Saturday, January 15, 2022

Boeing 757-200, N547US: Incident occurred January 15, 2022 at Los Angeles International Airport (KLAX), California

Delta Air Lines

https://registry.faa.gov/N547US 

LOS ANGELES, California — A Delta Air Lines flight from Los Angeles to Maui was forced to turn around Saturday morning and make an emergency landing at Los Angeles International Airport due to a mechanical issue.

The plane landed safely but had to be towed off the runway at LAX. Authorities said there it was an hydraulic failure.

Flight 362 was scheduled to leave LAX at 8:05 a.m., landing in Maui at 11:57 a m., according to the airline's website.

"They're towing it (Boeing 757) off the runway," said Charles Pannunzio, senior public information officer at Los Angeles World Airports.

No injuries were reported.

Piper PA-46-350P Malibu Mirage, N350XC: Incident occurred January 25, 2022 at Chicago/Rockford International Airport (KRFD), Winnebago County, Illinois

Federal Aviation Administration / Flight Standards District Office; Greater Chicago, Illinois

Aircraft landed and veered off runway. 

Cronkhite Air LLC


Date: 25-JAN-22
Time: 23:05:00Z
Regis#: N350XC
Aircraft Make: PIPER
Aircraft Model: PA46
Event Type: INCIDENT
Highest Injury: NONE
Aircraft Missing: No
Damage: UNKNOWN
Activity: PERSONAL
Flight Phase: LANDING (LDG)
Operation: 91
City: ROCKFORD
State: ILLINOIS

Diamond DA20-C1 Eclipse, N974DA: Accident occurred January 25, 2022 at Butts Army Airfield ( KFCS), Fort Carson, Colorado













This is preliminary information, subject to change, and may contain errors. Any errors in this report will be corrected when the final report has been completed. 

The National Transportation Safety Board did not travel to the scene of this accident. 

Additional Participating Entity:
Federal Aviation Administration / Flight Standards District Office; Denver, Colorado

Investigation Docket - National Transportation Safety Board:

L3 Doss Aviation

CAE-Doss

USAF 1st Flying Training Squadron


Location: Fort Carson, Colorado 
Accident Number: CEN22LA110
Date and Time: January 25, 2022, 07:28 Local 
Registration: N974DA
Aircraft: DIAMOND AIRCRAFT IND INC DA20-C1
Injuries: 2 None
Flight Conducted Under: Part 91: General aviation - Instructional

Aircraft and Owner/Operator Information

Aircraft Make: DIAMOND AIRCRAFT IND INC
Registration: N974DA
Model/Series: DA20-C1
Aircraft Category: Airplane
Amateur Built:
Operator: 
Operating Certificate(s) Held: None
Operator Designator Code:

Meteorological Information and Flight Plan

Conditions at Accident Site: VMC
Condition of Light: Day
Observation Facility, Elevation: KFCS, 5838 ft msl
Observation Time: 07:39 Local
Distance from Accident Site: 0 Nautical Miles 
Temperature/Dew Point: -3°C /-8°C
Lowest Cloud Condition: Scattered / 3400 ft AGL
Wind Speed/Gusts, Direction: 17 knots / 22 knots, 20°
Lowest Ceiling: 
Visibility: 10 miles
Altimeter Setting: 29.97 inches Hg
Type of Flight Plan Filed: None
Departure Point: Pueblo, CO (KPUB) 
Destination: Fort Carson, CO

Wreckage and Impact Information

Crew Injuries: 2 None 
Aircraft Damage: Substantial
Passenger Injuries: 
Aircraft Fire: None
Ground Injuries: N/A 
Aircraft Explosion: None
Total Injuries: 2 None 
Latitude, Longitude: 38.672946,-104.7501 (est)















A small aircraft used for training Air Force pilots landed short of a Fort Carson runway early Tuesday. No injuries were reported, according to a military press release.

At about 7:30 a.m., a Diamond DA20-C1 Eclipse landed short of a runway on Fort Carson. The civilian flight instructor and pilot under instruction, a member of the Air Force, were taken to Evans Army Medical Center on post “out of precaution,” according to Benjamin Faske, chief of public affairs for the 12th Flying Training Wing, out of Joint Base San Antonio-Randolph, Texas.

The 1st Flying Training Squadron, part of the 12th Flying Training Wing, provides flight training out of Pueblo Memorial Airport.

Next steps include an investigation into what happened and a damage assessment of the aircraft, which did not overturn, Faske said.

Bell UH-1E Iroquois, N333XL: Accident occurred January 23, 2022 in Gustine, Merced County, California

This is preliminary information, subject to change, and may contain errors. Any errors in this report will be corrected when the final report has been completed. 

The National Transportation Safety Board did not travel to the scene of this accident. 

Additional Participating Entity:
Federal Aviation Administration / Flight Standards District Office; Fresno, California

David Lee Aircraft Sales And Leasing LLC


Location: Gustine, California
Accident Number: WPR22LA084
Date and Time: January 23, 2022, 10:30 Local 
Registration: N333XL
Aircraft: Bell UH-1E Injuries: 1 None
Flight Conducted Under: Part 137: Agricultural

On January 23, 2022, about 1030 Pacific standard time, a Bell UH-1E, N333XL, was substantially damaged when it was involved in an accident near Gustine, California. The pilot was not injured. The helicopter was operated as a Title 14, Code of Federal Regulations Part 137 aerial application flight.

The pilot reported that he was applying herbicide to a wheat field and the accident occurred on the third load of the day. He reported that at the apex of an agricultural turn, he lost control of the helicopter and it descended and struck terrain. The pilot turned off the fuel boost, the master electrical switch and exited the helicopter through the roof window.

The helicopter came to rest on its left side in an open, level, field. All major components remained in the debris area around the airframe. The tail boom had partially separated from the fuselage. One main rotor blade separated from the hub about 24 inches outboard of the blade grip. The other main rotor blade remained attached and exhibited upward bending about 24 inches from the blade grip. The tail rotor assembly and the 90°gearbox remained attached to the top of the vertical stabilizer. The 90°gearbox exhibited a large crack at the top of the housing that exposed the internal gear assembly. The green paint around the cracked area was thermally damaged, and there was no evidence of residual oil around the cracked surface of the gearbox.

The helicopter was recovered to a secure location for further examination.

Aircraft and Owner/Operator Information

Aircraft Make: Bell 
Registration: N333XL
Model/Series: UH-1E 
Aircraft Category: Helicopter
Amateur Built:
Operator: 
Operating Certificate(s) Held: Agricultural aircraft (137)
Operator Designator Code:

Meteorological Information and Flight Plan

Conditions at Accident Site: 
Condition of Light:
Observation Facility, Elevation:
Observation Time:
Distance from Accident Site: 
Temperature/Dew Point:
Lowest Cloud Condition: 
Wind Speed/Gusts, Direction: / ,
Lowest Ceiling:
Visibility:
Altimeter Setting:
Type of Flight Plan Filed:
Departure Point: 
Destination:

Wreckage and Impact Information

Crew Injuries: 1 None
Aircraft Damage: Substantial
Passenger Injuries: N/A
Aircraft Fire: None
Ground Injuries: 
Aircraft Explosion: None
Total Injuries: 1 None
Latitude, Longitude: 37.102274,-120.97578

Cessna 172R Skyhawk, N37JA: Incident occurred January 25, 2022 at Auburn Municipal Airport (KAUN), Placer County, California

Federal Aviation Administration / Flight Standards District Office; Sacramento, California

Aircraft tire was flat upon landing and veered off runway striking a runway light. 

Flying Start Aero Services LLC


Date: 26-JAN-22
Time: 04:01:00Z
Regis#: N37JA
Aircraft Make: CESSNA
Aircraft Model: 172R
Event Type: INCIDENT
Highest Injury: NONE
Aircraft Missing: No
Damage: UNKNOWN
Activity: PERSONAL
Flight Phase: LANDING (LDG)
Operation: 91
City: AUBURN
State: CALIFORNIA

Erco 415-C Ercoupe, N99529: Incident occurred January 26, 2022 in Easton, Talbot County, Maryland

Federal Aviation Administration / Flight Standards District Office; Baltimore, Maryland

Aircraft experienced engine issues and landed in a field. 


Date: 26-JAN-22
Time: 20:15:00Z
Regis#: N99529
Aircraft Make: ERCOUPE
Aircraft Model: 415
Event Type: INCIDENT
Highest Injury: UNKNOWN
Aircraft Missing: No
Damage: UNKNOWN
Activity: PERSONAL
Flight Phase: EN ROUTE (ENR)
Operation: 91
City: EASTON
State: MARYLAND

Airbus A320-214, N123UW: Incident occurred January 27, 2022 at Pittsburgh International Airport (KPIT), Pennsylvania

Federal Aviation Administration / Flight Standards District Office; Allegheny, Pennsylvania

Aircraft struck a flock of birds and post flight inspection revealed damage to the landing lights and engine.  

American Airlines 


Date: 27-JAN-22
Time: 00:08:00Z
Regis#: N123UW
Aircraft Make: AIRBUS
Aircraft Model: A320
Event Type: INCIDENT
Highest Injury: NONE
Aircraft Missing: No
Damage: UNKNOWN
Activity: COMMERCIAL
Flight Phase: APPROACH (APR)
Operation: 121
Aircraft Operator: AMERICAN AIRLINES
Flight Number: AAL2738
City: PITTSBURGH
State: PENNSYLVANIA

Flight Design CTLS, N992SA: Accident occurred January 15, 2022 at Hana Airport (PHHN), East Maui, Hawaii

This is preliminary information, subject to change, and may contain errors. Any errors in this report will be corrected when the final report has been completed. 

The National Transportation Safety Board did not travel to the scene of this accident.

Additional Participating Entities:
Federal Aviation Administration / Flight Standards District Office; Honolulu, Hawaii
Rotax Aircraft Engines; Vernon, British Columbia, Canada


Location: Hana, Hawaii
Accident Number: ANC22LA012
Date and Time: January 15, 2022, 09:55 Local 
Registration: N992SA
Aircraft: FLIGHT DESIGN GMBH CTLS
Injuries: 1 Serious, 1 Minor
Flight Conducted Under: Part 91: General aviation - Personal

On January 15, 2022, about 0955 Hawaii standard time, a Flight Design CTLS light sport airplane, N992SA sustained substantial damage when it was involved in an accident near Hana, Hawaii. The pilot sustained serious injuries and the pilot-rated passenger sustained minor injuries. The airplane was operated by the pilot as a Title 14 Code of Federal Regulations Part 91 personal flight.

The pilot reported that, after completing four touch-and-go landings at the Hana Airport (PHHN), they elected to take a short break before returning to the Kahului Airport (OGG), Kahului, Hawaii. After their short break was complete, the pair departed for the return flight to OGG. The pilot said that just after takeoff from Runway 26, as the airplane climbed to about 75 ft above ground level, the airplane stopped climbing and it subsequently descended into an area of tree-covered terrain. As the airplane descended into the trees, it nosed down and struck the ground in a nose down attitude, just past the departure end of the runway. The airplane sustained substantial damage to the fuselage and wings.

The pilot stated that there were no outward indications of a mechanical anomaly; however, he believed that the engine was not making rated power.

Multiple pilot-rated witnesses reported that they heard no unusual sounds and the engine appeared to be operating normally.

The airplane was equipped with a Rotax 912ULS engine. A detailed examination is pending.

Aircraft and Owner/Operator Information

Aircraft Make: FLIGHT DESIGN GMBH
Registration: N992SA
Model/Series: CTLS 
Aircraft Category: Airplane
Amateur Built:
Operator: On file 
Operating Certificate(s) Held: None
Operator Designator Code:

Meteorological Information and Flight Plan

Conditions at Accident Site: VMC
Condition of Light: Day
Observation Facility, Elevation: PHOG,50 ft msl
Observation Time: 09:54 Local
Distance from Accident Site: 24 Nautical Miles
Temperature/Dew Point: 26°C /17°C
Lowest Cloud Condition: Few / 5000 ft AGL
Wind Speed/Gusts, Direction: / ,
Lowest Ceiling: 
Visibility: 10 miles
Altimeter Setting: 30.04 inches Hg 
Type of Flight Plan Filed: None
Departure Point: Hana, HI (HNM) 
Destination: Kahului, HI (OOG)

Wreckage and Impact Information

Crew Injuries: 1 Serious 
Aircraft Damage: Substantial
Passenger Injuries: 1 Minor
Aircraft Fire: None
Ground Injuries:
Aircraft Explosion: None
Total Injuries: 1 Serious, 1 Minor
Latitude, Longitude: 20.79556,-156.02172 




Two people have reportedly survived a small plane crash in East Maui at the Hāna Airport.

The incident was reported at 9:57 a.m. on Saturday, January 15, 2022, approximately 100 yards west of the Hāna Airport runway in heavy foliage.

Two men onboard, ages 61 and 70, were transported to the Maui Memorial Medical Center for further evaluation. One was transported via Medevac, and the other by ground ambulance, according to MFD reports.

“Initial assessments indicate neither victim sustained any life-threatening injuries,” according to the Maui Fire Department.

Engine 7 personnel arrived on scene and located the crash site. It was confirmed that two individuals were aboard a small privately owned aircraft.

Fire officials say one man was able to walk away from the wreckage. Engine 7 personnel utilized vehicle extrication equipment to free the second individual from entrapment within the plane.

Rescue 10 on Air 1 arrived on scene to “short-haul” the second man to awaiting Medics on the runway at Hāna Airport.






HONOLULU - Officials are investigating after a plane with two people onboard crashed after take off on Maui.

The Federal Aviation Administration said the Flight Design CTLS crashed after departing from Runway 26 at the around 9:50 a.m.

Maui fire officials said the plane was found in foliage about 100 yards west of the Hana Airport runway.

Authorities said one person was able to get out of the plane while the other passenger, who was trapped, had to be extricated and was transported by Air 1. One of the victims is around 70 years old.

MFD said both victims were taken to Maui Memorial Medical Center for further evaluation — one by medevac and the other by ground ambulance.

Officials said neither victim sustained any life-threatening injuries.

The FAA and the National Transportation Safety Board are investigating the crash.

Powerplant System/Component Malfunction/Failure: Piper PA-32R-300 Cherokee Lance, N8892E; accident occurred January 13, 2019 near Lenawee County Airport (KADG), Adrian, Michigan












Aviation Accident Final Report - National Transportation Safety Board

The National Transportation Safety Board did not travel to the scene of this accident. 

Additional Participating Entity:
Federal Aviation Administration / Flight Standards District Office; Belleville, Michigan

Investigation Docket - National Transportation Safety Board:

Northern Aviation Ltd


Location: Adrian, Michigan 
Accident Number: CEN19LA066
Date and Time: January 13, 2019, 17:46 Local
Registration: N8892E
Aircraft: Piper PA-32R-300 
Aircraft Damage: Substantial
Defining Event: Powerplant sys/comp malf/fail 
Injuries: 2 Minor
Flight Conducted Under: Part 91: General aviation - Personal

Analysis

The pilot was performing a flight with an inspection authorization (IA) rated mechanic, who had performed a recent annual inspection of the airplane. During approach to the airport, the engine lost total power. The airplane impacted a fence and terrain short of the runway and sustained substantial damage. Postaccident examination of the engine revealed that the crankshaft gear bolt fractured. Metallurgical examination of the bolt revealed features consistent with fatigue cracking that initiated at multiple sites near the bottom of a thread root. These smaller cracks coalesced and propagated inward through more than half the crack section of the bolt. The bolt began to cycle under reverse bending, which initiated fatigue cracking at multiple sites along the thread root on the opposite side.

The airframe and powerplant (A&P) mechanic who performed a recent overhaul of the engine stated that the engine was the first of the "big" Lycoming engines that he had overhauled. The A&P mechanic stated that he did not like using the Lycoming manuals because they were hard to follow. He mentioned several times that he had contacted Lycoming to request assistance, and they worked with him in providing the necessary documentation needed for the work he was doing. The A&P mechanic stated that he did not torque the crankshaft gear bolt to the engine manufacturer's specifications. The engine overhaul was signed off by the A&P mechanic, and he stated that the IA mechanic just removed and reinstalled the engine onto the airplane. Regulatory requirements state a certificated mechanic may not supervise the maintenance, preventive maintenance, or alteration of, or approve and return to service, any aircraft or appliance, or part thereof, for which he is rated unless he has satisfactorily performed the work concerned at an earlier date.

Probable Cause and Findings

The National Transportation Safety Board determines the probable cause(s) of this accident to be:
The airframe and powerplant mechanic's lack of experience in the overhaul of the engine model and the improper torque of the crankshaft gear bolt, which resulted in fatigue failure of the bolt and a total loss of engine power during an approach for landing.

Findings

Personnel issues Total experience w/ equipment - Maintenance personnel
Personnel issues Repair - Maintenance personnel
Aircraft Recip engine power section - Fatigue/wear/corrosion
Environmental issues Fence/fence post - Contributed to outcome

Factual Information

On January 13, 2019, at 1746 eastern daylight time, a Piper PA-32R-300, N8892E, experienced a total loss of engine power during a visual approach to runway 5 at Lenawee County Airport (ADG), Adrian, Michigan. The airplane impacted a fence and terrain short of runway 5 and sustained substantial damage. The private pilot and an airplane mechanic received minor injuries. The airplane was registered to Northern Aviation Ltd and operated by the pilot under Title 14 Code of Federal Regulations Part 91 as a maintenance test flight. The flight was not operating on a flight plan. Day visual meteorological conditions prevailed at the time of the accident. The local flight originated from ADG at 1630.

The pilot did not complete the Narrative History of Flight section of his National Transportation Safety Board Pilot/Operator Aircraft Accident/Incident Report, Form 6120.1. The pilot provided a statement to the Federal Aviation Administration (FAA) East Michigan Flight Standards District Office (FSDO) and in that statement he stated that the flight departed with the airplane mechanic with inspection authorization (IA), who signed off the airplane last annual inspection, for a post annual inspection flight. They flew north between Jackson and Lansing, Michigan, and then proceeded southwest to Coldwater, Michigan, and then Hillsdale, Michigan. They returned for an approach and landing to ADG on runway 5 with engine power set to 14 inches of manifold pressure, landing gear extended, and flaps extended. On short final for runway 5, the "engine shutoff," and there was "no sputter - it acted as if someone shutoff the key."

Post-accident examination of the engine (Lycoming IO-540-K1G5D, serial number L-13642-48A) revealed that the crankshaft gear bolt, part number 13S19649, was fractured through. A logbook entry dated August 24, 2013, at a tachometer time of 3,399.87 hours and a time since overhaul of 0 hours, stated that the engine was disassembled, and an AN8-14 bolt was installed. The illustrated parts catalog and mandatory service bulletin 475C for the engine specified an AN8-14A bolt. The tachometer time at the time of the accident was about 3,466 hours.

Following the accident, Federal Aviation Administration inspectors from the East Michigan Flight Standards District Office interviewed the airframe and power plant mechanic (AP) that last overhauled the airplane engine. During the interview, the AP stated he is the owner of a tool and die shop that also does manufacturing of various parts for the auto industry. He spends about 25% of his working time in his hangar performing aircraft repair. He stated that he is most comfortable working on old, small, fabric covered aircraft. The AP stated that he was the one that overhauled the engine on N8892E and the IA just removed and re-installed the engine onto the airplane. The AP also stated that this was the first of the "big" Lycoming engines that he had overhauled. The AP told inspectors that he does not like using the Lycoming manuals, as they are hard to follow. The AP mentioned several times that he had contacted Lycoming to request assistance, and they worked with him in providing the necessary documentation needed for the work he was doing. The AP stated that he did not torque the crankshaft gear bolt to the engine manufacturer's specifications.

The engine overhaul was signed off by the AP.

Part 65.81 General privileges and limitations, stated: 

(a) A certificated mechanic may perform or supervise the maintenance, preventive maintenance or alteration of an aircraft or appliance, or a part thereof, for which he is rated (but excluding major repairs to, and major alterations of, propellers, and any repair to, or alteration of, instruments), and may perform additional duties in accordance with §§ 65.85, 65.87, and 65.95. However, he may not supervise the maintenance, preventive maintenance, or alteration of, or approve and return to service, any aircraft or appliance, or part thereof, for which he is rated unless he has satisfactorily performed the work concerned at an earlier date. If he has not so performed that work at an earlier date, he may show his ability to do it by performing it to the satisfaction of the Administrator or under the direct supervision of a certificated and appropriately rated mechanic, or a certificated repairman, who has had previous experience in the specific operation concerned.

(b) A certificated mechanic may not exercise the privileges of his certificate and rating unless he understands the current instructions of the manufacturer, and the maintenance manuals, for the specific operation concerned.

A National Transportation Safety Board Materials Laboratory post-accident examination of the bolt revealed, that according to the dimensions for both AN8-14 and AN8-14A bolts, the grip length total length should be 1.59375 inches, the grip length should be 0.8125 inches, the threaded length should be a minimum 0.781 inches, and the diameter should be 0.500 inches in diameter. The (A) designation on the bolt part number indicates there should be no drilled hole in the shank. The fractured bolt measurements were consistent with the above dimensions and contained no drilled hole in the shank. Therefore, the bolt was consistent with an AN8-14A.

The bolt revealed that it had fractured 1.038 inches below the bolt head. Examination using visual and scanning electron microscopy (SEM) found features consistent with fatigue crack propagation and subsequent overstress. There were two smaller thumbnail cracks present on opposite 180° sides of the fracture surface. The thumbnail crack feature of the larger crack was located near the bottom of a thread root.

The smaller thumbnail crack exhibited crack arrest marks and ratchet marks, consistent with crack initiation at the thread root and propagation inward. The larger fatigue crack in the initial thumbnail area showed fatigue striations, consistent with fatigue crack propagation. This region also exhibited fatigue striations. The smaller opposite thumbnail crack also exhibited fatigue striations. In both thumbnail cracks, the striations were oriented consistent with the propagation from the outside surface inward. The small middle region exhibited dimple rupture, which had features consistent with subsequent overstress. Both fatigue cracks exhibited multiple crack initiation sites. There were no features consistent with material or mechanical defects, such as corrosion pits, pores, and voids.

The bolt features were consistent with fatigue cracking that initiated at multiple sites near the bottom of a thread root. These smaller cracked coalesced and propagated inward through more than half the crack section of the bolt. The bolt began to cycle under reverse bending, which initiated fatigue cracking at multiple sites along the thread root on the opposite side. Once both cracks had propagated inward to the extent present on the fracture surfaces, the remaining cross section of the bolt fractured from overstress.

History of Flight

Prior to flight Aircraft maintenance event
Approach-VFR pattern final Powerplant sys/comp malf/fail (Defining event)
Approach-VFR pattern final Loss of engine power (total)
Emergency descent Loss of engine power (total)
Landing Collision with terr/obj (non-CFIT)

Pilot Information

Certificate: Private 
Age: 64, Male
Airplane Rating(s): Single-engine land
Seat Occupied: Left
Other Aircraft Rating(s): None 
Restraint Used: Lap only
Instrument Rating(s): Airplane
Second Pilot Present: No
Instructor Rating(s): None 
Toxicology Performed: No
Medical Certification: Class 3 With waivers/limitations
Last FAA Medical Exam: December 12, 2017
Occupational Pilot: No
Last Flight Review or Equivalent: February 28, 2018
Flight Time: 1224 hours (Total, all aircraft), 1143 hours (Total, this make and model), 1051 hours (Pilot In Command, all aircraft), 7 hours (Last 90 days, all aircraft), 0 hours (Last 30 days, all aircraft), 1 hours (Last 24 hours, all aircraft)

Aircraft and Owner/Operator Information

Aircraft Make: Piper
Registration: N8892E
Model/Series: PA-32R-300
Aircraft Category: Airplane
Year of Manufacture: 1976
Amateur Built:
Airworthiness Certificate: Normal 
Serial Number: 32R-7680185
Landing Gear Type: Retractable - Tricycle 
Seats: 6
Date/Type of Last Inspection: January 8, 2019 Annual 
Certified Max Gross Wt.: 3600 lbs
Time Since Last Inspection:
Engines: 1 Reciprocating
Airframe Total Time:
Engine Manufacturer: Lycoming
ELT: C91 installed, not activated 
Engine Model/Series: IO-540-K1G5D
Registered Owner:
Rated Power: 300 Horsepower
Operator: 
Operating Certificate(s) Held: None

Meteorological Information and Flight Plan

Conditions at Accident Site: Visual (VMC) 
Condition of Light: Day
Observation Facility, Elevation: ADG,798 ft msl
Distance from Accident Site: 1 Nautical Miles
Observation Time: 17:53 Local
Direction from Accident Site: 230°
Lowest Cloud Condition: Clear
Visibility: 10 miles
Lowest Ceiling: None
Visibility (RVR):
Wind Speed/Gusts: 8 knots / 
Turbulence Type Forecast/Actual: None / None
Wind Direction: 70°
Turbulence Severity Forecast/Actual: N/A / N/A
Altimeter Setting: 30.3 inches Hg
Temperature/Dew Point: -2°C / -11°C
Precipitation and Obscuration: No Obscuration; No Precipitation
Departure Point: Adrian, MI (ADG)
Type of Flight Plan Filed: None
Destination: Adrian, MI (ADG)
Type of Clearance: None
Departure Time: 16:30 Local 
Type of Airspace:

Airport Information

Airport: Lenawee County Airport ADG
Runway Surface Type: Asphalt
Airport Elevation: 798 ft msl
Runway Surface Condition:
Runway Used: 5
IFR Approach: None
Runway Length/Width: 5001 ft / 100 ft 
VFR Approach/Landing: Forced landing; Traffic pattern

Wreckage and Impact Information

Crew Injuries: 1 Minor 
Aircraft Damage: Substantial
Passenger Injuries: 1 Minor 
Aircraft Fire: None
Ground Injuries: N/A 
Aircraft Explosion: None
Total Injuries: 2 Minor
Latitude, Longitude: 41.867778,-84.077224(est)



Controlled Flight into Terrain/Object (CFIT): Cessna TR182 Turbo Skylane RG, N736YU; fatal accident occurred January 11, 2020 in Billings, Yellowstone County, Montana






































\


David Gregory Healow

Rusty Jungels

Raymond Rumbold

Mikel Peterson 



Aviation Accident Final Report - National Transportation Safety Board

The National Transportation Safety Board traveled to the scene of this accident.

Additional Participating Entities:

Federal Aviation Administration / Flight Standards District Office; Helena, Montana
Textron Aviation; Wichita, Kansas
Lycoming Engines; Williamsport, Pennsylvania

Investigation Docket - National Transportation Safety Board:

Marginal Aviation LLC


Location: Billings, Montana
Accident Number: WPR20FA063
Date and Time: January 11, 2020, 18:01 Local 
Registration: N736YU
Aircraft: Cessna TR182 
Aircraft Damage: Destroyed
Defining Event: Controlled flight into terr/obj (CFIT)
Injuries: 4 Fatal
Flight Conducted Under: Part 91: General aviation - Personal

On January 11, 2020, at 1801 mountain standard time, a Cessna TR182 airplane, N736YU, was destroyed when it was involved in an accident near Billings, Montana. The pilot and three passengers were fatally injured. The airplane was operated as a Title 14 Code of Federal Regulations (CFR) Part 91 instructional flight.

The pilot’s wife reported that her husband planned to fly about 1630 and was expected to return to his home about 1730. According to Automatic dependent surveillance-broadcast (ADS-B) data, following its departure from Billings Logan International Airport (BIL), Billings, Montana, the airplane landed at Big Horn County Airport (00U), Hardin, Montana about 1715 and subsequently departed about 1740. Flight data retrieved from a multi-function display (MFD) on the airplane showed that the airplane began an immediate climb after it departed 00U and established its cruise altitude, about 4,796 ft msl at 1747:43 and maintained a similar altitude and a height above terrain (between 1,400 and 2,100 ft agl) for the remainder of the flight.

According to ADS-B data, the airplane then flew a straight track northwest towards Roundup, Montana (about 269° magnetic) until about 1753:53 when the airplane made a slight left turn to 257° and continued along this heading for the remainder of the recording. MFD data showed rising terrain about 40 seconds before the airplane crashed. The airplane was at an altitude of 4,954 ft msl (35 ft agl) when the data ended at 1801:22 about 1/2 nautical mile from the airplane’s initial impact point. The pilot’s wife contacted local law enforcement about 2000 when he did not return home.

According to the participants who flew with the accident pilot, he normally flew about 1,000 ft agl level over terrain and would use the autopilot “altitude hold” function for many flights. They also observed that he did not fly with a Federal Aviation Administration sectional chart as he relied mostly on the map on his MFD for terrain and chart information. 

According to the accident pilot’s business partner, based on a photograph taken by one of the rear seat passengers that had been sent to her during the accident flight, the accident pilot was in the right seat of the airplane during the accident flight. According to those who flew with the pilot, during these flights he would allow his passengers to fly the airplane from the left seat if they chose to and they would typically fly anywhere between 4,000 and 5,000 ft msl to destinations south, east, and north of the airport.

A passenger who flew with the accident pilot about one week prior to the accident reported that they flew to 00U, but then flew south and circled a landmark before returning to BIL. During the flight, they maintained an altitude of about 1,000 ft agl and used the autopilot for one leg of the flight. A review of other flight data retrieved from the MFD showed that the pilot typically flew at altitudes between about 1,000 and 2,000 ft agl during these flights.

The MFD flight data also showed that the pilot completed a leg from 00U to Roundup Airport (RPX), Roundup, Montana, several days before the accident. This track showed the airplane depart 00U about 1653 and flew a similar course as the accident flight. During cruise flight, the airplane passed within 0.3 nautical mile of the 185-ft radio tower that it impacted on the day of the accident. This part of the flight occurred at 1716 during cruise flight at an altitude of 4,680 ft msl (580 ft agl). The flight landed at RPX about 15 minutes later.

Pilot Information

Certificate: Airline transport; Commercial; Flight instructor
Age: 69, Male
Airplane Rating(s): Single-engine land; Multi-engine land
Seat Occupied: Right
Other Aircraft Rating(s): Glider; Helicopter
Restraint Used: Unknown
Instrument Rating(s): Airplane 
Second Pilot Present: No
Instructor Rating(s): Airplane single-engine; Instrument airplane
Toxicology Performed: Yes
Medical Certification: Class 2 With waivers/limitations 
Last FAA Medical Exam: August 7, 2018
Occupational Pilot: No
Last Flight Review or Equivalent:
Flight Time: 13800 hours (Total, all aircraft)

The co-owner of the accident airplane, who knew the accident pilot for 47 years, stated that the pilot started flying in 1972, that he did most of his flying and flight instructing in Billings, and was familiar with the area.

According to the pilot’s wife, the pilot was well rested on the day of the accident and did not exhibit any abnormal behavior that day or in the days that preceded the accident. 

Aircraft and Owner/Operator Information

Aircraft Make: Cessna 
Registration: N736YU
Model/Series: TR182 No Series 
Aircraft Category: Airplane
Year of Manufacture: 1978 
Amateur Built:
Airworthiness Certificate: Normal
Serial Number: R18200792
Landing Gear Type: Retractable - Tricycle 
Seats: 4
Date/Type of Last Inspection: January 3, 2019 Annual
Certified Max Gross Wt.: 3100 lbs
Time Since Last Inspection: 
Engines: 1 Reciprocating
Airframe Total Time: 3101.6 Hrs 
Engine Manufacturer: Lycoming Engines
ELT: Installed 
Engine Model/Series: O-540-L3C5D
Registered Owner: 
Rated Power: 235 Horsepower
Operator: 
Operating Certificate(s) Held: None

The airplane was equipped with an Aspen Evolution primary flight display (PFD and a Garmin GTN750 MFD. The Aspen Evolution was installed in front of the left seat occupant and drew barometric altitude information from its own internal air data computer, displaying that information on a digital tape on the right side of the display. The barometric altitude was adjustable by altimeter setting, which was displayed below the altitude tape. According to the Aspen installation manual, the altitude tape display should be within 40 ft of the calibrated test altitude. The altimeter setting at the time of the accident could not be determined as the Aspen unit did not record data. An Aspen MFD was located next to the PFD that was mounted to the instrument panel in front of the left seat occupant. Likewise, this unit did not record data.

The GTN750 was a touchscreen MFD mounted on the center instrument panel that was equipped with an obstacle range option and topography overlay available on the unit’s map page. According to a representative of the MFD manufacturer, the GPS altitude or “GSL” altitude, which is computed by satellite geometry, would have been displayed in the top left corner of the MFD’s map page. According to the Garmin pilot’s guide, the obstacle range could display unlighted obstacles below 1,000 ft agl. A representative from Garmin stated that the obstacle range would not have displayed obstructions below 200 ft agl.

The GTN750 also recorded pressure altitude and barometric altitude that was taken from the Aspen air data computer. The last data point recorded showed the barometric altitude was 4,954 ft msl and the GPS altitude was 4,747 ft GSL about the time of the accident. 

Meteorological Information and Flight Plan

Conditions at Accident Site: Visual (VMC)
Condition of Light: Night
Observation Facility, Elevation: 3662 ft msl
Distance from Accident Site: 27 Nautical Miles
Observation Time: 17:53 Local
Direction from Accident Site: 180°
Lowest Cloud Condition: Few / 12000 ft AGL
Visibility: 10 miles
Lowest Ceiling: Broken / 16000 ft AGL 
Visibility (RVR):
Wind Speed/Gusts: 14 knots / 
Turbulence Type Forecast/Actual:  /
Wind Direction: 240° 
Turbulence Severity Forecast/Actual:  /
Altimeter Setting: 29.65 inches Hg 
Temperature/Dew Point: -1°C / -10°C
Precipitation and Obscuration: No Obscuration; No Precipitation
Departure Point: Hardin, MT (00U)
Type of Flight Plan Filed: None
Destination: Roundup, MT (RPX) 
Type of Clearance: VFR flight following
Departure Time: 17:40 Local
Type of Airspace: Class E

Wreckage and Impact Information

Crew Injuries: 1 Fatal
Aircraft Damage: Destroyed
Passenger Injuries: 3 Fatal
Aircraft Fire: None
Ground Injuries: 
Aircraft Explosion: None
Total Injuries: 4 Fatal 
Latitude, Longitude: 46.232498,-108.36555

The airplane wreckage was located in mountainous terrain at an elevation of about 4,252 ft msl. All major sections of the airplane were accounted for at the accident site. The initial impact point was marked by several bent cross members and a broken guy wire about 65 ft high (4,809 ft msl) on an about 185-ft-tall radio tower, which was located on a peak with a field elevation of about 4,744 ft msl. Several sections of the outboard left wing (not shown in figure 1) were located about 100 ft north of the tower, and two pieces displayed longitudinal signatures consistent with impacting a wire. The remaining section of the left wing was found in the debris path about 350 ft from the main wreckage. Several airframe and engine fragments were distributed along the energy path, which was oriented on a heading of about 295º. The main wreckage was found about 1,450 ft northwest of the initial impact point in a coulee and included the right wing, fuselage, empennage, and engine. A 5-ft intermediate ground scar was located about 250 ft beyond the main wreckage.

The left wing was fragmented, and some sections were found near the tower. The control cables to the rudder, aileron, and elevator were recovered but exhibited multiple overload failures. The flap motor actuator measured 0.1 inch, consistent with a retracted flap position.

The engine crankshaft could only be partially rotated due to damage sustained during the impact. The ignition system displayed signatures consistent with normal operation and wear. Internal inspection of the case did not reveal any indications of oil starvation. The cylinder combustion chambers remained mechanically undamaged, and there was no evidence of foreign object ingestion or detonation.

Additional Information

Tower

According to FAA Advisory Circular 70/7460-1L, under Chapter 2.1 “Structures to be Marked or Lighted”: 

“Any temporary or permanent structure, including all appurtenances, that exceeds an overall height of 200 feet above ground level or exceeds any obstruction standard contained in 14 CFR Part 77 should be marked and/or lighted. However, an FAA aeronautical study may reveal that the absence of marking and/or lightning will not impair aviation safety. Conversely, the object may present such an
extraordinary hazard potential that higher standards may be recommended for increased conspicuity to ensure aviation safety.”

The excerpt continues to describe FAA action on structures that are less than 200 ft agl: “The FAA may also recommend marking and/or lighting a structure that does not exceed 200 ft above ground level or 14 CFR Part 77 standards because of its particular location.”

An FAA sectional chart valid from September 12, 2019, to March 26, 2020, did not list the tower as an obstacle. The FAA sectional chart legend lists the lowest obstruction marked on the sectional chart as “above 200 ft agl.” The maximum elevation figure for the sector of the sectional chart where the accident occurred was 5,100 ft msl.

Regulations for Obstructions and Minimum Safe Altitudes

According to 14 CFR 97.17, which contains the obstruction standards for navigable airspace:

“An existing object…would be an obstruction to air navigation if it is of greater height than any of the following heights or surfaces… (2) A height that is 200 ft AGL or above the established airport elevation…”

Title 14 CFR 91.119 provides the general minimum safe altitudes for operating an aircraft. According to the regulation:

“Except when necessary for takeoff and landing, no person may operate an aircraft below the following altitudes… (c) Over other than congested areas. An altitude of 500 feet above the surface, except over open water or sparsely populated areas. In those cases, the aircraft may not be operated closer than 500 feet to any person, vessel, vehicles, or structure.”