we found that they wer: using a westerly operation. When we arr :i. ved at the airport ther-=: was some fog over the west side of the field-but that was novin~ west, ATIS was calling it to be about a mile visibility out towar.5. the west but it was clearing up in Daytona so we were just goin; to_ do._ an NOB approach both engines __at Dela.J1d an=. then come back and do the back course. Do that singl2 engine. We finished our briefing, started the aircraft up, tha~ was when we called clearance the way we get our clearance for a local IFR flight. Everything was OK, we ramped out, called grount control. As we were taxiing out the right open airlight cane on. Checked the voltage, checked the power of the left alternator an~ found out that they were both were indicating less than 30 arnps total and according to the Cessna manual that was normal and duri.n; the runup that cleared up. When we checked the alternators the:: still weren't paralleling correctly, again a good parallel in bot:. the alterna~ors but we were still less than 30 amps total amperag~ on the system the right alternator light came on. During the ched. it went out. Proceeded nor~al takeoff, contacted departur=: control, we were going to radar vectors to the NDB and then finally got cleared for holding. During that time the right alternate= went out again the open air light came on. Checked the anp-era9= on both alternators and decided to shut down the right alternatc.:- and just work off the left cause t~e left was still under 30 amps. At that time no breakers were popped an average run. Went throu~ the procedures with that, I think it was the second or thir= paragraph or section down on the checklist in the airplane. w= continued to fly, went through about four circuits in the holdin; pattern got clearance for the approacht started our descent out c: 3, 000 ~lawn to 2, coo, leveled off, did the procedure turn, comir.;~ back inbound started descent. Started to level off at the NBA t~ ! I L/ get above it at around 600 feet. As the student brought the po~er up the at the same what happened is the right fire warning light came on. Immediately I took control of the aircraft and executed a missed approach going through my procedures making sure bringing the flaps and gear up and to make sure that the propellers and the forward going around. At that time also the low voltage light came on. Sbmehow we hadthe right alternator off low voltage and the engine fire light. I felt that the most critical emerge.i1cy at that tifle was the engine fire. So we went to the right engine we went to the fire checklist and went through our procedures then we went to securing the engine checklist and secured the right engine. At this time went to BYSE, the airplane was not climbi:ng. Due. to the fact that we were not climbing and we were just at the top of the cloud layer 600 feet top to bottom and it was solid fog. I also gave a PIREP to the university that it was solid dense £og west of I-95 and that was earlier in the flight. As we secured the engine we did not get a climb. out of the aircraft,_ wondering -why we weren't getting climb out of the aircraft due to the only two passengers on board and we only had roughly 700 lbs. of fuel on board, but the aircraft was not climbing. I went through and I checked the gear handle and the flap handle to make sure that the gear and flaps were up. - At this time we -entered the soup, we entered the clouds. I was flying the aircraft now, the student was doing the checklist. We, at that time made two mayday cails, mayday, mayday, mayday with the aircraft number 4973 Victor on the Unicom hoping that somebody would hear us or find us nearby. Could not receive anybody. Immediately went to 2535, made two calls on that frequency. Did not hear anybody. I checked the volume and the switch position and they were both normal. Went to 21.5 .and made two calls on that using the same calls as previous. I told the student to squawk- 77-00 on the transpender. At this --time I was still flyi~g the aircraft and we were coming up about 200 feet. About 200 feet I had to start the student start looking outside. He started to see trees just below us but we could still not see ahead of us. I had the student tighten his restraints and pul 1. the emergency crossfeed shutoff. We broke out of the clouds approxima~ely 170-150 feet, noticed a field to our left. We were too low to make that field, to make a turn towards that field. Then looking in front of us we saw powerlines and we knew we weren't going to clear the power 1 ines. I say abdut another, I'd say about a quarter mile ahead of us was when we noticed the field was directly in front of us. The student asked if I wanted tl:ie gear down and I said no. I did not know what type of field it •as, al 1 I know is it was a field. I had to turn to avoid th.e t=ee. During that turn the aircraft started to roll so I had to reta~d the throttle on the good engine to go ahead and maintain and control the aircraft. It was at that time we didn't have enough time. l remember pulling the throttles back. This time I couldn't remember if I pulled the mixtures back nor I can't reme1Ilber :if I put the flaps down also. I had my hands on the throttles and I had 1my hands, my left hand on the throttles and my right hand on the yoke during the impact. I remember the impact hj tting. We slid I couldn't tell you how long. The aircraft flipped over on its back and the cabin windshield broke allowing dirt and glass to fly Ll L j - _into the cockpit. We came to a rest in the field and the student asked me if I was OK. I replied yes I was OK and I asked him if he was OK and he said he was OK. AT this time I saw fire. Could not determine which side of the aircraft the fire was on, but I remember seeing the fire. Told the student that we were going to· have to get out of the airplane. I unlatched my seatbelt, got ant of the aircraft. I remember using the instrument panel to help h:e push myself through. Crawled on the cabin. The student was fallowing me. Lue to the fire we did not grab the fir:;t aid equipment. Felt that we should just leave the aircraft. Opened the cabin door, crawled out, and went to the center of the field away from the aircraft. At that time we sat down, we talked about we were both OK, w~ both walked out of the airplane. My neck was starting tc stiffen up on me and I had cuts to my head. They were bleeding, so I took off my shirt and used that as a bandage around my head e About ten minutes later We noticed the Sheriff IS department helicopter was circling·to the south of us about a half mile and then immediately either they saw or they directed in on our ELT is what they said. They came right to the field and found us and that is where the incident's at. Can you back up a little bit, Mike? Before you started to have the problems, what all did you have on, landing lights, perhaps? Negative, what we had on were our strobes and beacons. That was it. As far as external lighting the rest there was just the did not have radar on, no need for that because of the weather that day. Both number o