Aviation Accident Summaries

Aviation Accident Summary NYC05FA109

Groton, CT, USA

Aircraft #1

N5155N

Cessna 182Q

Analysis

The airplane impacted water during its second ILS (Instrument Landing System) approach to runway 5. Review of recorded radar data revealed that during the first approach, the airplane made several excursions to the right and left of the inbound course centerline. A tower controller observed the airplane "break out" of the clouds at 200 feet, left of the runway centerline. The airplane appeared to be headed straight for the control tower when the flight radioed a request to conduct a "circle to land." The airplane then continued into a cloud layer, and the controller instructed the pilot to "execute the published missed approach." The last radar target recorded prior to initiation of the missed approach placed the airplane at a Mode C altitude of 100 feet msl, about 1/2 mile from the runway threshold and 1/2 mile left of the course centerline. The flight was instructed to contact approach control and then received vectors for a second ILS approach. About 30 minutes later, the airplane was again established on the ILS Runway 5 approach. The tower controller cleared the flight to land, which was acknowledged. The tower controller then observed a target on his radar scope, identified as the accident airplane, that appeared to be left of the final approach course. The controller informed the flight that the airplane was left of course; however, no response was received. Radar data for the second approach showed a track similar to the first approach with several excursions to the right and left of the inbound course centerline. The last recorded radar hit placed the airplane at a mode C altitude of 400 feet msl, about 1 and 1/2 miles from the runway threshold and slightly left of course. Several witnesses in the area of the accident site recalled hearing an airplane about the time of the accident. The engine sounded normal, until rpm increased, followed by the sound of an impact. None of the witnesses observed the airplane due to the low visibility in the area. About 8 minutes after the accident, a floating debris field was located about 1.15 miles from the approach end of runway 5, on a 051-degree bearing. Pilots who had conducted approaches to runway 5, both prior to and after the accident airplane's first approach to the runway, recalled breaking out of the cloud layer around 200 to 250 feet above the ground. None of the pilots recalled any abnormalities with the ILS while conducting an approach to runway 5. Damage observed on the recovered wreckage was consistent with the airplane impacting the water in an uncontrolled descent. Examination of the recovered wreckage revealed no evidence suggesting mechanical malfunction or failure.

Factual Information

HISTORY OF FLIGHT On June 27, 2005, at 1320 eastern daylight time, a Cessna 182Q, N5155N, was destroyed when it impacted water following a loss of control while on approach to the Groton/New London Airport (GON), Groton, Connecticut. The airplane was registered to and operated by the pilot. The commercial pilot, pilot-rated passenger, and two other passengers were fatally injured. Instrument meteorological conditions prevailed, and an instrument flight rules (IFR) flight plan was filed for the flight that originated from the Portland International Jetport (PWM), Portland, Maine, about 1130. The personal flight was conducted under 14 CFR Part 91. Review of air traffic control (ATC) transcripts, recordings, and interviews with air traffic controllers from Groton tower revealed that the accident airplane conducted two ILS (Instrument Landing System) approaches to runway 5. On the first approach, approximately 1250, the pilot-rated passenger initially transmitted to the GON tower "…skylane five five november with you." The controller questioned the pilot-rated passenger if they were associated with the Rotarian Club, which the pilot-rated passenger replied "affirmative." The controller subsequently cleared the flight to land. About 2 minutes later, a tower controller observed the airplane "break out" of the clouds at 200 feet, left of the runway centerline. The airplane appeared to be headed straight for the control tower when the pilot-rated passenger radioed a request to conduct a "circle to land." The airplane then continued into a cloud layer, and the air traffic controller instructed the flight to "execute the published missed approach," which was acknowledged. The flight was instructed to contact Providence Approach Control and then received vectors for a second ILS approach. At 1315:34, the flight was cleared for the ILS Runway 5 approach. The flight was instructed to continue the approach, and then at 1318:27, cleared to land, which was acknowledged. The tower controller then observed a target on his radar scope, identified as the accident airplane, that appeared to be left of the final approach course. At 1320:54, the controller informed the flight that the airplane was left of course; however, no response was received. Review of recorded radar data revealed that during the first approach to GON, the airplane made several excursions to the right and left of the inbound course centerline. The last radar target recorded prior to the missed approach at 1252:56 placed the airplane at a Mode C altitude of 100 feet msl, about 1/2 mile from the runway threshold and 1/2 mile left of the course centerline. Radar data for the second approach showed a track similar to the first approach with several excursions to the right and left of the inbound course centerline. The last recorded radar hit at 1320:44 placed the airplane at a Mode C altitude of 400 feet msl, about 1 and 1/2 miles from the runway threshold and slightly left of course. Several witnesses in the area of the accident site recalled hearing an airplane about the time of the accident. The engine sounded normal, until rpm began to increase, followed by the sound of an impact. None of the witnesses observed the airplane due to the low visibility in the area. Pilots who had conducted approaches to runway 5, both prior to and after the accident airplane's first approach to the runway, recalled breaking out of the cloud layer around 200 to 250 feet above the ground. None of the pilots recalled any abnormalities with the ILS while conducting an approach to runway 5. About 8 minutes after the accident, United States Coast Guard personnel and private vessels located a floating debris field about 1.15 miles from the approach end of runway 5, on a 051-degree bearing. The main wreckage, which consisted of the main cabin and empennage, was located on June 29, 2005, about 300 feet southeast of the floating debris field, in 24 feet of tidal water. The engine was separated from the fuselage, and came to rest about 80 feet beyond the main wreckage. The two-bladed propeller assembly was separated from the engine. Both blades remained attached to the hub, and came to rest near the engine. The engine and propeller were recovered on June 30, 2005. The accident occurred during the hours of daylight, at 41 degrees, 18.57 minutes north longitude, 72 degrees, 03.78 minutes west latitude. PERSONNEL INFORMATION The pilot held a commercial pilot certificate for airplane single-engine and multi-engine land, and instrument airplane. The pilot's most recent application for a Federal Aviation Administration (FAA) second class medical certificate was dated September 21, 2004. Review of the pilot's logbook revealed that he had accumulated about 1,407 hours of total flight experience. Additionally, the logbook indicated the pilot had logged 58.2 hours of actual instrument flight time and 48.0 hours of simulated instrument flight time. He successfully completed the flight test for a commercial multi-engine instrument airplane rating on September 29, 2004. Since that flight test, the pilot had logged 9.5 hours of actual instrument flight time. The pilot-rated passenger held a private pilot certificate for airplane single-engine land. She was not instrument rated. The pilot's most recent application for a FAA third class medical certificate was dated on September 21, 2004. Review of the pilot's logbook revealed that she had accumulated about 544 hours of total flight experience. AIRCRAFT INFORMATION According to the logbooks for the airplane, the most recent annual inspection was completed on May 30, 2004. On that date, the tachometer time was recorded as 442.6 hours, and the airplane had accumulated 2,195.3 total hours of operation. In addition, the last documented engine oil and oil filter change was completed on October 8, 2004. On that date, the tachometer time was recorded as 503.5 hours, and the engine had accumulated 310.3 hours since major overhaul. The last maintenance action on the airplane entered in the logbooks was dated on May 23, 2005, at a tachometer time of 536.5 hours, when a landing gear part was removed and replaced. No records of an annual inspection being performed on the airplane in 2005 were located during the investigation. Review of the available maintenance records indicated the airplane's most recent 14 CFR Part 91.411 IFR certification of the altimeter, encoder, and static system took place in July 2001. METEOROLOGICAL INFORMATION The 1256 weather observation reported at GON included wind variable at 5 knots; 10 statute miles of visibility; an overcast cloud layer at 500 feet agl; temperature of 24 degrees Celsius; dew point of 22 degrees Celsius; and an altimeter setting of 30.25 inches of mercury. The 1327 weather observation reported at GON included calm winds; 5 statute miles of visibility; mist; an overcast cloud layer at 200 feet agl; temperature of 23 degrees Celsius; dew point of 21 degrees Celsius; and an altimeter setting of 30.25 inches of mercury. Both of the reports also included a note that the visibility to the south was 1 statute mile. AIRPORT INFORMATION The airport elevation at GON was 9 feet msl. AIDS TO NAVIGATION Review of the approach plate for the ILS Runway 5 approach at GON revealed that the final approach fix (FAF), identified as PINET intersection, was located 6.3 miles from the runway 5 threshold. The minimum crossing altitude at PINET was 1,777 feet msl. The minimums for the straight-in approach were 1/2 statute mile of visibility, and a minimum decision altitude of 208 feet msl (200 feet agl). The missed approach procedure was: climb to 2,000 feet, via the GON 062-degree radial to the BABET intersection, and hold. WRECKAGE AND IMPACT INFORMATION The wreckage was examined at a secured facility on June 28 to 30, 2005, under the supervision of a Safety Board investigator by representatives from the FAA, Cessna Aircraft, and Teledyne Continental Motors. The empennage, which included the vertical stabilizer, horizontal stabilizers, and the rudder, remained attached to the main fuselage by control cables. The elevator trim was observed in the approximate neutral position. About a 5-foot inboard section of the right wing was recovered. The leading edge of the wing section exhibited rearward accordion crush damage. Examination of the electrically driven wing flap jackscrew actuator installed in the wing revealed that the measured actuator jackscrew was consistent with the flaps being in the retracted position. The left wing was not located. Examination of the flight and trim control cable circuits and associated hardware did not reveal any evidence of a preexisting jam or failure. Examination of the cockpit area revealed that the pilot's airspeed indicator displayed a reading of 150 knots. The altimeter displayed a reading of 4,900 feet. The Kollsman window displayed an altimeter setting of 30.31 inches of mercury. The vertical speed indicator displayed a negative rate reading of 500 feet per minute. The horizontal situational indicator (HSI) was aligned to 050 degrees, and selected to a frequency of 111.30. The HSI heading bug was set to 049 degrees. The number 2 navigation radio course deviation indicator was set to 045 degrees. The turn coordinator displayed an inverted, right wing low, attitude. The primary attitude indicator face was destroyed. The engine tachometer gauge displayed a reading of 950 rpm, and 640.1 hours. The manifold pressure gauge displayed a reading of 32 inches of mercury. All other engine instruments gauge needles were deflected full scale left. The Hobbs meter displayed a reading of 1,542.5 hours. The throttle control was separated from the instrument panel and engine. The mixture control was positioned 3/4 inches out from the full rich setting. The propeller control was not recovered. The carburetor heat control was positioned to the "cold" setting. The engine cowl flap selector was set to the retracted position. The fuel selector valve was observed in the "BOTH" position. The engine was rotated through the crankshaft propeller flange. Thumb compression and valve train continuity was confirmed to all cylinders. The top and bottom spark plugs of all cylinder heads were removed; their electrodes were intact and light gray in color; however, they were contaminated with salt water. Both the left and right magnetos were removed from the engine case. The magnetos were water soaked. When rotated by hand, the right magneto only sparked on the number 5 lead. The left magneto could not be sparked. Disassembly of the carburetor revealed residual fuel remaining in the bowl. When the carburetor accelerator pump was actuated, fuel was observed. The carburetor finger screen was absent of debris. Residual oil was present throughout the engine, and no metal contamination was observed in the oil or oil filter element. The oil pump assembly was intact, and no damage was noted. The oil sump pickup screen was absent of debris. Internal examination of each cylinder was conducted using a lighted borescope. No abnormalities were observed to the valves, top surfaces of each piston, or the cylinder walls. However, debris was noted in the combustion area. The vacuum pump was removed from the engine. When rotated, suction from the inlet and outlet lines were observed. Disassembly of the pumps did not reveal any abnormalities. Examination of the propeller assembly revealed that one blade displayed s-bending, The other blade was bent rearward approximately 9-inches from the hub. Both blades exhibited leading edge nicks, and span-wise scratching. The propeller assembly spinner cap was crushed inward and twisted. The propeller governor was not recovered. Examination of all recovered electrical wiring and components did not reveal any evidence of arcing or fire. The circuit breaker panel was deformed and impact damaged. All of the recovered baggage from the accident airplane was weighed in the condition as received. The baggage was soaked with water. The total weight of the baggage was approximately 285 pounds. MEDICAL AND PATHOLOGICAL INFORMATION The Office of the Chief Medical Examiner, Farmington, Connecticut, performed autopsies on the pilot and pilot-rated passenger. The FAA Toxicology and Accident Research Laboratory, Oklahoma City, Oklahoma conducted toxicological testing on the pilot and pilot-rated passenger. The tests were negative for carbon monoxide, cyanide, ethanol, and drugs. ADDITIONAL INFORMATION The airplane wreckage was released on June 30, 2005, at the completion of the wreckage examination. No parts were retained.

Probable Cause and Findings

The pilot's failure to maintain aircraft control while executing an ILS (Instrument Landing System) approach to minimums.

 

Source: NTSB Aviation Accident Database

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