Aiken, SC, USA
N6655X
CESSNA 210A
During a visual flight rules (VFR) cross-country flight, an air traffic controller advised the non-instrument rated pilot that a broken line of weather with moderate-to-heavy precipitation existed, which extended almost to his destination airport. During the ensuing conversation, the pilot advised the controller that he was underneath the weather and that he had weather radar. The pilot then entered the weather in the vicinity of his destination airport. Radar imagery, witness statements, and measurements from local surface stations indicated that areas of light, moderate, and possibly heavy precipitation existed and that the airplane was most likely in instrument meteorological conditions in its final 2 minutes of flight. Review of radar data revealed that, after entering the weather, the pilot's altitude control became erratic, and the airplane entered an ever-tightening right turn, consistent with the pilot experiencing spatial disorientation. The airplane completed about two and a half 360-degree turns of progressively smaller diameter before radar contact was lost, and the airplane impacted terrain. No record of the pilot obtaining a weather briefing or filing a flight plan was discovered. Examination of the wreckage revealed no evidence of any preimpact malfunction or failure of the airplane or engine, and it did not reveal any evidence that on-board weather radar was installed. During the wreckage examination, the remains of a portable global positioning system receiver were discovered. The receiver was not certificated for use under instrument flight rules and was intended by the manufacturer to be used as an aid for VFR navigation. It was capable of displaying weather data and images from the NEXt-generation RADar (NEXRAD) ground radar network, but, unlike on-board weather radar, transmitted NEXRAD data is not real-time. The receiver manufacturer cautioned that the lapsed time between collection, processing, and dissemination of NEXRAD images can be significant, and, therefore, they should only be used for long-range planning purposes and not for short-range weather avoidance. Furthermore, according to the Federal Aviation Administration (FAA), NEXRAD data or any radar data should not be used to penetrate hazardous weather. Rather, it should be used in an early-warning capacity of pre-departure and en route evaluation. As discussed in the Safety Alert issued by the National Transportation Safety Board (NTSB) on in-cockpit NEXRAD, because NEXRAD images present radar data from multiple ground sites as a single mosaic image, the age indicated on the NEXRAD image does not show the age of the actual weather conditions but rather represents the time when the mosaic image was created. The actual weather conditions could be up to 15 to 20 minutes older than the age indicated on the image. Both the FAA and the NTSB advise that advanced avionics weather data systems should not be used as a substitute for a pre-flight weather briefing.
HISTORY OF FLIGHT On October 28, 2010, about 0934 eastern daylight time, a Cessna 210A, N6655X, was substantially damaged when it impacted terrain while maneuvering near Aiken South Carolina. The certificated private pilot was fatally injured. Instrument meteorological conditions prevailed for the flight that departed Beaufort County Airport (ARW), Beaufort, South Carolina, destined for Aiken Municipal Airport (AIK), Aiken, South Carolina. No flight plan was filed for the flight conducted under Title 14 Code of Federal Regulations (CFR) Part 91. According to air traffic control (ATC) voice and radar data, the airplane was approaching AIK at 4,500 feet above mean sea level (msl) when the pilot requested to return to ARW due to weather. The airplane was then observed by ATC to descend, do two complete 360 degree turns before descending below the radar coverage area. According to a witness, He heard the "groan of an airplane" pass at low altitude over his house on a heading of 102 degrees. He opened his window blinds but could not see anything. A few moments later he heard a "thud," and then a "kaboom." He stated that it sounded like "50 car doors slamming." He went outside and it was drizzling and he saw a dark gray plume of smoke "coming up." Moments later it began to rain harder. The airplane wreckage was later discovered by an employee of the local electric company after he observed a "flash" in the general vicinity of where the smoke plume was seen. PERSONNEL INFORMATION According to Federal Aviation Administration (FAA) records, the pilot held a private pilot certificate with a rating for airplane single-engine land. He did not possess an instrument rating which would have allowed him to fly in instrument meteorological conditions (IMC). His most recent application for an FAA third-class medical certificate was dated October 16, 2009. According to pilot records, he had accrued 396.3 total hours of flight experience of which 324.7 hours was as pilot in command. AIRCRAFT INFORMATION The accident aircraft was a high wing, strut braced, four seat airplane of conventional construction. It was powered by an air cooled, 6-cylinder, fuel injected, 260 horsepower Continental IO-470-E engine. According to FAA and maintenance records, the airplane was manufactured in 1960. It was involved in two previous accidents. One in 1967 when a pilot struck a light pole while taxiing, and one in 1969 when the nose gear collapsed on landing and the airplane nosed over. The airplane’s most recent annual inspection was completed on October 2, 2010. At the time of the inspection, the airplane had accrued 7, 987.5 total hours of operation. METEOROLOGICAL INFORMATION The reported weather at AIK, at 0935, approximately 2 minutes after the accident, included: calm winds, visibility 2 and 1/2 miles in light rain, broken clouds at 800 feet, overcast at 1,400 feet, temperature 21 degrees Celsius, dew point missing, and an altimeter setting of 30.10 inches of mercury. The reported weather at AIK at 0955, approximately 20 minutes after the accident included: calm winds, visibility 1 mile in heavy rain, overcast at 600 feet, temperature 21 degrees Celsius, dewpoint missing, and an altimeter setting of 30.11. Review of weather radar imagery from Columbia, South Carolina (KCAE), near the time of the accident, and at an elevation tilt that observed the flight altitudes that the accident airplane was being operated at revealed, that numerous areas of light to moderate reflectivity were present along the airplane's flight path. A vertical profile of reflectivity along the final portion of the flight path also indicated that during the final minutes of the flight, the accident airplane was flying through an area of light to moderate precipitation but, it could not be confirmed through weather radar imagery if the accident airplane was in similar conditions during the last two minutes of flight, however small precipitation-size hydrometeors were observed at altitudes directly above the airplane's position at this time which in combination with ceiling measurements from local surface stations indicated that the airplane was likely in IMC. WRECKAGE AND IMPACT INFORMATION Examination of the wreckage and accident site revealed, that the airplane had struck trees at an altitude of approximately 38 feet above ground level before coming to rest on the forest floor. Examination of the accident site revealed that a 353 foot long by 150 foot wide debris field existed which was oriented on a magnetic heading of 221 degrees, and which contained the highly fragmented remains of the airplane. Initial ground contact was evident in the form of a 3 foot deep crater near the beginning of the debris field, approximately 51 feet from the base of the broken trees. Pieces of the wings, fuselage, and flight controls were spread throughout the debris field. Examination of the debris field revealed that all of the major components of the airplane were present. Evidence of a post crash fire existed in the form of sooting and fire damage in the remains of the cabin, on the inboard portions of the wings, and on the remains of the fuel tanks. A burned tree was also evident along with a 10 foot long by 4 foot wide burn pattern on the ground that was co-located with the burned tree. Examination of the flight control system revealed numerous breaks in the cables which made up the system. Control continuity was established however, from the flight controls to the breaks in the system which exhibited signs of tensile overload. Examination of the wing flap actuators revealed that the wing flaps were retracted and examination of the nose gear actuator, the main landing gear, and landing gear doors revealed that the landing gear was retracted. Examination of the propeller system revealed that the propeller had been separated from its mounting location. All three propeller blades were also separated from the propeller hub. The propeller pitch control mechanism was discovered in the crater along with one propeller blade. A second propeller blade was discovered in close proximity to the crater, and the third propeller blade was discovered approximately 220 feet to the right of the crater Examination of all three propeller blades revealed evidence of chordwise scratching S-bending, and polishing of portions of the blade faces. Examination of the engine revealed no evidence of any preimpact failure or malfunction. The crankshaft could not be rotated due to impact damage but, internal examination revealed that crankshaft and camshaft continuity existed. Borescoping of the cylinders revealed no anomalies, and oil was present in the rocker boxes and galleries of the engine. Internal examination of the oil filter did not reveal the presence of debris or metal. Both magnetos exhibited impact damage, however, the left magneto when rotated exhibited sparking at its points, and internal examination of the right magneto did not reveal any evidence of preimpact malfunction. The spark plugs appeared normal and were light gray in color. The fuel injectors did not exhibit any evidence of preimpact blockage. The manifold valve screen was free of debris and an odor of fuel was present. The engine driven fuel pump could be rotated by hand and its splined drive shaft was intact. The vacuum pump drive was intact and internal examination revealed no evidence of any preimpact malfunction. Examination of the surviving portions of the flight instruments revealed that, the engine tachometer was indicating 2,300 rpm and 509 hours of operation. The fuel flow gauge exhibited a witness mark at approximately 12 gallons per hour. The attitude indicator's rotor wheel exhibited rotational scoring, and the turn and bank's electric gyro exhibited rotational scoring. MEDICAL AND PATHOLOGICAL INFORMATION An autopsy was performed on the pilot by Newberry Pathology Associates at the request of the Aiken County, South Carolina Coroner. Cause of death was multiple blunt force injuries. Toxicological testing of the pilot was conducted at the FAA Bioaeronautical Sciences Research Laboratory, Oklahoma City, Oklahoma. The specimens were negative for carbon monoxide, cyanide, basic, acidic, and neutral drugs. TESTS AND RESEARCH During the investigation no record of the pilot obtaining a weather briefing or filing a flight plan was discovered. Review of ATC Voice Data During review of ATC voice data by NTSB investigators, it was discovered that when the pilot initially checked in with the Jacksonville Air Route Traffic Control Center while in cruise at 4,500, he was given the local altimeter setting and was advised to maintain VFR. He was further advised that a broken line of weather with moderate to heavy precipitation extended almost to AIK and that, "I don't know if you are going to be able to pick your way through that" and was asked if he was underneath the weather. The pilot then advised the controller that he was underneath the weather and that "I got weather radar here". At 09:19:15, after making contact with Augusta Approach Control, The pilot was advised to descend VFR at "pilot's discretion" by the controller, to report AIK in sight, and to advise if he had the automated weather report for AIK. At 09:24:12, the pilot was advised by the controller that he was "picking up" light precipitation around AIK but, about 5 miles south and southeast of AIK was moderate precipitation. The controller then queried the pilot stating; "Do you think you'll be able to uh, make a good VFR descent there"? To which the pilot replied that he thought that he should be able to and if not, that he would "go a little North of it" and come back. At 09:25:18 the controller queried the pilot and asked him if the airplane was instrument flight rules (IFR) equipped and if he was IFR qualified, to which the pilot responded that he was not and that he would probably just turn around and head back in the direction of ARW. At 09:25:28, the controller advised that he understood, and to let him know when he picked up the airport which at this time was eight miles in front of the airplane. The pilot acknowledged this transmission. At 09:28:43, the controller advised the pilot that the airport was about 3 miles in front of him. This transmission was also acknowledged by the pilot. At 09:29:08, the controller asked the pilot to "Just let me know when you pick up Aiken for sure", and pointed out the airport's location again. The pilot also acknowledged this transmission but moments later advised that he was "heading back for" ARW. At 09:31:10, the pilot was advised to maintain VFR at "any altitude" while they coordinated a handoff to Columbia Approach Control. For approximately the next 2 minutes, Augusta Approach Control coordinated the handoff with Columbia Approach Control advising them that the pilot was unable to get into AIK under VFR and that he would be returning to ARW. At 09:33:06, the pilot was instructed to contact Columbia Approach Control. There was no response. At 09:33:20, the pilot was once again instructed to contact Columbia Approach Control. Four seconds later the pilot stated, "Augusta Approach declaring emerg". At 09:33:29, the pilot was instructed to contact Columbia Approach Control. This was acknowledged by the pilot at 09:33:37. No further radio transmissions from the pilot were received. Review of ATC Radar Data Review of ATC Radar data indicated at approximately 09:22 the pilot began his descent from 4,500 feet. This descent continued until approximately 09:24 when the airplane reached approximately 3,900 feet and then began to climb reaching an altitude of 4,300 feet at approximately 09:26 before descending again. At approximately 09:30, the airplane leveled off at 2,700 feet and turned right to an approximate heading of 060. About 1 mile later the airplane entered an ever tightening right turn and maintained an altitude of 2,700 to 2,900 until approximately 09:31, where it began to climb, reaching an altitude of 3,400 feet. It then began to descend again until approximately 09:32, where it leveled off at 3,100 feet for approximately 15 seconds, then climbed up to 3,700 feet, then descended again until radar contact was lost at 1,500 feet. Further examination of the radar data revealed that after entering the ever tightening right turn, the airplane completed approximately two and a half 360 degree turns of ever smaller diameter before radar contact was lost. The Garmin GPSMAP 696 During Examination of the debris field, the remains of a portable Garmin GPSMAP 696 were found. According to a family member, the pilot had won the GPSMAP 696 in a contest and would use it whenever he was flying. According to the manufacturer, the Garmin GPSMAP 696 was intended by the manufacturer as an aid for VFR navigation. It was not certificated for use under IFR. It was capable of receiving XM Satellite Weather, and could display images from the NEXRAD (NEXt-generation RADar) network of 158 high-resolution Doppler radar systems that are operated by the National Weather Service (NWS). According to the NWS, NEXRAD data provides centralized meteorological information for the continental United States and selected overseas locations. The maximum range of a single NEXRAD radar site is 250 nm. In addition to a wide array of services, the NEXRAD network provides important information about severe weather and air traffic safety. NEXRAD data however, is not real-time. The lapsed time between collection, processing, and dissemination of NEXRAD images can be significant and may not reflect the current radar synopsis. Due to the inherent delays and the relative age of the data, it should be used for long-range planning purposes only. NEXRAD data or any radar data should not be used to penetrate hazardous weather. Rather, it should be used in an early-warning capacity of pre-departure and enroute evaluation. There are also certain limitations associated with displayed NEXRAD images some but not all of them include: • NEXRAD base reflectivity does not provide sufficient information to determine cloud layers or precipitation characteristics (hail vs. rain). For example, it is not possible to distinguish between wet snow, wet hail, and rain. • NEXRAD base reflectivity is sampled at the minimum antenna elevation angle. An individual NEXRAD site cannot depict high altitude storms at close ranges, and has no information about storms directly over the site. FAA Guidance for Use of Advanced Avionics According to the FAA's Advanced Avionics Handbook (FAA-H-8083-6), advanced avionics can provide many of the same weather products available on the ground and have a variety of uses that can enhance awareness of weather that may be encountered during almost any phase of flight. Radar images, satellite weather pictures, Aviation Routine Weather Reports (METARs), terminal weather forecasts (TAFs), significant meteorological information (SIGMETs), Airmen’s Meteorological Information (AIRMETs), and other products can be readily accessible at any time during flight. Pilots must know the limitations of each type of product, and the ways in which cockpit weather systems can be used to gather information and remain clear of weather hazards throughout the flight. While thunderstorms and general areas of precipitation are detected through the use of radar, in advanced avionics, radar data can come from one of two sources: an onboard weather radar system or a ground weather surveillance radar system, such as NEXRAD where data is transmitted to the cockpit via a broadcast (or datalink) weather service. Onboard weather radar and ground weather surveillance radar systems each offer advantages and disadvantages to the pilot, and some aircraft use a combination of both systems. While onboard radar is real time, many downloaded radar images and other reports are delayed for some time period for various reasons. Given the nature of thunderstorms and other weather hazards, this delay could prove hazardous. Pilots therefore must know the true quality and age of the data. In the case of ground weather surveillance systems, weather inform
The pilot's inadequate weather planning and improper decision to continue a visual flight rules flight into instrument meteorological conditions, which resulted in a loss of control due to spatial disorientation. Contributing to the accident was the pilot’s improper use of in-cockpit next generation radar imagery for short-range weather avoidance.
Source: NTSB Aviation Accident Database
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