# NTSB DEN01FA041: Beech 65-A90, N616F, Lake Point, UT, January 15, 2001 - Type: NTSB accident investigation - Classification: Accident · Fatal · Field investigation · Final report - Date: January 14, 2001, 17:29 local (Jan 15, 2001, 00:29 UTC) - Place: Lake Point, UT - Coordinates: 40.683334, -112.349998 - Nearby events: https://openairdocs.org/map.md?lat=40.6833&lon=-112.3500&mi=10 - Phase of flight: [Enroute](https://openairdocs.org/ntsb-phases/400) (OpenAirDocs' grouping) - Highest injury: Fatal - Injuries: 9 fatal - Status: Completed, report October 23, 2001 - Report: Approved by Office Director - Parties: Federal Aviation Administration - NTSB case key (mKey): 50938 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=DEN01FA041 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/50938/pdf - Page: https://openairdocs.org/ntsb/DEN01FA041 ## Probable cause the pilot's exercise of poor judgment and his failure to maintain a safe altitude/clearance above the water. Contributing factors were the weather conditions that included low ceiling and visibility obscured by snow and mist, an inadequately equipped airplane for flying in instrument meteorological conditions, and the pilot's overconfidence in his personal ability in that he had reportedly done this on two previous occasions. ## Sequence of events In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf). - In flight encounter with weather, cruise - flight into known adverse weather - intentional, pilot in command (contributing factor) - weather condition - low ceiling (contributing factor) - weather condition - obscuration (contributing factor) - weather condition - snow (contributing factor) - weather condition - drizzle/mist (contributing factor) - In flight collision with terrain/water, descent - judgment - poor, pilot in command (cause) - flight/navigation instrument(s) - inadequate (contributing factor) - overconfidence in personal ability, pilot in command (contributing factor) - altitude/clearance - not maintained, pilot in command (cause) - terrain condition - water ## Analysis The pilot and eight parachutists were returning from a skydive meet. The pilot had obtained a weather briefing, which advised of instrument meteorological conditions at the destination, and filed a VFR flight plan, but it was never activated. Witnesses heard, but could not see, a twin engine turboprop pass over the airport, heading north out over the Great Salt Lake. They described the weather conditions as being a low ceiling with 1/4-mile visibility, light snow, haze, and fog. They said it was almost dark. The airplane impacted the water approximately 1/2-mile off shore. It had been stripped of all avionics except for one transceiver and a hand-held GPS receiver. One member of the skydive club, who had flown with the pilot, said he had previously encountered poor weather conditions and descended over the Great Salt Lake until he could see the ground, then proceeded to the airport. Another member related a similar experience, but said they descended over the Great Salt Lake in the vicinity of the accident site. The pilot was able to navigate in deteriorating weather conditions to Tooele Airport, using various landmarks. Examination of the airframe, engines, and propellers did not reveal evidence of any anomalies that would have precluded normal operation. ## Factual narrative HISTORY OF FLIGHT On January 14, 2001, at 1729 mountain standard time, a Beech 65-A90, N616F, owned by Flanagan Enterprises (Nevada), Inc., and operated by a private individual doing business as Skydive Salt Lake, was destroyed when it collided with water while descending over the Great Salt Lake near Lake Point, Utah. The airline transport certificated pilot and eight passengers were fatally injured. Instrument meteorological conditions prevailed, and a VFR (visual flight rules) flight plan had been filed but was never activated. The personal flight was being conducted under 14 CFR (Code of Federal Regulations) Part 91, and originated at Mesquite, Nevada, approximately 1615. According to Skydive Salt Lake employees, the pilot and passengers had flown to Mesquite on January 12 to sky dive, and were returning to Tooele, Utah, when the accident occurred. The pilot telephoned the Reno, Nevada, Flight Service Station (FSS) at 1526 and filed a VFR flight plan. The route of flight was from Mesquite direct to the Mormon Mesa VORTAC (Very high frequency Omnidirectional Radio range TACtical air navigation), then via V (Victor airway) 21 to the Fairfield VORTAC, then direct to the Tooele Airport. Using a true airspeed of 214 knots at 13,500 feet msl (mean sea level), the pilot estimated the time en route would be 1 hour, 23 minutes, and indicated there was 5 hours of fuel on board. He then requested and was given a standard weather briefing and was advised of an AIRMET (Airman's Meteorological Information) in effect from about Milford, Utah, north "for (occasional) moderate rime or mixed icing in the clouds and in (the) precipitation below one six thousand feet for some mountain obscurement in that area." The briefer also advised him of an AIRMET "for IFR (instrument flight rules) conditions...goes from the south edge of the Great Salt Lake due westward over to Lovelock, Nevada, and then north of that line, (so there) could be some IFR conditions in there right now." The briefer then asked, "You can make an IFR (instrument flight rules) approach, I presume?" The pilot answered, "Yes, sir." The briefer then added, "You need to," and gave the current Salt Lake City weather observation, which was below VFR minimums. The briefing terminated at 1533. According to the fixed base operator (FBO) at Mesquite, the airplane took off about 1615. There were no radio communications with the flight, and the pilot never activated the flight plan with FSS. Radar data retrieved from the Salt Lake City Air Route Traffic Control Center (ARTCC) indicates the airplane did not follow the filed route of flight, but flew direct from Mesquite to Tooele. According to the sheriff's department, the Tooele Valley Airport's weekend manager and the husband of one of the passengers were standing outside the airport office and heard an airplane pass overhead. From the sounds of the engines, they said it was a twin engine turboprop and they assumed it was N616F. They said the engine noise diminished as the airplane flew north and never returned. Radar data indicates a VFR target passed over the airport at 1727:35 at an altitude of 7,700 feet msl (above mean sea level), or approximately 3,400 feet above the ground. It was tracked to a point about 5 miles north of the airport, where it began a descending left turn. Between 1728:42 and 1729:42 (the last altitude return), the airplane lost 2,000 feet. The last radar contact was at 1729:47. An ALNOT (alert notice) was issued at 1919, the Tooele County Sheriff's Office was notified, and a search was initiated. The first body was located at 0045 the following morning. Debris and additional bodies were soon found washed ashore. The accident occurred during the hours of dusk at a location of 40 degrees, 40.798' (40.33') north latitude, and 112 degrees, 21.149 (23') minutes west longitude. According to the Park Service, water temperature at the time of the accident was 20 degrees F. High salinity precluded the water from freezing. CREW INFORMATION The pilot held an airline transport pilot certificate with airplane multiengine land rating and a Swearingen SA-227 type rating, and commercial privileges in airplanes single-engine land, dated August 8, 1985. He also held a first class airman medical certificate, dated July 31, 2000, with no restrictions or limitations. His most recent logbook washed ashore and was recovered by rescuers. The logbook contained entries from September 15, 1996, to December 23, 2000. The following flight times were recorded by aircraft make/model: Cessna 210 - 5.7 hours DeHaviland DHC-6 - 30.3 hours Beech 18 - 337.2 hours Beech 90 - 321.1 hours Beech 99 - 38.5 hours Boeing 737 (simulator) - 15.0 hours As of the last logbook entry, the following flight time totals were noted: Total time - 5,149.2 hours Pilot in command - 4,386.5 hours Second in Command - 747.7 hours Airplane Single Engine Land - 1,901.3 hours Airplane Multiengine Land - 3,232.9 hours Turbine - 2,251.9 hours Cross-Country - 2,275.7 hours Night - 838.8 hours Actual Instruments - 366.6 hours An entry was made in the pilot's logbook, dated January 10, 1999, indicating he had received a biennial flight review (BFR) in a Boeing 737 simulator. According to the Federal Aviation Administration (FAA), the pilot was not rated in the Boeing 737, therefore the BFR was not valid under 14 CFR 61.56(i)(3). Further review of the logbook indicated the pilot had logged 1.2 hours of night flying time in the previous 90 days, but did not indicate the number of landings he had made. FAA could not determine whether he satisfied the requirements of 14 CFR 61.57(b). In addition, the pilot had not logged any instrument flying time in the previous 6 calendar months. According to FAA, he was not qualified to serve as pilot in command of a civil aircraft carrying passengers in instrument meteorological conditions [14 CFR 61.57(c)]. AIRCRAFT INFORMATION N616F, a model 65-A90 (s/n LJ-165), was manufactured by the Beech Aircraft Corporation in 1966. It was equipped with two Pratt & Whitney PT6A-20 engines (s/n PCE20514, left; PCE 21398, right), each rated at 750 shaft horsepower, and two Hartzell 3-blade, all-metal, controllable pitch, reversible, and full-feathering propellers (m/n HC-B3TN-3B). According to the maintenance records, the airplane's wing spar had been modified with a failsafe strap modification. The owner said the airplane had been stripped for parachute jumping activities and was equipped for VFR flight only. The only avionics on board were a transceiver and a hand-held GPS (Global Positioning System) receiver . METEOROLOGICAL INFORMATION One witness, an instrument rated private pilot, was about 3 miles northeast of the Tooele Airport when he heard an "unusually loud sound...of a turboprop [that] passed overhead...[flying] from south to north." He estimated the airplane was 1/2-mile west of his position, "at pattern altitude or lower...500 feet agl on the runway centerline course." He said there was "no Doppler shift. Instead, as the sound passed, the pitch of the prop continued to rise. It sounded as if they were in a dive." He described the weather conditions as an indefinite ceiling, 1/4-mile visibility in haze/fog. It was "almost dark" and snowing. These observations were approximately the same as those given the Tooele County Sheriff's Department by the airport manager and the passenger's husband. The nearest official weather observation station was Salt Lake City International Airport (SLC), located 35 miles northeast of the accident site. The following observation was recorded one minute after the accident: Wind, 330 degrees at 6 knots; visibility, 0.5 miles, light snow, mist; ceiling, 500 feet broken, 900 feet overcast; temperature, -1 degree C; dew point, -1 degree C; altimeter setting, 30.13 inches of mercury; remarks: surface visibility 1mile. WRECKAGE AND IMPACT INFORMATION The wreckage was locat ## Aircraft - Registration: [N616F](https://openairdocs.org/deregistered/N616F-2002-01-14), registration cancelled 2002-01-14, S/N LJ-165, built 1966 (OpenAirDocs) - Reported make and model: Beech 65-A90 - Registry model: [Beech 65-A90](https://openairdocs.org/model/beech-65-a90) (registry code 1152908) (OpenAirDocs) - Registry engine: [Pratt & Whitney PT6A series](https://openairdocs.org/engine/pratt-whitney-pt6a-series) (registry code 52032, turbo-prop) (OpenAirDocs) - Category: Airplane - Serial number: LJ-165 - Airframe hours: 9725 - Engines: P&W PT6A-20 550 horsepower turbo prop - Damage: Destroyed - Flight: Personal, Part 91 - Operator: William C. Dause, doing business as Skydive Salt Lake - Registered owner: Flanagan Enterprises (Nevada), Inc. - Airworthiness certificate: Standard, Normal - Last inspection: AAIP, July 20, 2000, 136 hours before - Departed: 67L, Mesquite, NV - Destination: TVY, Tooele, UT - Flight plan: VFR - Airport: TVY, Bolinder Field-Tooele Valley ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 41; injuries: fatal; commercial, airline transport; airplane ratings: multi-engine land, single-engine land; instrument ratings: airplane; medical: class 1, valid medical--no waivers/lim.; seat: left; toxicology performed; flight hours: 5,149 total, 321 in this make and model, 4,387 as pilot in command, 44 in the last 90 days, 4 in the last 30 days ## Weather - Conditions: Instrument (IMC), Night - Wind: 330° at 6 knots - Visibility: 0.5 statute miles - Lowest ceiling: 500 ft broken - Temperature: 30 °F, dew point 30 °F - Altimeter: 30.12 inHg - Observed at: SLC, 35 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 20010114001359A](https://openairdocs.org/incident/20010114001359A), Jan 14, 2001: Beech 65A90, Lake Point, UT, No damage, 9 fatal. (-23)On January 14, 2001, at approximately 17:30 mountain standard time (MST), a Beech model BE-65-A90, N616F, operated by the pilot was destroyed when it… 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.