Aviation Accident Summaries

Aviation Accident Summary ERA11FA354

Valparaiso, FL, USA

Aircraft #1

N38029

BEECH C24R

Analysis

During a night instructional flight, the private pilot under instruction attempted a 360-degree power off approach. The maneuver, which is also practiced as a simulated engine failure, involves a 360-degree change of direction to a preselected landing spot. The pattern is designed to be circular, but the turn may be shallowed, steepened, or discontinued at any point to adjust the accuracy of the flight path. Flaps and landing gear can also be used to control descent rate. The maneuver generally commences about 2,000 feet over the intended landing spot (high key), descends to a 180-degree position about 1,000 to 1,200 feet (downwind key, or low key), continues to a 90-degree position about 800 feet (base-leg key) with a turn to final at a minimum of 300 feet. Radar data revealed that the airplane commenced the maneuver about 2,000 feet over the runway, but arrived at a 180-degree position about 400 feet high, and at a 90-degree position about 500 feet high. It continued around the circuit still high, and approaching the runway, the flight instructor advised the controller that student training was in progress, right base for the “option.” After being cleared for the option, the airplane descended to 1,100 feet over the runway. It then began a right turn away from the runway and had descended to 900 feet when the instructor stated that they were doing another 360-degree circuit. There were no further transmissions from the airplane, but there were two more radar returns, one at 900 feet, and the last at 600 feet in the right turn. About that time, a number of witnesses heard the engine “sputter,” but then all witnesses subsequently heard the engine power up. They then saw the airplane descend at a steep angle and impact an aircraft parking apron, coming to a stop in about 600 feet. Because of a postcrash fire, not all engine items could be extensively examined. Those that could, did not reveal any engine anomalies, except that one fuel injector was found completely blocked, while another was partially blocked, most likely due to thermal effects from the fire. Propeller ground scars indicated power at the time of ground impact. The engine had over 2,380 hours of operation since its last overhaul, and another pilot reported that he had an engine failure while overflying an outlying airport about 12 months earlier, which maintenance personnel could not duplicate. During that failure, the engine did not sputter, and it could not be restarted, either in flight or on the ground until the following day. No subsequent engine operating anomalies were noted. Radar and wreckage path evidence indicated the likelihood that neither pilot adequately monitored the airplane’s airspeed, which resulted in a right-turning aerodynamic stall. One pilot then attempted a recovery by adding power; however, by the time he did so, there was insufficient altitude to avoid the ground. The reason for the pilots’ distraction from monitoring airspeed cannot be definitively determined; whether related to the power-off approach, the sputtering engine, or something altogether different. However, in all scenarios, it remained incumbent upon both pilots to ensure that proper airspeed was maintained, which they did not do.

Factual Information

HISTORY OF FLIGHTOn June 23, 2011, at 0444 central daylight time, a Beech C24R, N38029, registered to and operated by Eglin Air Force Base Aero Club as a 14 Code of Federal Regulations Part 91 instructional flight, was substantially damaged when it impacted an aircraft parking ramp at Eglin A.F.B. (VPS), Valparaiso, Florida. Night visual meteorological conditions prevailed and a local flight plan was filed. The certificated flight instructor (CFI) and the private pilot under instruction were fatally injured. The flight originated at VPS at 0421. A radio communication transcript and radar data revealed that the airplane took off from runway 19 and remained in that runway’s left traffic pattern for several “options.” At 0434:40, a pilot from the airplane requested a “left ninety right two seventy” to runway 1. The request was approved, and a pilot later requested and was approved for an option to that runway. At 0437:44, a pilot requested “a right out to climb to two thousand feet” and a "high key" for runway 1. After a delay for a runway “sweep,” the controller approved the request and instructed the pilot to report high key. At 0442:43, when the airplane was at 2,000 feet, about mid-length along the 10,001-foot runway, a pilot stated, "down to high key, be right hand turn." The controller informed the pilot to report the base leg, which a pilot acknowledged. At 0443:11, a voice identified by the controller as the flight instructor stated that the airplane would be maneuvering south of the “apex.” At the time, the airplane was heading southbound, at an altitude of 1,600 feet above mean sea level (msl) and approximately 3,300 feet abeam the runway. At 0443:44, the flight instructor stated, "student training in progress, I guess we're in a right base for the option." About that time, the airplane was over taxiway H, just east of runway 1, heading northwest at 1,200 feet. At 0443:51, the controller stated “runway one nine, wind calm, cleared for the option,” which a pilot acknowledged. At the time, the airplane was angling over runway 1, about 2,000 feet from the approach end, at an altitude of 1,100 feet. The airplane then began a right turn, to the northeast, and at 0444:03, had begun to fly over the aircraft parking ramp at 900 feet. At 0444:05, a pilot stated that the airplane was doing “another…three sixty for runway zero one.” There were no further transmissions from the airplane. At 0444:08, the airplane was still over the parking ramp, headed northeast, at 900 feet. At 0444:13, the last radar contact occurred which indicated the airplane was in an increased right turn, at 600 feet. Numerous witnesses located on the flight line reported observing the airplane just before impact. One witness heard the engine “sputter” before it “throttled up hard” and flew “into the ground at a slightly more than 45-degree angle.” Another witness also heard the engine “sputter,” then “throttle up hard,” before the airplane flew “hard straight into the ground.” A third witness stated that he saw the airplane “coming in…at an angle into the ground,” and that “it sounded as the plane attempted to speed up.” A fourth witness heard the engine “flicker or sound as if it was about to cut off” before the airplane “[made] a nose dive towards the ground.” A fifth witness only heard the engine “throttle up” before the airplane hit the ground. PERSONNEL INFORMATIONThe CFI, age 65, held a commercial pilot certificate with ratings for airplane single-engine land, airplane multiengine land and instrument airplane, issued on January 25, 2000. In addition, he held a CFI certificate with ratings for airplane single-engine, airplane multiengine and instrument airplane, issued on November 8, 2009. The CFI also held a ground instructor certificate, issued on March 20, 2006. His last instrument proficiency check and last flight review were conducted on January 18, 2010. The CFI had logged 10,926.8 total flight hours in his civilian logbook; of which, 10,906.1 hours were as pilot-in-command (PIC), 334.9 hours were in the C24R, and 40.6 hours were as PIC in the C24R since July 13, 2010. The CFI had logged 859.2 hours of night flight time and his last night flight before the accident was on June 22, 2011. He also logged 157.8 hours in the last 90 days with 12.0 hours in the C24R; 71.7 hours in the last 30 days with 6.9 hours in the C24R; and 3.8 hours during the 24 hours prior to the accident. The CFI held an FAA second class medical certificate that was issued on May 11, 2011, with the restriction, "must wear corrective lenses." The family of the CFI provided additional information regarding his military flight time, with a total military flight time of 6,526.2 hours. Total military and civilian flight time was 17,453.0 hours. (Note: The Core Data of this report reflects military and civilian total flight time as well as total flight instructor flight time. Other categories of flight time only reflect civilian flight time, as military flight times in those categories were not provided.) The pilot receiving instruction, age 50, held a private pilot certificate with ratings for airplane single-engine land and instrument airplane, issued on January 28, 2011. The pilot was attending a 14 Code of Federal Regulations Part 141 commercial pilot certification course. The pilot had logged 471.8 total flight hours with 43.9 hours in the C24R. The pilot had logged 428.6 hours as PIC with 43.9 hours in the C24R. The pilot receiving instruction had flown 79.1 hours in the last 90 days with 26.7 hours in the C24R; 46.6 hours in the last 30 days with 13.2 hours in the C24R; and 3.8 hours in the 24 hours prior to the accident. The pilot's last flight review was on December 28, 2010, and he received a complex airplane endorsement in the Beech C24 R on March 2, 2011. The pilot held an FAA second class medical certificate which was issued on July 12, 2010, with the restriction, "must were corrective lenses." AIRCRAFT INFORMATIONThe Beech C24R was a four-place, single-engine airplane with a retractable tricycle landing gear, serial number MC746, manufactured in 1980. It was powered by a Lycoming IO-360, 200-horsepower, horizontally opposed four-cylinder engine, driving a two-bladed constant-speed propeller. The airplane logbooks revealed that the last annual inspection was completed on December 4, 2010, at a recorded tachometer time of 3,782.1 hours. The total airframe time at the annual inspection was 9,105.75 hours. The last 100-hour inspection was completed on April 23, 2011, at a recorded tachometer time of 3,881.63 hours, HOBBS time of 161.45 hours, and total airframe time of 9,204.92 hours. The estimated tachometer time at the accident site was 9,253.2 hours. The engine was factory-overhauled on November 5, 2003. The total time since major overhaul was 2,384.65 hours. The total hours on the engine at the accident site were 4,504.65 hours. The total time flown since the last 100-hour inspection was 47.77 hours. The altimeter and static system test and inspection was completed on June 30, 2009. The airplane was last refueled on June 22, 2011, with 14 gallons of 100 low lead fuel. According to a former aeroclub pilot, on June 14, 2010, he was overflying an outlying airport in the accident airplane when the engine quit without any power changes. He attempted a restart, but still could not get the engine to start, and subsequently completed a forced landing to the airport. Once on the ground, the pilot still could not get the engine to start, and finally had to have someone pick him up. The next day, when he wasn’t there, maintenance personnel did get the airplane started, but later could not duplicate the problem. The pilot had not had any problems with the engine prior to the incident, and during the subsequent week of flight training remaining to finish his commercial rating he also did not have any problems. The pilot further indicated that the engine did not sputter before it quit, it just ceased to operate. No additional engine failures were identified by the investigation. METEOROLOGICAL INFORMATIONThe 0455 VPS surface weather observation was: wind 290 degrees at 3 knots, visibility 10 miles, scattered clouds 1,600 feet, broken clouds at 1,900 feet, temperature 26 degrees Celsius, dew point temperature 23 degrees Celsius, and altimeter 29.95 inches of mercury. According to U.S. Naval Observatory data, civil twilight began at 0517 and sunrise occurred at 0545. AIRPORT INFORMATIONThe Beech C24R was a four-place, single-engine airplane with a retractable tricycle landing gear, serial number MC746, manufactured in 1980. It was powered by a Lycoming IO-360, 200-horsepower, horizontally opposed four-cylinder engine, driving a two-bladed constant-speed propeller. The airplane logbooks revealed that the last annual inspection was completed on December 4, 2010, at a recorded tachometer time of 3,782.1 hours. The total airframe time at the annual inspection was 9,105.75 hours. The last 100-hour inspection was completed on April 23, 2011, at a recorded tachometer time of 3,881.63 hours, HOBBS time of 161.45 hours, and total airframe time of 9,204.92 hours. The estimated tachometer time at the accident site was 9,253.2 hours. The engine was factory-overhauled on November 5, 2003. The total time since major overhaul was 2,384.65 hours. The total hours on the engine at the accident site were 4,504.65 hours. The total time flown since the last 100-hour inspection was 47.77 hours. The altimeter and static system test and inspection was completed on June 30, 2009. The airplane was last refueled on June 22, 2011, with 14 gallons of 100 low lead fuel. According to a former aeroclub pilot, on June 14, 2010, he was overflying an outlying airport in the accident airplane when the engine quit without any power changes. He attempted a restart, but still could not get the engine to start, and subsequently completed a forced landing to the airport. Once on the ground, the pilot still could not get the engine to start, and finally had to have someone pick him up. The next day, when he wasn’t there, maintenance personnel did get the airplane started, but later could not duplicate the problem. The pilot had not had any problems with the engine prior to the incident, and during the subsequent week of flight training remaining to finish his commercial rating he also did not have any problems. The pilot further indicated that the engine did not sputter before it quit, it just ceased to operate. No additional engine failures were identified by the investigation. WRECKAGE AND IMPACT INFORMATIONExamination of the crash site revealed that the airplane impacted the aircraft parking ramp between parking rows G and H, in a left wing low, nose down attitude on a heading of 292 degrees magnetic. The left main landing gear separated from the airframe and three propeller blade marks were present on the ramp. The airplane continued down the crash debris line (CDL) on a heading of 290 degrees magnetic for 203 feet, before the left wing collided with an external power cart located to the rear of an F-15 parking sun shade. The left wing separated and a post-crash fire ensued. The airplane continued down the CDL and came to rest in the infield, east of runway 19/01, on a heading of 202 degrees magnetic. The crash debris line extended for 600 feet. Examination of the nose section revealed that the engine assembly was displaced to the right. The engine remained secure on its engine mounts. The propeller assembly was connected to the propeller crankshaft flange. Both propeller blades remained attached to the propeller hub. One propeller blade exhibited twisting and the propeller blade tip was curled forward through mid-span about 15 degrees. The remaining 5 inches of the propeller blade was curled aft, and about 2.5 inches of the propeller blade tip was missing. The leading edge of the propeller blade exhibited gouging and chord wise scratching. Chord wise scarring was present on the cambered side. The remaining propeller blade exhibited twisting and the propeller blade tip was curled forward through mid-span about 90 degrees. The remaining 5 inches of the propeller blade was curled aft, and about 2.5 inches of the propeller blade tip was missing. The propeller spinner remained attached to the propeller hub and exhibited minor damage in the cuff areas. The upper and lower engine cowlings remained attached to the airframe and were fire damaged. The nose landing gear upper trunnion remained attached to the airframe. The lower section of the nose landing gear was separated from the upper trunnion. The position of the nose landing gear could not be determined. The forward cabin area was consumed by fire from the engine firewall, extending aft to the aft baggage compartment. The upper cabin structure was consumed by fire. The cabin windshield and cabin windows were destroyed. The right cabin door was separated from the airframe hinge attachment point. The door handle was in the locked position. The upper door pin was extended and the lower door pin was missing. The left cabin door and baggage compartment door were consumed by fire. Continuity of the flight control system was confirmed from the control yokes aft to all flight control surfaces, except for both elevators and the left aileron up cables. The left aileron up cable and both elevator cables separated at the wing spar splice plate. The cables exhibited failures consistent with overload. The throttle, propeller, mixture, and friction levers were destroyed. The fuel selector valve was in the right main fuel tank position. The instrument panel was displaced from the firewall to the right. All gyro instruments were consumed by post-crash fire. The left and right forward cabin seats remained attached to the seat tracks. The seatbelts and shoulder harnesses were consumed by fire. The rear bench seat remained attached to the airframe. The right wing remained attached at the wing root and was fire damaged. The leading edge of the right wing was not damaged. The right wing tip was separated. The right aileron was damaged and remained attached to all attachments points. The wing attachment for the right aileron inboard hinge was separated. The right flap was separated. The right main fuel tank was ruptured, exhibited hydraulic deformation, and no fuel was present. The fuel cap was secured with a tight seal. The right main landing gear separated at the upper trunnion wing attachment. The forward upper side of the right main landing gear trunnion fork exhibited scoring marks. The scoring marks were consistent with the gouge marks present at the initial point of impact, which measured about 3 inches in length and 1 inch wide. The aft fuselage was partially consumed by fire and the tail cone separated. The horizontal stabilator, with its trim tab; and vertical stabilizer, with its rudder and trim tab remained attached to the aft fuselage. The stabilator trim tab actuator extension was measured and observed to be about 1 inch, which equated to 5- degrees trailing edge down. The left wing was fire damaged, and was separated from the wing attach points. The leading edge of the wing exhibited accordion crushing, extending from the wing root outboard 3 feet. The leading edge of the wing was compressed inward at mid-span, extending outboard to the wing tip and inboard to the wing spar. The right main landing gear tire was located wedged under the leading edge of the wing, adjacent to the left main fuel tank. The leading edge of the wing was compressed rearward 11 feet 3 inches outboard of the wing root. Paint transfer marks were present on the leading edge of the wing from impact with the left rear tire of the external power cart. Paint transfer marks from the airplane were also present on the external power cart tire. The wing tip separated from the wing. The left main fuel tank was ruptured, exhibited hydraulic deformation, and no fuel was present. The left flap separated from its attachment point. The left aileron was damaged and remained attached to all attachments points. The wing attachment for the left aileron inboard hinge was separated. The

Probable Cause and Findings

The pilots’ failure to maintain airspeed, which resulted in an inadvertent, low altitude aerodynamic stall.

 

Source: NTSB Aviation Accident Database

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