NTSB Factual Report

HISTORY OF FLIGHT

On April 3, 2005, approximately 1450 mountain daylight time, a Beech E55, N3FJ, piloted by a private pilot, was destroyed when it departed controlled flight during an aborted (balked) landing or attempted go-around and impacted a parking lot and industrial building adjacent to the Fort Collins Downtown Airport (3V5), Fort Collins, Colorado. Day visual meteorological conditions prevailed at the time of the accident. The local personal flight was being conducted under the provisions of Title 14 CFR Part 91 without a flight plan. The pilot, the sole occupant aboard, was fatally injured. The flight originated approximately 1420.

The pilot had told his wife he was going to go fly. She reminded him they were having dinner with friends. He said he would be gone for about an hour.

There were several witnesses who either saw or heard the airplane as it flew towards the airport. They said the engines were "running rough" (witnesses 1 and 5), "cutting out" (witness 2), "backfiring and sputtering" (witnesses 3 and 4), and flying level between 200 and 300 feet (witness 5) or 400 feet (witness 4). Witness 6, a flight instructor who had just taken off from the airport, said he heard the pilot report entering the traffic pattern. He said the pilot's voice was "calm, routine."

Some witnesses said the airplane was landing; others thought it had just taken off. Witness 15 said the airplane was "way too low not to be landing," and was "quieter" than it had been when she saw it take off 30 minutes before. Others said the airplane was "high and extremely fast" (witnesses 8, 9, and 10). Witness 10, a flight school employee, observed the airplane throughout its landing approach. He said it "was high and hot, 100 kts+, approaching mid-field, (1) engine was windmilling, the other running OK." Asked which engine was windmilling, the employee said he was not sure. The airplane passed behind some buildings and his view was blocked, but he heard the engine "spool up for a go-around. I knew he was in trouble because of his high speed at mid-field and the fact of only (1) engine running." When the employee sighted the airplane again, it "hit the ground and exploded into a big fire ball and was followed by a lot of black smoke."

Other witnesses said the airplane was taking off. Witness 7 said the airplane was having "engine trouble, sputtering," as it was taking off. Witness 11, a student pilot who was preflighting his airplane on the ramp, stopped to watched "the Baron departing runway 11." He wrote, "As the airplane was gaining altitude, it began to bank to the left . . . The bank continued to about 80 degrees to the left. At about 100-150 feet, the tail seemed to slip to the right and the plane banked further left and went inverted. The plane went into the building inverted and pointing slightly to the left."

Other witnesses, who were stopped at traffic lights or driving near the airport perimeter, saw the airplane "twist to one side and then spiral several times" (witness 12); "flipping back and forth and it went into a spin (witness 13); "[do] a couple of flips in the air and then it just dropped nose first" (witness 16), and "[go] out of control doing circles and flips" (witness 17). Witness 18 saw the airplane "in a nose dive spinning around," and witness 19 saw it "spin a few times." Most of the witnesses who saw the finals seconds of flight conceded that the airplane made a left bank, rolled inverted, and descended nose first (11, 20, 21, 23).

Of the witnesses who said the airplane was either landing or taking off, none could attest to actually seeing the airplane touch down or being on the runway.

PERSONNEL INFORMATION

The pilot, age 72, held a private pilot certificate with airplane single/multiengine land and instrument ratings. He also held a special issuance third class medical certificate, dated August 14, 2003, with the limitation, "Must wear corrective lenses for near and distant vision. Not valid for any class after August 31, 2005."

According to his most recent FAA application for a third class airman medical certificate, the pilot estimated he had logged 1,000 hours total time, but 0 hours in the previous 6 months.

When the pilot applied for airplane insurance on July 16, 2004, he listed the following flight time (in hours):

Total time: 997

Retractable: 622

Multiengine/Beech E55: 173

Based on records kept by the airplane's co-owner, the following flight time was calculated (in hours):

Total time: 1,024.7

Beech E55: 200.7

Last 12 months: 27.7

Last 90 days: 5.2

AIRCRAFT INFORMATION

N3FJ (s.n. TE-879), a model E55, was manufactured by the Beech Aircraft Corporation in 1972. It was powered by two Continental IO-520-C engines (s.n. 223114-72C, left; 231786-R, right), each rated at 285 horsepower, driving two Hartzell BHC-C2YF-2CHYF propellers each with two FC8475-6R blades.

According to the airplane's maintenance records, the last annual/100-hour inspections were accomplished on April 10, 2004, at a Hobbs meter reading of 2,390.1 hours. Total airframe time was 3,657.1 hours, and engine total times were 2,319.4 hours (1,078.1 hours since major overhaul). The engines had been overhauled on August 4, 1988, at a Hobbs meter reading of 1312.2 hours. The propellers were overhauled on June 26, 1998, at a tachometer reading of 2002.0 hours.

The most recent weight and balance check was made on October 2, 2003. The most recent pitot-static/altimeter/transponder/encoder check was made on July 18, 2003 (Hobbs, 2,342.9 hours). The emergency locator transmitter (ELT) battery was also changed on that date. On July 18, 2003, vortex generators were installed (Hobbs meter, 1,407.5 hours). On July 18, 1997, gamijectors were installed on both engines (Hobbs, 1,938.1 hours).

METEOROLOGICAL INFORMATION

Weather recorded 5 minutes after the accident by the Automated Weather Observation Station (AWOS) at the Fort Collins-Loveland Airport (FNL), located 10 miles southeast of the accident site, was as follows: Wind, 190 degrees at 10 knots, gusts to 15 knots; visibility, 10 statute miles (or greater); sky condition, clear; temperature, 23 degrees C.; dew point, -8 degrees C.; altimeter setting, 29.74 inches of mercury.

AERODROME INFORMATION

Fort Collins Downtown Airport (3V5) is located 2 miles east of the city. It is situated at an elevation of 4,939 feet msl. The main runway is 11-29 (5,300 feet x 44 feet, asphalt). There is an unnumbered east-west runway that is used principally by ultralite aircraft.

WRECKAGE AND IMPACT INFORMATION

The accident occurred at a location of 40 degrees, 35.184 minutes north latitude, and 105 degrees, 01.919 minutes west longitude, and at an elevation of 4,926 feet msl. The airplane impacted an asphalt parking lot, rebounded, and skidded backwards into the loading bay of an industrial building. It also hit two guard posts embedded in the asphalt. The closed overhead door was crushed inward and partially collapsed on the airplane. On impact, the airplane exploded and burned. The building and a utility trucked parked nearby sustained fire damage.

The building, Poudre Valley Air, a heating and air conditioning company, was closed for the weekend. About ten company vehicles, mostly trucks, were parked in the parking lot. The parking lot was surrounded by a chain link fence. Examination of the vehicles, fence and surrounding buildings and trees revealed no evidence that they hade been struck by the airplane. Parking lot impact marks began 50 feet from, and continued up to, the airplane. The marks were mostly shallow gouges and scrapes.

The nose section aft to the passenger cabin was completely consumed by fire. Both elevators and trim tabs remained attached to the horizontal stabilizer. The outer half of the left elevator was burned off. The rudder, crushed at the top, and trim tab remained attached to the vertical stabilizer. The right wing skin was burned away, exposing the internal skeletal structure. The left wing was destroyed. The landing gear bellcrank was extended. The left flap jackscrew measured 6-1/8 inches and, after aligning the fractured right flap actuator, it measured 6-5/8 inches. According to the Raytheon investigator, this equated to the landing gear being down and the flaps being fully extended (full flap actuator extension is 6-1/4 inches), or 30 degrees. Rudder trim was in the neutral zone, and elevator trim was nose up (amount undetermined). Aileron trim could not be determined.

The left engine sustained impact damage and fire exposure. The right engine was relatively intact, although it had been exposed to fire. The fuel selectors were positioned on the main tanks. Both propellers were separated from their respective engines. One blade on the left propeller was curled under the back side; the other blade was relatively undamaged. The right propeller bore 80-degree chordwise scratches on the cambered surface, and the spinner bore spiraling striations and was crushed around the dome.

MEDICAL AND PATHOLOGICAL INFORMATION

An autopsy was performed on the pilot by the Larimer County Medical Examiner's Office on April 3, 2005. The cause of death was attributed to "massive head and neck blunt force injuries. . ." The autopsy report (2005CA-34) stated, "While there was evidence of remote aortic valve replacement and hypertrophic myocardial hypertrophy, there was not a definitive natural disease process which seems to have contributed to this accident . . . there was no evidence of inhalation of products of combustion . . ."

An unmarked vial of an unknown liquid was recovered from the wreckage and given to the Larimer County Coroner's investigator for analysis. It was later determined that the vial contained glucose.

A toxicological screen was conducted by FAA's Civil Aeromedical Institute (CAMI) in Oklahoma City, Oklahoma. According to CAMI's report (#200500076001), no carbon monoxide or cyanide were detected in blood and no ethanol was detected in urine. Sildenafil (Viagra) and desmethylsildenafil (metabolite) were detected in both blood and urine. In addition, 2585 mg/dl glucose was detected in urine, and 8.3 (%) hemoglobin A1C was detected in blood. The report stated, "Elevated postmortem vitreous glucose levels...are considered hyperglycemic conditions which may or may not have been a factor in the accident. An abnormally high postmortem vitreous glucose level could have been caused by diabetes mellitus or several other medical conditions. Elevated glucose levels can also be caused by emergency medical treatment, strenuous exercise, strong emotions, shock and burns. Elevated postmortem urine glucose levels could be caused by diabetes mellitus or several other medical conditions, which may or may not have been a factor in the accident. It is impossible at the present time to identify hypoglycemic conditions in postmortem specimens. Glucose levels in postmortem samples drop rapidly and frequently drop to zero."

TESTS AND RESEARCH

On April 4 and 5, 2005, the engines were disassembled and inspected at Beegles Aircraft Service, Inc., Greeley, Colorado. No mechanical discrepancies or failures were noted with either engine. However, the top and bottom spark plugs from cylinders 1 and 6 on the left engine were carbon-fouled. Although the left engine fuel pump drive shaft was intact, the fuel manifold spring was found jammed. The fuel manifold and injectors were sent to Teledyne Continental Motors for further testing.

On April 6, 2005, the propellers were disassembled and inspected at Beegles Aircraft Service, Inc., Greeley, Colorado. According to the Hartzell investigator's report, "The left propeller did not have power and was not feathered at the time of impact. The blade damage to the right propeller indicated that it was operating at moderate or high power."

On September 14, 2005, the fuel manifold valves, metering units, pumps, and throttle bodies were disassembled and examined under NTSB supervision at Teledyne Continental Motors in Mobile, Alabama. No anomalies were noted.

ADDITIONAL INFORMATION

The following are excerpts from the "Beechcraft Twin Engine (Piston) Safety Information" booklet, dated May 1994:

"Loss of power from one engine affects both climb performance and controllability of twin-engine airplanes. [It] creates yaw due to asymmetrical thrust [and] reduces airflow over the wing, causing a roll towards the "dead" engine. Drag caused by a windmilling propeller and [extended] landing gear or flaps will severely degrade or destroy performance. A single engine go-around is impossible and the airplane is committed to a landing. "

The wreckage was released to the insurance company on December 8, 2005.

In addition to the Federal Aviation Administration, parties to the investigation were the Raytheon Aircraft Corporation and Teledyne Continental Motors.

NTSB Probable Cause

the pilot's failure to maintain aircraft control. Contributing factors were the left engine loss of power for reasons undetermined, and the pilot allowing the airspeed to drop below Vmc during an attempted single-engine go-around.