Aviation Accident Summaries

Aviation Accident Summary MIA05FA044

Weston, FL, USA

Aircraft #1

N6195N

Cessna 210N

Analysis

A witness who was driving a car westbound on Interstate 75, stated that he observed the lights of an airplane in the night sky, and noted that the airplane descended at a steep descent angle, while proceeding from north to south, and it disappeared below his horizon. The witness further stated at that time it was raining intensely, was very windy, and the visibility had been greatly reduced. Emergency personnel responded, and the wreckage was found in about 3 feet of swamp water and sawgrass. At 1958:28, the pilot communicated with the Fort Lauderdale North Departure Controller, stating, "flight express one zero six level three thousand golf at Opa Locka." At 1957:28, the controller responded, "flight express one oh six fly heading one ah nine zero vectors for Opa Locka." At 1957:32, the pilot acknowledged, saying, "one nine zero degrees express one zero six." At 1959:33, the controller stated "flight express oh one zero six descend and maintain two thousand", and the pilot responded " down to two thousand flight express one oh six." At 2001:15, the controller stated " flight express one zero six contact Miami approach on one two five point five", and at 2001:19, the pilot responded, "twenty five five flight express one oh six." At 2001:51, the pilot stated, "Miami approach flight express one zero six level two thousand", and at 2001:56, the Miami South Departure Radar Controller responded, "flight express one oh six Miami approach good evening." At 2005:27, the controller stated "flight express one oh six Miami, and there was no response. Subsequent attempts by the controller to communicate with the flight yielded negative results. Radar data showed that after receiving instructions to descend and maintain 2000 feet, the pilot maintained 2,000 feet for about 9 seconds. The data then showed the airplane at an altitude of 1,900 feet for about 2 minutes and 25 seconds, after which the data showed the airplane to be in a gradual descent. At 2005:15 the last reliable radar data showed the airplane at 800 feet. The radar data also showed the pilot to be on a near steady southerly heading during the flight leg. The debris field was about 100 yards long, oriented on a southerly direction, and the sawgrass had been slashed consistent with a descent to the northern-most impact point. After recovery from the swamp, postcrash examination of the airframe, flight controls, and engine did not reveal any preaccident anomalies. A weather study conducted by the NTSB showed that at about the time of the accident, cloud bases were near 1,600 feet, and cloud tops were above 7,000 feet, with higher clouds above. The flight visibility was 0 miles in clouds and about 10 miles below the lowest cloud base. Conditions were also determined to be conducive to light turbulence below 5,000 feet, and the weather radar displayed echoes consistent with light rain being present.

Factual Information

HISTORY OF FLIGHT On December 31, 2004, about 2005 eastern standard time, a Cessna 210N, N6195N, registered to and operated by Flight Express Incorporated, as Express flight 106, a Title 14 CFR Part 91 positioning flight from Orlando, Florida, to Opa Locka, Florida, crashed into the Florida Everglades, west of Fort Lauderdale, Florida. Night instrument meteorological conditions prevailed in the area at the time, and an instrument flight rules flight plan was filed. The commercial-rated pilot received fatal injuries, and the airplane was destroyed. The airplane departed from Orlando Executive Airport, the same day, about 1900. According to information obtained from the FAA, Miami Approach Control, the accident airplane was en route to Opa Locka Airport, Opa Locka, Florida, when the accident occurred. Preceding the accident, at 1958:28, the pilot communicated with the Fort Lauderdale North Departure Controller, stating, "flight express one zero six level three thousand golf at Opa Locka." At 1957:28, the controller responded, "flight express one oh six fly heading one ah nine zero vectors for Opa Locka." At 1957:32, the pilot acknowledged, saying, "one nine zero degrees express one zero six." At 1959:33, the controller stated "flight express oh one zero six descend and maintain two thousand", and the pilot responded " down to two thousand flight express one oh six." At 2001:15, the controller stated " flight express one zero six contact Miami approach on one two five point five", and at 2001:19, the pilot responded, "twenty five five flight express one oh six." At 2001:51, the pilot stated, "Miami approach flight express one zero six level two thousand", and at 2001:56, the Miami South Departure Radar Controller responded, "flight express one oh six Miami approach good evening." At 2005:27, the controller stated "flight express one oh six Miami, and there was no response. Subsequent attempts by the controller to communicate with the flight yielded negative results. According to FAA Miami Approach Control, recorded radar information, at 1959:44, the airplane had been at 2,900 feet, and subsequent data showed it in a continued descent. At 2001:48 the airplane was at 2,000 feet, and the data showed it at a constant altitude of 2,000 feet until 2001:58. At 2002:03 the airplane was at 1,900 feet , and it remained at 1,900 feet until 2004:28. At 2004:33 and 2004:38 the airplane was at an altitude of 1,800 feet, and at 2004:43 it was at 1,700 feet. At 2004:48 the airplane was at 1,600 feet. Discrete radar data for the consecutive time segments of 2004:53, 2004:58, 2005:03, 2005:08, and 2005:13 showed the airplane at 1,100 feet. The airplane was last observed on radar at an altitude of 800 feet. The radar data showed the airplane to be on a steady southerly heading with slight variations of 197 to 200 degrees throughout the flight leg. U.S. Coast Guard and Broward County emergency personnel received the report of an airplane crash having occurred, and responded to the reported position. The main wreckage of N6195N was located in the Florida Everglades, about 21 miles west of Fort Lauderdale, Florida, in geographic position 26 degrees 08.256 minutes North Latitude, 080 degrees 31.757 minutes West Longitude, in about 3 feet of swamp water and sawgrass, about 1 mile south of I-75 in the vicinity of mile marker 28. A witness who was driving a car westbound on Interstate 75, stated that he observed the lights of an airplane in the night sky, and noted that the airplane descended at a steep descent angle, while proceeding from north to south, and it disappeared below his horizon. The witness further stated at that time it was raining intensely, was very windy, and the visibility had been greatly reduced. He said that after seeing the airplane descend and disappear from sight he telephoned "911," and reported the accident. PERSONNEL INFORMATION Records obtained from the FAA Airman Records Branch, Oklahoma City, Oklahoma, showed that the pilot held an FAA commercial pilot certificate, with airplane single and multiengine land and instrument ratings. He also held an FAA certified flight instructor certificate with airplane single and multi-engine and instrument ratings, as well as an advanced ground instructor instrument certificate both of which were issued on July 9, 2004. He held an FAA first class medical certificate, issued on July 20, 2004, with the limitation "holder must wear corrective lenses." Records obtained from the operator showed that the pilot had accumulated about 1,943 flight hours, of which about 316 hours were in the Cessna 210 airplane. About 267 hours had been flown in the last 90 days, and 83 hours were flown in the last 30 days. Documentation obtained from the operator showed that on December 28, 29, and 30, 2005, the days immediately preceding the accident date, each day the pilot began duty at 1730, and terminated at 2350. AIRCRAFT INFORMATION N6195N was a Cessna 210N, serial number 21062966. It was outfitted to carry cargo, and was equipped with only one seat. The airplane did not have any cargo aboard at the time of the accident. The engine was a Teledyne Continental IO-520-L47B reciprocating engine, rated at 300 horsepower, serial number 295267. The engine had accumulated a total flight time of 1,016.4 hours at the time of the accident. The airplane was also equipped with a three-bladed McCauley D3A34C404 propeller. which had accumulated about 586.8 hours. The airplane's maintenance records showed that it had last received an annual inspection on August 18, 2004, and had received a 100-hour inspection on December 31, 2004, the day of the accident. At the time of the accident, the airplane had accumulated about 15,399.4 hours. The maintenance records also indicated that the airplane had last received a pitot static system, altimeter, and transponder/encoder check on March 11, 2003. METEOROLOGICAL INFORMATION The Fort Lauderdale Executive Airport, Fort Lauderdale, Florida, 2009, surface weather observation, was few clouds at 2,100 feet, ceiling was broken at 2,800 feet, overcast at 7,500 feet, surface wind 110 degrees at 8 knots, and the visibility was 7 statue miles. The temperature was 21 degrees Celsius, the dew point temperature was 19 degrees Celsius, and the altimeter was 30.29 inHg. The NTSB conducted a meteorological study, and based upon information obtained, at the time of the accident cloud bases were determined to be near 1,600 feet with tops above 7,000 feet, as well as higher clouds being above. The flight visibility was 0 miles in the clouds, and almost 10 miles below the lowest cloud base. Conditions were also determined to be conducive to the presence of light turbulence below 5,000 feet, and the freezing level was above 14,000 feet. Weather radar displayed echoes consistent with light rain being present. According to the study, the Miami, Florida, Doppler Weather Radar images showed weak weather radar echoes in the area of the accident. WRECKAGE AND IMPACT INFORMATION The main wreckage of N6195N was located in the Florida Everglades, about 21 miles west of Fort Lauderdale, Florida, in an area of swamp water and sawgrass, about 1 mile south of I-75 in the vicinity of mile marker 28. The debris field was about 100 yards long, oriented in a southerly direction, with the engine at the southern extremity of the debris field. When viewed from the side in a profile view, the sawgrass had been cut in a level swath, with the descent to the surface of the swamp being evident, and coinciding with the northern most extremity of the debris field. Major components of the airplane were accounted for at the accident site, and there was no evidence of a fire having occurred. After recovery from the swamp, the NTSB and a manufacturer's technical representative from Cessna Airplane Company examined the accident airplane. The cabin area had been crushed consistent with impact forces, and the seat back being broken and bent aft. Of the cockpit instruments that were recovered, the altimeter had incurred impact damage and displayed an altitude of 627 feet, and the barometric pressure reading in the Kollsman window was 30.30 inHg; the airspeed indicator, rpm, suction gauge, cylinder head temperature, and oil temperature gauge pointers all read 0, and pointed to the bottom of their respective scales. The oil pressure gauge had broken, its glass was missing, and the pointer was at the bottom of the green arc. The localizer and ADF indicators displayed 100 and 016 degrees respectively. The empennage had separated from the remainder of the fuselage, and was located in about the center of the debris path. There was damage to the leading edge of the vertical stabilizer and there was some buckling noted on both sides. Both the right and left horizontal stabilizers exhibited skin damage, with the left horizontal stabilizer also having torn and separated at the root area. The rudder had remained attached to the stabilizer and it displayed slight buckling on both sides. The elevator had separated from the horizontal stabilizer and also had damage on both sides. According to the aircraft manufacturer's representative, examination of the landing gear actuator showed that the landing gear was in the retracted position, however the gear had incurred damage consistent with the impact forces. The flap actuator was indicative of the flaps having been extended to 30-degree down, extended position. Flight control cable continuity was not confirmed due to the extensive impact damage, and the control cables had separated consistent with overload. The right wing separated from the main fuselage at the wing root area, and was found at the site folded forward of the fuselage and had flipped upside down. The leading edge of the wing sustained impact damage forward of the flap. The wing was also significantly torn and twisted aft, from mid span, outboard. The left wing had remained attached to the fuselage and the leading edge displayed an area of impact damage forward of the flap. The section of the wing from the flap, outboard exhibited twisting and compression damage. In addition, the flap had twisted and had torn exhibiting damage inboard, close to the fuselage. The aileron remained attached to the wing, but had also incurred bucking damage, and had twisted. The airplane's windshield was not located, and no evidence of bird remains was found at the accident site. The propeller showed no evidence of preimpact failure or malfunction. The spinner, the two-bladed propeller, and the hub assembly had separated from the engine as a unit, with the propeller bolts having been pulled out from the hub, and the damage was consistent with overstress. Both propeller blades exhibited bending and twisting signatures with one blade displaying more leading edge damage, twisting, and "S" bending than the other propeller blade. Examination of the engine and accessories showed that all four engine mounts had separated, and one mount was missing. The crankshaft flange was noted to be bent, and the propeller governor had separated. The propeller drive gear and propeller governor screen were in good condition and the screen was clean. The front lower case had separated and the propeller drive gear was exposed. The oil cooler had separated The No. 6 cylinder flanges were distorted, and the cooling fins were damaged and some were missing. The rocker cover had also been broken consistent with impact. The No. 4 and No. 2 cylinders were intact but had incurred some damage. The No. 3 rocker cover had a hole and had some damage to the cooling fins. The No. 1 and No. 3 cylinder was intact, and had little damage. The lower right hand side induction system had cracked at the No. 3 cylinder, and both exhausts had been crushed but were in place. In addition, the rear section of the induction system had separated, and was missing. The alternator was also missing after having separated at the bracket. The alternator drive pulley had separated and the adjustment rod was present, but had incurred damage. After removal of the No. 6 rocker cover. the crankshaft was rotated and compression was noted on all cylinders. There was rotation through to the back of the accessory case and proper valve action was observed. When the No. 6 valve cover and rocker were removed, No. 6 exhaust side push rod was found to be bent, consistent with the governor having sheared during impact. The fuel system displayed no preaccident anomalies, and the spider and nozzles were intact. The main fuel line off the fuel pump to the distributor had separated at the fuel pump. The fuel servo had separated from the engine. The fuel lines and the fuel manifold valve contained a fluid which was consistent with aviation fuel. The fuel injectors were removed, and there was fuel present, with no blockages being noted. The engine driven fuel pump was rotated freely, had its drive pin intact, and when opened the blades were intact, and water and fuel were found in the pump body. The fuel selector valve was not recovered. The left and right magnetos were intact, and displayed little impact damage. The magneto ground leads had been pulled off both magnetos. The right magneto was full of water however the gear and drive bushings displayed no anomalies. Magnetos were placed to dry, and were tested and found to produce a spark on all terminals. The ignition harness incurred damage, consistent with the impact. Maintenance records indicated that the vacuum pump had recently been installed, and it was found to be in place. When examined, the drive would not turn, and the unit was torn down and found to have water inside, with no anomalies being noted. MEDICAL AND PATHOLOGICAL INFORMATION On January 1, 2005, a Medical Examiner with the Broward County Medical Examiner's Office, performed a postmortem examination of the pilot. The cause of death was attributed to blunt force trauma. No findings, which could be considered causal to the accident, were reported. The Broward County Medical Examiner's Office conducted toxicology testing on specimens obtained from the pilot. The tests were negative for drugs, ethanol and carbon monoxide. In addition, the FAA Toxicological Laboratory, Oklahoma City, Oklahoma, conducted toxicological tests on samples obtained from the pilot. The tests were negative for carbon monoxide, cyanide, volatiles, and drugs. ADDITIONAL INFORMATATION On January 4, 2005, the NTSB released the wreckage of N6195N to Mr. Larry Addison, Air and Sea Crash Recovery.

Probable Cause and Findings

The pilot's failure to maintain his assigned altitude, and allowed the airplane to descend for undetermined reasons resulting in an in-flight collision with terrain. Factors in the accident were clouds, rain, and the dark night.

 

Source: NTSB Aviation Accident Database

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