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Crash of a Cessna 340 in Bartow: 5 killed

Date & Time: Dec 24, 2017 at 0717 LT
Type of aircraft:
Registration:
N247AT
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Bartow – Key West
MSN:
340-0214
YOM:
1973
Location:
Crew on board:
1
Crew fatalities:
Pax on board:
4
Pax fatalities:
Other fatalities:
Total fatalities:
5
Captain / Total flying hours:
1600
Aircraft flight hours:
1607
Circumstances:
The instrument-rated private pilot and four passengers boarded the multiengine airplane inside a hangar. The pilot then requested that the airplane be towed from the hangar to the ramp, since he did not want to hit anything on the ramp while taxiing in the dense fog. Witnesses heard the pre-takeoff engine run-up toward the end of the runway but could not see the airplane as it departed; the engines sounded normal during the run-up and takeoff. A witness video recorded the takeoff but the airplane was not visible due to the dense fog. During the takeoff roll the airplane's tires chirped, which is consistent with the wheels touching down on the runway with a side load. The video ended before the accident occurred. The witnesses stated that the takeoff continued and then they heard the airplane impact the ground and saw an explosion. The weather conditions at the time of the accident included visibility less than 1/4 mile in fog and an overcast ceiling at 300 ft above ground level. The airplane's weight at the time of the accident was about 105 lbs over the maximum takeoff weight, which exceeded the center of gravity moment envelope. The excess weight would have likely extended the takeoff roll, decreased the climb rate, and increased the amount of elevator pressure required to lift off of the runway. A majority of the airplane was consumed by postcrash fire. The ground impact marks and wreckage distribution were consistent with the airplane rolling left over the departure end of the runway and impacting the ground inverted in a nearly vertical, nose-low attitude. Examination of the engines revealed operating signatures consistent with takeoff power at the time of impact. The elevator trim tab and actuator were found beyond their full up travel limits and the trim cable exhibited tension overload separations near the actuator. It is likely that, when the cable separated in overload, the chain turned the sprocket and extended the actuator rod beyond full travel. No anomalies were observed with the airframe, engines, or cockpit instrumentation that would have precluded normal operation. The investigation was unable to determine the status of the autopilot during the accident takeoff. Based on the evidence it's likely that when the airplane entered instrument meteorological conditions the pilot experienced spatial disorientation, which resulted in a loss of control and descent into terrain.
Probable cause:
The pilot's loss of control due to spatial disorientation during takeoff in instrument meteorological conditions.
Final Report:

Crash of a Gulfstream G150 in Key West

Date & Time: Oct 31, 2011 at 1942 LT
Type of aircraft:
Operator:
Registration:
N480JJ
Flight Type:
Survivors:
Yes
Schedule:
Stuart - Key West
MSN:
241
YOM:
2007
Crew on board:
2
Crew fatalities:
Pax on board:
2
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
11000
Captain / Total hours on type:
290.00
Aircraft flight hours:
1190
Circumstances:
The airplane was approaching the destination airport in night visual meteorological conditions. After losing sight of the runway once and going around, they continued the approach, even though the pilot in command (PIC) stated that he thought they were going to land long. The PIC stated that the main landing gear touched down near the 1,000-foot marker of the 4,801-foot-long runway, about the landing reference speed (Vref) of 120 knots. The PIC stated that he then applied the brakes but thought they were not working; he had not yet activated the thrust reversers. He alerted the second in command (SIC), who also depressed the brake pedals with no apparent results. The PIC suggested a go-around, but the SIC responded that it was too late. The airplane subsequently traveled off the end of the runway, struck a gravel berm, and came to rest about 816 feet beyond the end of the runway. During the impact, one of the passenger seats dislodged from its seat track and was found on the cabin floor, with the passenger still in it. Review of cockpit voice recorder, video, and performance data revealed that the main landing gear touched down at Vref and about 1,650 feet beyond the approach end of the runway. The nosegear then touched down 2.4 seconds later and about 2,120 feet beyond the approach end of the runway, with about 2,680 feet of runway remaining. Digital electronic engine control data revealed that about 8 seconds after weight-on-wheels, the power levers were advanced from the idle position to the takeoff position. The power levers were then returned to the idle position 6 seconds later. The power levers were moved to the reverse thrust position 8 seconds after that and remained in that position for the duration of the accident sequence; both thrust reversers deployed when commanded. Examination and testing of the airplane systems did not reveal any evidence of preimpact mechanical malfunctions with the wheels brakes or any other systems. Although armed, the airbrakes did not deploy upon touchdown; the data available was inconclusive to determine what position the throttles were in at touchdown and why the airbrakes did not deploy. It is likely that the pilots did not detect the wheel braking because its effect was less than expected with the airplane at full power and with the airbrakes stowed. Landing distance data revealed that the airplane required about 2,551 feet to stop at its given weight in the given weather conditions. With a runway distance of 2,680 feet remaining, the airplane could have stopped or gone around uneventfully with appropriate use of all deceleration devices. The landing procedure stated to activate the thrust reversers after nosewheel touchdown and then apply the brakes, as necessary; however, the PIC only applied the brakes. Further, no callouts were made to verify ground spoiler or reverse thrust deployment. The PIC then stated that he was going to go around, but the SIC said it was too late, so the thrust levers were brought back to idle and the reversers were deployed. The PIC's delayed decision to stop or go around resulted in about a 22-second delay in thrust reverser activation, which resulted in the runway overrun. Additionally, the procedure for a (perceived) failed brake system would have been to activate the emergency brake, which neither pilot did. Examination of the seats revealed that a forward-facing seat was installed in the aft-facing position and an aft-facing seat was installed in the forward-facing position. Additionally, the ejected seat's shear plungers were found in the raised position. Had the seat been installed correctly, the plungers would have been in the lowered position, in the seat track. The improper installation most likely resulted in the passenger’s seat separating from the seat track and exacerbating his injuries.
Probable cause:
The pilot in command's failure to follow the normal landing procedures (placing engines into reverse thrust first and then brake), his delayed decision to continue the landing or go-around, and the flight crew's failure to follow emergency procedures once a perceived loss of brakes occurred. Contributing to the seriousness of the passenger's injury was the improper securing of the passenger seat by maintenance personnel.
Final Report:

Crash of a Partenavia P.68 in Gainesville: 3 killed

Date & Time: Nov 7, 2008 at 0246 LT
Type of aircraft:
Operator:
Registration:
N681KW
Flight Type:
Survivors:
No
Schedule:
Key West - Gainesville
MSN:
273
YOM:
1983
Crew on board:
1
Crew fatalities:
Pax on board:
2
Pax fatalities:
Other fatalities:
Total fatalities:
3
Captain / Total flying hours:
8300
Captain / Total hours on type:
1500.00
Aircraft flight hours:
6971
Circumstances:
The pilot of the multiengine airplane was flying two passengers at night on an instrument-flight-rules flight plan. One of the passengers had been on an organ recipient waiting list and his wife was accompanying him. A viable matched organ was available at a distant hospital and the passenger had to arrive on short notice for surgery the following morning. All radio communications during the flight between the pilot and air traffic control (ATC), a flight service station (FSS), and a fixed-based operator (FBO) were routine. The pilot was aware of the weather at the destination airport, and had commented to ATC about 75 miles from the destination that the weather was "going up and down…like a real thin fog layer.” Additionally, better weather conditions prevailed at nearby suitable airports. The pilot mentioned one of those airports to ATC in the event he decided to divert. According to an employee at an FBO located at the destination airport, the pilot contacted him via radio and asked about the current weather conditions. The employee replied that the visibility was low due to fog and that he could not see the terminal lights from the FBO. The pilot then asked which of the two alternate airports was closer and the employee stated that he did not know. The employee then heard the pilot “click” the runway lights and contact the local FSS. about 5 miles from runway 29, just prior to the initial approach fix, the pilot radioed on the common traffic advisory frequency and reported a 5-mile final leg for runway 29. The FSS reported that the current weather was automated showing an indefinite ceiling of 100 feet vertical visibility and 1/4 mile visibility in fog. The pilota cknowledged the weather information. The weather was below the minimum published requirements for the instrument-landing-system (ILS) approach at the destination airport. Radar data showed that the flight intercepted and tracked the localizer, then intercepted the glideslope about 1 minute later. There were a few radar targets without altitude data due to intermittent Mode C transponder returns. The last recorded radar target with altitude indicated the airplane was at 600 feet, on glideslope and heading for the approach; however, the three subsequent and final targets did not show altitude information. The last recorded radar target was about 1.4 miles from the runway threshold. The airplane flew below glideslope and impacted 100-foot-tall trees about 4,150 feet from the runway 29 threshold. On-ground facility checks and a postaccident flight check of the ILS runway 29 approach conducted by the Federal Aviation Administration did not reveal malfunctions with the ILS. The cabin and cockpit area, including the NAV/COMM/APP, equipment were consumed by a postimpact fire which precluded viable component testing. Detailed examination of the wreckage that was not consumed by fire did not reveal preimpact mechanical malfunctions that may have contributed to the accident. Given that the pilot was aware of the weather conditions before and during the approach, it is possible that the pilot’s goal of expeditiously transporting a patient to a hospital for an organ transplant may have affected his decision to initiate and continue an instrument approach while the weather conditions were below the published minimum requirements for the approach.
Probable cause:
The pilot's failure to maintain the proper glidepath during an instrument-landing-system (ILS) approach. Contributing to the accident were the pilot's decision to initiate the ILS approach with weather below the published minimums, and the pilot's self-induced pressure to expeditiously transport an organ recipient to a hospital.
Final Report:

Crash of a Grumman G-73 Turbo Mallard off Key West: 2 killed

Date & Time: Mar 18, 1994 at 1143 LT
Type of aircraft:
Operator:
Registration:
N150FB
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Key West Harbour - Key West
MSN:
J-51
YOM:
1950
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
2
Captain / Total flying hours:
7725
Captain / Total hours on type:
3100.00
Aircraft flight hours:
17119
Circumstances:
The flightcrew had completed a 14 cfr part 135 charter flight and had landed in the harbor at Key West, Florida. They had moored the seaplane and departed. About an hour later, they reboarded the seaplane to fly it to an airport for refueling, then to return to the harbor to board the passengers. During takeoff, the seaplane was observed to pitch nose up, roll left, and crash nose down in the harbor. Due to the damage done by tidal flow and recovery attempts, the exact condition of the aft bilge drain plugs was unknown. During a check of the CVR recording, the crew was not heard to call out the bilge pumps during the before-takeoff checklist. After lift-off, both pilots made comments about keeping the nose down due to water in the aft portion of the aircraft. Both pilots were killed.
Probable cause:
Failure of the pilot-in-command to assure the bilges were adequately pumped free of water (adequately preflighted), which resulted in the aft center of gravity limit to be exceeded, and failure of the aircrew to follow the checklist. A factor related to the accident was: the water leak.
Final Report:

Crash of a Cessna 421B Golden Eagle II near Flamingo: 3 killed

Date & Time: Nov 9, 1990 at 1447 LT
Registration:
N21ST
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Key West - Naples
MSN:
421B-0963
YOM:
1975
Crew on board:
1
Crew fatalities:
Pax on board:
2
Pax fatalities:
Other fatalities:
Total fatalities:
3
Captain / Total flying hours:
10100
Captain / Total hours on type:
50.00
Aircraft flight hours:
2741
Circumstances:
As the aircraft (N21ST) was en route on a flight from Key West to Naples, FL, the pilot of another aircraft saw a 'fireball' in the vicinity of where N21ST subsequently crashed. When N21ST did not arrive, a search was initiated. The wreckage was found the next day at 1704 est, in the Everglades National Park, near Flamingo, FL. During impact, the main wreckage was buried in 30 feet of mud. The left outboard wing section (from just outboard of the engine nacelle to the wing tip) was found approximately 1 mile from the main wreckage. An exam revealed the wing had failed where the nacelle fuel tank and the aux fuel tank boost pumps were mounted. No exhaust system failure or leakage from the fuel tanks was found in the area of the fire. The greatest fire damage was at a point where the left nacelle fuel tank boost pump was mounted and aft from there to where the rear wing spar had burned thru. The electrical fuel boost pumps were not recovered after the accident. The ignition source for the fire was not determined. All three occupants were killed.
Probable cause:
An undetermined airframe/component/system failure/malfunction, which resulted in a fuel fed fire in the left wing.
Final Report:

Crash of a Rockwell Grand Commander 680 off Key West: 2 killed

Date & Time: Mar 1, 1985 at 0015 LT
Operator:
Registration:
N709G
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Belize City - Key West
MSN:
680-865-82
YOM:
1960
Crew on board:
1
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
2
Circumstances:
A Coast Guard Falcon aircraft was on scene when the aircraft ditched in the Atlantic ocean due to fuel exhaustion. A life raft and marker were dropped by the Coast Guard aircraft. A search was conducted all day on 3/1/85 and was called off at sunset on on 3/2/85. The occupants were presumed to have been fatally injured or drowned. The aircraft was presumed to have been destroyed.
Probable cause:
Occurrence #1: loss of engine power (total) - nonmechanical
Phase of operation: cruise
Findings
1. (c) planning/decision - improper - pilot in command
2. (c) fluid, fuel - exhaustion
3. (c) fuel supply - inadequate - pilot in command
----------
Occurrence #2: forced landing
Phase of operation: descent - emergency
----------
Occurrence #3: ditching
Phase of operation: landing - flare/touchdown
Findings
4. (f) light condition - dark night
Final Report: