# NTSB CEN22LA221: Cameron Balloons Z-90, N65009, Burlington, WI, June 2, 2022 - Type: NTSB accident investigation - Classification: Accident · Serious injuries · Class 3 · Limited · Final report - Date: June 1, 2022, 20:15 local (Jun 2, 2022, 01:15 UTC) - Place: Burlington, WI - Coordinates: 42.671222, -88.268074 - Nearby events: https://openairdocs.org/map.md?lat=42.6712&lon=-88.2681&mi=10 - Phase of flight: [Landing](https://openairdocs.org/ntsb-phases/550) (OpenAirDocs' grouping) - Defining event: [Landing: Collision during takeoff/land](https://openairdocs.org/ntsb-events/490) - Highest injury: Serious injuries - Injuries: 3 serious - Status: Completed - Report: Approved by Office Director - Investigation class: Class 3 - NTSB office: Central Region - Parties: Federal Aviation Administration - NTSB case key (mKey): 105172 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=CEN22LA221 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/105172/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=105172 - Page: https://openairdocs.org/ntsb/CEN22LA221 ## Probable cause The pilot’s selection of an inappropriate landing location and his failure to avoid an oncoming freight train, which resulted in the train colliding with and dragging the balloon. ## 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 · Pilot (probable cause); cases with it: [Cameron Balloons Z-90, 1 case](https://openairdocs.org/ntsb-findings/02041520/cases.md?model=1880300), [All aircraft, 3,098 cases](https://openairdocs.org/ntsb-findings/02041520/cases.md) - [Object/animal/substance: ground vehicle](https://openairdocs.org/ntsb-findings/03022025): Environmental issues › Physical environment · Decision related to condition (probable cause); cases with it: [Cameron Balloons Z-90, 1 case](https://openairdocs.org/ntsb-findings/03022025/cases.md?model=1880300), [All aircraft, 132 cases](https://openairdocs.org/ntsb-findings/03022025/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Landing: Collision during takeoff/land](https://openairdocs.org/ntsb-events/490) (defining event); cases with it: [Cameron Balloons Z-90, 1 case](https://openairdocs.org/ntsb-events/490/sequence.md?model=1880300), [All aircraft, 1,309 cases](https://openairdocs.org/ntsb-events/490/sequence.md) ## Analysis The pilot was making an approach from the southeast to land the hot air balloon on a road that paralleled railroad tracks. A freight train was traveling northbound on the tracks at the same time. The balloon initially touched down in a grassy area east of the road, between the road and the railroad tracks. The balloon skipped normally and stopped near the railroad tracks. The balloon envelope dipped as a result of being slightly deflated for the landing and caught on one of the uprights of an empty lumber car as it passed, which lifted the balloon off the ground and dragged it. As the balloon was dragged, the uprights, envelope, burners, and fuel lines separated from the basket and the pilot and passengers were ejected. The engineer in the engine cab immediately stopped the train. The basket came to rest inverted along the east side of the railroad tracks. The envelope climbed to 200 ft. and drifted north until it cooled and came to rest on the road, about 80 ft from the basket. The pilot misjudged the landing, which placed him too close to the railroad tracks and resulted in the balloon’s envelope being caught and the balloon being dragged by the freight train as it went by. ## Factual narrative On June 1, 2022, about 2015 central daylight time, a Cameron Z-90 balloon, N65009, was substantially damaged when it was involved in an accident near Burlington, Wisconsin. The pilot and 2 passengers were seriously injured. The balloon was operated as a Title 14 Code of Federal Regulations Part 91 other work use flight. The pilot reported he had taken off with two passengers near the Burlington Municipal Airport (BUU) and drifted southeast. About an hour into the flight, the lake effect wind moved in and the pilot looked for a place to land. The pilot selected a road east of some railroad tracks and gave the passengers a landing briefing. The pilot noted their speed was 4 mph. The pilot also noticed a slow-moving train to his left but did not think it was a factor. The pilot remembered seeing the park east of the road and contacting the train. The pilot reported being knocked unconscious and that he did not recall anything else. The engineer on the Canadian National freight train reported that he saw the balloon descending and began to slow the train as he did not know where the balloon was going. He said that he saw the balloon approach the train in his side mirror, at which time he applied the emergency brakes. The balloon then landed in the grassy area between the railroad tracks and a street. As the balloon began to lose air and become limp it started to blow toward the rail cars. The balloon envelope caught on one of the cars, 15 cars back from the engine, and the balloon was pulled off the ground. The envelope then ripped away from the basket and ascended about 200 ft into the air. None of the occupants of the train were injured. Onboard forward- and rear-facing video recordings from the freight train engine showed that the balloon descended toward a road that ran parallel to railroad tracks just east of the train. In both videos, the balloon envelope was fully inflated as it slowly descended toward the road near an electrical substation. In the rear-facing video, the pilot engaged the burners just before the balloon disappeared behind the first freight car. A witness who was at the nearby dog park reported that the balloon came over the tree line south of the dog park about 50 ft above the trees. The balloon descended as if it were going to land in the park but continued over the adjacent street toward the railroad tracks, which at the time had a train traveling northbound. The balloon landed in the grassy area between the railroad tracks and the street, and the balloon envelope became limp. The balloon then caught on one of the train cars which pulled the balloon off the ground. The envelope tore away from the basket and the three individuals in the basket fell out. A Federal Aviation Administration inspector who responded to the scene reported that witness marks showed the balloon initially touched down in the grassy area between the road and the railroad tracks, and again a second time closer to the railroad tracks. The balloonenvelope caught on one of the uprights of an empty lumber car as it passed, which lifted the balloon off the ground and dragged it. The balloon basket was intact and found inverted near the railroad tracks. Both propane tanks were intact and remained secured in the basket. One fuel line was separated from one tank. The fuel line to the second tank was separated near the burner attachment end. The envelope came to rest on a road, about 80 ft north of the basket. The aluminum uprights fractured at the basket attach points. The cross tubes and burners were broken out at their attach points at the top of the uprights. The envelope sustained substantial damage to the A-blocks, carabiner attachments, and flying lines. Additionally, several panels to the envelope were ripped. Control continuity to the envelope spring top and turning vents was confirmed. Postaccident examination of the balloon showed no mechanical malfunctions or failures that would have precluded normal operation. ## Aircraft - Registration: [N65009](https://openairdocs.org/deregistered/N65009-2023-09-26), registration cancelled 2023-09-26, S/N 6612 (OpenAirDocs) - Reported make and model: CAMERON BALLOONS Z-90 - Registry model: [Cameron Balloons Z-90](https://openairdocs.org/model/cameron-balloons-z-90) (registry code 1880300) (OpenAirDocs) - Category: Balloon - Serial number: 6612 - Year built: 2017 - Damage: Substantial damage - Flight: Other work use, Part 91 - Airworthiness certificate: Standard, Balloon - Departed: Burlington, WI ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 63; commercial; airplane ratings: single-engine sea; instrument ratings: airplane; medical: class 3, with waivers/limitations; last flight review August 1, 2021; seat: none; restraint: none; flight hours: 983 total, 18 in this make and model, 832 as pilot in command, 6 in the last 90 days, 3 in the last 30 days, 1 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: calm - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 66 °F, dew point 55 °F - Altimeter: 29.92 inHg - Observed at: KBUU, 1 nm away - METAR: KBUU 020055Z AUTO 00000KT 10SM 19/13 A2992 RMK AO2 T01870126 PWINO ## 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 20220601008849A](https://openairdocs.org/incident/20220601008849A), Jun 1, 2022: Cameron Balloons Z-90, Burlington, WI, Substantial damage. On June 1, 2022, at approximately 2015 local time a Cameron Z90 lp gas hot air manned balloon floated into a [privacy data omitted]freight train in Burlington… ## Docket (8 files) The files NTSB released with the investigation on July 6, 2023, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=105172. 12.3 MB in all. - Pilot/operator aircraft accident report, NTSB form 6120.1 (item 1, PDF, 11 pages, 2.1 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=14055947&FileExtension=pdf&FileName=NTSB%206120.1%20Pilot_Redacted-Rel.pdf - Witness statements (item 2, PDF, 2 pages, 201 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=14056255&FileExtension=pdf&FileName=Burlington%20PD%20Witness%20Statements_Redacted-Rel.pdf - Accident scene (item 3, PDF, 1 page, 316 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=13985976&FileExtension=pdf&FileName=Accident%20Scene-Rel.pdf - FAA inspector's e-mail (item 4, PDF, 1 page, 81 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=13985301&FileExtension=pdf&FileName=Balloon%20Accident_Redacted-Rel.pdf - FAA inspector's statement (item 5, PDF, 1 page, 83 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=14057856&FileExtension=pdf&FileName=FAA%20Inspector%27s%20Statement-Rel.pdf - Train conductor's statement (item 6, PDF, 1 page, 161 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=13985487&FileExtension=pdf&FileName=TRANS%20478%20(002)_Redacted-Rel.pdf - Train video looking aft (item 7, MP4, 8.2 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=13985757&FileExtension=mp4&FileName=CN3025_MUXED_06022022_011430(UTC)_to_0622022_011500(UTC)-Rel.mp4 - Photos (item 8, PDF, 4 pages, 1.2 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=14056803&FileExtension=pdf&FileName=Burlington%20Balloon%20Accident%20Photos-Rel.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.