NTSB Factual Report

HISTORY OF FLIGHT

On January 21, 2005, about 0943 central standard time, a Cessna 421C Riley Turbine Eagle, N844JK, piloted by a private pilot, was destroyed on impact with terrain and a house in Overland Park, Kansas, following takeoff from Johnson County Executive Airport (OJC), Olathe, Kansas. Instrument meteorological conditions prevailed at the time of the accident. The Title 14 Code of Federal Regulations (CFR) Part 91 personal flight was operating on an instrument flight rules (IFR) flight plan. The pilot and four passengers were fatally injured. The flight was originating at the time of the accident and was en route to Zephyrhills Municipal Airport (ZPA), Zephyrhills, Florida.

On January 20, 2005, a mechanic stated that , he performed a preflight inspection and replaced the tires on N844JK. He also checked the engine oil, added one quart to each engine, performed a visual inspection through the oil door, and inspected the empennage. The mechanic left the hangar at 1825, and there were no "squawkable" airplane items prior to the accident flight.

At 0925, a caller representing N844JK called Columbia Automated Flight Service Station by telephone and obtained a preflight pilot brief for an IFR flight from OJC to ZPA. The filed flight plan listed "/G," a "Global Positioning System (GPS)/Global Navigation Satellite System (GNSS) equipped aircraft with en route and terminal capability."

At 0937, OJC Tower contacted the Departure West Controller (DW) for release on N844JK. DW released N844JK on a 130 degree heading climbing to 3,000 feet.

N844JK then departed from runway 36.

At 0940:15, N844JK, "kansas city departure eight four four juliet kilo with you off o j c turning right one three zero"

At 0940:19, DW, "twin cessna eight four four juliet kilo kansas city departure uh ident"

At 0940:28, N844JK, "j k roger"

At 0940:29, DW, "twin cessna three four yankee traffic four miles northeast of the executive airport southwest bound is a centurion level at four thousand and your radar contract one mile north of the executive airport"

At 0940:42, N844JK, "that for four j k"

At 0940:44, DW, "four juliet kilo affirmative"

At 0940:51, DW, "twin cessna four juliet kilo you copy that traffic is at your ah two miles east of your position now southwest bound level at four thousand"

At 0940:58, N844JK, "yea i copied but i'm in the i am the i m m c"

At 0941:02, DW, "ah roger just maintain three thousand"

There were no further recorded transmissions from N844JK.

A witness reported that he heard the airplane engine and looked to the east and saw a small airplane traveling north to south about 450 - 500 feet above ground level (AGL) and "well below the fog bank." At that time, the airplane was about 300 yards from the accident site and fairly level. He stated that the landing gear was not extended, and he did not see any open doors on the airplane. About 200 yards from the accident site, the airplane rolled right wing down. The airplane banked almost 90 degrees and then descended with the right wing and airplane nose in a downward attitude. There was a "tremendous" explosion and fireball.

A second witness reported that he heard an airplane louder than normal probably because it was so low. The airplane was flying north to south, and its right wing was aiming towards the ground. The airplane impacted the ground almost straight up and down.

A third witness stated that he first saw the airplane when it was 75-100 feet AGL and heard a noise, which he said was "like a loud humming noise." He didn't think the engines were running, but he said, "it happened so quick." The airplane descended in a 45-degree nose-down attitude when "it came out of the fog." He did not see the impact because a house blocked his view.

PERSONNEL INFORMATION

The pilot held a private pilot certificate with single-engine land, multiengine land, and instrument airplane ratings. On March 1, 2004, the pilot was issued a third class airman medical certificate with the following limitation: "must wear corrective lenses". The pilot reported a total flight time of 6,000 hours at the date of his last airman medical certificate issuance. Copies of pilot logbooks were provided to the National Transportation Safety Board by the airplane mechanic. The most recent logbook copy ("blue book") had a beginning date of September 24, 2004, and an ending date of January 14. All of the pages in this pilot log were unsigned and subsequent entries after the first page were without a year annotation.

On February 5, 1976, the pilot was issued a private pilot certificate with a single-engine land rating.

On October 3, 1976, the pilot failed the flight examination portion for an instrument airplane rating. He was to be reexamined on the following: VOR, ILS, NDB approaches and holding patterns.

On October 8, 1976, the pilot was issued an instrument airplane rating.

On February 12, 1977, the pilot was issued an airplane multiengine land rating.

On December 8, 1996, the pilot was involved in an aviation accident investigated by the National Transportation Safety Board (NTSB) under accident identification ATL97LA022.

On April 18, 1999, according to Federal Aviation Administration (FAA) records, the pilot was involved in an aviation "incident" in N844JK at Lee's Summit Airport, Lee's Summit, Missouri. After touchdown, the right brake locked and the airplane departed the runway approximately 2/10 mile later. The left main gear struck a raised concrete taxiway causing left engine and propeller damage. The left wing trailing edge and support structure for the left landing gear were damaged.

On April 5, 2004, the pilot completed the FAA's Pilot Proficiency Wings, Phase VII and, according to a document from Recurrent Training Center, Inc., Savoy, Illinois, the pilot completed an instrument proficiency check and flight review.

A pilot, who had flown and attended recurrent flight training with the accident pilot, stated that the accident pilot always seemed to maintain aircraft control and thought he was very careful. He was a "thorough pilot" and knew how to interpret the "gauges very well." He said that N844JK was "a lot of airplane" for the accident pilot as opposed to the Cessna 310 in which they were partners in. He never saw the accident pilot write down air traffic control clearances. He never saw the accident pilot make mistakes with altitude assignments. He thought that the accident pilot had about 4,500-5,000 hours of flight time, and he did not know how much instrument time he accumulated. He said that the accident pilot would fly in weather that he wouldn't fly in. He heard from other people that the accident pilot would like to use the accident airplane autopilot and was "fairly reliant" on it.

AIRCRAFT INFORMATION

The 1979 Cessna 421C, serial number 421C0681, was registered on May 31, 2002, to Riley Rocket, Inc., of which the pilot was president. On January 26, 1982, under Riley Aircraft Supplemental Type Certificate SA4293WE, dated January 22, 1982, the airplane was equipped with:

Two Lycoming LTP 101-600A-1A (left engine serial number (S/N) LE50045 and the right engine S/N LE50046), turbo propeller engines

Two Harztell propellers, model HCB3TN-3C/T101T3B-13Q (left propeller S/N BU10008 and right propeller S/N BU10010)

Two 103 gallon main fuel tanks in each wing and two 37.5 gallon aluminum fuel tanks in each Aft Nacelle

Dual Trim System

Air conditioning System

Janitrol Aero Div. Midland Ross Heater Package

Power Distribution, (electrical) Auxilec System

On February 6, 2002, the left wing rear spar was repaired which was accomplished per a structural analysis report 995705. The report states that the aircraft ran off the runway at Lee's Summit, Missouri on April 18, 1999. The off runway excursion drove the left main landing gear strut up and into the upper wing skin. The damage also included front spar web damage and some minor damage to the rear spar lower chord.

Title 49 CFR Part 830 Notification and Reporting of Aircraft Accidents or Incidents and Overdue Aircraft, and Preservation or Aircraft Wreckage, Mail, Cargo, and Records, states, "The operator of any civil aircraft, or any public aircraft not operated by the Armed Forces or an intelligence agency of the United States, or any foreign aircraft shall immediately, and by the most expeditious means available, notify the nearest National Transportation Safety Board (Board) field office when: (a) An aircraft accident or any of the following listed incidents occur... Aircraft accident means an occurrence associated with the operation of an aircraft which takes place between the time any person boards the aircraft with the intention of flight and all such persons have disembarked, and in which any person suffers death or serious injury, or in which the aircraft receives substantial damage. ...Substantial damage means damage or failure which adversely affects the structural strength, performance, or flight characteristics of the aircraft, and which would normally require major repair or replacement of the affected component. Engine failure or damage limited to an engine if only one engine fails or is damaged, bent fairings or cowling, dented skin, small punctured holes in the skin or fabric, ground damage to rotor or propeller blades, and damage to landing gear, wheels, tires, flaps, engine accessories, brakes, or wingtips are not considered 'substantial damage' for the purpose of this part."

On November 22, 2002, a Garmin 430 VHF Comm/VOR/ILS/GPS was installed in the airplane with a placard stating "GPS NOT APPROVED FOR IFR NAVIGATION"

On January 20, 2005, logbook records show that the airplane accumulated a total time of 2,957.3 hours.

A fuel receipt with a Coffey County Airport address, dated January 14, 2005, shows that the airplane was fueled with 78.1 gallons of Jet A.

According to the mechanic who performed the preflight inspection, the airplane was "topped off" and would have consumed approximately 20-30 gallons of fuel during the return flight from Coffey County to OJC. He said that the cruise fuel consumption was 52 gallons/hour and 60 gallons/hour near airport operations. The mechanic thought that the airplane held 103 gallons of fuel in each wing tank and 37 gallons of fuel in each nacelle tank. He stated that the accident pilot would usually like to use the fuel in the nacelle fuel tanks.

A weight and balance form for N844JK dated January 10, 2003, listed:

Empty weight: 5,196.8 lbs

Arm: 152.7963 inches

Useful load: 2,383.2 lbs

The forward and aft center of gravity limits with the landing gear extended are :

153.1 inches aft of datum at 7,579 lbs

147.1 inches aft of datum at 6,100 lbs or less

157.7 inches aft of datum at 7,579 lbs

158.0 inches aft of datum at 7,050 lbs or less

Department of Motor Vehicle records indicate the pilot and passenger weights as follows:

Left front pilot seat (seat 1): 200 lbs

Right front pilot seat (seat 2): 180 lbs

First row left passenger seat (seat 3): 200 lbs

First row right passenger seat (seat 4): 145 lbs

Second row right passenger seat (seat 5): 240 lbs

Recovered baggage weight was 314.5 lbs.

The weight of Jet A at 60 degrees Farnenheight is 6.8 lbs/gallon.

METEOROLOGICAL INFORMATION

The OJC Automated Weather Observing System recorded at:

0853: wind 090 at 9 knots; surface visibility 1 statute mile (SM); mist; sky condition overcast 100 feet AGL; temperature -1 degree Celsius (C) and dew point -1 degree C; altimeter 30.05 inches of mercury (Hg); remarks ceiling 100 feet AGL, variable 600 feet AGL.

0924: wind 100 at 10 knots; visibility 1 1/2 SM; mist; sky condition overcast 300 feet AGL; temperature -1 degrees C, dew point -1 degree C; altimeter 30.03 inches of Hg.

0953: wind 110 at 11 knots; visibility 1 3/4 SM; mist; sky condition overcast 300 feet AGL; temperature -1 degrees C, dew point -1 degree C; altimeter 30.04 inches of Hg.

AIRPORT INFORMATION

OJC was a controlled airport served by runway 18-36 (4,099 feet by 75 feet) with an airport elevation of 1,096 feet.

WRECKAGE AND IMPACT INFORMATION

The main wreckage was located at GPS coordinates: 38 degrees 51.65 seconds North and 094 degrees 43.12 seconds West or about 1.2 nautical miles and 48 degrees from OJC. The wreckage path was approximately 1,000 feet long with a magnetic heading of 260 degrees. The northeastern most area of the wreckage path contained broken tree limbs from a tree approximately 45 feet in height. The main wreckage was about 87 feet from the tree and an 18 foot long ground scar was located between the main wreckage and tree. The main wreckage was resting against a fractured concrete retaining wall that belonged to a house. Aircraft debris penetrated the walls of the house and neighboring houses. A smell consistent with Jet A was present at the accident site and in the home with the fractured retaining wall.

Both engines were separated from the airframe and found along the wreckage path. The right engine was located approximately 250 feet from the main wreckage in the driveway of a neighboring house. The right engine and a section of attached right wing were covered with soot. Vehicles and the ground between the main wreckage and right engine exhibited fire damage and soot. The left engine was located approximately 550 feet west of the main wreckage.

Both wings and empennage were attached to the fuselage and contained features consistent with overload.

Fractures in the flight control cables exhibited necking with a 45-degree shear lip consistent with overload throughout the flight control system. The flight controls were connected from the wings and empennage to the cockpit area. The flight control surfaces were attached.

The landing gear was in the retracted position.

The emergency locator transmitter, which was installed in the aft fuselage of the airplane, was found broken apart outside of the fuselage.

MEDICAL AND PATHOLOGICAL INFORMATION

An autopsy of the pilot was conducted by the Johnson County Coroner on January 22, 2006. Autopsy toxicological test results were negative for all substance tested.

Federal Aviation Administration (FAA) Final Forensic Toxicology Fatal Accident Report stated: carbon monoxide not performed, cyanide not performed, volatiles 28 (mg/dL, mg/hg) ethanol detected in muscle, and 37 (mg/dL, mg/hg) ethanol detected in liver.

TESTS AND RESEARCH

Radar data for N844JK shows at:

0940:32, altitude 1,800 feet, heading 348 degrees, speed 126 knots.

0940:36, altitude 1,900 feet, heading 007 degrees, speed 132 knots.

0940:41, altitude 1,900 feet, heading 025 degrees, speed 139 knots.

0940:45, altitude 2,000 feet, heading 032 degrees, speed 132 knots.

0940:50, altitude 2,000 feet, heading 052 degrees, speed 134 knots.

0940:55, altitude 2,100 feet, heading 093 degrees, speed 143 knots.

0940:59, altitude 2,200 feet, heading 111 degrees, speed 150 knots.

0941:04, altitude 2,000 feet, heading 130 degrees, speed 159 knots.

The horizontal situation indicator (HSI) and Integrated Flight Control System (IFCS) mode selector light bulb filaments were examined by the National Transportation Safety Board's Materials Laboratory.

The HSI course cursor was indicating approximately 110 degrees/290 degrees with the arrow pointing to 110 degrees. The pointer tip on the opposite side was missing and the heading bug was approximately 180 degrees.

The rotor was removed freely from the rotor housing and its examination showed that it was minimally damaged. Above the vanes, some scoring marks were noticed, but no damage was noted on the rotor's lower edges, though at the lower chamfer and around the vanes localized paint was removed. The rotor housing was sectioned in half to expose the interior surface. On one half of the housing axial scoring marks were observed almost entirely around that half of the housing. On the opposing half of the housing, circumferential scoring/rubbing marks were observed over more than 90 degrees, and an area of angled scoring marks was also noted. Detailed optical and scanning electron microscope examination of the circumferentia

NTSB Probable Cause

The pilot's failure to maintain adequate altitude/clearance during cruise flight, resulting in collision with trees. Contributing factors were the low altitude and low ceiling.