# NTSB CEN18FA368: Piper PA32RT, N500MJ, St Ignace, MI, September 1, 2018 - Type: NTSB accident investigation - Classification: Accident · Fatal · Field investigation · Final report - Date: August 31, 2018, 21:45 local (Sep 1, 2018, 01:45 UTC) - Place: St Ignace, MI - Coordinates: 45.9025, -84.706947 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=45.9025&lon=-84.7069&mi=10 - Phase of flight: [Initial climb](https://openairdocs.org/ntsb-phases/350) (OpenAirDocs' grouping) - Defining event: [Initial climb: Loss of control in flight](https://openairdocs.org/ntsb-events/240) - Highest injury: Fatal - Injuries: 1 fatal - Status: Completed, report September 23, 2020 - Report: Approved by Office Director - NTSB office: Central Region - Parties: Lycoming Engines, Piper Aircraft, FAA FSDO - NTSB case key (mKey): 98218 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=CEN18FA368 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/98218/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=98218 - Page: https://openairdocs.org/ntsb/CEN18FA368 ## Probable cause The pilot's failure to maintain sufficient altitude after takeoff in dark night conditions which resulted in a collision with the water. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Performance/control parameters: altitude](https://openairdocs.org/ntsb-findings/01062012): Aircraft › Aircraft oper/perf/capability · Not attained/maintained (probable cause); cases with it: [Piper PA-32RT-300T, 3 cases](https://openairdocs.org/ntsb-findings/01062012/cases.md?model=7103216), [All aircraft, 1,310 cases](https://openairdocs.org/ntsb-findings/01062012/cases.md) - [Light condition: dark](https://openairdocs.org/ntsb-findings/03036020): Environmental issues › Conditions/weather/phenomena · Effect on operation (probable cause); cases with it: [Piper PA-32RT-300T, 2 cases](https://openairdocs.org/ntsb-findings/03036020/cases.md?model=7103216), [All aircraft, 448 cases](https://openairdocs.org/ntsb-findings/03036020/cases.md) - [Use of equip/info: aircraft control](https://openairdocs.org/ntsb-findings/02063040): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Piper PA-32RT-300T, 7 cases](https://openairdocs.org/ntsb-findings/02063040/cases.md?model=7103216), [All aircraft, 9,295 cases](https://openairdocs.org/ntsb-findings/02063040/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Initial climb: Loss of visual reference](https://openairdocs.org/ntsb-events/402); cases with it: [Piper PA-32RT-300T, 1 case](https://openairdocs.org/ntsb-events/402/sequence.md?model=7103216), [All aircraft, 242 cases](https://openairdocs.org/ntsb-events/402/sequence.md) - [Initial climb: Loss of control in flight](https://openairdocs.org/ntsb-events/240) (defining event); cases with it: [Piper PA-32RT-300T, 5 cases](https://openairdocs.org/ntsb-events/240/sequence.md?model=7103216), [All aircraft, 5,002 cases](https://openairdocs.org/ntsb-events/240/sequence.md) ## Analysis The instrument-rated pilot took off in dark night conditions over a lake that bordered the departure end of the runway. The airport manager witnessed the airplane depart and reported that the takeoff sounded normal. Two witnesses who were facing the lake reported that they observed an aircraft take off from the airport, and fly about 100 to 200 ft above the lake surface. It then banked to the right and disappeared from sight. About 10 to 15 seconds later, the witnesses heard what sounded like a crash into the water or an explosion. There were no distress radio calls from the pilot and there was no radar information for the flight. The airport manager and first responders reported that it was a very dark night and that there was no distinguishable horizon. Examination of the airframe and engine did not reveal any preimpact anomalies that would have precluded normal operation, and evidence was consistent with a slight right wing down, nose low, high speed impact with the water. A right turn would have been necessary at some point after takeoff to fly towards the destination airport and evidence is consistent that a right turn had been initiated. Although the reason for the impact with the water could not be determined, the overwater departure in dark night conditions would not have provided adequate visual cues to assure a positive rate of climb during the departure and initial turnout on course as a pilot would be vulnerable to illusions if flight instruments were not used to conduct the takeoff and initial climb. ## Factual narrative During the on-scene investigation, investigators observed large geese nesting adjacent to the departure end of runway 7 and walking around during daylight hours. According to the airport manager, the geese are typically bedded down at night. During the on-scene investigation, a search of the area surrounding the departure end of runway 7 did not reveal any deceased bird remnants. Passengers from the airplane's earlier flight on the day of the accident were interviewed. They did not report any mechanical defects with the airplane and stated that the flight seemed normal. Runway 7 had a published magnetic heading of 074 degrees. The departure end of runway 7 at 83D was located about 820 feet from Lake Huron, and aircraft departing from runway 7 fly over water during the initial climb. The destination airport MCD was located about 4.5 nm away on a magnetic course of about 118 degrees. On August 31, 2018, about 2145 eastern daylight time, a Piper PA32RT-300T, N500MJ, was destroyed when it was involved in an accident near St Ignace, Michigan. The instrument-rated private pilot was fatally injured. The airplane was operated as a Title 14 Code of Federal Regulations Part 91 personal flight. The manager of Mackinac County Airport (83D), St Ignace, Michigan, reported that, about 2000, the pilot fueled his airplane and told the manager that he would be returning to Mackinac Island Airport (MCD) to pick up five passengers. The manager said he was in his office about 2145 when he observed the airplane taxi to runway 7 and the airplane took off. He stated that the airplane sounded normal during takeoff. About 5 minutes later, the manager received a call from 911 dispatch, and the manager confirmed to dispatch that an airplane had just departed 83D. Two witnesses who were facing a lake bordering the airport reported that they observed a low-flying airplane take off from the airport. They stated that the airplane was flying about 100 to 200 ft above the surface of the water, then the airplane banked to the right and they lost sight of it. About 10 to 15 seconds later, the witnesses heard what sounded like a crash into the water or an explosion. A county deputy sheriff spoke with four other witnesses who were staying at a nearby motel, and they reported similar observations to him. There were no distress radio calls from the pilot, and there was no radar information available for the flight. An autopsy of the pilot was performed on behalf of the Mackinac County Medical Examiner's Office. The cause of death was listed as multiple blunt force injuries and no significant natural disease was noted. The Federal Aviation Administration Forensic Sciences Laboratory performed toxicological testing on the pilot's tissue samples. The toxicology tests were negative for drugs. Small amounts of ethanol were detected and its presence was most likely produced post mortem because the body had been submerged in water before recovery 17 days after the accident. The airportmanager reported that it was a very dark night and that there was no distinguishable horizon. First responders who were present at the accident site about 15 to 20 minutes after the accident also reported that it was a very dark night and that there was no visible horizon. Pilot flight logbooks were not available. Divers from the Michigan State Police (MSP) located the airplane wreckage in 44 ft of water, about 1 mile from the departure end of runway 7. MSP recovered the wreckage and transported it to a secure facility at 83D for examination by the National Transportation Safety Board. Examination of the airframe, engine, and propeller occurred on September 5-6. The airframe was severely damaged, and deformations were consistent with a slightly right-wing-down, nose-low, high-speed impact with the water. Flight control continuity was confirmed from the cockpit to all flight control surfaces. Bending signatures on the propeller blades and impact marks on the pitch change stops were consistent with the propeller rotating at impact. The airframe, engine, and propeller examinations did not show any preimpact anomalies that would have precluded normal operation. During the wreckage examination, MSP technicians swabbed the wreckage for evidence of bird residue from a possible bird strike. No bird residue was found within the interior or exterior of the wreckage. ## Aircraft - Registration: [N500MJ](https://openairdocs.org/deregistered/N500MJ-2021-10-02), registration cancelled 2021-10-02, S/N 32R-7987051, built 1978 (OpenAirDocs) - Reported make and model: Piper PA32RT (300T) - Registry model: [Piper PA-32RT-300T](https://openairdocs.org/model/piper-pa-32rt-300t) (registry code 7103216) (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: 32R-7987051 - Year built: 1978 - Airframe hours: 3276 - Engines: Lycoming TIO540S1AD 300 horsepower reciprocating - Damage: Destroyed - Flight: Personal, Part 91 - Airworthiness certificate: Standard, Normal - Last inspection: Annual, August 16, 2016 - Departed: 83D, St Ignace, MI - Destination: BUU, Burlington, WI - Airport: 83D, Mackinac County Airport, runway 7, 3,801 × 75 ft, concrete - Equipment: Stall warning system, Angle of attack indicator, Auto-pilot ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 64; injuries: fatal; private; airplane ratings: single-engine land; instrument ratings: airplane; medical: class 3, with waivers/limitations; seat: left; toxicology performed; flight hours: 650 total, 50 in this make and model, 2 in the last 24 hours ## Weather - Conditions: Visual (VMC), Night/dark - Wind: 160° at 8 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 72 °F, dew point 55 °F - Altimeter: 30.03 inHg - Observed at: MCD, 6 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 20180831006729A](https://openairdocs.org/incident/20180831006729A), Aug 31, 2018: Piper PA-32RT-300T, Saint Ignace, MI, Destroyed, 1 fatal. On August 31, 2018 at 2145 eastern daylight time, a Piper PA-32RT-300T, turbo lance ii aircraft, N500MJ, registered to and operated by a private pilot, was… ## Docket (9 files) The files NTSB released with the investigation on September 7, 2020, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=98218. 2.0 MB in all. - Memorandum for the Record Witness Interview Summaries CEN18FA368 (item 1, .PDF, 186 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40486688&FileExtension=.PDF&FileName=Memorandum%20for%20the%20Record%20Witness%20Interview%20Summaries%20CEN18FA368-Master.PDF - Memorandum for the Record Airframe Examinations Findings CEN18FA368 (item 2, .PDF, 198 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40486689&FileExtension=.PDF&FileName=Memorandum%20for%20the%20Record%20Airframe%20Examinations%20Findings%20CEN18FA368-Master.PDF - Memorandum for the Record Engine Examination Findings CEN18FA368 (item 3, .PDF, 200 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40486690&FileExtension=.PDF&FileName=Memorandum%20for%20the%20Record%20Engine%20Examination%20Findings%20CEN18FA368-Master.PDF - Memorandum for the Record First Responder Observations CEN18FA368 (item 4, .PDF, 190 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40486691&FileExtension=.PDF&FileName=Memorandum%20for%20the%20Record%20First%20Responder%20Observations%20CEN18FA368-Master.PDF - Memorandum for the Record Michigan State Police On-Scene Laboratory Findings on Bird Residue CEN18FA368 (item 5, .PDF, 180 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40486692&FileExtension=.PDF&FileName=Memorandum%20for%20the%20Record%20Michigan%20State%20Police%20On-Scene%20Laboratory%20Findings%20on%20Bird%20Residue%20CEN18FA368-Master.PDF - Memorandum for the Record Previous Flight Passenger Interview Summaries CEN18FA368 (item 6, .PDF, 188 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40486693&FileExtension=.PDF&FileName=Memorandum%20for%20the%20Record%20Previous%20Flight%20Passenger%20Interview%20Summaries%20CEN18FA368-Master.PDF - Propeller Examination Observations CEN18FA368 (item 7, .PDF, 594 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40486694&FileExtension=.PDF&FileName=Propeller%20Examination%20Observations%20CEN18FA368-Master.PDF - Mackinac County Sheriff Report CEN18FA368 (item 8, .PDF, 73 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40486695&FileExtension=.PDF&FileName=Mackinac%20County%20Sheriff%20Report%20CEN18FA368-Master.PDF - Toxicology Report CEN18FA368 (item 9, .PDF, 172 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40486696&FileExtension=.PDF&FileName=Toxicology%20Report%20CEN18FA368-Master.PDF From the NTSB's public API. 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