Whitethorn, CA, USA
N9904E
Cessna 182P
The airplane impacted a mountain about 1 nautical mile from the departure airport during the en route climb phase of an instrument departure. The airport is on the coast next to the ocean with mountains immediately adjacent to the east that rise to 3,000 feet msl. A witness saw the airplane depart to the south in dense fog with the ground visibility less than 1/4-mile and follow the coastline until entering the fog layer. The witness noted that the direction of flight was unusual; typically, airplanes depart to the north, then turn left over the ocean to avoid the mountains. After the airplane entered the fog layer it climbed to about 500 to 700 feet above ground level (agl) and then made a 90-degree turn to the left toward the mountains. The airspace overlying the airport is Class G and there is no radar coverage in the area below 6,000 feet. The left-seated pilot held an instrument rating; the right-seated pilot did not. Both pilots had made flights together to this airport twice before (about 11 days prior to the accident and 2 days prior to the accident). Numerous residents around the airport reported that a dense fog surrounded the airport and cloaked the mountains. One witness stated that as he drove his automobile up the mountains away from the coastline, he came out of the clouds around 1,300 feet mean sea level (msl). Records maintained at the Automated Flight Service Station (AFSS) disclosed that the pilot contacted the facility twice for weather information. During the first call, about 3 hours prior to departure, she requested a weather briefing. The briefer advised that an AIRMET for instrument flight rule (IFR) conditions was current for the area. He then queried her, "how does it look outside?" The pilot responded by saying, "It's foggy probably visibility is less than 2." During her second telephone call, about 1 hour 45 minutes later, she was again told about the AIRMET for IFR conditions in the coastal areas and she filed an IFR flight plan requesting a direct routing and a 6,000 foot cruise altitude. She called the AFSS again and received her IFR clearance "as filed"; no heading or other departure instructions was requested by the pilot nor given in the clearance. The airport does not have a specified instrument departure. Examination of the accident site revealed that the left wing hit a tree first in a wings level, slightly nose high attitude. Post accident examinations revealed no mechanical anomalies with the airframe or engine that would have precluded normal operation. The AFSS specialist who read the IFR clearance to the pilot was given the IFR clearance by the Air Route Traffic Control Center (ARTCC) controller along with a clearance void time, but not a time check as required. When the pilot did not communicate with the radar controller on or before the void time, the controller transmitted "in the blind" and did not receive a reply. At that time, the controller should have considered the aircraft overdue and made the appropriate notifications, including issuing an Alert Notice (ALNOT), which would have initiated search and rescue efforts. However, the controller, with approval from his supervisor, removed the flight plan from the system. This action deleted any record of the flight and adversely impacted search and rescue efforts. Although the actions of the ARTCC controllers did not cause or contribute to this accident, their performance hindered the timeliness of search and rescue efforts.
HISTORY OF FLIGHT On August 04, 2006, about 1100 Pacific daylight time, a Cessna 182P, N9904E, impacted a mountain shortly after departing from Shelter Cove Airport, Whitethorn, California. The two pilots, who were partial owners, were operating the airplane under the provisions of 14 CFR Part 91. The two occupants, both private pilots, were fatally injured; the airplane sustained substantial damage. The personal cross-country flight was originating from Shelter Cove Airport, with a planned destination of Ukiah, California. Instrument meteorological conditions prevailed in the area surrounding the accident site. An instrument flight rules (IFR) flight plan had been filed and a clearance had been issued; however, the flight plan was never activated. On August 05, 2006, paragliders spotted the wreckage while operating in the area. Local authorities were notified of the accident, and located the wreckage about 1900. Investigators conducted an interview with a witness who resided in a trailer located on a campground adjacent to airport property at the end of runway 12. He recalled observing the accident airplane depart on August 04, 2006. He stated that sometime after 0900, he took his dog for a walk [he was unclear of the exact time]. He noted that there was a dense fog surrounding the airport and the entire Shelter Cove area, which provided less than 1/4-mile visibility. He witnessed the airplane takeoff heading in a southerly direction along the coastline. The witness noted that the direction of flight was unusual, as a majority of the time, airplanes depart to the north. The airplane headed toward a dark cloud to the south and entered the fog layer. Although he could only discern the airplane's silhouette after it entered the fog, the witness stated that he observed it climb to about 500 to 700 feet above ground level (agl). The airplane subsequently made a 90-degree turn to the left. He heard the engine momentarily increase in revolutions per minute (rpm) as if it were revving. The engine noise ceased and he believed that he heard a faint sound akin to the collapsing of an aluminum can. During a telephone conversation with the National Transportation Safety Board investigator-in-charge (IIC), an airplane mechanic based in Ukiah stated that the right-seated pilot contacted him about 1500 the day prior to the accident via telephone. He noted that the pilot was utilizing a cell phone during their conversations and the reception was poor, making it difficult to communicate. The pilot stated that he was attempting to troubleshoot an oil leak, as he had previously experienced oil residue covering the cowling and windshield area. The pilot speculated that the oil was originating from the filler cap area. After attempting to find the leak and subsequently performing engine runs, the pilot still could not precisely identify the source of the leak. The mechanic told the pilot to bring the airplane to his facilities in Ukiah where he could attempt to troubleshoot the problem. The pilot agreed, but stated that he would have to wait for the fog to lift before he could depart from Shelter Cove. The mechanic further stated that the pilot reported that he had "lost 4 quarts" of oil during his pervious flight from Van Nuys, California, to Shelter Cove. The pilot added 3 quarts of oil when he arrived in Shelter Cove, at which point the engine indicated it contained a total of 8 quarts. The pilot also expressed concern that there was no place in the area where he would be able to purchase additional oil. PERSONNEL INFORMATION Left-seated Pilot A review of the airmen records maintained by the Federal Aviation Administration (FAA) disclosed that the left-seated pilot held a private pilot certificate with airplane ratings for single engine and instrument flight. Her most recent third-class medical certificate was issued on March 20, 2005, with a limitation that she "must have available glasses for near vision." The Safety Board IIC reviewed copies of the left-seated pilot's personal flight logbooks. According to the logbook entries, she first received her private pilot license in March 1990, followed by her instrument rating in May 1992. The records indicated that her total flight experience equated to 709.6 hours, with 588.5 hours logged as pilot-in-command. She had amassed 149.2 hours under simulated instrument meteorological conditions (IMC), and had acquired 38.7 hours of actual time operating in IMC. The logbooks additionally revealed that the left-seated pilot had accumulated a majority of her flight time prior to 1998 (650 hours). The entries indicated that she accrued 33.2 hours from April 2005 to July 24, 2006 (the last entry), all of which were performed in the accident airplane. Within that time frame only two flights were noted as being conducted under simulated instrument meteorological conditions, one of which was on June 22, 2005 (1.3 hours) and the other on July 01, 2006 (1.7 hours). The last flight recorded was the only logbook entry that indicated the pilot had flown to an airport near the accident site. The entry showed that she had logged 3.3 hours from Van Nuys to Ukiah; no instrument meteorological conditions were noted for that flight. The last two entries in the endorsement section of her logbook were dated July 20, 2006, and were signed by the same certificated flight instructor (CFI). One of the entries noted that the pilot had satisfactorily completed a biennial flight review, and the other stated that the pilot had satisfactorily completed an instrument competency check. Right-seated Pilot According to the FAA airmen records, the right-seated pilot held a private pilot certificate with an airplane rating for single engine land. His most recent third-class medical certificate was issued without limitations on June 20, 2005. The pilot's personal flight records were not recovered. On his last application for a medical certificate, he reported a total flight time 670 hours. Accident Aircraft Pilot Logbook Entries Within the wreckage, investigators found an airplane log with numerous entries containing both pilots' names. According to the other owners of the airplane, the log was utilized as a means to track the airplane usage by each owner/pilot. The first flight entry listing the accident pilots was dated on March 07, 2006. In pertinent part, the left-seated pilot's name was recorded on an entry dated July 24, indicating that on that date she had flown the airplane 3.3 hours from Van Nuys to Ukiah. The following entry indicated that the right-seated pilot had flown a 3.5-hour flight from Ukiah back to Van Nuys. The left-seated pilot's next, and final entry, was dated August 02, where she logged 3.6 hours from Van Nuys to Shelter Cove. The following entry contained the right-seated pilot's name and the airplane's starting tachometer reading; no other information was written in that entry. AIRCRAFT INFORMATION The Cessna 182P, serial number 18263964, was manufactured in 1975. A review of the logbooks revealed that the most recent annual inspection were performed on August 12, 2005, at a total time of 4,206.5 hours, corresponding to 110.3 flight hours prior to the accident. The powerplant, a Teledyne Continental Motors O-470-S, serial number 226420-R, was last overhauled on February 05, 1996, equating to about 1170 hours prior to the accident. The maintenance records listed the last maintenance as occurring on April 20, 2006, where the airplane underwent a 50-hour inspection, which included an oil change. A review of the voice recordings from the McMinnville, Oregon, Automated Flight Service Station (AFSS) disclosed that the left-seated pilot filed an instrument flight rules (IFR) flight plan indicating that at the time of departure the airplane had 3 hours of fuel on board. The recordings further revealed that the left-seated pilot requested her intentions of making an instrument landing system (ILS) approach at Ukiah, to which the briefer asked, "Is that just for practice?" She replied, "No we have got some problems with our aircraft." METEOROLOGICAL INFORMATION Numerous Whitethorn residents reported that the morning of the accident a dense fog surrounded the airport and the Shelter Cove area. One witness stated that he drove his automobile from Shelter Cove to Garberville around the time of the accident. He reported that as he ascended up the mountain out of Shelter Cove he came out of the clouds around 1,300 feet. The Safety Board IIC reviewed the Geostationary Operational Environmental Satellite (GOES)-11 satellite imagery for the following times: 1015, 1030, and 1045. An examination of the images revealed coastal stratus and fog along the Pacific coast with the accident area obscured by clouds and fog. The infrared satellite imagery indicated a radiative cloud top temperature of 283.3 degrees Kelvin (10.17 degrees Celsius), which corresponded to cloud tops near 9,400 feet mean sea level (msl). The closest weather observation station was near Garberville, California, about 15 nautical miles from the accident site on a magnetic bearing of about 076 degrees. At 1030, it recorded the temperature at 21.2 degrees Celsius; dew point 12.1 degrees Celsius; wind west-northwest at 2 miles per hours; altimeter 29.91 inHg; sky conditions clear. A routine aviation weather report (METAR) generated by an Automated Surface Observation System (ASOS) in Arcata/Eureka, California (located 57 nautical miles north of the accident site), reported that at 0953 there was an overcast cloud layer at 400 feet above ground level (agl) with mist. An updated weather report at 1053 reported a broken cloud layer at 400 feet agl with haze. Records maintained at the McMinnville AFSS disclosed that the left-seated pilot (using the accident airplane's registration number) contacted the facility twice for weather information. The first call, at 0800, was a request for a weather briefing for a flight from Shelter Cove to Ukiah at an altitude of 7,500 feet msl. The briefer advised that an AIRMET (Airman's Meteorological Information) for instrument flight rule (IFR) conditions was current for the coast and encompassed the departure airport. He then queried her, "how does it look outside?" The left-seated pilot responded by saying, "It's foggy probably visibility is less than 2." The briefer indicated that between 1100 and 1300, the instrument meteorological conditions (IMC) "may lift," but indicated that at the time visual flight rules (VFR) was "not recommended." She stated that she intended to file an IFR flight plan "a little later." The left-seated pilot made a second telephone call at 0941 to the AFSS requesting an "IFR weather update." The briefer informed her of the AIRMET for IFR in the coastal areas, additionally stating that there was stratus, but it was "burning off." She filed an IFR flight plan that said she would be operating at 6,000 feet msl and wanted a direct route from Shelter Cove to Ukiah, rather than following along victor airway V494. COMMUNICATIONS Safety Board investigators reviewed recordings from McMinnville AFSS and Oakland Air Route Traffic Control Center (ARTCC). The tape recordings revealed that following the left-seated pilot's telephone request to file a flight plan, an AFSS specialist contacted the D42 controller at ARTCC. The specialist requested an IFR clearance for N9904E from 0Q5 (Shelter Cove) to Ukiah. The D42 controller acknowledged the request and stated that he had a flight progress strip for the airplane, stating, "N9904E is cleared to cleared from the Shelter Cove Airport to the Ukiah Airport, climb and maintain climb and maintain 7,000. Squawk 4235. Clearance void if not off [the ground] by 1755. If not off by 1755 advise Oakland Center not later than 1800 of intentions. Departure frequency will be 132.2." The AFSS specialist verified the departure frequency and asked whether the flight was "cleared as filed" or via any other point. The D42 controller advised the flight was "cleared as filed." The call was terminated with the operating initials of both employees. Radar data supplied by the United States Air Force from the RBR and RBL long-range radar sites and radar data from the FAA did not show any radar returns in the Shelter Cove area between 1030 and 1130. FAA radar data obtained from Oakland ARTCC did not include any information for transponder code 4235. There were no recorded voice communications between the pilots of N9904E and the Oakland ARTCC R42 sector controller on August 4, 2006, between 1042 and 1105. AERODROME INFORMATION The Airport/ Facility Directory (AFD), Southwest U. S., indicated Shelter Cove Airport (0Q5) runway 12/30 was 3,400 feet long and 75 feet wide. The runway surface was composed of asphalt. The airport elevation was 69 feet msl. The non-towered airport was situated in class "G" airspace. A note in the remarks section of the AFD stated, "Expect crosswinds, downdrafts, and extended periods of fog year round." The airport was situated on the only stretch of flat terrain in the immediate vicinity that was adjacent to the ocean. The runway was nearly centered on the rectangular shaped flat area, which dimensions were about 1 mile in length (north-south) and 1,400 feet in width. The terrain just east of the flat stretch was mountainous with peaks reaching about 2,000 feet msl. To both the north and south of the flat land was open ocean. Locals to the area reported that the standard procedures for departing aircraft were to takeoff to the north using runway 30 and shortly thereafter turn left away from the adjacent terrain. If the aircraft's destination were to the south, a 180-degree turn would be initiated until the desired heading was reached. WRECKAGE AND IMPACT The accident site was located in the costal hills about 1 nautical mile (nm) east of the departure end of runway 12 at Shelter Cove. In character, the hills were steeply slopped, averaging between 70 to 80 degrees, and populated by scattered mature fir trees and manzanita scrub brush typical of the mid to northern California coastal region. The main wreckage was located at an estimated 40 degrees 01.469 minutes north latitude and 124 degrees 02.880 minutes west longitude, at an elevation of about 960 feet msl. The main wreckage came to rest inverted on the southern side of a 1,350-foot steep hill, with the right wing and tail section attached to the fuselage. The left wing separated at the wing root and was the farthest debris found from the main wreckage; it was located upslope about 150 feet on a median magnetic bearing of about 305 degrees. All control surfaces were accounted for at the accident site. Trees were located between the left wing and the main wreckage that appeared to have been recently broken and cut, with freshly severed limbs. One tree branch, about 4 inches in diameter was identified immediately east of the left wing that had a diagonal cut, consistent in appearance to a propeller severing it. Brush with lacerated branches was found on the slope leading down to the main wreckage. The front of the airplane (nose section) was upslope of the fuselage on a measured magnetic bearing of about 060 degrees. The right main landing gear was still affixed, while the nose gear and left main landing gear had separated from the airframe. The tail section was bent aft of station 134 where the aluminum structure had crumpled leaving an angle of about 55 degrees between the tail structure and fuselage. The fuselage had sustained vertical crush deformation, with the forward cockpit area crushed inward and forward toward the engine. The left cabin door was separated from the fuselage and the aft left baggage door was ajar. The engine and right wing remained attached to the fuselage. The propeller hub, with two propeller blades, was attached to the engine and imbedded within the soil of the slope. The right wing was inverted with the wing flap visually in the retracted position and the strut was still attached. The aileron had separated from the outboard hinges, but remained attached by a forward hinge; the control surface was deforme
The pilot's loss of situational awareness with regard to the airplane's proximity to mountainous terrain, and her failure to maintain an adequate terrain clearance altitude or flight path, which resulted in an in-flight collision with the terrain.
Source: NTSB Aviation Accident Database
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