# NTSB ATL96LA024: Piper PA-32-300, N4219T, Monroe, NC, December 19, 1995 - Type: NTSB accident investigation - Classification: Accident · No injuries · Limited investigation · Final report - Date: December 19, 1995, 18:45 local (23:45 UTC) - Place: Monroe, NC - Coordinates: 35.070148, -80.520706 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=35.0701&lon=-80.5207&mi=10 - Phase of flight: [Approach](https://openairdocs.org/ntsb-phases/500) (OpenAirDocs' grouping) - Highest injury: No injuries - Injuries: 1 uninjured - Status: Completed, report July 11, 1996 - Report: Approved by Office Director - NTSB case key (mKey): 3679 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=ATL96LA024 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/3679/pdf - Page: https://openairdocs.org/ntsb/ATL96LA024 ## Probable cause The pilot's inadequate planning and failure to follow operating procedures resulted in his descent below the decision height while on final approach. ## Sequence of events In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf). - In flight collision with object, approach - faf/outer marker to threshold (ifr) - planning/decision - inadequate, pilot in command (cause) - procedures/directives - not followed, pilot in command (cause) - decision height - not maintained, pilot in command (cause) - object - tree(s) (cause) ## Analysis According to the pilot, as he approached the decision height on the ILS approach, he observed ground lights, but never established visual contact with runway 5. Unable to identify the runway, the pilot executed a missed approach. During the climbout, the airplane collided with a 75 foot tall tree 2000 feet from the approach end of the runway. The decision height for the approach is 306 feet above the ground. The pilot diverted to another airport and landed without further incident. No approved weather reporting facility was located at the airport. According to Title 14 CFR Part 135.225, no pilot may begin an instrument approach to an airport without an approved weather reporting facility; nor can the pilot descend below the decision height (DH) if actual weather conditions are less than the published minimums. ## Factual narrative On December 19, 1995, at 1845 eastern standard time, a Piper PA- 32-300, N4219T, collided with a tree 2000 feet from the approach end of runway 05 at the Monroe Municipal Airport in Monroe, North Carolina. The domestic cargo flight operated under the provisions of Title 14 CFR Part 135 with an instrument flight plan filed. Instrument weather conditions prevailed at the time of the accident. The aircraft sustained substantial damage; the pilot was not injured. The flight departed Whitesville, North Carolina, at 1745 hours. According to the pilot, while on the final approach phase of the ILS runway 05 approach, he noticed lights on the ground. As he continued the approach descent, the airplane collided with a 75 foot tall tree. The decision height for the ILS runway 5 approach is 306 feet above the ground. The pilot said, visual contact with the airport was never established. The pilot executed the missed approach procedure, and flew to Columbia, South Carolina; the flight landed without incident. According to Monroe Airport personnel, there in no weather reporting facility located on the airport. The nearest weather reporting facility is located in Charlotte, North Carolina. Title 14 CFR Part 135.225 stated that, "no pilot may begin an instrument procedure to an airport unless that airport has a weather reporting facility operated by the U.S. National weather service...or a source approved by the Administrator". Part 135.225 (b) also states that, "no pilot may begin the final approach segment of an instrument approach procedure to an airport unless the approach may be continued and landing made if the pilot finds, upon reaching the authorized minimum descent altitude (MDA) or decision height (DH), that the actual weather conditions are at least equal to the minimums prescribed for the procedure". ## Aircraft - Registration: [N4219T](https://openairdocs.org/aircraft/N4219T), registered now, S/N 32-7240037, built 1971 (OpenAirDocs) - Reported make and model: Piper PA-32-300 - Registry model: [Piper PA-32-300](https://openairdocs.org/model/piper-pa-32-300) (registry code 7103212) (OpenAirDocs) - Registry engine: [Lycoming TI0-540 series](https://openairdocs.org/engine/lycoming-ti0-540-series) (registry code 41533, turbo-prop) (OpenAirDocs) - Category: Airplane - Serial number: 32-7240037 - Airframe hours: 2525 - Engines: Lycoming IO-540-K1A5 300 horsepower reciprocating - Damage: Substantial damage - Flight: Part 135 - Registered owner: Always Aviation - Airworthiness certificate: Standard, Normal - Last inspection: Annual, August 1, 1995, 41 hours before - Departed: CPC, WHITEVILLE, NC - Destination: EQY - Flight plan: IFR - Airport: EQY, Monroe Airport, runway 5, 5,500 × 100 ft, asphalt ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 35; commercial; airplane ratings: multi-engine land, single-engine land; instrument ratings: airplane; medical: class 1, valid medical--no waivers/lim.; seat: left; flight hours: 2,159 total, 271 in this make and model, 2,110 as pilot in command, 52 in the last 90 days, 17 in the last 30 days, 1 in the last 24 hours ## Weather - Conditions: Instrument (IMC), Night/dark - Wind: 90° at 3 knots - Visibility: 1 statute miles - Lowest ceiling: 200 ft overcast - Temperature: 41 °F, dew point 41 °F - Altimeter: 29.00 inHg - Observed at: CLT, 22 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 19951219041579A](https://openairdocs.org/incident/19951219041579A), Dec 19, 1995: Piper PA32300, Monroe, NC, Substantial damage. On ILS saw airport lights at dh. Unable land. Began missed approach. Struck trees. Diverted to alternate. Busted dh ## Other investigations on N4219T (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 CEN23LA415](https://openairdocs.org/ntsb/CEN23LA415), Sep 11, 2023: Piper PA-32-300 (N4219T), Moberly, MO, substantial damage. Probable cause: The flight instructor’s inadequate fuel management that resulted in fuel starvation and a total loss of engine power during an approach for landing. 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.