Aviation Accident Summaries

Aviation Accident Summary ERA21LA035

Ellicott, NY, USA

Aircraft #1

N791GA

GRUMMAN GA7

Analysis

The pilot rented the airplane and completed a long cross-country flight 4 days before the accident. Before the return (accident) flight, the pilot discussed weather decisions and avoiding icing conditions with his flight instructor via telephone. The instructor subsequently checked a commercial website and realized that the pilot had departed on the return flight. He hoped that the pilot would divert due to the poor weather conditions and sent him a text message to that effect. Review of air traffic control data revealed that, while approaching the destination airport, the pilot provided a pilot report indicating that the airplane was in and out of clouds, updrafts, downdrafts, snow, and light-to-moderate turbulence. The pilot then flew an instrument approach to the destination airport, but radar contact was lost while the airplane was on a 1-mile final approach to the runway. Review of the last 1 minute of data revealed an approximate 500 ft-per-minute descent, consistent with the pilot’s descent on the instrument approach. A witness who lived near the airport reported that he could not see well due to wind and snow and did not initially hear the airplane. He then heard loud engine noise for 10 to 15 seconds followed by silence. The wreckage was located the following day about 1/2 mile from the runway threshold. The wreckage path was consistent with a gradual descent into trees. Examination of the airframe, engines, and recorded data did not reveal any preimpact mechanical malfunctions. The last automatic dependent surveillance-broadcast target indicated an altitude of 2,250 ft mean sea level (msl), which was 527 ft above airport elevation. The recorded weather at the airport 2 minutes after the accident included scattered clouds at 500 ft above ground level and 3/4-mile visibility in light snow and mist. Review of the instrument approach chart revealed a minimum descent altitude of 2,100 ft msl at a distance of 1.1 miles (with minimum visibility 1/2 mile) from the airport with a local altimeter setting and no vertical guidance. If vertical guidance was used on the GPS, the minimum descent altitude was 1,921 ft msl (with minimum visibility 1/2 mile) with local altimeter setting. Although the last target was recorded about 1 mile from the runway threshold and the wreckage was located about 1/2 mile from the runway threshold, there were no data available from the last target to the wreckage. The pilot’s logbook was not recovered, and neither his total time nor his recent instrument flight rules experience could be determined. The circumstances of the accident are consistent with the pilot’s continued descent below the minimum descent altitude while conducting an instrument approach in instrument meteorological conditions, which resulted in controlled flight into terrain.

Factual Information

HISTORY OF FLIGHTOn November 1, 2020, about 1748 eastern daylight time, a Grumman American GA-7, N791GA, was destroyed when it was involved in an accident near Ellicott, New York. The pilot and two passengers were fatally injured. The airplane was operated as a Title 14 Code of Federal Regulations Part 91 personal flight. The airplane was based at Chautauqua County/Jamestown Airport (JHW), Jamestown, New York. The pilot rented the airplane and flew uneventfully from JHW to Burlington-Alamance Regional Airport (BUY), Burlington, North Carolina, on October 28, 2020. According to the pilot’s flight instructor, they spoke via telephone before the accident flight and discussed weather decisions and avoiding icing conditions. The instructor then checked a commercial website and realized that the pilot had departed on the return flight to JHW. He hoped that the pilot would divert and sent him a text message to that effect. The instructor subsequently drove to the airport and listened to air traffic control communications as well as common traffic advisory frequency communication (CTAF). The instructor did not hear any communications on the CTAF and added that the weather conditions were conducive to in-flight icing. According to air traffic control data provided by the Federal Aviation Administration (FAA), a controller asked for a pilot report while the airplane was in-bound to JHW. The pilot did not report ice accumulation, but reported being in and out of clouds, updrafts, downdrafts, snow, and light-to-moderate turbulence. The pilot requested and was cleared for the RNAV RWY 25 approach to JHW. Radar contact was lost about 1 mile northeast of the runway 25 threshold (consistent with a 1-mile final approach to runway 25) and no further communications were received from the accident airplane. Review of the last 1 minute of data revealed a descent from 2,750 ft mean sea level (msl) to 2,250 msl, consistent with a descent on the approach. (see figure 1.) Figure 1. Flightpath while on final approach to runway 25 at JHW. A witness who lived near the airport reported that he was in a tree stand for hunting purposes. The witness could not see well due to wind and snow and did not initially hear the airplane. He then heard loud engine noise for 10 to 15 seconds, followed by silence. The tree stand was located about 3/4 mile northeast of the accident site. Later that evening, the witness was notified that there had been an airplane accident and he assisted first responders in their search for the airplane. The witness subsequently observed tops of trees severed near where he heard the engine noise increase. The severed trees were located about 1/4 mile east of where the wreckage was located. PERSONNEL INFORMATIONThe pilot’s logbook was not recovered. According to an insurance application dated October 2018, the pilot had accrued 1,082 total hours of flight experience; of which 37 hours were in actual instrument meteorological conditions (IMC). The pilot’s total and recent IMC experience at the time of the accident could not be determined. METEOROLOGICAL INFORMATIONThe pilot obtained weather briefings via a commercial weather service. For more information, see Weather Factual Report in the public docket for this investigation. The weather conditions reported at JHW at 1750 (about 2 minutes after the accident) included wind from 280° at 20 knots with gusts to 30 knots, visibility 3/4 statute miles in light snow and mist, scattered clouds at 500 ft above ground level (agl), a broken ceiling at 1,000 ft agl, an overcast ceiling at 1,700 ft agl, a temperature of -1°C, a dew point of -2°C, and an altimeter setting of 29.85 inches of mercury. The remarks of the weather observation noted a peak wind from 270° at 30 knots at 1747, ceiling varying between 800 and 1,300 ft agl, 0.01 inches of precipitation since 1656, the freezing rain sensor was not operating, and the runway visual range sensor was not operating. WRECKAGE AND IMPACT INFORMATIONThe wreckage was located the following day in a wooded area about 1/2 mile from the approach end of runway 25. The wreckage came to rest upright, and the left engine had separated. The wreckage was fragmented, but all major components of the airplane were accounted for at the scene. The wreckage was examined following recovery. Both outer wing sections had separated, the empennage separated, and the cockpit was destroyed. The landing gear was extended and the preimpact flap position could not be determined. The elevator trim tab was in a position consistent with cruise flight. Flight control continuity could not be verified due to fragmentation, but all cable breaks were consistent with overload during the impact. The fuel selectors could not be located. Examination of the airframe did not reveal any preimpact mechanical anomalies. A Garmin GDU 700L was recovered and data successfully downloaded. The unit did not record flight parameters, but recorded engine parameters. Examination of both engines and review of the recorded engine data did not reveal any preimpact mechanical anomalies. Both propeller blades remained attached to the left engine propeller hub. One blade exhibited leading edge gouges, chordwise scratching and tip curling. The other blade exhibited s-bending, leading edge gouges and tip curling. Both propeller blades also remained attached to the right engine propeller hub. Both propeller blades exhibited leading edge gouging and chordwise scratching. ADDITIONAL INFORMATIONThe last automatic dependent surveillance-broadcast (ADS-B) target was recorded at 1747:44, about 1 mile from the runway threshold, indicating an altitude of 2,250 ft msl, 527 ft above airport elevation. Review of the instrument approach procedure for the JHW RNAV (GPS) RWY 25 revealed a minimum descent altitude of 2,100 ft msl at a distance of 1.1 miles (with minimum visibility 1/2 mile) from the airport with a local altimeter setting and no vertical guidance. If vertical guidance was used on the GPS, the minimum descent altitude was 1,921 ft msl (with minimum visibility 1/2 mile) with local altimeter setting. Although the last ADS-B target was recorded about 1 mile from the runway threshold and the wreckage was located about 1/2 mile from the runway threshold, there was no data available from the last ADS-B target to the wreckage. MEDICAL AND PATHOLOGICAL INFORMATIONAn autopsy was performed on the pilot by the Erie County Medical Examiner’s Office, Buffalo, New York. The cause of death was multiple blunt force injuries. Toxicology testing was performed by the FAA’s Forensic Sciences Laboratory. The results were negative for drugs and alcohol.

Probable Cause and Findings

The pilot’s continued descent below the minimum descent altitude while conducting an instrument approach in instrument meteorological conditions, which resulted in controlled flight into terrain.

 

Source: NTSB Aviation Accident Database

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