# NTSB CEN17LA078: Textron 525C, N525PZ, Howell, MI, January 16, 2017 - Type: NTSB accident investigation - Classification: Accident · Serious injuries · Limited investigation · Final report - Date: January 16, 2017, 11:59 local (16:59 UTC) - Place: Howell, MI - Coordinates: 42.627223, -83.973609 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=42.6272&lon=-83.9736&mi=10 - Phase of flight: [Landing](https://openairdocs.org/ntsb-phases/550) (OpenAirDocs' grouping) - Defining event: [Landing-landing roll: Runway excursion](https://openairdocs.org/ntsb-events/300) - Highest injury: Serious injuries - Injuries: 1 serious - Status: Completed, report November 6, 2019 - Report: Approved by Office Director - NTSB office: Central Region - Parties: FAA, Textron Aviation - NTSB case key (mKey): 94613 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=CEN17LA078 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/94613/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=94613 - Page: https://openairdocs.org/ntsb/CEN17LA078 ## Probable cause The pilot's attempted landing on the ice-covered runway, which resulted in a runway excursion and impact with terrain. Contributing to the accident was airport personnel's lack of training regarding issuance of NOTAMs ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Use of equip/info: aircraft control](https://openairdocs.org/ntsb-findings/02063040): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Textron 525C, 1 case](https://openairdocs.org/ntsb-findings/02063040/cases.md?model=2076628), [All aircraft, 9,295 cases](https://openairdocs.org/ntsb-findings/02063040/cases.md) - [Performance/control parameters: surface speed/braking](https://openairdocs.org/ntsb-findings/01062045): Aircraft › Aircraft oper/perf/capability · Capability exceeded (probable cause); cases with it: [Textron 525C, 1 case](https://openairdocs.org/ntsb-findings/01062045/cases.md?model=2076628), [All aircraft, 238 cases](https://openairdocs.org/ntsb-findings/01062045/cases.md) - [Runway/land/takeoff/taxi surface: snow/slush/ice covered surface](https://openairdocs.org/ntsb-findings/03023015): Environmental issues › Physical environment · Ability to respond/compensate (probable cause); cases with it: [Textron 525C, 1 case](https://openairdocs.org/ntsb-findings/03023015/cases.md?model=2076628), [All aircraft, 219 cases](https://openairdocs.org/ntsb-findings/03023015/cases.md) - [Runway/land/takeoff/taxi surface: snow/slush/ice covered surface](https://openairdocs.org/ntsb-findings/03023015): Environmental issues › Physical environment · Availability of related info (probable cause); cases with it: [Textron 525C, 1 case](https://openairdocs.org/ntsb-findings/03023015/cases.md?model=2076628), [All aircraft, 219 cases](https://openairdocs.org/ntsb-findings/03023015/cases.md) - [Training](https://openairdocs.org/ntsb-findings/04031000): Organizational issues › Support/oversight/monitoring · Airport (probable cause); cases with it: [Textron 525C, 1 case](https://openairdocs.org/ntsb-findings/04031000/cases.md?model=2076628), [All aircraft, 26 cases](https://openairdocs.org/ntsb-findings/04031000/cases.md) - [Use of equip/info: use of automation](https://openairdocs.org/ntsb-findings/02063010): Personnel issues › Task performance · Airport personnel (probable cause); cases with it: [Textron 525C, 1 case](https://openairdocs.org/ntsb-findings/02063010/cases.md?model=2076628), [All aircraft, 17 cases](https://openairdocs.org/ntsb-findings/02063010/cases.md) - [Use of equip/info: use of policy/procedure](https://openairdocs.org/ntsb-findings/02063032): Personnel issues › Task performance · Airport personnel (probable cause); cases with it: [Textron 525C, 1 case](https://openairdocs.org/ntsb-findings/02063032/cases.md?model=2076628), [All aircraft, 191 cases](https://openairdocs.org/ntsb-findings/02063032/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Landing-landing roll: Other weather encounter](https://openairdocs.org/ntsb-events/400); cases with it: [Textron 525C, 1 case](https://openairdocs.org/ntsb-events/400/sequence.md?model=2076628), [All aircraft, 1,127 cases](https://openairdocs.org/ntsb-events/400/sequence.md) - [Landing-landing roll: Runway excursion](https://openairdocs.org/ntsb-events/300) (defining event); cases with it: [Textron 525C, 1 case](https://openairdocs.org/ntsb-events/300/sequence.md?model=2076628), [All aircraft, 3,643 cases](https://openairdocs.org/ntsb-events/300/sequence.md) - [Landing-landing roll: Collision with terr/obj (non-CFIT) ](https://openairdocs.org/ntsb-events/470); cases with it: [Textron 525C, 1 case](https://openairdocs.org/ntsb-events/470/sequence.md?model=2076628), [All aircraft, 10,189 cases](https://openairdocs.org/ntsb-events/470/sequence.md) ## Analysis After exiting the clouds during the landing approach at the uncontrolled airport, the private pilot of the small jet canceled his instrument flight plan with air traffic control. He stated that, although there was no precipitation when he exited the clouds, he suspected the runway may be icy due to the weather conditions. The pilot saw an airplane holding short on the taxiway at the end of the runway and assumed it was preparing to takeoff, which he stated led him to believe that the runway condition was good. Although the pilot announced his location and intentions on the airport's common traffic advisory frequency (CTAF), he did not inquire about the runway condition via CTAF/UNICOM. Witnesses reported that the approach looked normal. After touchdown, the pilot applied brakes and realized he had no braking action. He subsequently retracted the speed brakes, spoilers, and flaps, and added takeoff power. The airplane yawed to the left and the pilot reduced engine power to idle while applying rudder to correct the airplane's track. The airplane continued off the runway, where it traveled through a fence and across a road before coming to rest inverted. The pilot and mechanic seated in the airplane that was holding short of the runway during the landing reported that they were only taxiing to a maintenance facility and did not intend to take off. They reported that the taxiways were icy. A witness who assisted the pilot following the accident reported that the roads at the time were covered in ice and "very slick." Recorded data from the airplane showed that the pilot flew a stabilized approach and that the airplane touched down near the approach end of the runway; however, given the icy runway conditions, the airplane's landing distance required exceeded the available runway by more than 8,000 ft. Airport personnel had not issued a NOTAM regarding the icy runway conditions. The airport manager stated he was not at the airport at the time of the accident, and that he was still trying to learn the new digital NOTAM manager system. The employee who was at the airport was authorized to issue NOTAMs, but had not yet been trained on the new system. ## Factual narrative On January 16, 2017, at 1159 eastern standard time, a Textron Aviation 525C, N525PZ, collided with the terrain following a loss of control on landing at the Livingston County Airport (OZW), Howell, Michigan. The private pilot received serious injuries. The airplane was substantially damaged by impact forces and a post impact fire. The airplane was registered to and operated by Zeliff Aviation, Inc., under the provisions of 14 Code of Federal Regulations Part 91 as a business flight. Visual meteorological conditions prevailed near the accident site and the flight was operated on an instrument flight rules flight plan. The flight originated from the Genessee County Airport (GCQ), Batavia, New York at 1057.The pilot reported that prior to the flight he checked the weather and Notices to Airmen (NOTAMs) on the Aviation Digital Data Services Meteorological Terminal Aviation Routine Weather Reports (ADD METAR) website. When preparing for the Instrument Landing System (ILS) runway 13 approach at OZW, the pilot listened to the Automated Terminal Information Service (ATIS) and he used the airplane's flight management system (FMS) to determine the landing performance data. The pilot stated the Next Generation Radar (NEXRAD) was showing rain in the area, but the onboard radar was not. He did not encounter any precipitation once he descended below the clouds. He then canceled his flight plan and continued the approach. The pilot stated he knew there was a possibility of there being ice on the runway, as the weather conditions were favorable for ice. He stated he decided to continue the approach making sure he was accurately flying the approach speeds and that he did not land long on the runway. He stated he was prepared to go-around if the runway was icy. In addition, he saw an airplane holding short on a taxiway at the end of the runway, which appeared to be waiting for him to land so that it could depart, and this led him to believe the runway condition was good. The pilot did not use the common traffic advisory frequency (CTAF) to inquire about the runway conditions. The pilot stated that upon touchdown, he applied the speed brakes and spoilers. Once the nose wheel touched down, he applied the brakes and realized he had no braking action. He retracted the speed brakes, spoilers and flaps and applied takeoff power. The airplane yawed to the left, so he reduced the power to idle and applied right rudder to correct the airplane's heading. The airplane continued off the runway where it contacted a fence, a ditch, and crossed a road prior to coming to rest. The pilot next recalled the airplane came to rest with him hanging upside down by the seatbelt. He crawled out of the airplane and noticed the wings had separated. The lineman who was working in the fixed base operator reported hearing the pilot announce that he was on the ILS approach and then again that he was on short final. He stated the airplane touched down prior to the taxiway A-2 turnoff, and heasked the pilot if he knew where he was going to park. He walked outside and noticed the airplane was near the east end of the runway. He recalled hearing the engine power increase followed by the impact and black smoke. The airplane that was sitting at the end of the runway was being taxied to a maintenance shop and was not going to takeoff. The pilot and mechanic in the airplane stated they saw the airplane during its approach which looked "normal." They stated the taxiways were icy and there was mist/light rain in the area. Another witness who saw the accident and assisted the pilot following the accident, stated the roads were covered with ice and "very slick." This witness stated that the sleet and freezing rain had started about an hour before the accident. The aircraft recording system (AReS II) data from the airplane was downloaded. The data showed the airplane was ½ mile from the runway at 200 ft above ground level at an airspeed of 110 knots, and that the airplane touched down near the approach end of the runway prior to veering to the left. After touching down, the throttles were advanced for a period of about 15 seconds, reduced, then advanced momentarily once again. The Model 525C landing performance data charts show that at a weight of 14,500 lbs, a landing reference speed (Vref) of 108 KIAS, and with no wind, the landing distance on a wet icy runway would have been about 13,625 ft. The length of runway 13 was 5,002 ft. A NOTAM had not been issued regarding the icy runway conditions at OZW. The airport manager stated he was not at the airport at the time of the accident, and that he was still trying to learn the new digital NOTAM manager system. The employee who was at the airport was authorized to issue NOTAMs, but had not yet been trained on the new system. Subsequent to the accident, the airport manager reported that the employees have been trained on inspecting runway conditions and issuing NOTAMs. ## Aircraft - Registration: [N525PZ](https://openairdocs.org/deregistered/N525PZ-2017-03-07), registration cancelled 2017-03-07, S/N 525C0196, built 2015 (OpenAirDocs) - Reported make and model: TEXTRON AVIATION INC 525C - Registry model: [Textron 525C](https://openairdocs.org/model/textron-525c) (registry code 2076628) (OpenAirDocs) - Registry engine: [Williams FJ44-4A](https://openairdocs.org/engine/williams-fj44-4a) (registry code 66011, turbo-fan) (OpenAirDocs) - Category: Airplane - Serial number: 525C0196 - Year built: 2015 - Airframe hours: 320 - Engines: WILLIAMS FJ44-4A 3621 lbs thrust turbo fan; WILLIAMS FJ44-4A 3621 lbs thrust turbo fan - Damage: Substantial damage - Fire: On-Ground - Flight: Business, Part 91 - Airworthiness certificate: Standard, Normal - Last inspection: Continuous airworthiness, January 14, 2017 - Departed: GVO, Batavia, NY - Destination: OZW, Howell, MI - Flight plan: IFR - Airport: OZW, Livingston Co., runway 13, 5,002 × 100 ft, concrete - Equipment: Stall warning system, Satellite tracking device, Onboard weather, Electronic primary flight display, Electronic multifunction display, Electronic flight bag or handheld device, ADS-B, Data recorder, Auto-pilot, Angle of attack indicator ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 60; injuries: serious; private; airplane ratings: single-engine land, multi-engine land; instrument ratings: airplane; medical: class 2, with waivers/limitations; last flight review April 10, 2016; seat: left; restraint: 5-point; flight hours: 5,800 total, 320 in this make and model, 66.4 in the last 90 days, 23.8 in the last 30 days, 1 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: 130° at 4 knots - Visibility: 3 statute miles - Lowest ceiling: 5,500 ft overcast - Temperature: 30 °F, dew point 27 °F - Altimeter: 30.28 inHg - Observed at: KOZW ## 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 20170116000109A](https://openairdocs.org/incident/20170116000109A), Jan 16, 2017: Cessna 525, Howell, MI, Destroyed. Pilot stated "I touched down just before the 1000? Marks, lets call it 800? From the beginning of 13. It was about 300? Later I had the speed brakes and… ## Docket (13 files) The files NTSB released with the investigation on January 17, 2018, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=94613. 10.5 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 1.1 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40459406&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Master.PDF - Air Traffic Control Information (item 2, .PDF, 1.4 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40459407&FileExtension=.PDF&FileName=Air%20Traffic%20Control%20Information-Master.PDF - State of Michigan Aircraft Accident Report (item 3, .PDF, 75 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40459408&FileExtension=.PDF&FileName=State%20of%20Michigan%20Aircraft%20Accident%20Report-Master.PDF - Record of Conversation (item 4, .PDF, 338 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40459409&FileExtension=.PDF&FileName=Record%20of%20Conversation-Master.PDF - Witness (item 5, .PDF, 407 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40459410&FileExtension=.PDF&FileName=Witness-Master.PDF - Email (item 6, .PDF, 76 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40459411&FileExtension=.PDF&FileName=Email-Master.PDF - Textron Aviation Aircraft Incident/Accident Technical Report (item 7, .PDF, 349 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40459412&FileExtension=.PDF&FileName=Textron%20Aviation%20Aircraft%20Incident%2FAccident%20Technical%20Report-Master.PDF - Performance Charts and Operating Procedures (item 8, .PDF, 1.5 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40459413&FileExtension=.PDF&FileName=Performance%20Charts%20and%20Operating%20Procedures-Master.PDF - ARES II Data Plots (item 9, .PDF, 308 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40459414&FileExtension=.PDF&FileName=ARES%20II%20Data%20Plots-Master.PDF - NOTAMs (item 10, .PDF, 768 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40459415&FileExtension=.PDF&FileName=NOTAMs-Master.PDF - Weather Information (item 11, .PDF, 1.2 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40459416&FileExtension=.PDF&FileName=Weather%20Information-Master.PDF - Google Earth Images (item 12, .PDF, 2.5 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40459417&FileExtension=.PDF&FileName=Google%20Earth%20Images-Master.PDF - Statement of Party Representatives to NTSB Investigation (item 13, .PDF, 468 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40459418&FileExtension=.PDF&FileName=Statement%20of%20Party%20Representatives%20to%20NTSB%20Investigation-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.