# NTSB ATL03FA052: Beech BE-36A, N343BA, Mount Airy, NC, March 2, 2003 - Type: NTSB accident investigation - Classification: Accident · Fatal · Field investigation · Final report - Date: March 1, 2003, 19:30 local (Mar 2, 2003, 00:30 UTC) - Place: Mount Airy, NC - Coordinates: 36.427501, -80.558052 - Nearby events: https://openairdocs.org/map.md?lat=36.4275&lon=-80.5581&mi=10 - Phase of flight: [Initial climb](https://openairdocs.org/ntsb-phases/350) (OpenAirDocs' grouping) - Highest injury: Fatal - Injuries: 5 fatal - Status: Completed, report December 28, 2004 - Report: Approved by Office Director - Parties: Greensboro FSDO - NTSB case key (mKey): 56585 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=ATL03FA052 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/56585/pdf - Page: https://openairdocs.org/ntsb/ATL03FA052 ## Probable cause The pilots failure to maintain control of the aircraft due to spatial disorientation. A factor was low clouds. ## Sequence of events In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf). - Loss of control - in flight, takeoff - initial climb - aircraft control - not maintained, pilot in command (cause) - spatial disorientation, pilot in command (cause) - weather condition - low ceiling (contributing factor) - In flight collision with terrain/water, descent - uncontrolled - terrain condition - ground ## Analysis According to the airport manager, the instrument flight collided with the ground shortly after takeoff. Weather at the time of the accident was wind calm, visibility two statue miles, drizzle, ceiling overcast 500 feet, temperature eight degrees Celsius, dew point six degrees Celsius, altimeter 30.00 inches of mercury. Examination of the wreckage site found that the airplane had collided with terrain on the south side of an east-west oriented hill, in a near vertical nose-down attitude. The engine and forward cabin had penetrated the ground to a depth of about eight feet. The wreckage examination failed to disclose anomalies with the airframe or systems. ## Factual narrative HISTORY OF FLIGHT On March 1, 2003, at 1930 eastern standard time, a Beech BE-36A, N343BA, registered to and operated by the commercial pilot, collided with terrain shortly after takeoff from the Mount Airy/Surry County Airport in Mount Airy, North Carolina. The personal flight was operated under the provisions of Title 14 CFR Part 91 and instrument flight rules (IFR). Instrument meteorological conditions prevailed, and an instrument flight plan was filed. The pilot and four passengers received fatal injuries, and the airplane was destroyed. The flight was originating from Mount Airy, North Carolina, at the time of the accident on March 1, 2003. The airport manager stated that he had watched the pilot load the airplane, and he heard the pilot file an IFR flight plan in the airport lobby for a flight to the Curtis L. Brown, Jr. Field identifier 4W1, located in Elizabethtown, North Carolina. The manager stated that the pilot reported he was expecting an 800-foot ceiling and 2 statute miles visibility at arrival in Elizabethtown. After the airplane was loaded, the airport manager noted that the Elizabethtown Automated Weather Observation System (AWOS) readout was reporting the ceiling was 500 feet broken, 1,800 feet overcast, and 2 statute miles visibility in light drizzling rain. The airport manager heard the airplane takeoff from runway 18, and he stated that the engine sounded normal. Shortly after the takeoff, the airport manager said he received a telephone call from a local resident who stated that she had heard an airplane making a "flapping" sound followed by the sound of a crash. The airport manager stated that he notified the local authorities, who then initiated a search from the residents home. He said the airplane was quickly located near the resident who reported the accident. PERSONAL INFORMATION A review of information on file with the FAA Airman's Certification Division, Oklahoma City, Oklahoma, revealed the pilot was issued a commercial pilot certificate on June 7, 2002, with ratings for airplane single and multiengine land, and instrument airplane. A review of records on file with the FAA Aero Medical Records revealed the pilot held a second-class medical certificate issued on March 5, 2002, with no restrictions. The pilot reported on his application for the medical certificate that he had accumulated 475 total flight hours, and a review of the pilot's logbook revealed that the pilot had accumulated 712 total flight hours. The flight book review also disclosed that the pilot had accumulated 44 hours of actual instrument flying, 3 hours of actual instrument flying within the last 90-days. AIRCRAFT INFORMATION A review of maintenance records revealed that the last recorded total time for the airframe was during the annual inspection on December 16, 2002, of 4,852.53 hours, and an engine total time of 205.1 since factory overhaul. The tachometer time and hobs meter was damaged and the current airframe times could not be recovered. The altimeter system, static pressure system, and transponder were inspected on July 23, 2002. Refueling records on file at Mount Airy-Surry County Airport, Mount Airy, North Carolina, revealed that N343BA, was topped off with 26.4 gallons of fuel on March 1, 2003. The engine logbooks revealed that the factory-overhauled engine was installed on August 31, 2001, and that the engine was equipped with a Shadin fuel flow indicating system installed under STC-SA449GL. METEOROLOGICAL INFORMATION Mount Airy Automated Surface Observation at 1920, wind calm, visibility two statue miles, drizzle, ceiling overcast 500 feet, temperature eight degrees Celsius, dew point six degrees Celsius, altimeter 30.00 inches of mercury. Instrument meteorological conditions prevailed at the time of the accident. According to local law enforcement Surry County Sheriff Department and ground search teams, the visibility in the vicinity of the crash scene was very low with fog. WRECKAGE AND IMPACT INFORMATION Examination of the wreckage site found that the airplane had collided with terrain on the south side of an east-west oriented hill, in a near vertical nose-down attitude. The engine and forward cabin had penetrated the ground to a depth of about eight feet. The wing leading edges had collapsed rearward, and were compressed flat to the front wing spars. The top and bottom wing panel skins were symmetrically ballooned outward, exposing the wing internal structure. The flap and aileron control surfaces remained loosely attached to the wings. The rear cabin and rear fuselage displayed accordion crush damage. The empennage was found lying partially on top of the fuselage structure and on the hillside. The top of the airplane and empennage were on a northerly heading towards the airport. Flight control continuity could not be verified, however flight control components were examined, and no anomalies were noted. It was found during the recovery of the airplane that the landing gear was retracted, flaps retracted, and that the nose trim tab was set to 10 degrees trailing edge down. The fuel selector was found positioned on the right main wing tank. The electric fuel boost pump system had been modified to a boost pump that could be selected to either LOW or ON (High). The cabin door and the two utility baggage doors were separated from the airplane. Both utility doors had separated from their hinges and had fragmented into multiple pieces. The instrument panel was damaged, and the engine and flight instruments were dislodged from the normally install positions. The lower instrument panel switches were deformed or missing. The King 200 (2-axis) autopilot enunciator panel was not located. The airplane was equipped with an auxiliary electric-driven instrument air pump mounted on the firewall. The artificial horizon was disassembled. There was scoring present on the gyro mechanism. The engine was a Teledyne Continental Motors IO-550. Examination of the engine and accessory components revealed the following. The engine and propeller were located 8 feet below ground level at the accident site. The engine remained partially attached to the firewall by control cables, wiring and hoses. The engine driven fuel pump, alternator, air conditioner compressor, outboard portions of the propeller governor and the starter were separated from the engine. Both magnetos separated from their mounting flanges and were resting on the top of the engine. A small amount of fuel was found in the separated engine driven fuel pump at the accident site. The cooling fins on the Number 5 and 6 cylinders revealed heavy impact damage on the top and forward facing portions. The number 5 and 6 valve covers were found broken. All six cylinders remained attached to the engine case. The engine was moved to a storage facility in Mount Airy, North Carolina for a post recovery disassembly and examination. The engine was rinsed prior to the post-recovery examination to remove mud and soil from the engine. The engine driven fuel pump was broken off of the engine at its attachment flange. The lead seal and safety wire was found intact. All fuel lines to and from the fuel pump were fractured at the fuel pump fittings. The fuel pump drive coupler was found fractured at mid-span with the pump end remaining in the fuel pump. Some fuel was found in the engine driven fuel pump. The throttle arm remained attached to the throttle body at the throttle shaft and was separated from the throttle cable attachment end. The throttle shaft was bent and the throttle arm was partially disengaged. The fuel metering unit mixture arm was found bent and resting against the full rich stop. The fuel distribution manifold fuel screen was found clean and free of particles. The plunger moved up and down with spring tension noted and the diaphragm was found intact. The wiring harness was found impact damaged and was cut by impact forces in numerous locations. Both mag ## Aircraft - Registration: [N343BA](https://openairdocs.org/deregistered/N343BA-2004-01-05), registration cancelled 2004-01-05, S/N E-1317, built 1978 (OpenAirDocs) - Reported make and model: Beech BE-36A - Registry model: [Beech A36](https://openairdocs.org/model/beech-a36) (registry code 1151604) (OpenAirDocs) - Registry engine: [Continental IO-520 series](https://openairdocs.org/engine/continental-io-520-series) (registry code 17032, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: E-1317 - Airframe hours: 4853 - Engines: Continental IO-550 300 horsepower reciprocating - Damage: Destroyed - Flight: Personal, Part 91 - Registered owner: Oscar Nathan Harris II - Airworthiness certificate: Standard, Utility - Last inspection: Annual, December 16, 2002 - Departed: MWK, Mount Airy, NC - Destination: EYF, Elizabethtown, NC - Flight plan: IFR - Airport: MWK, Mount Airy/Surry County, runway 18, 4,300 × 75 ft, asphalt ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 32; injuries: fatal; commercial; airplane ratings: multi-engine land, single-engine land; instrument ratings: airplane; medical: class 2, valid medical--no waivers/lim.; last flight review June 7, 2002; seat: left; toxicology performed; flight hours: 712 total, 272 in this make and model, 653 as pilot in command, 110 in the last 90 days, 28 in the last 30 days, 0 in the last 24 hours ## Weather - Conditions: Instrument (IMC), Dusk - Wind: 0° at 0 knots - Visibility: 2 statute miles - Lowest ceiling: 500 ft overcast - Temperature: 46 °F, dew point 43 °F - Altimeter: 30.00 inHg - Observed at: MWK, 2 nm away ## FAA reports on this event (1) The FAA's own accident and incident reports, matched to the aircraft by N-number and date (OpenAirDocs). - [Accident 20030301008069A](https://openairdocs.org/incident/20030301008069A), Mar 1, 2003: Beech A36, Mount Airy, NC, Destroyed, 5 fatal. (-23) Pilot in command received IFR clearance from raleigh fss via land line. Aircraft departed Mount Airy (mwk) enroute elizabethtown (eyf). Aircraft appeared… ## Other investigations on N343BA (1) From the NTSB's public API. Aircraft are matched to registry aircraft by N-number and event date, checked against the reported serial number, make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model. - [NTSB MKC84LA023](https://openairdocs.org/ntsb/MKC84LA023), Nov 13, 1983: Beech A-36 (N343BA), Satanta, KS, substantial damage From the NTSB's public API. Aircraft are matched to registry aircraft by N-number and event date, checked against the reported serial number, make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model. --- OpenAirDocs.org is an independent research project of [Contrail Labs](https://contraillabs.com/). It is not affiliated with the FAA or the NTSB. Source documents are U.S. government works in the public domain.