# NTSB CEN15LA275: Diamond Aircraft Ind DA 20 C1, N919DA, Pueblo, CO, June 10, 2015 - Type: NTSB accident investigation - Classification: Accident · No injuries · Limited investigation · Final report - Date: June 10, 2015, 15:38 local (21:38 UTC) - Place: Pueblo, CO - Coordinates: 38.299167, -104.50389 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=38.2992&lon=-104.5039&mi=10 - Phase of flight: [Landing](https://openairdocs.org/ntsb-phases/550) (OpenAirDocs' grouping) - Defining event: [Landing: Hard landing](https://openairdocs.org/ntsb-events/092) - Highest injury: No injuries - Injuries: 1 uninjured - Status: Completed, report December 14, 2015 - Report: Approved by Office Director - NTSB office: Central Region - Parties: Flight Standards District Office, Doss Aviation - NTSB case key (mKey): 91385 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=CEN15LA275 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/91385/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=91385 - Page: https://openairdocs.org/ntsb/CEN15LA275 ## Probable cause The student pilot’s decision to continue the approach and landing despite recognizing that the wind speed was above the published limit for solo flight, which resulted in a porpoised landing. Contributing to the accident was the failure of the flight instructor and supervisor of flying to direct the student to go around or divert. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Info processing/decision: decision making/judgment](https://openairdocs.org/ntsb-findings/02041520): Personnel issues › Action/decision · Student/instructed pilot (probable cause); cases with it: [Diamond Aircraft Ind DA20-C1, 7 cases](https://openairdocs.org/ntsb-findings/02041520/cases.md?model=2990001), [All aircraft, 3,098 cases](https://openairdocs.org/ntsb-findings/02041520/cases.md) - [Wind: high wind](https://openairdocs.org/ntsb-findings/03034055): Environmental issues › Conditions/weather/phenomena · Effect on operation (probable cause); cases with it: [Diamond Aircraft Ind DA20-C1, 1 case](https://openairdocs.org/ntsb-findings/03034055/cases.md?model=2990001), [All aircraft, 112 cases](https://openairdocs.org/ntsb-findings/03034055/cases.md) - [Performance/control parameters](https://openairdocs.org/ntsb-findings/01062000): Aircraft › Aircraft oper/perf/capability · Not attained/maintained (probable cause); cases with it: [Diamond Aircraft Ind DA20-C1, 5 cases](https://openairdocs.org/ntsb-findings/01062000/cases.md?model=2990001), [All aircraft, 1,269 cases](https://openairdocs.org/ntsb-findings/01062000/cases.md) - [Info processing/decision: decision making/judgment](https://openairdocs.org/ntsb-findings/02041520): Personnel issues › Action/decision · Flt operations/dispatcher (probable cause); cases with it: [Diamond Aircraft Ind DA20-C1, 7 cases](https://openairdocs.org/ntsb-findings/02041520/cases.md?model=2990001), [All aircraft, 3,098 cases](https://openairdocs.org/ntsb-findings/02041520/cases.md) - [Info processing/decision: decision making/judgment](https://openairdocs.org/ntsb-findings/02041520): Personnel issues › Action/decision · Instructor/check pilot (probable cause); cases with it: [Diamond Aircraft Ind DA20-C1, 7 cases](https://openairdocs.org/ntsb-findings/02041520/cases.md?model=2990001), [All aircraft, 3,098 cases](https://openairdocs.org/ntsb-findings/02041520/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Landing: Hard landing](https://openairdocs.org/ntsb-events/092) (defining event); cases with it: [Diamond Aircraft Ind DA20-C1, 9 cases](https://openairdocs.org/ntsb-events/092/sequence.md?model=2990001), [All aircraft, 2,102 cases](https://openairdocs.org/ntsb-events/092/sequence.md) ## Analysis The student pilot was flying the second of four required cross-country solo flights for his training syllabus. About 53 minutes before the accident, the supervisor of flying (SOF) directed the student to return to his home airport due to convective activity south and west of the airport. The airport tower controller cleared the flight to land, and, about 1 minute before the accident, reported that the wind was 200 degrees at 20 knots, which was the published wind limit for solo flight. As the student turned the airplane from the base to final legs in the airport traffic pattern, the controller reported that the wind had increased to 40 knots due to a thunderstorm gust front. The student reported that he chose to continue the approach and landing despite recognizing that the wind speed was above the published limit for solo flight because he believed that the SOF and an airborne flight instructor, who had been advising him throughout the approach, would continue to advise him until landing. He added that he thought that he was expected to land unless specifically told to go around or divert. The student was also concerned about the thunderstorm approaching the airport from the southwest and believed the better option was to attempt the landing rather than go around and risk entering the weather. As the student landed the airplane, it porpoised multiple times before sliding to a stop. Despite the high wind and thunderstorm conditions, neither the SOF nor the flight instructor directed the student to go around or divert to another airport. The flight instructor reported that he was overly concerned with distracting the student while he was on final, and the SOF had left the step desk area to walk outside and evaluate the weather. The SOF was using an on-line, predictive weather service to assist with launch, recall, and divert decisions. As convective activity increased south and west of the airport during the hour leading up to the accident, the storms moved northeast more rapidly than forecast, which led to the SOF's late recall of the student. ## Factual narrative On June 10, 2015, at 1538 mountain daylight time, a single engine Diamond Aircraft Industries Inc. DA20-C1 airplane, N919DA, was substantially damaged during landing at the Pueblo Memorial Airport (PUB), Pueblo, Colorado. The solo student pilot was not injured. The airplane was owned by Doss Aviation Incorporated and operated under contract for the United States Air Force (USAF). Visual meteorological conditions prevailed for the 14 Code of Federal Regulations Part 91 public aircraft (no longer using Public Use) flight, which was returning on a training flight from the Lamar Municipal Airport (LAA), Lamar, Colorado. The student was flying his second of four required cross-country solos in the USAF directed syllabus. Prior to the flight, a flight instructor conducted a briefing with the student, which included a review of the weather information, planned route of flight, and possible divert airports if the weather precluded a return to PUB. Following this briefing, the supervisor of flying (SOF) reviewed weather information with the student and identified a flight instructor that would be airborne until the student landed. The flight to LAA was uneventful. At 1445, as the student was making his last approach at LAA, the SOF initiated a weather recall to PUB. On the return flight from LAA, with convective activity in the area increasing, the airborne flight instructor directed the student to fly direct to PUB. The PUB tower controller subsequently cleared the student to land on runway 17 and reported wind 190 degrees at 26 knots (published wind limit for solo flight was 20 knots). About one minute prior to the accident, the controller reported wind 200 degrees at 20 knots. As the student turned the airplane from base to final, the controller reported wind 210 degrees at 40 knots. During his landing, the student allowed the airplane to contact the runway nose wheel first. The airplane subsequently porpoised multiple times and slid to a stop, during which the nose wheel assembly strut penetrated the fuselage. The student stated two reasons why he elected to continue the approach and landing, despite recognizing the wind velocity was above the published limits. First, he had received guidance from the SOF and the airborne flight instructor throughout his arrival and thought they would continue to advise him until landing. Therefore, the student perceived that he was expected to land unless he was specifically told to go-around or divert. Second, the student noticed the storms approaching PUB from the southwest and perceived the better option was to attempt the landing than to risk a go-around and possible entry into the weather. When asked about the lack of instructor input during the final portion of the flight, the airborne flight instructor pilot stated that he did not want to distract the student during a critical phase of flight. The SOF stated that he was not providing inputs because he heard the airborne flight instructor talking with thestudent. Also, the SOF left the step desk area (inside the Doss building) to walk outside and evaluate the weather. During this time, the SOF did not hear the out of limits wind callout by the controller. The terminal aerodrome forecast (TAF) for PUB contained a remark of thunderstorm in the vicinity (VCTS), but there was no specific convective activity forecast during the time the student would be flying, plus two hours after scheduled landing. The SOF was utilizing WeatherTAP, an online weather service which updates weather data products in real time and allows viewing of current weather information. Next-generation radar (NEXRAD) is updated every six minutes (every four minutes during severe weather) and severe weather watches, warnings and advisories are updated every three minutes. The service also has a storm table that shows attributes of each storm cell, such as where the cell is currently located and where it projects the cell to be in 15-minute intervals. Additionally, the service shows real-time, high-resolution lightning data that is updated every minute. Using this information, the SOF estimated that storm cells forming south and west of PUB were more than an hour from affecting PUB when he initiated the weather recall. The accident occurred 53 minutes after the SOF initiated the recall. Graphical views of convective activity for the time frame of this accident are located in the public docket for this investigation. ## Aircraft - Registration: [N919DA](https://openairdocs.org/aircraft/N919DA), registered now, S/N C0393, built 2006 (OpenAirDocs) - Reported make and model: DIAMOND AIRCRAFT IND INC DA 20 C1 - Registry model: [Diamond Aircraft Ind DA20-C1](https://openairdocs.org/model/diamond-aircraft-ind-da20-c1) (registry code 2990001) (OpenAirDocs) - Registry engine: [Continental IO-240-B](https://openairdocs.org/engine/continental-io-240-b) (registry code 17177, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: C0393 - Year built: 2006 - Airframe hours: 5148 - Engines: Continental IO-240-B/1004 125 horsepower reciprocating - Damage: Substantial damage - Flight: Instructional, Part 91 - Operator: Doss Aviation Inc - Registered owner: Doss Aviation Inc - Airworthiness certificate: Standard, Utility - Last inspection: 100 hour, May 29, 2015, 8 hours before - Departed: LAA, Lamar, CO - Destination: PUB, Pueblo, CO - Airport: PUB, Pueblo Memorial, runway 17, 8,310 × 150 ft, asphalt - Equipment: Stall warning system ## Flight crew As NTSB recorded them. NTSB leaves out names. - Student pilot; age 25; injuries: none; student; medical: class 3, without waivers/limitations; last flight review June 8, 2015; seat: right; restraint: 4-point; flight hours: 24 total, 24 in this make and model, 5 as pilot in command, 24 in the last 90 days, 23 in the last 30 days, 3 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: 210° at 30 knots, gusting 39 - Visibility: 8 statute miles - Lowest ceiling: 8,000 ft broken - Temperature: 79 °F, dew point 52 °F - Altimeter: 29.82 inHg - Observed at: KPUB, 1 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 20150610007849A](https://openairdocs.org/incident/20150610007849A), Jun 10, 2015: Diamond Aircraft Ind Inc DA20-C1, Pueblo, CO, Substantial damage. On June 10, 2015 at 1538 mountain daylight time (MDT), a single engine Diamond DA20-C1, registration number N919DA, was substantially damaged during landing at… ## Docket (1 files) The files NTSB released with the investigation on November 5, 2015, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=91385. 420 KB in all. - Graphical View of Convective Activity (item 1, .PDF, 420 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40433647&FileExtension=.PDF&FileName=Graphical%20View%20of%20Convective%20Activity-Master.PDF 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.