NTSB Factual Report

HISTORY OF FLIGHT

On May 9, 1999, at 1800 eastern daylight time, a Cessna 205, N8157Z, operated by Grand Lake Skydiving, was destroyed during a collision with terrain following a forced landing after takeoff from the Lakefield Airport (CQA), Celina, Ohio. The certificated commercial pilot and five parachutists were fatally injured. Visual meteorological conditions prevailed for the parachuting flight that originated at CQA. No flight plan was filed for the flight conducted under 14 CFR Part 91.

Several witnesses reported hearing the airplane during climb out. They described smooth uninterrupted engine noise. Each witness described smooth engine noise, brief "sputtering," and then a total loss of engine power. One witness who was standing across the road from the accident site when he noticed the airplane, stated:

"We came out of the house and I watched it cause it looked low. The engine sounded normal. All of a sudden it started to sputter. He kept on climbing while the engine was sputtering. When the engine was sputtering he was still trying to climb. He wasn't going very fast and he was lower than normal. Then the engine quit and the nose kind of went over. As soon as the airplane started its dive, the one guy jumped out. Part of the chute came out but it didn't open."

With a model of an airplane in his hand, the witness demonstrated a slightly nose-up climbing motion. He described the engine sputtering and the airplane descending straight down at the same pitch attitude. The witness said the nose dropped, a parachutist exited, and the airplane entered a spiraling descent. He said two more jumpers exited the airplane before ground contact.

A member of the Civil Air Patrol (CAP) was with his brother when both witnessed the accident. They were approximately 1/2 mile north of the airplane's departure path. The CAP member was an aircraft owner and private pilot with approximately 450 hours of flight experience. He said:

"That airplane, with a constant-speed propeller and a lot of horsepower, makes a lot of noise. I mean it goes 'baaaah'." I know he was climbing out because of the noise. The engine sounded great. She was cranking real good. It sputtered twice, 'B-dat, B-dat', and then nothing, pure silence. I ran to where I could see the plane and it was in a spin. It spun twice before the jumper came out. The jumper came out about two hundred feet. I knew when he came out that they weren't high enough. The plane came straight down. There was no forward motion. He had all that field in front of him. Why in the heck he didn't get the nose down, I don't know."

According to the CAP member's brother:

"We heard the airplane and he was climbing out. You can tell. The engine sputtered and just stopped. We said, 'Oh, he's in trouble.' We ran about 50 yards where we could see the airplane. The airplane was in a flat-type spin. It was a slow rotation and kind of pancaked the ground. What bothered me so much was that I had plenty of time to watch it. I saw a person exit too, and I saw the streamer of the chute. The undeployed chute, I guess you could say. He was about 300 feet. You know, that engine, it sounded like your lawnmower running out of gas. One moment you're wide open and the next, boom, your done."

A fourth witness said:

"The airplane was going east. We heard it sputter, then it was silent. It didn't look like he was climbing and he didn't look that high. The airplane just kinda hung there. It just hung there for a minute. Then it just fell, like it was on a string and someone cut the string. Then it spiraled down. The aircraft was already spinning when we saw that guy jump out."

With a model of an airplane in her hand, the witness demonstrated a slow spinning motion with the airplane in a flat attitude.

A fifth witness said he observed the takeoff and initial climb. He said:

"I heard the engine running and I was watching him. He rotated about where they usually rotate. The engine sounded fine. He was climbing about 700 feet per minute. It was running good, in a good climb, about a normal flight attitude."

According to the operator of Grand Lake Skydiving, the pilot was hired the day of the accident. He briefed the pilot on refueling procedures and how to measure fuel quantity in the tanks with a measuring stick. The operator said he briefed and demonstrated flight characteristics, flight patterns, and jump procedures to the pilot in the airplane. He said the pilot then performed three takeoffs and landings during a 1.3 hour familiarization flight.

After the flight, fuel was added and the pilot began flying parachutists. According to the operator, the added fuel brought the total fuel on board to 30 gallons.

A review of jump logs and conversations with the operator revealed the pilot flew three lifts of jumpers to approximately 10,000 feet. Each lift was approximately 30 minutes in duration. The accident flight occurred during the fourth lift. No fuel was dispensed into N8157Z between the first and fourth lift.

The accident occurred during the hours of daylight approximately 40 degrees, 29 minutes north latitude, and 84 degrees, 33 minutes west longitude.

PILOT INFORMATION

The pilot held a commercial pilot's certificate with ratings for airplane single engine land and instrument airplane. The pilot also held a private pilot's certificate for airplane multi-engine land; visual flight rules only. The pilot was issued the commercial pilot's certificate on May 1, 1999. On May 1, 1999, the pilot was also issued an FAA Form 8060-5, Notice of Disapproval of Application for a commercial multi-engine IFR certificate.

The pilot's most recent FAA third class medical certificate was issued July 9, 1997.

According to Federal Aviation Regulation (FAR) 61.39:

"...to be eligible for a practical test for a certificate or rating issued under this part, an applicant must: Hold at least a current third class medical certificate, if a medical certificate is required."

A review of the pilot's logbook and a completed NTSB Form 6120.1/2, Pilot/Operator Report revealed the pilot had 277 hours of flight experience. He recorded 190 hours of single-engine experience and 86 hours in multi-engine airplanes. The pilot had 2.3 hours of flight experience in the Cessna 205.

AIRCRAFT INFORMATION

The airplane was registered as a 1962 Cessna 210-5 (205). The registration certificate was issued February 21, 1995. On that date, the airplane was equipped with a Continental IO-470 series engine. According to the registration certificate, the IO-470 produced 260 horsepower and had a fuel consumption rate of 19.50 gallons per hour.

The airplane was subsequently equipped with Continental IO-520 series engine that produced 285 horsepower. An approved FAA Form 337 for the engine upgrade was issued July 21, 1998.

The airplane was on an annual inspection program. The last inspection was performed July 21, 1998, and the airplane had flown 59 hours since that date. The airplane had accumulated 5,164 hours of total flight time.

METEOROLOGICAL INFORMATION

Clear skies and variable winds at 4 knots were reported in Lima, Ohio, at the Lima Allen County Airport, 28 miles east of CQA.

WRECKAGE INFORMATION

The airplane was examined at the scene on May 10, 1999. There was no odor of fuel and all major components were accounted for at the scene. The airplane came to rest at the point of initial ground contact in an open field approximately 1/2 mile long and 1/4 mile wide.

According to the Ohio State Police, three jumpers were found outside the airplane, and were separated from it by distances of 15, 21, and 63 feet respectively. The parachutist at 63 feet was found with his parachute partially deployed.

The three-bladed propeller was separated from the engine and partially buried in its impact crater. The bottom of the fuselage was crushed upward into the cockpit and cabin areas. The cabin roof was collapsed downward. The instrument panel was destroyed. Flight control continuity was established from the flight control surfaces to the cockpit area.

The fuel selector was intact with the right tank selected.

The bottom of the left wing was crushed up and aft in compression. The wing was removed and approximately 1.5 gallons of fuel was drained from the left fuel tank. The wing tank was filled with water and a leak test was performed. The examination and leak test revealed the fuel bladder was voided in several places by fractured sheet metal. The wing fuel vent was broken and filled with dirt. The vent appeared to have failed in overload.

The right wing was intact. The wing was removed and approximately 8 ounces of fuel was drained from the right wing tank. The wing tank was filled with water and a leak test was performed. Examination of the wing during the test revealed no leaks, and the wing vent was absent of obstructions.

The wreckage was moved to CQA for further examination.

MEDICAL AND PATHOLOGICAL INFORMATION

Dr. Lee D. Lehman of the Montgomery County Coroner's Office, Dayton, Ohio, performed an autopsy on the pilot on May 11, 1999.

The FAA Toxicology Accident Research Laboratory, Oklahoma City, Oklahoma, performed toxicological testing.

TESTS AND RESEARCH

Continued examination of the airframe and a cursory examination of the engine was performed at the Lakefield Airport on May 11, 1999.

The fuel selector was removed. Examination revealed the valve was operational and free of obstructions. The auxiliary fuel pump housing contained a small amount of fuel and the pump operated with electrical power applied. Examination of the fuel control/mixture control unit revealed flow through the unit. Removal of the filter screen revealed dirt and debris on one side of the cylindrical screen.

The flow divider on the engine was absent of debris and contained residual fuel. Residual fuel was found throughout the fuel system to the engine.

The engine was rotated through the alternator pulley drive. Continuity was established through the valvetrain, powertrain, and accessory sections. Compression was confirmed using the thumb method.

The operator provided weight and balance information, individual occupant weights, and a seating plan for the accident flight. The maximum gross weight for the airplane was 3,300 pounds and the aft center-of-gravity (cg) limit was 47.27 inches aft of datum.

Weight and balance figures for the accident flight were computed at a fuel weight of 60 pounds. Preliminary calculations revealed the airplane weighed 3,060 pounds with the cg at 48.30 inches aft of datum.

A weight and balance was also computed using the same figures, minus the first parachutist that departed the airplane. The calculations revealed the airplane weight to be about 2,898 pounds, and the cg 48.76 inches aft of datum.

The engine was removed and shipped to Pittsburgh, Pennsylvania, for further examination.

The engine was examined at the Pittsburgh Institute of Aeronautics, Pittsburgh, Pennsylvania, on December 2, 1999.

Detailed examination of the engine revealed the starter was separated by impact and the mount flange was broken. The right magneto was skewed slightly in its mount due to impact.

The cylinders, pistons, and valves were examined by borescope and revealed no abnormal wear or anomalies. The engine was rotated through the left rear accessory drive and continuity was established through the valvetrain and power train. Compression was confirmed using the thumb method.

Both magnetos were tested and they each produced spark at all terminal leads.

ADDITIONAL INFORMATION

On May 11, 1999, a copy of the Grand Lake Skydiving Standard Operating Procedures (SOP) manual was requested. According to the operator of Grand Lake Skydiving, no such document was in existence. When asked if the club had an SOP, the operator replied:

"No. I do the checks and I have them fly the way I want them flown. At 60 [mph] we rotate, at 80 [mph] we lift off, and we climb out at 100 miles per hour and about 500 to 700 feet per minute. Seat belts stay on 'till 1,000 feet. In flight emergencies below 1,000 feet, everyone stays in the plane.

The operator went on to explain that the jumpmaster on the accident flight was experienced and well known to the other jumpers. He said:

"[She] was a regular. She jumped here about every other weekend. These were all experienced jumpers."

The operator did provide a copy of the Skydiving Aircraft Operations Manual published by the United States Parachuting Association (USPA).

The manual defined organizational roles and responsibilities for an SOP and outlined what subject areas should be covered, and how that information might be disseminated to all participants. Areas covered in the manual included Operating Procedures, Maintenance, Pilot Training, Certification and Qualifications, Emergency Procedures, and Safety Program.

According to a letter from the FAA to the USPA that was included in the manual:

"...the manual contains operating procedures and practices which should be very useful to parachutists, drop zone operators, and the entire parachute industry. The information contained in the manual should provide a level of standardization that will help to promote safety."

According to FAR 61.23, a person:

"Must hold at least a second-class medical certificate when exercising the privileges of a commercial pilot certificate."

The airplane wreckage was released to the owner on May 11, 1999.

NTSB Probable Cause

was the pilot's failure to refuel the airplane which resulted in fuel exhaustion and a loss of engine power. Also causal to the accident was the pilot's failure to maintain aircraft control after the power loss. A factor in the accident was a lack of published operational or safety procedures for the parachute club and the operator's failure to verify the pilot's medical qualifications.