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Aircraft:Beech 23
Where:Macon, GA
Injuries:2 fatal
Phase of Flight:Takeoff

At 1445 Eastern Standard Time, a Beech 23 collided with trees and subsequently the ground, and burst into flames while maneuvering for an emergency landing following a reported loss of engine power near Macon, Georgia. The personal flight was operated by the pilot under the provisions of Title 14 CFR Part 91 with no flight plan filed. Visual weather conditions prevailed at the time of the accident. The airplane was destroyed, and the private pilot and his passenger received fatal injuries. The flight departed the Herbert Smart Airport in Macon, Georgia, at 1443.

According to witnesses located at the departure airport, the two pilots were last seen at the ready line for an east departure at the departure airport. No further visual contact was observed until the airplane was next seen colliding with trees about one mile east of the airport. According to the witnesses, the engine was heard sputtering, followed by the in-flight collision with 100-foot trees. During the collision, the right outboard wing panel was torn from the airframe; the witnesses observed the airplane as it started a free-fall to the ground. According to two young eyewitnesses located adjacent to the accident site, approximately five seconds after the airplane collided with the ground, it burst into flames.

PERSONNEL INFORMATION
The pilot held a private pilot certificate with an airplane single-engine rating. According to Federal Aviation records, the pilot had accumulated a total of 83 flight hours, however the pilot flight logs were not recovered for examination. The pilot's total flight time in the Beech 23 was not determined. The pilot held a third class medical certificate, valid when wearing corrective lens.

AIRCRAFT INFORMATION
The Beech BE-23 was owned and operated by the pilot. It was a low-wing airplane powered by a Lycoming O-320-D3B engine. The airframe maintenance logs were not recovered for examination. However, according to a work order recovered from Macon Aviation in Macon, Georgia, the annual inspection was completed. Macon Aviation did not record the aircraft total time on the work order. The invoice also showed that AD 99-05-13 (Airworthiness Directive) was accomplished during the annual inspection. Additionally, the work order did not address AD-75-01-04 which specifically address part number 169-920000-59 which is the fuel selector installed in the airplane at the time of the accident. AD-75-01-04 is a recurring inspection which checks the shutoff characteristics of the fuel valve. The examination of the fuel selector valve revealed that it was fire damaged and it was in the shutoff position at the accident site.

According to refueling records, the airplane was last refueled at Macon Aviation with 11.6 gallons of aviation fuel.

METEOROLOGICAL INFORMATION
The 1453 Macon weather observation reported surface winds at sky clear, visibility 10 miles, wind 020 degrees at four knots. The temperature and dew points were 60 degrees and 40 degrees respectively. The altimeter reading was 30.21 inches. According to icing probability curves, weather conditions were favorable for the formation of carburetor ice.

WRECKAGE AND IMPACT INFORMATION
Examination of the accident site disclosed that wreckage debris was scattered over an area 120 feet long and 40 feet wide. The main wreckage rested 120 feet east of the freshly broken tree branches. The right outboard wing panel rested 116 feet west of the main wreckage. Further examination of the airplane wreckage revealed that the nose and center sections of the airframe sustained heavy fire damage. The wreckage path was orientated on a 120-degree magnetic heading.

During the onsite examination of the airframe, the extremities of the airframe were located in the immediate vicinity of the wreckage path. The right wing panel, with the flap assembly attached, rested against a tall freshly broken tree along the wreckage path. A small, fire damaged area was located approximately mid-span the wing. The main wreckage, which included the fuselage, empennage, left wing, and the engine assembly was orientated on a 280 degree magnetic heading. The fire damage extended aft through the vertical fin and laterally through the left wing tip. The grass surrounding the wreckage was burned throughout the entire width and length of the wreckage path.

The subsequent wreckage examination showed that the accessory section of the engine assembly had melted and was fire damaged. All accessory components normally installed on the rear of the engine were also fire damaged. The carburetor assembly also sustained internal and external fire damage; the composite float assembly in the carburetor bowl was heat stressed.

The propeller assembly remained attached to the engine. Examination of the propeller blades showed some deformation to the bladed. There were several freshly broken tree branches in the immediately vicinity of the right wing assembly. There were also several branches with diagonal slashes completely through the diameter of the branch.

The airframe and engine examinations failed to disclose a mechanical malfunction or component failure.

MEDICAL AND PATHOLOGICAL INFORMATION
The toxicological examinations revealed 12% carbon monoxide level in the blood and 0.3 (ug/ml) cyanide was detected in the blood. The toxicology examination also revealed 0.083 (ug/ml) of meclizine in the blood specimens. Meclizine is described as a prescribed or over-the-counter sedative.

The toxicological examination was negative for alcohol.

The National Transportation Safety Board determines the probable cause(s) of this accident/incident as follows: The loss of engine power for undetermined reasons. A factor was conditions favorable for the formation of carburetor ice.

Source: NTSB

Aircraft:Beech BE-23-24
Where:Delaware, OH
Injuries:3 fatal, 1 injury
Phase of flight:Approach

A Beech BE-23-24 was substantially damaged during a forced landing near Kingston, Ohio. The certificated airline transport pilot and two passengers were fatally injured. A third passenger was seriously injured. Night visual meteorological conditions prevailed for the personal flight that departed Burke Lakefront Airport (BKL), Cleveland, Ohio; destined for Ohio State University Airport (OSU), Columbus, Ohio. No flight plan was filed and the flight was conducted under 14 CFR Part 91.

Earlier that evening, the airplane departed Columbus at 1747, and flew to BKL, arriving at 1841. There was no record of the airplane being fueled while at BKL. The airplane then departed at 2130. Once airborne, the pilot contacted air traffic control and requested radar traffic advisories. A transponder code was assigned and the flight progressed with no report of difficulty. Once in the Columbus area, the airplane was handed-off to Columbus Approach Control, and at 2228, the pilot reported starting a descent from 6,500 feet msl.

Approximately 4 minutes after initiating a descent, the pilot reported a rough running engine, and requested vectors to the nearest airport. The controller advised the pilot that Delaware Municipal Airport (DLZ), Delaware, Ohio, was the closest airport at 265 degrees. The pilot acknowledged the transmission, and declared an emergency. The controller added that the airport was 13 miles away. At 2235, another pilot over Delaware reported the runway lights were on at the airport. The controller confirmed with the accident pilot that he had received the transmission. The accident pilot acknowledged the transmission, adding that he did not see the lights. At 2236, the controller advised the pilot he was about 12.5 miles from the runway. The pilot replied he would not make the airport, adding the engine was not even maintaining 1,000 rpm.

After receiving this transmission, the controller requested assistance from a Columbus Police Helicopter that was approximately 12 miles to the southwest. The helicopter pilot asked the location of the airplane, and radar vectors were provided. The controller advised the pilot that a police helicopter was en route. The pilot replied they were heading towards the interstate highway. This was the last transmission received from the accident airplane. Several minutes later, the helicopter pilot reported seeing traffic backed-up on the four-lane highway.

The accident happened during the hours of darkness.

PILOT INFORMATION
The pilot held an airline transport pilot certificate with a multi-engine-land rating, and a commercial pilot certificate with a single-engine-land rating. In addition, he held a certified flight instructor rating for airplane single-engine-land, multi-engine-land, and airplane instrument. According to the pilot's latest logbook, he had 2,489.6 hours of total flight experience with 2,267.6 hours of that in single-engine-land airplanes. In addition, his logbook reflected that his last flight in the accident airplane make and model was about six months before the accident. During the 30-day window that preceded the accident, the pilot flew a total of 28.8 hours. In the 60-day window he flew 58.7 hours, and in the 90-day window he flew 100.2 hours. All of the flight time logged by the pilot during the 30, 60, and 90-day windows was in a Cessna 208B.

AIRCRAFT INFORMATION
According to the Pilot's Operating Handbook (POH), the airplane was a single engine, low wing, with fixed landing gear. It was primarily constructed of aluminum, and could seat up to four occupants. The airplane was capable of carrying 59.8 gallons of fuel. To facilitate partial fueling of the airplane, each of the two fuel tanks was equipped with a visual indicator called a 'tab.' Then both fuel tanks were fueled to the base of the 'tabs,' the airplane would have a total of 30 gallons of fuel onboard, with approximately 1 gallon unusable.

According to performance data in the POH, on a standard day, the airplane would use 9.1 gph of fuel at 63 percent power and 6,500 feet. At 75 percent power, the airplane would use 12.3 gph of fuel. The POH also stated that start, run-up, taxi, and the takeoff acceleration, would require about 0.8 gallons of fuel. According to the preflight inspection section of the POH, the pilot was required to check the quantity of fuel in each tank, and to ensure that the filler caps are secure.

METEOROLOGICAL INFORMATION
At 2251, Port Columbus International Airport, Columbus, Ohio, (CMH) reported wind 160 degrees at 3 knots, visibility 10 miles, clear skies, temperature 55 degrees Fahrenheit, dew point 48 degrees Fahrenheit, and an altimeter setting of 30.13 inches of mercury.

WRECKAGE AND IMPACT INFORMATION
The wreckage was examined at a recovery facility in Sunbury, Ohio. Both the left and right wings were attached to the fuselage, along with the horizontal stabilizer and the vertical stabilizer. All the flight control surfaces were accounted for, including the flaps. The majority of the impact damage was confined to the engine compartment, and the forward portion of the cockpit area. Flight control continuity was verified from each of the control surfaces to the pilot station, and elevator trim was approximately neutral.

The fuel selector was set to the left tank. Approximately 1/16 of a gallon was drained from the left tank. The left tank fuel line fitting was broken consistent with impact damage. Approximately 1/8 of a gallon of fuel was drained from the right fuel tank. In addition, approximately 3 oz. of fuel was drained from the gascolator. A trace amount of fuel was recovered from the fuel line that connected the engine driven fuel pump to the airframe, and less than a teaspoon of fuel was recovered from the engine driven fuel pump. A trace amount of fuel was recovered from the line that connected the engine driven fuel pump to the fuel injector. The fuel screen was removed from the injector. No contaminates were identified, and a trace of fuel was recovered. The fuel injector was removed and held upside down. A trace of fuel was recovered. The fuel line that connected the fuel injector to the fuel manifold was removed, and no fuel was recovered. The manifold was opened and no fuel was found. In addition, no fuel was found in any of the four injector-lines. All four injectors were removed and no obstructions were identified.

Approximately 15 gallons of water was added to the right fuel tank. The fuel selector was set to the right tank, and electrical power was applied to the electric fuel boost pump. The pump activated, and water was expelled from the fuel bulkhead fitting at the firewall. Power to the electric fuel boost pump was removed, and the fuel selector was repositioned to the left tank. Because the left tank fuel line fitting had broken, the left inboard fuel tank feed line was submerged in a container of water. Again, electrical power was applied to the electric fuel boost pump. The pump activated and water was expelled from the fuel bulkhead fitting at the firewall.

Examination of the engine and accessories revealed that the engine driven fuel pump had partially separated from the engine. The pump was removed and disassembled. No pre-impact failures were identified. The vacuum pump was removed, and the sheer coupling was intact. The pump was disassembled, and the vanes and vane housing were intact. All of the spark plug electrodes, except for two, were grayish in color. The number 2 cylinder bottom sparkplug could not be removed because of impact damage, and was not examined. The number 1 cylinder bottom sparkplug electrode was covered in non-combusted oil.

A rotational force was applied to the engine crankshaft. Thumb compression was obtained on all four cylinders and spark was observed on all eight magneto-towers. Continuity of the ignition leads could not be verified because of impact damage. In addition, the engine driven fuel pump pad articulated, and the vacuum pump pad rotated.

ADDITIONAL INFORMATION
According to the owner of the recovery company that removed the airplane from the interstate highway, there was no evidence of spilled fuel on the road were the airplane came to rest, nor did he find any fuel on the bed of the truck used to move the airplane. He added that besides not seeing any fuel, he did not detect the aroma of fuel.

According to the president of the flying club that owned the airplane, the pilot went to work for a cargo company flying a Cessna 208B. After that, the pilot did not rent the accident airplane, or one of the same make and model. In addition, the president flew the accident airplane the day before the accident with a student. Before the flight, the president's student estimated the left tank had approximately 7 1/2 gallons of fuel, and the right had 15 gallons. The student also noted that his observation matched the fuel quantity gauges. The president then flew the airplane for about 1.3 hours. After the flight was completed, the airplane was not serviced until the next day when the accident pilot requested it be fueled to the 'tabs.'

An interview was conducted with the line attendant that serviced the airplane at Columbus. The attendant was asked to complete a written statement, and was advised he would be asked a few questions afterwards.

According to the attendant, he received a fuel order around 1745, to fuel both tanks to the 'tabs' on the accident airplane. After fueling the tanks to the 'tabs,' he replaced the fuel caps. He then watched the pilot open the left fuel cap, and check the fuel level. The pilot told the attendant he was surprised it only took 13.2 gallons to service the airplane. The attendant added that the airplane was on level terrain when it was serviced, and that he only remembered seeing the pilot check the left fuel tank.
In a statement given to an Ohio State Trooper, the passenger that survived the accident stated she did not remember seeing the pilot visual check either fuel tank while the airplane was in Cleveland. She added that right before the accident, the pilot started getting 'nervous,' and then the airplane went 'crazy.'

The National Transportation Safety Board determines the probable cause(s) of this accident/incident as follows. The pilot's failure to check both fuel tanks visually during the preflight inspection. A factor in the accident was the dark night.

Source: NTSB

Aircraft: Beech 24R
Where
: Wauseon, Ohio
Injuries:
3 fatal
Phase of Flight:
landing

At 1510 eastern daylight time, a Beech 24R was substantially damaged while attempting to land at Fulton County Airport (USE), Wauseon, Ohio. The certificated airline transport pilot and the two passengers were fatally injured. No flight plan was filed for the flight that originated at Oakland-Troy Airport (7D2), Troy, Michigan, about 1415. Visual meteorological conditions prevailed for the personal flight conducted under 14 CFR Part 91. The pilot, along with his wife and daughter, flew from Minnesota to Troy to attend a wedding the following day.

According to the general manager of a fixed base operator at Oakland-Troy Airport, on the day of the accident, the pilot arrived with his family shortly before 1330, and requested that the airplane be filled with fuel. While the airplane was being fueled, the pilot asked if anyone had flown that day, and if so, did they talk about the weather conditions. The general manager replied that due to the "very, very windy" weather conditions, few people had flown that day, except for a Mitsubishi MU-2. He did not think the pilot would fly that day based on the wind conditions, which he estimated to be from the west-southwest about 40 miles per hour.

After paying for the fuel, the pilot went to the terminal building to use the Weather Data Inc., computer. Approximately 30-40 minutes later, he returned to the FBO, and prepared the airplane for flight.

A witness, a certificated pilot who reported over 1,000 hours of flight time, said he was at his parents' house about 3 miles east of Fulton County Airport, when he heard a "normal aircraft sound" fly overhead from east to southwest; at an altitude of approximately 1,000 feet, between 1510 and 1515. As the airplane flew overhead, he made the comment, "Who would be out in these winds?" He left his parents' house at 1530, and did not learn about the accident until later that day.

A review of radar data revealed that a target emitting a visual flight rules (VFR) transponder beacon code approached Fulton County Airport from the northeast. The last 2 1/2 minutes of radar data revealed that the target turned west and tracked toward runway 27. During that time, the target descended from 1,900 feet msl to 900 feet msl, before the data ended at 1909:52. The last radar return was located approximately 0.19 miles from the end of the runway, at a ground speed of 68 knots. The elevation of the airport was 779 feet msl.

The wreckage was located about 1545, by an individual who was driving on a road perpendicular to the runway.

The accident occurred during the hours of daylight, approximately 41 degrees, 36 minutes north latitude, and 84 degrees, 07 minutes west longitude.

PILOT INFORMATION

The pilot held an air transport pilot certificate with a rating for rotorcraft-helicopter. He also held a commercial certificate with ratings for airplane single engine land, and instrument airplane. His most recent Federal Aviation Administration (FAA) third class medical was issued on August 14, 2001.

Examination of the pilot's logbook revealed that he had a total of approximately 4,113 flight hours, of which, 14 hours were in the last 90 days.

A certified flight instructor had given the pilot 1.7 hours of flight instruction in the airplane on May 8, 2003. Examination of flight logs revealed the pilot had accrued a total of approximately 7 hours in make and model at the time of the accident.

METEOROLOGICAL INFORMATION

Weather reported at Toledo Express Airport (TOL), Toledo, Ohio, about 14 nautical miles west of Wauseon, at 1452, included winds from 240 degrees at 33 knots gusting to 45 knots, visibility 10 statute miles, scattered clouds 4,200 feet, overcast clouds 5,500 feet, temperature 59 degrees F, dew point 41 degrees F, and a barometric pressure of 29.50 inches Hg.

An urgent weather message, which was issued by the National Weather Service at 1202, and expired at 2000, included Wauseon, Ohio. According to the message:
"An intense low pressure system over the upper Great Lakes will cause strong southwest to west winds across southern Michigan...northern Indiana...and northwest Ohio today. Winds will be sustained at 25 to 35 mph with gusts of 45 to 55 mph much of the day.

A wind advisory is issued when sustained winds of 30 mph or greater are expected for at least an hour or wind gust of 45 mph or greater occur at any time. Without extra precautions these winds may cause minor property damage. Motorists in high profile vehicles should exercise great care."

The manager of the Fulton County Airport stated that the wind conditions at the airport at the time of the accident were from the west, southwest between 30-40 mph and gusting to 40-50 mph.

Runway 27 was a 3,882-foot-long and 75-foot-wide asphalt runway with 80-foot trees located on the north and south sides of the first third of the runway. The trees on the north side of the runway were about 200 feet from runway centerline, while the trees on the south side of the runway were about 550 feet from runway centerline. The airport manager described turbulence that occurred at times between the two sections of trees as a "terrible, terrible funnel effect...with lots of rolling wind."

WRECKAGE INFORMATION

The wreckage was examined at the site. All major components and all flight control surfaces were accounted for at the scene. The wreckage was located off airport property, in a muddy, barren cornfield, about 350 feet north of the approach end of runway 27.

The airplane came to rest upright, the nose gear was separated, and both wings remained partially attached to the fuselage. The cockpit area was crushed, and there was no post-impact fire.

The wreckage path measured 100 feet from the initial ground scar to the main wreckage, and was oriented 358 degrees magnetic. The airplane came to rest oriented 240 degrees magnetic.

The initial impact point was a ground scar, where broken pieces of green navigational lens were found imbedded. Also found along the wreckage path were the right wing tip, landing light, nose landing gear, and the lower and upper section of the engine cowling.

Examination of the airplane revealed that the left main landing gear was extended, and the right main landing gear was retracted. The landing gear selector handle was broken and in the "up" position.

Control cable continuity was established for each of the flight control surfaces to the cockpit.

Examination of the flap actuator jack screw revealed that the flaps were fully extended.

The left wing fuel tank was full and the right wing fuel tank was partially filled with blue-colored fuel. The fuel selector valve was found set to the right tank.

The engine was intact, but exhibited impact damage, and all three propeller blades remained attached to the propeller hub. The first blade was straight and exhibited some front face polishing. The second blade was bent slightly aft and also exhibited front face polishing. The third blade was bent aft and exhibited front face polishing and trailing edge nicks near the tip.

The top and bottom spark plugs were removed, and appeared light gray in color.

The fuel injector nozzles were removed and examined. The nozzles were absent of debris, except for the #1 nozzle.

All of the fuel lines were intact and secure. Fuel was present at the fuel pump, injector, and flow divider.

The fuel servo filter screen was removed and found absent of debris. In addition, a small amount of fuel was found in the firewall fuel strainer bowl, and the filter was absent of debris.

Valve train continuity and compression in each cylinder were confirmed by manual rotation of the propeller flange. While the engine was being rotated, spark was produced to each ignition lead, except the #3 bottom due to the harness being torn. The harness was then manually cut at the terminal, the engine was rotated again, and spark was observed.

The oil suction screen was removed and examined. The only debris noted was an inch-long, thin piece of sealant.

MEDICAL AND PATHOLOGICAL INFORMATION

An autopsy was performed on the pilot by the Lucas County Coroner's Office, Toledo, Ohio. Toxicological testing was performed by the FAA Toxicology Accident Research Laboratory, Oklahoma City, Oklahoma.

ADDITIONAL INFORMATION

A review of fueling records revealed that the airplane was fueled with 37.3 gallons of 100 LL fuel on the day of the accident, which filled the tanks.

The airport manager reported that the airport commission, along with state and local government, had been working for several years to have the trees, which were located on private property, removed.

A review of the Airport/Facility Directory revealed that there were no remarks, which warned pilots of the possible encounter with turbulence when landing on runway 27.

The National Transportation Safety Board determines the probable cause(s) of this accident as follows: The pilot's failure to maintain control during the approach-to-landing. Factors were the high wind gusts and turbulence, and the pilot's decision to fly in those weather conditions.

Source: NTSB

Aircraft: Beech C24R
Where: Virginia Beach, VA
Injuries: 2 fatal
Phase of flight: Landing

A single-engine Beech C24R airplane sustained substantial damage when it collided with trees and terrain following a loss of control while attempting to return to land on Runway 32 at the Norfolk International Airport (ORF), near Norfolk, Virginia. The instrument rated private pilot, his passenger, and two dogs sustained fatal injuries. An instrument flight rules (IFR) flight plan was filed for the cross-country flight destined for the Hilton Head Island Airport (HXD), near Hilton Head, South Carolina. Visual meteorological conditions prevailed for the personal flight conducted under 14 Code of Federal Regulations Part 91.

A review of the air traffic control communications revealed the flight was cleared for take-off on Runway 32 (a 4,875-foot-long, by 150-foot-wide asphalt runway) at 1127:04. Shortly after takeoff, the 1,493-hour instrument rated private pilot informed air traffic control that a "door had opened" and that he needed to return to the airport. A tower controller then instructed the pilot to turn left and enter the downwind leg of the traffic pattern for Runway 32, and the pilot acknowledged. The controller then asked the pilot if he was able to make a short approach, to which the pilot replied that he could. The controller then cleared the pilot to land on Runway 32. A few moments later, the tower controller advised the pilot to extend the downwind leg due to traffic on final approach, and that the tower would inform him when he could turn onto the base leg. The pilot again acknowledged the radio transmission. At 1129:43, the tower controller instructed the pilot to turn onto the base leg, and again, the pilot acknowledged. This was the last radio communication received from the pilot.

A review of the radar data indicated the airplane departed runway 32 and leveled-off at an altitude of 200 feet mean sea level (msl), while maintaining a ground speed of 100 knots. Radar data revealed that the airplane executed a left turn to a southeasterly heading and flew parallel to the runway. Radar data also revealed that as the airplane proceeded on this heading, its ground speed decreased to 70 knots. When the airplane was about one-mile beyond the end of the runway, another left turn was initiated toward the northeast before the radar data ended at 1130.

A witness, who was working in his garage, reported that he heard "a large shaking sound which sounded like a semi-type truck braking down in front of [his] house." The witness then looked up and saw the airplane flying "very slow" about 20-feet-high above the tree line. The airplane was shaking and it sounded like it was losing power. The witness was provided a model airplane to demonstrate the flight attitude of the airplane. The witness demonstrated that the airplane had a slightly nose-high attitude and was in a shallow left hand turn. The airplane was shaking violently. The witness then maneuvered the model airplane so it simultaneously rolled rapidly to the left (inverted) and the nose of the airplane dropped toward the ground. The witness further stated that he lost sight of the airplane as it descended into the trees.

The aircraft stalled while in the traffic pattern and struck trees, then crashed into the ground.

The National Transportation Safety Board determines the probable cause(s) of this accident to be: The pilot's failure to maintain airspeed, which resulted in an inadvertent stall/spin while maneuvering at a low altitude. Contributing was the pilot's diverted attention to an open door.

Source: National Transportation Board

Aircraft: Beechcraft F33A
Where: Buckeye, AZ
Injuries: 1 fatal
Phase of flight: Landing

After crossing flight paths with a military fighter jet, the single engine airplane entered an increasingly steep descent and subsequently impacted terrain. The student pilot was flying her third solo flight of the flight-training syllabus. The ATCA solo flight order authorized the student to depart from Phoenix Goodyear airport, fly to Buckeye Airport, perform at least one landing, taxi back, takeoff, then proceed to a practice area south of the Phoenix Goodyear Airport, perform steep turns, slow flight, and stalls, and finally return to Phoenix Goodyear Airport. The student was reported as overdue at 1615. Five aircraft were launched to search for the overdue airplane at 1640. The Maricopa County Sheriff Department helicopter located the wreckage on at 0040 in flat desert terrain 12.5 miles south-southeast of the Buckeye Airport.

The solo student pilot departed the airport and proceeded to climb towards a designated practice area. Upon reaching 4,500 feet the pilot reduced power and entered a 500-foot-per-minute descent. At this point the pilot may have been alerted by the on-board TCAS (traffic/collision alerting device) that there was traffic approaching from her right side, close to her altitude. The sun was also off her right side at an elevation of 31 degrees above the horizon. Within seconds an F-16 fighter jet crossed in front of her from right to left. The closest point of approach between the two aircraft, as determined by a radar data study, was 1,850 feet laterally and 400 feet vertically. A study of the wake and vortex turbulence that would have been produced by the F-16 determined that the generated vortices could not have dropped low enough to affect the path of the student's airplane. After the F-16 passed, the student's airplane continued an increasingly steep linear descent, eventually exceeding 2,500 feet per minute before impacting the terrain at a 50-degree nose down, right wing down attitude, 29 seconds after the encounter. Multiple close examinations of the aircraft wreckage failed to reveal any evidence of mechanical failure or malfunction. A review of the student's available medical records, autopsy, and toxicology analysis did not reveal any physiological inconsistencies. It is certainly possible (and consistent with the circumstances of the accident) that the student pilot lost consciousness following her presumed near collision; however, there is not enough information available to fully support this hypothesis.

The National Transportation Safety Board determines the probable cause(s) of this accident to be: The student pilot's failure to maintain aircraft control for undetermined reasons.

Source: National Transportation Board

Aircraft: Beech 35-A33
Where:Heber City, UT
Injuries:1 Fatal
Phase Of Flight:Maneuvering

A Beech 35-A33 impacted terrain while maneuvering about 10 nautical miles north of Heber City, Utah. The non-instrument rated commercial pilot, the sole occupant, was fatally injured, and the airplane sustained substantial damage. The airplane was registered to and operated by the pilot. A visual flight rules (VFR) flight plan was filed for the personal cross-country flight conducted under 14 CFR Part 91. The airplane departed Billings, Montana, about 0910 with an intended destination of Spanish Fork, Utah. Visual meteorological conditions prevailed for the departure from Billings, and instrument meteorological conditions prevailed at the accident site.

According to information provided by Salt Lake City Air Route Traffic Control Center (ARTCC), the flight was receiving VFR flight following services. About 1119, the controller working the flight advised the pilot that there was a storm system in the Salt Lake valley and to the south. The pilot acknowledged receiving the information. About 1138, the pilot was again advised of deteriorating weather conditions along his route of flight. Again, the pilot acknowledged receiving the information. About 1151, the pilot reported that he was over Evanston, Wyoming, at 8,000 feet mean sea level (msl), following I-80 south, and that if needed, he would turn around and land at Fort Bridger, Wyoming. About 1209, relaying through another aircraft, the pilot was informed that radar contact was lost. About 1214, again relaying through another aircraft, the pilot reported that he planned to go through "either Heber City or Provo canyon." About 1217, another relay was attempted to inform the pilot about level 2 and 3 precipitation in those canyons, and no reply was received. Several other attempts were made to relay without success. Further attempts were made to contact the airplane, and no reply was received.

Radar data provided by Salt Lake City ARTCC indicated that radar contact with the airplane was lost about 1206. The last minute of continuous recorded radar data shows the airplane proceeding southbound along I-80 near the town of Wahsatch, Utah, located about 37 nautical miles north-northeast of the accident site. Between 1204:45 and 1205:45, the airplane traveled a distance of 2.6 miles, consistent with a ground speed of approximately 135 knots, and descended from 7,300 to 7,100 feet msl. (The elevation of Wahsatch is 6,742 feet.)

A witness, who was a private pilot, reported to the NTSB investigator-in-charge (IIC) that about 1215, he observed a single-engine, retractable gear airplane flying south along I-80 through the town of Coalville, Utah, located about 16 nautical miles north of the accident site. The witness stated the ceiling was about 500 feet, and there was light snow and sleet falling. He estimated the airplane was about 300 feet above ground level (agl), "going fairly slow," about 100 to 120 mph. He later saw pictures of the accident airplane and realized it was the same airplane he had seen.

A witness reported to the Summit County Sheriff's Office that at 1226, she was near mile marker 2 on State Road 40, located about 4 nautical miles north of the accident site, and observed a "white plane with what she thought were red letters" flying overhead. (The accident airplane was painted white with blue and red trim.) According to the witness, "it was snowing hard and there was little visibility." The airplane was heading south, following State Road 40, "flying low" at an altitude of "approximately 300 feet off of the ground."

At 1229:02, one radar return was recorded from the airplane. This last return showed the airplane located approximately 1/2 mile north of the accident site at an altitude of 7,000 feet msl.

According to a report prepared by the Summit County Sheriff's Office, at 1230, the Summit County Dispatch Center received an emergency call in regards to a low flying airplane near mile marker 8 on State Road 40. At the time of the call, officers working in the area were unable to locate the low flying airplane. They reported that "the weather in the area was extreme. Visibility was less than 500 feet with heavy snow." About 1530, Summit Dispatch received a report that an airplane was down near mile marker 6 on State Road 40. The caller advised that the airplane was approximately 500 feet east of the roadway. Officers responded to the scene and identified the airplane as N1254Z.

PERSONNEL INFORMATION

The pilot held a commercial pilot certificate with an airplane single engine land rating. He did not hold an instrument rating. His most recent medical certificate was a second class medical, with the limitation, must wear corrective lenses. On the application for this medical certificate, the pilot reported that he had accumulated 1,090 hours total flight time. The pilot's flight logbooks were not examined during the investigation.

AIRCRAFT INFORMATION

Examination of the airplane's maintenance records indicated that the 1961 model Beech Debonair received its most recent annual inspection at a total time of 3,823.2 hours. As of that date, the engine, a Continental IO-470-K, S/N 86029, had accumulated 394.5 hours since major overhaul. Review of the maintenance records revealed no evidence of any uncorrected maintenance discrepancies.

METEOROLOGICAL INFORMATION

The following weather conditions were reported at Heber City, Utah, located approximately 10 nautical miles south of the accident site, elevation 5,637 feet:

At 1155, wind from 320 degrees at 7 knots, visibility 2 1/2 statute miles, rain, sky conditions: broken clouds at 1,600 feet, overcast at 2,300 feet, temperature 2 degrees C, dew point 1 degree C, and altimeter 29.83 inches.

At 1255, wind from 280 degrees at 3 knots, visibility 7 statute miles, light rain, sky conditions: scattered clouds at 1,700 feet, broken clouds at 3,300 feet, overcast at 4,200 feet, temperature 2 degrees C, dew point 1 degree C, and altimeter 29.81 inches.

According to information provided by Cedar City Automated Flight Service Station (AFSS), at 0741, the pilot received a weather briefing from Great Falls AFSS for a VFR flight from Billings, Montana to Spanish Fork, Utah. The pilot stated that the flight would take about 3 and 1/2 hours and that his planned route was "through the basin down to Lander...then west [to] Fort Bridger...Heber City then through the Provo canyon." The briefer began the briefing by stating "for western Wyoming and the rest of the route airmet for occasional mountain obscuration, clouds, precipitation, mist and fog, VFR not recommended into that area." While en route, the pilot twice contacted Cedar City AFSS, at 1121 and 1140, requested and was given current and forecast weather conditions along the route from Fort Bridger to Evanston to Provo. During each contact, he was told that VFR flight was not recommended along the route.

WRECKAGE AND IMPACT INFORMATION

Summit County Sheriff's Office personnel examined the accident site and reported the main wreckage was located at 40:39.375 North latitude and 11:27.291 West longitude at an elevation of 6,933 feet. According to the Summit County Sheriff's Office report, when officers reached the scene about 1600, there was approximately 1 inch of new snow on the airplane. The airplane was facing north, and there was a ground scar marking the initial impact point about 100 feet south of the airplane. Branches were broken from the oak brush located between the ground scar and the airplane. The outboard third of the right wing separated and was found at the initial impact point.

The wreckage was recovered from the accident site and moved to the Heber City Municipal Airport. The wreckage was examined by the NTSB IIC and representatives from the FAA and Teledyne Continental Motors. The engine was separated from the airframe. The propeller remained attached to the engine crankshaft. One of the blades was bent aft approximately 8 inches from the propeller hub and exhibited chordwise scratching and gouging throughout the span of the blade. The other blade was bent aft and exhibited blade twisting with chordwise scratching on the outboard 12 inches of the forward side of the blade. The rocker arm covers and the top spark plugs were removed. The engine was rotated by hand using the propeller, and engine continuity was confirmed. "Thumb" compression was obtained on all cylinders. Both magnetos sparked at all leads during hand rotation of the propeller. The cylinder combustion chambers were examined through the spark plug holes using a lighted borescope. There was no visible evidence of foreign object ingestion or detonation, and the valves appeared to be intact and undamaged. The fuel pump turned freely and was not damaged. The fuel pump drive was intact and undamaged. The fuel manifold valve was disassembled and the screen was free of debris; the diaphragm and spring were undamaged. Inspection of the engine did not reveal any abnormalities that would have prevented normal operation and production of rated horsepower.

MEDICAL AND PATHOLOGICAL INFORMATION

An autopsy of the pilot was conducted by the State of Utah's Office of the Medical Examiner in Salt Lake City, Utah. Toxicology tests conducted by the FAA's Toxicology and Accident Research Laboratory were negative for carbon monoxide, cyanide, ethanol and drugs.

The National Transportation Safety Board determines the probable cause(s) of this accident as follows: The pilot's continued VFR flight into IMC and his subsequent failure to maintain terrain clearance while maneuvering resulting in an in-flight collision with terrain. Contributing factors were low ceilings, snow, and mountainous terrain.

Source: NTSB

Aircraft: Beech D35
Where: Agua Dulce, CA
Injuries: 1 fatal
Phase of Flight: Cruise

About 2003 hours Pacific daylight time, a Beech D35 operated by the pilot, collided with upsloping mountainous terrain about 3 miles east-northeast of Agua Dulce, California. The airplane was destroyed, and the instrument-rated private pilot was fatally injured. Instrument meteorological conditions prevailed in the vicinity, and no flight plan was filed for the personal flight that was performed under 14 CFR Part 91. The flight originated from Santa Paula, California, approximately 1945.

An acquaintance of the pilot reported to the National Transportation Safety Board investigator that upon departure, the pilot intended to fly in an easterly direction to Chandler, Arizona, where he was to meet her. No witnesses reported observing the airplane impact the hillside.

The property owner, onto whose land the airplane crashed, reported to the Safety Board investigator that he was home at 2000. He did not observe or hear the impact, and he did not hear any engine noise at that time or thereafter. The airplane collided into the mountainside about 700 feet from his home.

PERSONNEL INFORMATION
A copy of the pilot's personal flight record logbook was examined. It indicated that he had a total of approximately 2,072 hours of experience flying airplanes. During the 90-day period preceding the accident, the logbook indicated the pilot flew his airplane for about 57 hours, of which 18 hours were flown at night.

The pilot was issued an instrument rating in 1983. His total instrument flying experience was approximately 76 hours, of which 6 hours were logged as "actual" and 70 hours were logged as "simulated." No evidence of any instrument competency flight check or proficiency flying was observed between 1993 and the accident date.

An acquaintance of the pilot reported to the Safety Board investigator that the pilot had flown the accident route of flight on many occasions. Also, he was familiar with the area. The acquaintance also reported that the pilot worked as an automotive mechanic

AIRPLANE INFORMATION
No current aircraft maintenance logbook was located. A written statement was subsequently received from a Federal Aviation Administration (FAA) certificated mechanic in which he reported that an annual inspection was accomplished on the accident airplane. The mechanic indicated that he had assisted the pilot in performing the inspection. All airworthiness directives had been complied with. Also, the pitot-static system and the transponder check were accomplished.

METEOROLOGICAL INFORMATION
On the date of the accident sunset occurred about 1935 at the accident site. Civil twilight ended about 2002. No illumination from the moon was present at 2003.

The nearest airport to the accident site located south of the San Gabriel Mountains that reported its surface weather is the Burbank-Glendale-Pasadena Airport. Burbank's elevation is 775 feet mean sea level (MSL), and it is located about 18.6 nautical miles and 179 degrees (magnetic) south of the accident site. At 1953, Burbank reported an overcast ceiling at 2,600 feet above ground level, or about 3,375 feet MSL.

A hillside resident located about 1/3-mile downslope from the accident site reported that at 2000 his home (approximate elevation 3,200 feet MSL) was shrouded in ground fog (low clouds). There was no evidence of precipitation.

According to the FAA, at the time of the accident low ceilings were forecast for the accident site area. The FAA reported that the pilot did not file a flight plan and neither requested nor received any weather briefing services.

Both of the Direct User Access Terminal (DUAT) vendors verbally reported to the Safety Board investigator that a search of their computer transactions failed to produce any evidence that the pilot (using his name or airplane registration number) received any weather briefing services or made any inquiries on the date of the accident.

AIDS TO NAVIGATION
According to the FAA, all electronic aids to navigation pertinent to the airplane's route of flight were functional.

COMMUNICATION
The FAA reported that it had not been requested to provide any services to the accident pilot/airplane.

WRECKAGE AND IMPACT INFORMATION
The initial point of impact (IPI) occurred on estimated 10-degree upsloping terrain at an elevation of about 3,560 feet mean sea level. The approximate global positioning satellite (GPS) coordinates of the IPI are 34 degrees 30 minutes 08.8 seconds north latitude by 118 degrees 16 minutes 15.3 seconds west longitude. The main wreckage was found on an adjacent hill northeast of the IPI, at GPS coordinates of approximately 34 degrees 30 minutes 14.0 seconds north latitude by 118 degrees 16 minutes 09.0 seconds west longitude.

The approximate magnetic bearing between the IPI and the main wreckage is 031 degrees. The distance is about 750 feet.

An examination of the terrain at the IPI revealed ground scar consistent in appearance with the dimensions and shape of the airplane. Fragments from the right and left wing tips were located about 16 feet southeast and northwest, respectively, from the main impact crater. Portions of engine cowl were found in the crater and within 75 feet to the northeast.

The left wing's pitot tube was found on the left side of the impact crater. One propeller blade was found about 120 feet upslope from the IPI; the second blade was found attached to the engine, which had separated from its airframe attachments, and was about 75 feet downslope from the main wreckage. Both propeller blades were observed torsionally twisted, scratched in a chordwise direction, and bent into an "S" shape.

The main wreckage was found upside down, on a heading of about 050 degrees, with the wing flaps and landing gear retracted. The leading edges of both wings were observed accordioned in an aft direction. All of the flight control surfaces were found attached to the airframe. The continuity of the flight control system was confirmed between the aft empennage and the crushed mid-fuselage section. There was no evidence of oil streaking, sooting, or charred (fire damage) material in any of the wreckage.

Inside the cabin, various hand tools, plastic gasoline containers, and associated maintenance-related equipment were observed.

MEDICAL AND PATHOLOGICAL INFORMATION
An autopsy was performed by the Los Angeles County Coroner's Office. Results of toxicology tests on the pilot were negative for carbon monoxide and ethanol. Phenylpropanolamine was detected in specimens from the pilot's blood and urine. This drug is contained in over-the-counter decongestant and weight loss medications.

TESTS AND RESEARCH
The engine was examined on scene. The crankshaft could not be rotated. There was no evidence of oil leakage onto the external case surface, and no evidence of soot or heat distress signatures was present in the vicinity of the exhaust stacks. The sparkplugs were removed and examined. According to the Continental engine representative, all observed plugs presented an appearance consistent with normal wear signatures. Specifically, the electrodes were dry, and the wear pattern was normal in appearance.

ADDITIONAL INFORMATION
The accident site is located about 0.5 miles north of California State Highway 14, which principally has a northeast to southwest orientation. The accident site is visible from the highway, which has an elevation of about 3,000 feet in this area.

The maximum elevation of Highway 14 is reached in the Soledad Pass. The Pass's elevation is 3,225 feet MSL. This local is about 8 miles east of the accident site.

The National Transportation Safety Board determines the probable cause(s) of this accident as follows: The pilot's failure to maintain terrain clearance while cruising up a mountain pass, on a dark night, in IMC conditions, and his improper in-flight decision to perform a VFR flight in the inclement weather.

Source: NTSB

Aircraft: Beech G35
Where:  Falmouth, MA
Injuries: None
Phase of Flight: Taxiing

A Beech G35 was substantially damaged during a collision with trees while taxiing for takeoff at Falmouth Airpark (5B6), Falmouth, Massachusetts. The certificated private pilot and passenger were not injured. Visual meteorological conditions prevailed, and no flight plan was filed.

The pilot was interviewed via telephone and submitted a written statement. He stated that he performed a preflight inspection of the airplane, then started the engine while parked on the apron adjacent to his hangar.

The pilot increased the throttle in order to start the airplane moving over snow that had accumulated on the apron and taxiway. He then reduced the throttle after the airplane began accelerating; however, the engine continued to run at a higher rpm. The pilot tried again to reduce the throttle, to no avail. The airplane continued to accelerate at a "higher than normal" rate across the taxiway.

The pilot then applied full right rudder pedal and right brake, but the airplane did not respond, and continued to slide on the snow. The airplane impacted a line of trees, on the opposite side of the taxiway, head-on.

Additionally, the pilot reported that after the accident he and a friend inspected the throttle and carburetor. He reported hearing a "snapping sound" and felt a "binding" of the throttle cable.

The pilot's hanger was located in a residential area of the Falmouth Airpark. Access to the runway was provided via a 50-foot wide grass taxiway that ran perpendicular to the apron immediately in front of the pilot's hangar. Examination of pictures taken by the pilot on the day of the accident revealed that the taxiway and the grass portion of the apron in front of the hanger were covered with patches of snow.

The airplane was a 1956 Beech G35, and had accumulated 3,430 total flight hours at the time of the accident. The airplane's most recent annual inspection was performed and the airplane had accumulated 64 flight hours since that time.

The pilot held a private pilot certificate with a rating for airplane single engine land, and a third class medical certificate. At the time of the accident he reported 796 hours of total flight experience, and 47 hours of flight experience in make and model.

A Federal Aviation Administration (FAA) inspector examined the airplane. The inspector found that the throttle was stiff, but he could only duplicate the snapping sound heard by the pilot once, and noted a very slight vibration within the throttle. The inspector also found that the throttle moved completely from the idle to the full power position with no obstruction or hindrance.

The National Transportation Safety Board determines the probable cause(s) of this accident as follows: The pilot's failure to maintain control of the airplane during taxi. A factor was the snow-covered taxiway.

Source: NTSB

Aircraft:Beech K35
Where:Fillmore, UT
Injuries: None
Phase of Flight:Climbout

A Beech K35 was substantially damaged when it collided with terrain during initial climb following takeoff from Fillmore Airport, Fillmore, Utah. The private pilot and three passengers were not injured. Visual meteorological conditions prevailed, and no flight plan was filed for the business cross-country flight. The intended destination was St. George, Utah.

According to the pilot, during takeoff roll on runway 22, the aircraft was "trimmed incorrect[ly] and left the runway premature[ly]." The airplane lifted off the runway, settled back down, and immediately lifted off the runway again. The aircraft had insufficient airspeed and the stall warning horn sounded. He retarded the throttle and the airplane departed the runway to the left into the grass. The propeller, cowling and landing gear were bent, and the fuselage was wrinkled.

When asked what recommendation the pilot could make as to how the accident could have been prevented, he stated 'use of a checklist.'

The National Transportation Safety Board determines the probable cause(s) of this accident/incident as follows: The pilot's failure to adequately remove ice and snow from the airplane. A contributing factor was the pilot's inability to maintain control during climb due to degradation of the airplane's aerodynamic performance.

Source: NTSB

Aircraft: Beech V35B
Where: Bay St. Louis, MS
Injuries:None
Phase of Flight:Landing

On June 27, 2004, about 0730 central daylight time, a Beech V35B, N2167L, registered to a private individual, was landed with the landing gear retracted at the Stennis International Airport, Bay Saint Louis, Mississippi. Visual meteorological conditions prevailed at the time and no flight plan was filed for the 14 CFR Part 91 personal flight from the Mobile Downtown Airport, Mobile, Alabama, to the Stennis International Airport, Bay Saint Louis, Mississippi. The airplane was substantially damaged and the private-rated pilot, the sole occupant, was not injured. The flight originated about 0700, from the Mobile Downtown Airport.

The pilot stated that the flight proceeded to the destination airport where he descended to traffic pattern altitude and entered the downwind leg at a normal 45-degree entry. When abeam the numbers during the downwind leg, he placed the landing gear selector handle to the down position and observed three green lights. He also reported that the airplane slowed as though the extended gear drag was present. The rest of the approach was what he considered typical and at no time was there any indication that something was "amiss." After a typical final approach he reduced power to idle and entered ground effect, then during the flare approximately 2-5 feet above the runway surface, he heard the gear warning horn sound but it was not until the propeller contacted the runway surface did he realize, "...the gear must not have been locked, or must have cycled back into the up position." The airplane came to rest on the right side of the runway. The pilot further stated that after the airplane was raised from the runway, all landing gears were in their respective wheel wells with the doors fully closed. He then entered the cockpit, noted the landing gear motor circuit breaker was popped, and cycled the landing gear selector handle from the down to the up then down position. He then pushed in the landing gear motor circuit breaker, turned on the master switch, and the landing gear extended. The airplane was then towed to the hangar.

Following recovery of the airplane, it was placed on jacks and in the presence of an FAA airworthiness inspector, six complete landing gear retraction checks were performed with no discrepancies noted.

The National Transportation Safety Board determines the probable cause(s) of this accident as follows: The failure of the pilot to verify the landing gear was extended prior to touchdown resulting in a gear-up landing.

Source: NTSB

Aircraft: Beech A36
Where: Santa Monica, CA
Injuries: 2 fatal
Phase of Flight: Takeoff

A Beech A36 was ditched into the ocean following a loss of engine power after departure from Santa Monica Municipal Airport, Santa Monica, California. The instrument rated private pilot, who was also a registered co-owner of the airplane, was operating it under the provisions of 14 CFR Part 91. The pilot and one passenger sustained fatal injuries; a third occupant listed on the instrument flight plan was not located. The airplane was destroyed. The pilot was destined for Brown Field Municipal Airport, San Diego, California to pick up a passenger and intended to return to Santa Monica later that day. Visual meteorological conditions prevailed and an instrument flight plan was in effect.

The airplane impacted the water off of Santa Monica beach approximately 2.5 statute miles west-southwest of the Santa Monica Airport and about 250 yards off shore. It was submerged in 20 feet of water. The pilot and one occupant were recovered from the airplane. Searches for the third occupant continued but were unsuccessful. Acquaintances of the pilot were unaware of who the third person would have been and at the time of this report, there was no additional information of a third person onboard the airplane.

According to the co-owner of the airplane, he and the pilot normally kept the utility doors locked when there were no aft seat passengers. They also agreed that when ditching the airplane, the cabin door would be unlatched prior to impact with the water. Initial responders reported that the cabin door was unlatched and that the utility doors were locked.

Witness Information

A lifeguard reported that he was 1 mile north of the airplane when he saw it at 400 feet above water level. It appeared to be at lower than normal altitude for airplanes flying in the area and continued a descent toward the ocean. The flight path of the airplane was toward Santa Monica airport from the southwest to the northeast. The lifeguard stated that the pilot appeared to be in control of the airplane and that from the time he first noticed the airplane until its impact with the water, approximately 5 seconds had gone by.

An additional witness was on the beach and took photos of the airplane as it approached the water. The photos show the airplane in a level flight attitude descent, approaching the beach from the west with the landing gear retracted. As the airplane impacted the water, it was in an upright attitude and moving in an easterly direction toward the beach. Upon impact, the airplane turned to a west-southwest heading on the surface of the water, and subsequently sank.

Personnel Information

The pilot held a private pilot certificate for single-engine airplanes with an instrument rating. He was issued a third class medical certificate with the restriction that he must wear corrective lenses during flight.

Copies of the pilot's personal flight logbook were obtained from his family. The total flight time logged was 428.4 hours. The pilot obtained his instrument rating in the accident airplane, which equated to his most recent flight review. The pilot logged 70.6 hours in the last 12 months, 15 hours in the last 6 months, and 2.2 hours in the past 30 days.

Pilot Information

According to Angel Flight personnel, the pilot had volunteered his time and airplane services to assist in the transport of a medical patient from San Diego to the Los Angeles area. The pilot was on the initial leg of the trip to pick up the patient when the accident occurred. The pilot received an Angel Flight checkout and the accident flight was his first mission.

Maintenance Information

An engine logbook entry showed that the engine was overhauled at a total time of 1,775 hours. The engine was field overhauled; there was no tachometer time noted in the maintenance entry. The connecting rod bearings and bushings, and the associated nuts and bolts, were replaced during this overhaul. Following the overhaul, mineral oil was installed in the engine. The engine was placed into storage.

An engine logbook entry indicated, in part, "Due to the long period of storage, it was disassembled, cleaned, inspected, and reassembled in accordance with the TCM IO-520 Overhaul manual, applicable Service Bulletins, and Airworthiness Directives." The engine was reinstalled on the airplane at a tachometer time of 2,819.89 hours.

An annual inspection was performed on the airplane. The tachometer time for the airplane was 3,321.61, and the time since major overhaul (TSMOH) of the engine was 502.72. The logbook entry indicated that all six cylinders were removed due to a blow by condition.

The aviation maintenance technician (AMT) that performed the annual inspection was interviewed. At the time of the annual inspection, the pilot was employed part-time at Corporate Jet Support, Hayward, California, about 5 hours per day. He worked full-time as a Production Supervisor for American Airlines, approximately 8 hours per day.

The AMT performed two annual inspections on the airplane. The AMT noted that during the inspection, the engine was removed from the airplane because the cylinders had to be removed. The exhaust and intake tubes were detached and the cylinders were pulled, as well as the pistons. The connecting rods were not removed. The cylinders were removed due to a blow by condition that was causing low compression. After the cylinders were repaired, they were reinstalled and the engine operated normally.

Wreckage and Impact Information

The airplane impacted offshore of the Santa Monica beach. Divers assisted in the recovery of the airplane that was floated to the surface, and pulled ashore. During the airplane recovery from the water, the cabin door departed from the rest of the structure and was not recovered.

Medical and Pathological Information

The Los Angeles County Coroner completed autopsies on the pilot and passenger. The cause of death for both occupants was attributed to drowning with complications from blunt force trauma. The FAA Bioaeronautical Research Laboratory performed toxicology testing on specimens of the pilot and passenger. Refer to the toxicology reports (contained in the public docket) for specific test parameters and results.

Survival Aspects

The airframe and seats were examined. The throw-over control yoke was positioned to the left side of the cockpit. The airplane was equipped with six seats which were outfitted with lap seatbelts. The two rearmost seats were stowed (latched up). The rear seats had lap belts that had airframe manufacturer identification tags sewn onto the belt material. The center and front seat lap seatbelts had no identification tags. Investigators examined the center and forward seatbelts. There was no visible evidence of webbing stretch or separated threads. The forward seats moved fore and aft on the seat tracks and would lock in position. The forward seats were removed and no deformation was evident to the seats or seat pans. The cockpit area remained intact and crushing was evident on the right and left fuselage sidewalls in the areas over the wing front spar. The cabin door latch bolt receivers on the fuselage were undamaged. The cabin emergency windows were found in the closed position. According to the aircraft manufacturer, the emergency windows opened normally when activated.

The Teledyne Continental IO-520-BA engine was examined. Both magnetos were severed from their attachment flanges on the engine and resting on the top of the engine casing, which had a hole that stretched from the top cylinder base nuts of cylinders 1 and 2, approximately 8 inches across and 6 inches wide at its widest section fore and aft.

The number 2 cylinder connecting rod was visible through the hole and portions of it and the connecting rod cap were fractured from the rod end. A 2.5-inch portion of the connecting rod from the crankshaft end contained the top portion of an attachment bolt and was located loose in the engine, just below the connecting rod. Two sections of bearing were peened and bent; one was located within the engine and one was located on the outside of the engine, between cylinders number 1 and 3. A bottom section of the cap bolt was also located between cylinders number 1 and 3 as well as a fractured and deformed portion of a castellated nut. A 1.25-inch section of rod cap was identified between the two cylinders. The other castellated nut was located between cylinders number 1 and 3, outside of the engine. It was fractured at one end and twisted.

The oil pan was removed and investigators noted sand in the pan. The sand was strained through a sieve and a 2.0-inch section of rod cap and both top and bottom bolt sections were identified. A 0.25-inch piece of castellated nut was also identified. Following the removal of the oil pan, investigators noted a hole in the bottom of the engine case, in alignment with the number 2 cylinder connecting rod above. The number 2 cylinder connecting rod was still attached to the piston by the piston pin. Upon initial examination, there were no signs of heat distress on the connecting rod and rod cap pieces or upon borescope inspection of the engine through the damaged case hole.

The engine was disassembled at Teledyne Continental Motors (TCM), Mobile, Alabama. The NTSB investigator and representatives from TCM and Raytheon Aircraft Company were present. After the engine was disassembled, the components were examined. The crankshaft was removed with the connecting rods (excluding the number 2 connecting rod) still attached. The cotter pins were removed from the castellated nuts, the torque values and lengths were measured and all values, excluding the upper and lower torque values for the number 1 connecting rod hardware (399 and 307 inch-pounds) and the upper torque value for the number 3 connecting rod hardware (467 inch-pounds), were within the manufacturer's specified limits of 475- 525 inch pounds. Investigators noted that the area surrounding the number 1 connecting rod appeared battered.

Materials Laboratory Report

The number 2 connecting rod, cap, bearings, bolts, nuts, and metal slivers from the engine were submitted to the NTSB Materials Laboratory for further examination. The cap and one arm of the connecting rod were fractured, both bolts and nuts were fractured and separated and the bearing was highly distorted. The assembly orientations were found by fracture matching the bolts and by aligning the bearing anti-rotation slots on the connecting rod pieces. One of the bolts had more damaged threads than the other, and one nut had a greater amount of deformation and fractures than the other nut

The connecting rod was fractured through the cap and one arm of the yoke. Magnified visual examinations of the fracture surfaces and surrounding areas revealed features such as surface topography and deformation patterns, which according to the metallurgist, was indicative of bending overstress separation at both fractures. No indications of preexisting cracking were found.

The fractured bolt from the numbered side of the connecting rod, was fractured through the grip slightly outboard of the rod split line. Although heavily damaged by post separation and mechanical contact, the fracture contained features and deformation patterns, according to the metallurgist, indicative of an overstress separation with no indications of preexisting cracking. The majority of the bolt threads were heavily deformed and distorted with the thread crest flattened toward the centerline of the bolt and lipped over on both sides of the thread flank, as if they were radially contacted and smashed. One region of the threads was sheared on one side of the bolt and no remnants of the cotter pin were found in the holes.

The bore of the mating bolt hole in the connecting rod arm showed significant axial scraping and damage. The metallurgist stated that the scraping and damage appeared consistent with contact by the bolt threads.

The bolt from the unnumbered side of the connecting rod had its head portion trapped in the deformed rod cap piece. The head was not removed. The metallurgist stated that the bolt was fractured just outboard of the split line and contained features typical of an overstress separation. The bolt threads were locally damaged and deformed but no threads were sheared. No remnants of the cotter pin were found in the holes.

Nut A was fractured in two pieces. It was heavily distorted and fractured in two places. The nut fractures were heavily damaged obscuring many of the features. The metallurgist stated that the undamaged fracture regions appeared typical of overstress separations. Although locally damaged, the internal threads were generally intact and not fractured or sheared. Contact patterns were apparent on the pressure flanks of the nut threads, consistent with prior full engagement with mating threads. The nut pieces had at least two smoothly curved deformation areas that approximated the major diameter of the bolt threads.

Nut B was fractured at one location at a cotter pin slot. The exterior of the nut was locally damaged in several areas including a severe dent in the washer face adjacent to the fracture. Contact patterns were apparent on the pressure flanks of the nut threads consistent with prior full engagement with mating threads. The majority of the internal nut threads were sheared as if the nut were pulled off the bolt. However, small regions that contained about 4 threads were not fractured. Four of these regions of intact threads were found evenly distributed around the inner diameter of the nut. The size and relative orientations of these regions matched the size and spacing of the cotter pin holes in the bolt. Additionally, the two threads furthest from the washer face were not sheared. According to the metallurgist, the pattern of intact threads indicates that at the time of shearing, the nut was rotated in the loosening direction approximately 4 threads from a position that would allow a cotter pin to be inserted through a hole in the bolt and slots in the nut.

The National Transportation Safety Board determines the probable cause(s) of this accident to be: The failure of an aviation maintenance technician to properly torque and cotter pin the number 2 connecting rod bolts at their attach point to the crankshaft, which resulted in the separation of the connecting rod in flight, and complete power loss.

Aircraft: Beech B36TC
Where:
San Diego, California
Injuries:
None
Phase of Flight:
Landing

A Beech B36TC overran the runway during the landing roll at Montgomery Field Airport (MYF), San Diego, California. The aircraft is operated under the provisions of 14 CFR Part 91. The commercial pilot, the sole occupant, was not injured; the airplane sustained substantial damage. The personal cross-country flight departed the Big Bear City Airport (L35), Big Bear City, California, about 1530, with San Diego as the final destination. Visual meteorological conditions prevailed, and an instrument flight rules (IFR) flight plan had been filed.

In a written statement, the pilot reported that she was cleared for the instrument landing system (ILS) approach to MYF, circle to land runway 10R.

The airplane landed long, and the pilot applied brakes upon touchdown. The left main tire blew out and the pilot attempted a go-around. The airplane overran the runway and veered to the left, resulting in the left wing colliding with a runway end identifier light. The airplane continued to the left and encountered a ditch filled with soft mud. The pilot did not report any mechanical problems with the airplane prior to the accident.

The National Transportation Safety Board determines the probable cause(s) of this accident as follows:
The pilot's misjudged speed and altitude, which led to a failure to attain the proper touchdown point and a subsequent runway overrun. Also causal was the pilot's delayed decision to perform a go-around.

Source: NTSB

Aircraft: Beech BE-36A
Where:Mount Airy, NC
Injuries: 4 fatal
Phase of Flight: Takeoff

At 1930 eastern standard time, a Beech BE-36A registered to and operated by the commercial pilot, collided with terrain shortly after takeoff from the Mount Airy/Surry County Airport in Mount Airy, North Carolina. The personal flight was operated under the provisions of Title 14 CFR Part 91 and instrument flight rules (IFR). Instrument meteorological conditions prevailed, and an instrument flight plan was filed. The pilot and four passengers received fatal injuries, and the airplane was destroyed.

The airport manager stated that he had watched the pilot load the airplane, and he heard the pilot file an IFR flight plan in the airport lobby for a flight to the Curtis L. Brown, Jr. Field identifier 4W1, located in Elizabethtown, North Carolina. The manager stated that the pilot reported he was expecting an 800-foot ceiling and 2 statute miles visibility at arrival in Elizabethtown. After the airplane was loaded, the airport manager noted that the Elizabethtown Automated Weather Observation System (AWOS) readout was reporting the ceiling was 500 feet broken, 1,800 feet overcast, and 2 statute miles visibility in light drizzling rain. The airport manager heard the airplane takeoff from runway 18, and he stated that the engine sounded normal. Shortly after the takeoff, the airport manager said he received a telephone call from a local resident who stated that she had heard an airplane making a "flapping" sound followed by the sound of a crash. The airport manager stated that he notified the local authorities, who then initiated a search from the resident's home. He said the airplane was quickly located near the resident who reported the accident.

PERSONAL INFORMATION
A review of information on file with the FAA Airman's Certification Division, Oklahoma City, Oklahoma, revealed the pilot was issued a commercial pilot certificate with ratings for airplane single and multiengine land, and instrument airplane. A review of records on file with the FAA Aero Medical Records revealed the pilot held a second-class medical certificate with no restrictions. The pilot reported on his application for the medical certificate that he had accumulated 475 total flight hours, and a review of the pilot's logbook revealed that the pilot had accumulated 712 total flight hours. The flight book review also disclosed that the pilot had accumulated 44 hours of actual instrument flying, 3 hours of actual instrument flying within the last 90-days.

AIRCRAFT INFORMATION
A review of maintenance records revealed that the last recorded total time for the airframe was during the annual inspection of 4,852.53 hours, and an engine total time of 205.1 since factory overhaul. The tachometer time and hobs meter was damaged and the current airframe times could not be recovered. Refueling records on file at Mount Airy-Surry County Airport, Mount Airy, North Carolina, revealed that the airplane was topped off with 26.4 gallons of fuel. The engine logbooks revealed that the factory-overhauled engine was equipped with a Shadin fuel flow indicating system installed under STC-SA449GL.

METEOROLOGICAL INFORMATION
Mount Airy Automated Surface Observation at 1920, wind calm, visibility two statue miles, drizzle, ceiling overcast 500 feet, temperature eight degrees Celsius, dew point six degrees Celsius, altimeter 30.00 inches of mercury. Instrument meteorological conditions prevailed at the time of the accident. According to local law enforcement Surry County Sheriff Department and ground search teams, the visibility in the vicinity of the crash scene was very low with fog.

WRECKAGE AND IMPACT INFORMATION
Examination of the wreckage site found that the airplane had collided with terrain on the south side of an east-west oriented hill, in a near vertical nose-down attitude. The engine and forward cabin had penetrated the ground to a depth of about eight feet. The wing leading edges had collapsed rearward, and were compressed flat to the front wing spars. The top and bottom wing panel skins were symmetrically ballooned outward, exposing the wing internal structure. The flap and aileron control surfaces remained loosely attached to the wings. The rear cabin and rear fuselage displayed accordion crush damage. The empennage was found lying partially on top of the fuselage structure and on the hillside. The top of the airplane and empennage were on a northerly heading towards the airport. Flight control continuity could not be verified, however flight control components were examined, and no anomalies were noted. It was found during the recovery of the airplane that the landing gear was retracted, flaps retracted, and that the nose trim tab was set to 10 degrees trailing edge down.

The fuel selector was found positioned on the right main wing tank. The electric fuel boost pump system had been modified to a boost pump that could be selected to either LOW or ON (High). The cabin door and the two utility baggage doors were separated from the airplane. Both utility doors had separated from their hinges and had fragmented into multiple pieces.

The instrument panel was damaged, and the engine and flight instruments were dislodged from the normally install positions. The lower instrument panel switches were deformed or missing. The King 200 (2-axis) autopilot enunciator panel was not located. The airplane was equipped with an auxiliary electric-driven instrument air pump mounted on the firewall. The artificial horizon was disassembled. There was scoring present on the gyro mechanism.

The engine was a Teledyne Continental Motors IO-550. Examination of the engine and accessory components revealed the following. The engine and propeller were located 8 feet below ground level at the accident site. The engine remained partially attached to the firewall by control cables, wiring and hoses. The engine driven fuel pump, alternator, air conditioner compressor, outboard portions of the propeller governor and the starter were separated from the engine. Both magnetos separated from their mounting flanges and were resting on the top of the engine. A small amount of fuel was found in the separated engine driven fuel pump at the accident site. The cooling fins on the Number 5 and 6 cylinders revealed heavy impact damage on the top and forward facing portions. The number 5 and 6 valve covers were found broken. All six cylinders remained attached to the engine case. The engine was moved to a storage facility in Mount Airy, North Carolina for a post recovery disassembly and examination. The engine was rinsed prior to the post-recovery examination to remove mud and soil from the engine.

The engine driven fuel pump was broken off of the engine at its attachment flange. The lead seal and safety wire was found intact. All fuel lines to and from the fuel pump were fractured at the fuel pump fittings. The fuel pump drive coupler was found fractured at mid-span with the pump end remaining in the fuel pump. Some fuel was found in the engine driven fuel pump. The throttle arm remained attached to the throttle body at the throttle shaft and was separated from the throttle cable attachment end. The throttle shaft was bent and the throttle arm was partially disengaged. The fuel metering unit mixture arm was found bent and resting against the full rich stop. The fuel distribution manifold fuel screen was found clean and free of particles. The plunger moved up and down with spring tension noted and the diaphragm was found intact. The wiring harness was found impact damaged and was cut by impact forces in numerous locations. Both magnetos were impact damaged and contained some mud in the internal mechanisms. Both impulse couplers actuated during hand rotation. No spark was produced from either magneto during hand rotation. The number 1,2,3,4 and 6 top spark plugs and the number 1,2,3,4, and 5 bottom spark plugs were removed and appeared "normal" when compared to the Champion Aviation Check-a Plug index. The number 5 top and number 6 bottom spark plugs were impact damaged and were not removed for inspection.

The number 5 cylinder sustained heavy impact damage. The number 5 intake valve retainer halves were found displaced slightly outward from the normal position. The number 5 intake push-rod tubes were found bent upward and aft, and were removed from the engine prior to hand rotation of the crankshaft. The engine was rotated by hand utilizing the fuel pump drive coupler fitting on the aft end of the crankshaft. Continuity to the engine camshaft, engine driven accessories and to the front end of the crankshaft was established during rotation. The engine crankshaft was separated at the propeller flange, which remained attached to the propeller.

The propeller was a three-bladed McCauley propeller. One propeller blade had separated from the propeller hub, and one blade was loose in the hub. All three-pitch change knobs separated from their respective blades. The two blades that remained attached to the propeller hub were bent aft eight to 12 inches out from the hub. All three blades tips were bent forward and partially separated. Blade face polishing was minimal. The spinner was crushed around the structure of the hub.

MEDICAL AND PATHOLOGICAL INFORMATION
The Office of the Chief Medical Examiner, Chapel Hill, North Carolina, conducted a postmortem examination of the pilot. The reported cause of death was "massive blunt force injury". The forensic Toxicology Research Section, Federal Aviation Administration, Oklahoma City, Oklahoma performed postmortem toxicology of specimens from the pilot. Carbon Monoxide and Cyanide testing was not performed. No Ethanol was detected in the urine. The following drugs were identified; Paroxetine was detected in the Liver 4.912 (ug/mL, ug/g), Paroxetine was also detected in the urine 0.141 (ug/mL, ug/g), Doxylamine was detected in the Liver, Dextromethorphan was present in the Liver, Dextrorphan was detected in the Lever, Dextrorphan was also detected in the kidney, Pseudoephedrine was detected in the Liver, Phenylpropanolamine was detected in the Lever, and Acetaminophen was detected in the Urine 16.82 (ug/ml, ug/g).

ADDITIONAL INFORMATION
A review of voice transcripts provided by the FAA Raleigh (RDU) Automated Flight Service Station (AFSS) found the pilot contacted the RDU AFSS on four separated occasions requested weather information. He was provided an outlook briefing for a flight from Mount Airy (MWK) North Carolina to Elizabethtown (EYF), North Carolina. These outlook briefings occurred at 1737 Coordinated Universal Time (UTC) 2010 UTC, 2029 UTC, and 2324 UTC at which time he filed an IFR flight plan from Mount Airy, North Carolina to Elizabethtown, North Carolina with an Alternate of Fayetteville (FAY) North Carolina.

The National Transportation Safety Board determines the probable cause(s) of this accident as follows: The pilot's failure to maintain control of the aircraft due to spatial disorientation. A factor was low clouds.

Source: NTSB

Aircraft: Beech D-45
Where: Minden, LA
Injuries:2 Fatal
Phase of Flight: Go-around

The airplane impacted wooded terrain west of the runway following an uncontrolled descent from a go-around from runway 01. Strong gusty winds (15 to 25 knots) from the east prevailed at the airport at the time of the accident. The private pilot, who occupied the front seat, had accumulated a total of 1,012.3 hours in the accident airplane. The pilot rated passenger, who occupied the aft seat, had accumulated a total of 321.5 hours, with none in the accident airplane.

Review of the private pilot's personal and FAA medical records indicated that he had an essential tremor, a condition that caused his head and hands to shake noticeably, and not associated with any other disease. He continued to have progressive symptoms even on medications. He had an episode of unusual behavior, possibly related to his medications, in 1996 which occurred during operation of an aircraft. At the time of the accident, the private pilot was on fairly large doses of diazepam and propanolol to treat his essential tremor, medications which he did not note on his most recent application for a medical certificate. The FAA medical records indicated that the FAA did not consider the private pilot medically qualified in 1996 and in 2000.

Toxicological tests for the private pilot were positive for diazepam (0.393 ug/ml) and its metabolites in blood and for propanolol in the blood and liver. Diazepam and its metabolites have substantial adverse effects on judgment, alertness, and performance. The pilot, in fact, complained of sedation from the diazepam, and adverse performance effects would be expected at the levels used. Propanolol which lowers blood pressure and reduces heart rate response to stress, may result in dizziness, fatigue, and decreased G-tolerance, particularly at high doses. The private pilot was impaired from the diazepam, possibly from propanolol, and possibly from his essential tremor.

No evidence of uncorrected discrepancies was found in the maintenance records. No evidence of an in-flight mechanical and/or flight control malfunction was found that would have rendered the airplane uncontrollable prior to the impact.

THE CAUSE
The National Transportation Safety Board determines the probable cause(s) of this accident as follows: The private pilot's failure to maintain aircraft control during a go-around. Contributing factors were the private pilot's impairment due to drugs, the pilot-rated passenger's lack of experience in the airplane, and the prevailing gusty crosswind conditions.

Source: National Transportation Board

Aircraft: Beech 65
Where: Lawrenceville, GA
Injuries: 1 fatal, 3 minor
Phase of flight: Takeoff

During the preflight inspection, some water was present in the fuel sample; it was drained until a clear sample was observed. Subsequently, the fuel tanks were topped off, and the remaining preflight inspection revealed no other anomalies. The pilot initiated a takeoff and upon reaching rotation speed, the airplane became airborne and the landing gear was retracted. The right engine immediately lost power, and the pilot feathered the engine and attempted to return to the airport. Shortly thereafter, the left engine lost power. The pilot informed the air traffic controller that the airplane had lost all power. The airplane subsequently collided with trees and terrain and a post crash fire ensued. A post-accident examination of the airframe and engine revealed no mechanical malfunctions or failures that would have precluded normal operation. Examination of fuel retrieved from the right main fuel tank, as well as fuel from the fixed base operator, revealed no anomalies. The left fuel selector valve was observed in the plugged port (no fluid flow) position, but it was most likely moved to that position during the accident sequence. The right fuel selector valve was partially aligned with the main fuel passageway and was unobstructed. The reason for the loss of engine power to both engines was not determined.

The National Transportation Safety Board determines the probable cause(s) of this accident to be: The failure of both engines for undetermined reasons.

Source: National Transportation Board

Aircraft:Beech C90 King Air
Where:Dallas, TX
Injuries:1 Serious
Phase of Flight:Landing

HISTORY OF FLIGHT
A Beech C90 (King Air) twin-turboprop airplane was substantially damaged when it impacted a residential area during a forced landing following a loss of engine power while on approach to the Dallas Love Airport, Dallas, Texas. Private individuals, who were in the process of purchasing the aircraft, operated the airplane. The commercial pilot, who was the sole occupant, sustained serious injuries. Visual meteorological conditions prevailed and an instrument flight rules flight plan was filed for the 14 Code of Federal Regulations Part 91 business flight. The cross-country flight originated from Taos, New Mexico, at 1115 (2 hours and 7 minutes prior to the accident).

According to reports from Dallas Love Air Traffic Control Tower, the flight was on a visual approach to runway 13L. When the airplane was on final approach, the controller noticed the airplane in 'level flight descending out of sight behind hangars.' The controller asked the pilot if he was experiencing a problem; however, the controller did not receive a reply. The airplane descended into a residential area where it struck power lines, a tree, a natural gas meter, two private residences, and a fence.

According to an FAA inspector, who responded to the accident site, the flight departed from Dallas Love Airport at 0757 on the morning of the accident after the pilot had the fuel tanks topped off with 244 gallons of fuel. Air traffic control data indicated that the airplane descended from radar coverage into Taos at 1044 (2 hours and 47 minutes after departure). According to service personnel in Taos, the airplane was on the ground for approximately 15 minutes, and departed for Dallas with just the pilot on board.

An FAA inspector, who interviewed the pilot, stated that the pilot reported that while the airplane was on base leg to runway 13L at Dallas Love, the right engine began to surge. The pilot turned on the boost pumps and retracted the landing gear. The pilot reported that the right engine lost total power and the airplane's airspeed was approaching the minimum controllable airspeed (Vmc); therefore, he reduced power on the left engine and attempted a forced landing to the residential area.

In a written statement, submitted to the NTSB investigator-in-charge (IIC), the pilot reported that the return flight from Taos was uneventful until the flight approached Wichita Falls, Texas, when the pilot noticed that the right hand fuel gauge 'spiked to zero and returned to its previous indication.' The pilot reported that the 'anomaly happened twice and did not occur again for the remainder of the flight.' He added that the flight continued 'normally' until the airplane turned onto short final for runway 13L. The right engine 'began to surge violently, so [he] brought the power back and increased power to the left engine. This made the airplane aircraft roll to the right, so [he] brought [the left] engine back as well.' The pilot realized that the airplane would not make it to the runway and he looked for a place to land. The pilot found an alley in a residential area and attempted to land there. He stated that the airplane was about to impact the power lines, so he 'retracted the landing gear, brought the condition levers back to cut-off, and kept flying until [he] blacked out.'

One witness, who was located in the residential area, stated that she heard a 'crackling sound,' which caused her to look up and see the airplane 'barely hitting the electric tower. The motor wasn't on.' She added that one of the wings clipped a television satellite dish and the side of a house. The aircraft continued across the street and impacted a garage and a tree where it came to rest.

Another witness, who was also located in the residential area, stated that he noticed the airplane flying very low. He observed the airplane impact electrical wires with the lower left wing and 'sparks flew everywhere.' The airplane then disappeared from his view. He added that he thought the 'engines were missing or sputtering.'

PERSONNEL INFORMATION
The commercial pilot held a second-class medical certificate without limitations. The pilot reported having accumulated approximately 7,000 total flight hours, of which 5,000 hours were in multi-engine airplanes and 100 hours were in the same make and model as the accident airplane.

AIRCRAFT INFORMATION
The aircraft was equipped with two 550 shaft-horsepower Pratt & Whitney PT6A-21 engines. Review of maintenance records revealed that the aircraft underwent Phase 2 and Phase 3 inspections in accordance with the Beech King Air inspection procedures on April 27, 2001, at an aircraft total time of 7,325.2 hours. At the time of the last inspection, the engines had accumulated a total of 7,325.2 hours, and had accumulated 3,892.2 and 3,669.8 hours since the last overhaul on the left and right engines, respectively. The left and right engines had accumulated 1,405.2 and 1,182.8 hours since their last hot section inspections, respectively. During the aircraft's last inspection, McCauley 4-bladed propellers were installed in accordance with Supplemental Type Certificate (STC) SA1241GL at propeller total times of 50.8 hours for both the left and right propellers. At the time of the accident, the airplane had accumulated a total of 7,356 hours.

According to the King Air C90 Pilot Operating Handbook fuel system description, 'the fuel system consists of two separate systems connected by a crossfeed system. Fuel for each engine is supplied from a nacelle tank and four interconnected wing tanks for a total of 192 gallons of usable fuel for each side with all tanks full. The outboard wing tanks supply the center section wing tank by gravity flow. The nacelle tank draws its fuel supply from the center section tank. Since the center section tank is lower than the other wing tanks and the nacelle tank, the fuel is transferred to the nacelle tank by the fuel transfer pump in the low spot of the center section tank. Each system has two filler openings, one in the nacelle tank and one in the leading edge tank. To assure that the system is properly filled, service the nacelle tank first, then the wing tanks.'

In written statements provided by the fueling service in Dallas, the aircraft refueling personnel, who fueled the airplane on the morning of the accident, stated that they filled the nacelle fuel tanks prior to filling the wing fuel tanks.

WRECKAGE AND IMPACT INFORMATION
The airplane came to rest upright in the yard of a residence. A tree was crushed under the belly of the aircraft. Review of photographs taken at the accident site revealed that the airplane's wings, outboard of both engines, sustained impact damage, which compromised the fuel system. The propellers remained attached to the engines. The left and right propeller blades were intact and attached to the propeller hubs and were bent and twisted. The engines remained attached to their wings; however, they were deflected downward. The left horizontal stabilizer was torn from its attachment fitting.

Cockpit documentation revealed that the fuel boost and transfer pumps were in the OFF position, the power levers were in the mid-range position, the propeller levers were in the full forward position, and the condition levers were at the low idle position. The rudder trim was set in the neutral position, the aileron trim was found in the maximum (5 degrees) right wing down trim, and the elevator trim was set at a 7 degree up position.

TESTS AND RESEARCH
An environmental inspector with the City of Dallas' Storm Water Quality department conducted a petroleum risk test. According to the inspector, upon his arrival at the accident site, he noticed the 'fire department spraying fire-suppressing [foam] around plane wreckage. Water runoff from related activities showed no signs of any petroleum product. No rainbow sheen or fuel odor was noted on and in water. A test of runoff with 'Spilfyter' (brand) chemical classifier showed negative results for petroleum risk with pH normal at neutral.' The inspector returned to the accident site the following day and conducted the same tests and 'found no signs of fuel in street, curb, or storm drain system.'

An NTSB investigator and a representative of the aircraft manufacturer examined the fuel lines of the airplane at Air Salvage of Dallas, Lancaster, Texas. According to the NTSB investigator, approximately 1 liter of fuel was drained from the left and right fuel sumps located in the belly of the aircraft. They then examined both the left and right engines and noted that for each engine, there was no fuel in the line between the firewall to the fuel heater, nor was there fuel in the line between the fuel pump and the fuel control unit.

The National Transportation Safety Board determines the probable cause(s) of this accident/incident as follows: The pilot's failure to refuel the airplane, which resulted in fuel exhaustion and subsequent loss of dual engine power while on approach.

Source: National Transportation Safety Board

Aircraft:Beech Travel Air
Where:Dunbar, WI
Injuries:I fatal
Phase of Flight:Instrument approach

A Beech D-95A Travelair was destroyed when it impacted the ground near Dunbar, Wisconsin. The impact site was approximately eight miles south of Ford Airport (IMT), Iron Mountain, Michigan. The 14 CFR Part 91 positioning flight had departed Huntsville International Airport (HSV), Huntsville, Alabama, at 2339 on January 5, 2000, en route to Ford Airport. At 0337, the pilot reported the airplane was established on the final approach course on the ILS Rwy 01 approach to Ford Airport. At 0338, the pilot reported moderate rime icing at 3,200 feet mean sea level to Minneapolis Center. There were no further communications with the airplane. The airline transport pilot received fatal injuries. Visual meteorological conditions prevailed at IMT and an IFR flight plan had been filed.

The operator reported that the pilot was notified at approximately 1630 of a Part 135 flight for parts delivery from IMT to HSV. The operator reported the pilot obtained a weather briefing and filed a flight plan prior to leaving home. The operator reported the pilot departed for HSV at approximately 1730.

The pilot contacted the Green Bay, Wisconsin, Automated Flight Service Station (AFSS) at 1648 for a pre-flight briefing and filed an IFR flight plan from IMT to HSV. The takeoff time was listed as 1710 with 4 hours 15 minutes en route at 160 nautical miles per hours. The estimated time at arrival was 2125.

Minneapolis ARTCC reported the subject aircraft departed IMT at 1732. HSV tower reported it arrived at HSV at 2227.

The airplane was topped off with 94 gallons of 100 LL/Avgas. A lineman reported that he brought the pilot something to eat from a local restaurant. The lineman and mechanic reported the pilot was cold, and that the pilot had informed them that the airplane's heater had not worked since shortly after takeoff. The mechanic reported that he and the pilot went out to the airplane. The mechanic drained about two spoonfuls of fuel out of the heater drain bowl. The mechanic reported the pilot operationally checked the heater and it "appeared to function normal for the couple of minutes that he let it run." The lineman reported that the pilot said he would "stop somewhere and spend the night" if the heater did not work on the return trip.

The pilot contacted the Anniston, Alabama, AFSS at 2330 for a pre-flight briefing and filed an IFR flight plan from HSV to IMT. The takeoff time was listed as 2345 with 4 hours 15 minutes en route at 160 nautical miles per hour. The estimated time of arrival was 0400.

The HSV tower reported that the aircraft departed HSV at 2339.

At 0257:29, the pilot contacted Minneapolis ARTCC and reported he was at 9,000 feet mean sea level (msl).

At 0257:50, the pilot reported he was, "... just starting to pick up a little bit of ice here in the tops. Do you have any reports up ahead of us down below at all?"

At 0258:24, ATC cleared the pilot to descend to 7,000 feet msl.

AT 0259:04, the pilot reported, "We just came out on top again here at nine. Maybe we can stay up here for a bit longer."

At 0259:09, ATC responded, "' maintain niner thousand."

At 0324:19, the pilot reported, "'going ten degrees left for the localizer."

At 0324:55, ATC reported, "' roger. You can report established on the localizer. Change to my frequency one two one point two five."

At 0325:03, the pilot reported, "We'll report that, and, ah, we're on one twenty one and a quarter.'

At 0325:08, ATC reported, "' descend at pilot's discretion. Maintain three thousand two hundred."

At 0325:14, the pilot reported, "Make that three point two."

At 0334:34, the last radar contact indicated the airplane was at 3,900 feet msl and on a heading toward IMT which was approximately 22 nautical miles to the north.

At 0336:37, ATC reported, "Radar contact is lost. Are you established on the localizer?"

At 0336:42, the pilot responded, "Yes, sir, we are and we're just getting some pretty good moderate ice here at thirty two hundred."

At 0336:48, ATC reported, "Roger. Cleared for the ILS Runway One approach to the Iron Mountain airport. Before you leave my frequency, could you tell me what type of icing you're getting and the temperature?"

At 0336:59, the pilot responded, "It's rime, sir, and we're at about, oh, it looks like about, minus ten C."

At 0337:09, ATC reported, "Roger. Thank you sir. And, change to advisory frequency approved. Cancellation or down time this frequency."

At 0337:18, N5918S reported, "Back with you for cancellation"

There were no further transmissions from the aircraft.

A search was initiated for the aircraft and it was located in a wooded area with rolling hills. There were no witnesses to the accident.

PERSONNEL INFORMATION
The pilot was an airline transport rated pilot with single and multi-engine land ratings, and a commercial single engine sea rating. He was a Certified Flight Instructor in single and multi-engine land airplanes, and an instrument instructor. He held a Class 2 medical certificate. He had a total of about 10,000 hours of flight time. 4,600 hours were in multi-engine airplanes, with about 400 hours in make and model.

The pilot was designated as Pilot in Command (PIC) in the Beech D-95A on July 12, 1996. He had also been designated as PIC in the following aircraft: C-402, C-404, C-310, C-208, and C-441. His last Part 135 check ride was in the C-414.

AIRCRAFT INFORMATION
The airplane was a twin engine Beech D-95A, Travel Air. The airplane seated 4 and had a maximum gross weight of 4,200 pounds. The engines were 180 horsepower Lycoming IO-360-B1B engines. The airplane had flown about 26 hours since the last inspection and had a total time of about 8,924 hours.

The airplane was equipped with the following de-ice/anti-ice equipment: propeller anti-ice, windshield anti-ice, de-icing boots and heated pitot tube.

METEOROLOGICAL CONDITIONS
At 0254, the weather reported at IMT was: Ceiling 1,700 feet overcast; visibility 8 miles; temperature -5 degrees C; dew point -7 degrees C; winds 180 degrees at 11 knots; altimeter setting 29.83 inches of Hg.; snow ended 0207 began 0228 and ended 0241.

At 0315, the weather reported at IMT was: Ceiling 1,300 feet overcast; visibility 7 miles; temperature -5 degrees C; dew point -6 degrees C; winds 170 degrees at 8 knots; altimeter setting 29.83 inches of Hg.

At 0354, the weather reported at IMT was: Ceiling 1,100 feet overcast; visibility 6 miles, mist; temperature -4 degrees C; dew point -6 degrees C; winds 180 degrees at 8 knots; altimeter setting 29.81 inches of Hg.

The following AIRMETs were issued by the Aviation Weather Advisory Center (AWC) in Kansas City, Missouri :
AIRMET Sierra Update 1 for IFR reported occasional ceilings/visibilities below 1,000 feet / 3 miles in clouds... precipitation and mist. Conditions moving eastward during the period...continuing beyond 0900 through 1500. The area encompassed by this AIRMET included the accident site.

AIRMET Tango Update 1 for Turbulence reported occasional moderate turbulence below 6,000 feet due to occasional strong and gusty low level flow across the area. Conditions continuing beyond 0900 through 1600. The area encompassed by this AIRMET included the accident site.

AIRMET Zulu Update 1 for Ice reported occasional moderate rime or mixed icing in cloud and in precipitation below 10,000 feet. Conditions continuing beyond 0900 through 1500. Freezing Level... Surface to 4,000 feet for an area that included the accident location. The area encompassed by this AIRMET included the accident site.

AIDS TO NAVIGATION
The IMT ILS Rwy 1 instrument approach plate indicates that the Final Approach Fix (FAF) for the localizer approach is 5.0 nautical miles from the runway. The ILS glideslope intercept altitude is 2,900 feet msl. The altitude of the glideslope over the FAF is 2,804 feet msl. The inbound heading is 010 degrees. The IMT airport elevation is 1,182 feet msl.

WRECKAGE AND IMPACT INFORMATION
The location of the main wreckage was about 7.8 nautical miles south of the IMT airport and at coordinates 45 degrees 41.5 minutes North, 88 degrees 8.2 minutes West. The fuselage and cockpit were destroyed by fire.

The wreckage path was on a heading of approximately 002 degrees. A tree about 60 feet in height and about 370 feet from the main wreckage had its top branches broken, and it appeared to be the initial tree impacted by the airplane.

A broken branch with a diagonal cut that exhibited a gray paint transfer was found under a tree about 60 feet from the initial impact.

The outboard left wing panel was separated outboard of the left engine nacelle and was found along the left side of the wreckage trail about 150 feet from the initial tree impact.

A fragment of the crushed nose cone that exhibited burn damage was found co-located with the left wing panel.

The crushed nosecone was found lodged about 25 feet up in a tree that was about 200 feet from the initial impact point. The fiberglass nosecone exhibited crushing, tearing, and traces of smoke and burn damage. The heater unit located just aft of the nosecone of the airplane was found in the main wreckage. The heater unit exhibited impact damage and traces of smoke and burn damage.

The left stabilizer and elevator were found about 220 feet from the initial impact point. They were separated from the empennage at a location near the inboard end of the elevator. The elevator trim tab was positioned beyond normal limits of travel. The actuator mount was separated from the stabilizer. The stabilizer exhibited crush damage along the leading edge.

The right outboard wing panel was found about 250 feet from the initial impact point. It was separated at a location near the inboard end of the aileron. The adjacent inboard four-foot section of the right wing panel was found about 350 feet from the initial impact point. The fuel filler cap was found secured within the fuel filler port.

The outboard three-quarters of the right elevator and stabilizer were located next to the inboard end of the right wing at the main wreckage site.

The main wreckage came to rest approximately 370 to 400 feet north of the initial impact. The wreckage included the fuselage, inboard wings, vertical stabilizer, and both engines. The fuselage was found inverted with both engines still attached to their respective engine mounts. The fuselage, cockpit, and cabin area were destroyed by fire.

The right propeller was still attached to the right engine crankshaft. The left propeller was separated from the left engine crankshaft at a location about two inches behind the propeller mount flange. The left propeller was found in the ground under the left engine.

The right landing gear was found in the extended position. The right main landing gear door was nicked along the front edge of the gear door. The left main landing gear door had two impact nicks along the front edge of the gear door. The nose landing gear assembly was found in the extended position.

The cockpit instruments, flight controls, engine controls and fuel tank selector controls were destroyed by fire.

The elevator control cables were found to be continuous from the cockpit aft to the elevator bellcrank. One of the two rudder cables was found separated with a broomstraw separation at a location about four feet aft of the aft wing spar. The other cable exhibited continuous continuity. The rudder trim tab and elevator trim tabs were continuous and were traced from the cockpit aft to a location adjacent to the horizontal stabilizers.

The inspection of the left engine revealed continuity. Thumb compression and suction were confirmed on all cylinders. The left and right magnetos exhibited internal fire damage and did not produce spark. The engine driven fuel pump arm was cycled but no suction or pressure was noted. The pump was opened and fuel was found in the unit.

The vacuum pump drive was damaged by impact and fire and would not rotate. The pump was opened and the rotor and vanes were found intact.

The inspection of the right engine revealed continuity. Thumb compression and suction were confirmed on all cylinders. Fuel was observed coming out of the engine driven fuel pump outlet port when the engine was rotated. Both the left and right magnetos produced spark.

The vacuum pump drive was rotated and suction and pressure was noted from the ports. The pump was opened and the rotor and vanes were found intact.

The left propeller assembly was separated from the left engine crankshaft. The crankshaft fracture surface exhibited a 45-degree lip along the circumference of the crankshaft. Both propeller blades were missing about 3 inches of their blade tips. Both blades exhibited twist and nicks along the leading edges.

The right engine propeller assembly remained attached to the right engine. It exhibited leading edge nicking and aft curling of both blade tips. The spinner on the right propeller exhibited about 45 degrees of torsional twisting.

MEDICAL AND PATHOLOGICAL INFORMATION
A Forensic Toxicology Fatal Accident Report was prepared by the FAA Civil Aeromedical Institute. The report indicated the following results:
Carbon monoxide: Not performed.
Cyanide: Not performed.
No ethanol detected in kidney.
No ethanol detected in muscle.
No drugs detected in kidney.
ADDITIONAL INFORMATION

The official Weather Service definition of moderate icing is: "The rate of accumulation is such that even short encounters become potentially hazardous and use of deicing/anti-icing equipment or diversion is necessary."

According to the Beechcraft Safety Communique, July 16, 1980, Travel Air D-95A's were CAR Part 3 type certificated airplanes which were approved for flight into light to moderate icing conditions. However, they were not approved for extended flight in moderate icing conditions or any flights in any severe icing condition.

The National Transportation Safety Board determines the probable cause(s) of this accident/incident as follows: The pilot failed to maintain a proper glidepath and obstacle clearance during an instrument approach. Additional factors to the accident included the dark night, icing conditions, flight into known adverse weather, and conditions conducive to pilot fatigue.

Source: NTSB

Aircraft: Beech 95B55
Where: Clarion, IA
Injuries: 1 fatal
Phase of flight: Cruising

A Beech 95-B55 operated by a private pilot, was substantially damaged when it impacted the ground near Clarion, Iowa. The 14 Code of Federal Regulations Part 91 personal flight was operating in visual meteorological conditions without a flight plan. The pilot, who was the sole occupant, was fatally injured. The local flight originated from the Clarion Municipal Airport (CAV), Clarion, Iowa, about 1410.

The pilot's son reported that he spoke with the pilot prior to the accident. He said that his father told him he was planning to fly the accident airplane on a local flight.

A witness to the accident reported seeing the airplane flying northwest when it suddenly entered a counter-clockwise spinning dive toward the ground. The witness stated to a Federal Aviation Administration (FAA) inspector that the airplane made about four revolutions before impacting the ground.

The pilot held a private pilot certificate with single engine land, multiengine land, and instrument airplane ratings. The pilot held a third-class medical certificate. The medical certificate stated that the pilot must wear corrective lenses for near and distant vision, and use hearing amplification. According to flight instructor records, the pilot had received a flight review on May 10, 2010, in a single engine Piper PA-28-236. The pilot's flight logbook was not available for review; however, the pilot reported having 4,000 hours total flight experience on his most recent medical application.

The airplane was a Beechcraft model 95-B55. It was a twin-engine monoplane with predominately aluminum construction. It had a retractable tricycle landing gear, and could seat 6 occupants including the pilot. The airplane was powered by two Continental model IO-470-L engines, each rated to produce 260 horsepower.

The most recent maintenance logbook entry indicated that an annual inspection of the airframe was completed on July 1, 2007, at a total airframe time of 8,854 hours.

The most recent maintenance logbook entry, dated April 9, 2007, for the left engine indicated that all six cylinders were removed from the engine and replaced due to low compression. The maintenance entry indicated that the left engine was inspected in accordance with an annual inspection on that date.

The most recent maintenance logbook entry, dated April 9, 2007, for the right engine indicated that three cylinders were removed from the engine due to low compression. Those cylinders were honed, the affected pistons cleaned, and new piston rings installed. The maintenance entry indicated that the right engine was inspected in accordance with an annual inspection on that date.

No subsequent maintenance entries were found in the airframe, engine, or propeller logbooks.

The weather reporting station at CAV recorded the weather conditions at 1415 as: wind 340 degrees at 8 knots; 10 miles visibility; clear skies; temperature 13 degrees Celsius; dew point -3 degrees Celsius; altimeter setting 30.05 inches of mercury.

The airplane impacted a level field about 0.5 miles west of CAV. The aft fuselage was in a near vertical orientation when first responders arrived on scene. Federal Aviation Administration inspectors found the left engine magneto switch positioned to the "R" position. The switch for the right engine was positioned to "Both.” The switch assembly was broken loose from the airframe. The fuel flow indicator was broken loose from its mounting and the instrument lens was broken. The instrument face was bent and the indicator needles showed no fuel flow on the left engine and 12 gallons per hour fuel flow on the right engine. The left propeller control was found in an aft "feathered" position at the accident scene. There was significant crushing in the area of the engine controls and instrument panel.

The National Transportation Safety Board determines the probable cause(s) of this accident to be: The pilot's failure to maintain control of the airplane. Contributing to the accident was the loss of left engine power for undetermined reasons.

Aircraft: Breezy
Where:Pell City, AL
Injuries:1 fatal
Phase of Flight:Low passes

A Moore Sammie, M-Breezy, experimental airplane, N9167C, registered to a private owner/operator, collided with the ground after takeoff at Pell City Airport, Alabama. The personal flight was operated by the pilot under the provisions of Title 14 CFR Part 91 with no flight plan filed. Visual meteorological conditions prevailed at the time of the accident. The airplane sustained substantial damage, and the private pilot received fatal injuries.

According to witnesses, the airplane made several low altitude passes along runway 20 with steep turn maneuvers to reverse the direction. During the last steep turn maneuver, the airplane began a downward spin. The airplane continued this spiral until it hit the ground. The spiral began approximately 300 feet above the ground. The witnesses pulled the pilot from the wreckage, and began cardio pulmonary resuscitation and first aid. They worked on the pilot until the rescue personnel arrived.

A Lycoming 0-320, 180 horsepower engine, powered the experimental airplane. Airplane logbooks were not recovered for examination.

The pilot held a private pilot certificate with an airplane single engine land rating. The pilot's total flight time was approximately 1250 hours. The pilot held a third class medical certificate with no waivers or limitations.

The Anniston Metropolitan Airport 1753 weather observation reported winds 160 at 9 knots with gusts up to 15 knots, visibility 10 statute miles, temperature 23 degrees Celsius, and a dew point of 8 degrees Celsius. There were few clouds at 6500 feet above ground level with no ceiling. The altimeter was 30.19. Visual conditions prevailed at the time of accident; conditions of light were dusk.   

Examination of the wreckage site revealed the airplane came to rest at the north end of runway 20. The airplane showed signs of crush damage. All flight controls and flight surfaces were present at the site. The pilot did not report any mechanical or flight control malfunction prior to the accident.

The State Toxicology and Accident Research Laboratory in Oklahoma City, Oklahoma performed the forensic toxicology. The cause of death was head trauma.

THE CAUSE
The National Transportation Safety Board determines the probable cause(s) of this accident as follows: The pilot's failure to maintain flying speed, followed by an inadvertent stall spin, and subsequent collision with terrain.

Source: National Transportation Board