CHI94FA329

NTSB accident investigation · Piper PA-23-250 · Beaver Island, MI · September 15, 1994

Accident · FatalField investigationFinal report
Date
September 15, 1994, 19:00 local (23:00 UTC)
Place
Beaver Island, MI
Injuries
3 fatal
Damage
Destroyed
Phase of flight
Maneuvering
Aircraft
N13909Piper PA-23-250
Weather
Visual (VMC) · Day
Status
Completed · report October 16, 1995
Report
Approved by Office Director
FAA report
19940915027919A
Case key
9391

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

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Probable cause

The pilot's failure to maintain control of the airplane. The pilot's buzzing and his impairment of judgment and performance due to alcohol were factors in the accident.

Sequence of events

NTSB’s coding before 2008: each occurrence and phase of flight, and the causes and factors under it. The codes are defined in NTSB’s coding manual.

Loss of control - in flightManeuvering
Buzzing - performedPilot in commandFactor
Aircraft control - not maintainedPilot in commandCause
Impairment(alcohol)Pilot in commandFactor
In flight collision with terrain/waterDescent - uncontrolled

Analysis

The airplane was observed flying low over trees performing a series of pitch up and down maneuvers, turning left and right, then descend straight down into trees. The on-scene investigation revealed no airframe or control system failure. The county sheriff stated he detected a strong odor of alcohol on the pilot and one passenger during his on-scene activities. The pilot's autopsy identified 0.06 gm of ethanol per 100 gm of liver tissue.

Factual narrative

History of flight

On September 15, 1994, at 1900 eastern daylight time (edt), a Piper PA-23-250, N13909, registered to Edward Maudrie and Sons Fishery, Incorporated, of St. James, Michigan, and piloted by a multi-engine rated private pilot, was destroyed during a collision with trees and terrain. Visual meteorological conditions prevailed at the time of the accident. The 14 CFR Part 91 flight was not operating on a flight plan. The pilot and two passengers were fatally injured. The flight departed from Beaver Island, Michigan, at 1830 edt.

The Beaver Island Airport manager said he observed the pilot looking at the bottom of the airplane's right engine cowl before boarding with the passengers and departing. He said the pilot did not open the cowl of the right engine. He said the pilot did not preflight the airplane or do a runup before takeoff.

The only eyewitness to the accident said the airplane was flying low, in a left to right pattern making a "...whom, whom..." sound. He said the airplane made a series of pitch up and down motions before descending straight down into the trees.

Personnel information

The pilot's logbook was not made available for review by his estate. A representative from the estate said he could not find the logbook. Federal Aviation Administration records show the pilot's last medical examination was October 7, 1988.

Aircraft information

The airframe and powerplant logbooks for N13909 were not found in the wreckage. The Charlevoix County Sheriff's Department representative on Beaver Island said that airplane paperwork was not found or removed during their on-scene activities. A representative from the estate stated the airframe and power- plant logbooks were not located during a search of the pilot's properties. The left tachometer showed 2,954.9 hours on its recording face. The right tachometer showed 2,957.6 hours on its recording face.

Wreckage and impact information

N13909's wreckage was confined to one location in a dense wooded area. Many tree limbs, ranging between one inch and five inches in diameter were found with cut marks on one and/or both ends around the wreckage site. The airplane wreckage was oriented on an approximate 120 degree magnetic heading.

The tailcone and empennage were positioned on top of the aft fuselage. Both wings were crushed aft to the main spar. The fuselage had been crushed aft to the cockpit's front seats. The instrument panel was found parallel with the ground's surface. The cabin area, aft of the front seats, had been crushed aft, outward and was split open at the top side. The front of both engines were positioned approximately 45 degrees to the ground. Both were buried up to the first set of cylinders.

Both wing fuel bladders were torn over their entire upper and lower surfaces. Fuel was not found in the recesses of the bladders. An odor similar to aviation gasoline was found in soil samples taken from below both wings.

Control continuity between the stabilator and ailerons were established up to the control yoke. Continuity between the rudder and rudder pedals was established.

An examination of the left and right engines revealed no mechanical anomolies that would prevent it from producing power. The right propeller had one blade bent aft about 70 degrees beginning at the one-third span position. This blade had a wavy appearance over the bent surface area. The second blade was curved forward about 80 degrees starting from the propeller hub. The propeller was partially separated from the propeller extension at the front of the engine. Chordwise scuffing was observed on both blades.

The left propeller had one blade that was wavy in appearance. This blade had a gouge about two inches long and approximately 1/2 inch deep beginning about four inches in from its tip. The second blade was bent aft about 45 degrees. This propeller's extension was not bent, and the propeller was still attached to it at all bolt positions. All four propeller blades had chordwise scuffing.

Additional information

The pilot's wife said that on the day of the accident, her husband came home after eating supper, remained there for about 30 minutes, then left for another 30 minutes, came home again, changed clothing and "...left to go bird hunting around 5:45."

An investigation into the pilot's pre-departure activities revealed he had eaten supper at a local bar around 1600 edt. The owner of the bar stated that the pilot did not consume any alcoholic beverages during his meal. The owner was asked for the September 15, 1994, patron billing receipts. He said the billing receipts for that day had been thrown away at the day's conclusion. The county sheriff he said that he detected a strong odor of alcohol on the body of the pilot and one passenger during his on-scene activities.

A toxicological examination was conducted by the Department of Defence, Armed Forces Institute of Pathology in Washington, D.C. The report said that the specimens received showed "Marked putrefaction." An analysis for carbon monoxide and cyanide were not performed due to a lack of specimens. The report says that 5 mg/dL of acetaldehyde was found in the liver and kidney. 20 mg/dL of ethanol was found in the liver and 78 mg/dL was found in the kidney.

The autopsy examination was conducted at the Blodgett Memorial Medical Center, Blodgett, Michigan. The report states the pilot's fatal injuries were a result of multiple injuries. It also states that 0.06 g. of ethanol per 100 g. of liver tissue was identified during the examination.

The wreckage was released to the pilot's brother-in-law on September 17, 1994.

Aircraft

Registration
N13909
Reported as
Piper PA-23-250
Category
Airplane
Serial number
27-4539
Engine
Lycoming IO-540-C4B5, 250 horsepower, reciprocating
Damage
Destroyed
Flight
Personal · Part 91
Registered owner
Edward Maudrie & Sons Fishery
Airworthiness certificate
Standard, Normal
Destination
6Y8 · MI

Matched to the registry by N-number and the event date; the registry’s history has gaps, so older matches can be wrong. Compare the reported make and model.

Flight crew

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
34
Certificate
Private
Airplane ratings
Single-engine land
Medical
Class 2
Seat
Left
Toxicology
Performed

Weather

Conditions
Visual (VMC) · Day
Visibility
15 statute miles
Lowest ceiling
None

FAA reports on this event · 1

The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.