Aviation Accident Summaries

Aviation Accident Summary WPR11FA395

Brookings, OR, USA

Aircraft #1

N199BF

MAULE M-7-235C

Analysis

The pilot was flying the newly purchased airplane on a cross-country flight under visual flight rules (VFR); the pilot had not filed a VFR flight plan. As he neared his intermediate destination airport, the pilot obtained an in-flight weather briefing, which indicated that airmen's meteorological information (AIRMET) Sierra for instrument meteorological conditions was active and included the arrival airport and surrounding area. The AIRMET reported ceilings below 1,000 feet and visibility below 3 statute miles in broken conditions. The destination airport, located about 1 mile south of the accident site, reported visibility less than 1/4 statute mile, fog, and ceiling overcast at 200 feet. The pilot had not filed an instrument flight rules flight plan. It is likely that the pilot's visibility was obscured by clouds and that he did not realize how low he was flying while on approach to the airport. One witness reported seeing and hearing the airplane circling overhead while it was on approach to the airport and then hearing impact sounds. One witness reported seeing the airplane descend out of the cloud base, which he estimated was about 170 feet above the surface. He observed the airplane bank right, strike a tree, cartwheel, strike another tree, and then hit the ground. Another witness stated that she saw the airplane strike a tree and that, at the time, there was "a little fog." A postaccident examination of the airplane and engine revealed no mechanical malfunctions or failures that would have precluded normal operation.

Factual Information

HISTORY OF FLIGHT On August 21, 2011, at 1212 Pacific daylight time, a Maule M-7-235C, N199BF, descended into terrain while maneuvering about 1 mile south of the Brookings Airport (BOK), Brookings, Oregon. The pilot/owner operated the airplane under the provisions of 14 Code of Federal Regulations Part 91 as a personal flight. The pilot was fatally injured, and the airplane was substantially damaged. Instrument meteorological conditions (IMC) prevailed for the flight, and no flight plan had been filed. According to the family and previous owner of the airplane, the accident pilot had purchased the airplane in Portland, Oregon, and was flying the airplane back home to Louisiana. It was not clear where the pilot departed from that morning, but at 1200 he contacted Seattle flight watch while in flight for weather conditions along his route of flight, which included his destination of Monterey Regional Airport (MRY), Monterey, California. Witnesses reported that they observed an airplane circling in the fog before they heard trees breaking. One of the witnesses located at a church parking lot, about 2 miles south of the airport, reported that he heard the airplane approaching from the south. He heard the engine sound decrease as if the power had been reduced, then saw a float-equipped airplane descend out of the base of the clouds, which he estimated to be about 170 feet above the surface. Immediately thereafter, the engine sound increased as if power had been increased, and the airplane's nose began to rise. The airplane banked to the right, and struck a tree about 100 yards to the northwest of the witness's position. The airplane cartwheeled and crashed to the ground after hitting another tree. Another witness walking his dog on a utility road reported seeing the airplane flying overhead and hearing the engine. He stated that the engine was "constant and loud" and not sputtering. He said that as the airplane passed over him, he saw it make a left descending turn. He lost sight of the airplane, but heard a loud thud, followed by another thud. Shortly thereafter, the airplane was found nose down in heavily wooded steep terrain about 1 mile south of BOK near a residence. PERSONNEL INFORMATION The pilot, age 63, held a commercial pilot certificate with ratings for airplane single-engine and multiengine land, airplane single-engine sea, rotorcraft-helicopter, and instrument airplane. The pilot held a second-class airman medical certificate issued September 17, 2009, with the limitation that he must have available glasses for near vision. On the pilot's most recent Federal Aviation Administration (FAA) medical application he reported 3,000 total flight hours with 150 in the past 6 months. AIRCRAFT INFORMATION The four-seat, high-wing, fixed-gear airplane, N199BF, serial number 25032C, was manufactured in 1999. It was powered by a Lycoming IO-540-W1A5 235-hp engine, serial number L-26363-48A. A review of the airplane's logbooks showed an annual inspection had been completed January 04, 2011, at a recorded tachometer reading and airframe total time of 803.1 hours. The last maintenance performed was dated August 5, 2011, at a tachometer time of 850.6 hours. METEOROLOGICAL INFORMATION At 1132, weather was reported at BOK as wind at 230 degrees at 3 knots; 1/4 mile visibility; fog; overcast clouds at 200 feet; and a temperature of 13 degrees Celsius. At 1156, weather reported at BOK was wind from 200 degrees at 04 knots, visibility less than 1/4 mile, fog, an overcast ceiling of 200 feet, temperature 13 degrees Celsius, missing dew point temperature, and an altimeter of 29.99 inches of mercury. At 1229, the reported weather at BOK was, wind from 240 degrees at 4 knots1/2 mile visibility, fog, ceiling overcast at 200 feet above ground level (agl), temperature 13 degrees Celsius, a missing dew point temperature, and an altimeter setting of 29.99 inches of mercury. A pilot, about 66 miles to the south of the accident location, flying at an altitude of 900 feet, reported overcast skies over Arcata Airport, Arcata, California. There were no SIGMET's (Significant Meteorological Information) active for the accident region at the time of the accident. There were several AIRMET's (Airmen's Meteorological Information) active for the west coast of the United States, below 18,000 feet, at the accident time. AIRMET Sierra for instrument flight rule (IFR) conditions was the only one active for the accident location. It covered the Washington, Oregon, California, and coastal water areas, and identified ceilings below 1,000 feet and visibilities below 3 statute miles in broken conditions. The terminal aerodrome forecasts (TAF) issued for Jack McNamara Field Airport (CEC), Crescent City, California, located approximately 19 miles south-southeast of the accident site, forecasted at the time of the accident, variable wind conditions at 3 knots, visibilities greater than 6 miles, with an overcast ceiling at 5,000 feet agl. The area forecast (AF) for the coastal stations of Oregon and northern California, issued at 0345 PDT, forecasted for the time of the accident scattered clouds at 2,000 feet mean sea level (msl) in Oregon, and a broken to overcast ceiling at 1,000 feet msl with cloud tops to 2,000 feet msl, and visibility between 3 to 5 miles with mist in northern California. A detailed report is attached to the public docket for this accident. According to the Brookings Police Department, the accident area was covered by a heavy fog when they arrived at the accident site; it was estimated that the fog base was about 300-500 feet. COMMUNICATIONS At 1200, the accident pilot radioed the Seattle Flight Watch position at the Prescott Fort Worth Contracted Flight Service Station (PRC FCFSS) to request weather conditions from the vicinity of Gold Beach, Oregon, to Monterey, California. The pilot identified himself as a Visual Flight Rules (VFR) flight with the last departure point of 4S1. His route of flight was DCT (direct) to MRY, with an estimated time en route of 2 hours. During the in-flight briefing, the briefer stated that the satellite picture looked like there was a fog or marine layer along the California coast. It looked like Monterey was still beneath a broken ceiling with visibility 10 miles and ceiling 1,300 broken. Prior to ending the briefing to the accident pilot, the briefer indicated that the sky was clear along the entire route over the coastal range, and there were a couple of AIRMETS out for mountain obscuration and Instrument Flight Rules (IFR) along the coast. AIRPORT INFORMATION According to the FAA's airport/facility directory for Brookings Airport, the single asphalt runway was oriented along a northwest/southeast heading (runways 30 and 12), and was 2,900 feet in length by 60 feet wide. The pattern altitude was identified as 1,459 feet mean sea level (msl), and there was no control tower. WRECKAGE AND IMPACT INFORMATION The accident site was located in the backyard of a residence in heavily forested terrain. The airplane had come to rest in a ravine. The right pontoon remained in tall fir trees, near the main wreckage, and the left pontoon remained with the main wreckage. The airplane came to rest in a nose down attitude with the empennage elevated. The airplane remained mostly intact; both wings remained attached to the fuselage, and the horizontal stabilizers remained attached to the tail section. The engine remained attached to the fuselage, and the propeller assembly remained attached to the engine. Inside the cockpit, the throttle control and the propeller control exhibited some extension and the mixture control was full forward. MEDICAL AND PATHOLOGICAL INFORMATION The pilot was critically injured in the accident. He was subsequently transported to a local area hospital where he died from his injuries several days later. Neither an autopsy nor toxicology were performed. TEST AND RESEARCH The airframe and engine were examined with no mechanical malfunctions or anomalies that would have precluded normal operation. A detailed report is attached to the docket for this accident. The airframe examination established flight control continuity from the cockpit/cabin area to each of the flight control surfaces. The associated hardware for the flight controls remained connected and in place. The rudder cable ends in the cockpit area exhibited splayed separation points and the aileron and flap cables had been cut by recovery personnel to facilitate recovery of the airplane. The visual examination of the engine revealed no obvious holes in the crankcase. There was no evidence of a mechanical malfunction. Mechanical continuity was established throughout the engine. Crankshaft rotation produced thumb compression in each cylinder, with accessory gear and valve train continuity established. Two GARMIN Global Positioning System (GPS) units (GPSMAP 696 and GPSMAP 396) and an Apple iPad2 were shipped to the National Transportation Safety Board (NTSB) vehicle recorder laboratory in Washington, D.C. A detailed report is attached to the docket for this accident. The GARMIN GPSMAP 696 was a battery-powered portable multi-function display and GPS receiver. The unit had a built-in Jeppesen database, and was capable of receiving XM satellite radio including NEXTRAD radar, lightning, METARs, TAFs, and TFRs. The unit was able to store date, route-of flight, and flight time information for up to 50 flights. The track log records latitude, longitude, date, time, and groundspeed information for an unspecified number of points. Depending on how the unit is configured, once the track log memory becomes full, new information either overwrites old information or the recordings stop until the memory is downloaded. The GARMIN GPSMAP 396 was a battery powered portable GPS receiver, which included mostly the same recording capabilities as the GARMIN GPSMAP 696. Both GPS units were visually inspected with the specialist noting that the units had not sustained substantial damage. Data from both units was downloaded normally. No track log data was downloaded from the GPSMAP 696; upon further inspection, the specialist reported that the record mode setting was selected to the OFF position. The GPSMAP 396 identified 71 track logs, five user defined waypoints, and one user defined route dated from December 13, 2009, to the date of the accident, August 21, 2011. One full track log was recorded on the date of the accident. The downloaded track log data included the following parameters for each recorded data point: GPS date, GPS time, latitude, longitude, GPS altitude, average groundspeed, and average track during the interval. The GPS track was from Gold Beach, Oregon, to the accident site. The flight was down the coast line, until it turned inland for the accident airport. The track showed the airplane in a left descending turn near the departure end of the runway; however, once it came out of the turn, it flew a forward track toward the accident site. The specialist noted that one aviation related app had been installed on the device – ForeFlight, there were no retained flight plans that pertained to the accident flight.

Probable Cause and Findings

The pilot’s improper decision to continue flight under visual flight rules into instrument meteorological conditions, which resulted in a collision with trees while on approach for landing.

 

Source: NTSB Aviation Accident Database

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