# NTSB ERA09FA185: Cessna 182P, N1913M, Carrollton, GA, March 8, 2009 - Type: NTSB accident investigation - Classification: Accident · Fatal · Field investigation · Final report - Date: March 8, 2009, 08:45 local (12:45 UTC) - Place: Carrollton, GA - Coordinates: 33.546112, -85.141113 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=33.5461&lon=-85.1411&mi=10 - Phase of flight: [Enroute](https://openairdocs.org/ntsb-phases/400) (OpenAirDocs' grouping) - Defining event: [Enroute: Loss of control in flight](https://openairdocs.org/ntsb-events/240) - Highest injury: Fatal - Injuries: 3 fatal - Status: Completed, report July 22, 2010 - Report: Approved by Office Director - NTSB office: Eastern Region Aviation - Parties: Cessna Aircraft Company, FAA/FSDO, Teledyne Continental Motors - NTSB case key (mKey): 73450 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=ERA09FA185 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/73450/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=73450 - Page: https://openairdocs.org/ntsb/ERA09FA185 ## Probable cause The pilot's decision to continue visual flight rules flight into an area of reduced visibility weather conditions, which resulted in disorientation and subsequent loss of aircraft control. ## 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: [Cessna 182P, 18 cases](https://openairdocs.org/ntsb-findings/02041520/cases.md?model=2075816), [All aircraft, 3,098 cases](https://openairdocs.org/ntsb-findings/02041520/cases.md) - [Performance/control parameters](https://openairdocs.org/ntsb-findings/01062000): Aircraft › Aircraft oper/perf/capability · Not attained/maintained (probable cause); cases with it: [Cessna 182P, 8 cases](https://openairdocs.org/ntsb-findings/01062000/cases.md?model=2075816), [All aircraft, 1,269 cases](https://openairdocs.org/ntsb-findings/01062000/cases.md) - [Ceiling/visibility/precip: low visibility](https://openairdocs.org/ntsb-findings/03035015): Environmental issues › Conditions/weather/phenomena · Not specified; cases with it: [Cessna 182P, 2 cases](https://openairdocs.org/ntsb-findings/03035015/cases.md?model=2075816), [All aircraft, 175 cases](https://openairdocs.org/ntsb-findings/03035015/cases.md) - [Perception/orientation/illusion: spatial disorientation](https://openairdocs.org/ntsb-findings/02022025): Personnel issues › Psychological · Pilot (probable cause); cases with it: [Cessna 182P, 2 cases](https://openairdocs.org/ntsb-findings/02022025/cases.md?model=2075816), [All aircraft, 358 cases](https://openairdocs.org/ntsb-findings/02022025/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Enroute: Loss of control in flight](https://openairdocs.org/ntsb-events/240) (defining event); cases with it: [Cessna 182P, 17 cases](https://openairdocs.org/ntsb-events/240/sequence.md?model=2075816), [All aircraft, 5,002 cases](https://openairdocs.org/ntsb-events/240/sequence.md) - [Uncontrolled descent: Collision with terr/obj (non-CFIT) ](https://openairdocs.org/ntsb-events/470); cases with it: [Cessna 182P, 47 cases](https://openairdocs.org/ntsb-events/470/sequence.md?model=2075816), [All aircraft, 10,189 cases](https://openairdocs.org/ntsb-events/470/sequence.md) ## Analysis The non-instrument-rated pilot and two passengers departed under visual meteorological conditions and encountered instrument meteorological conditions while en route to their destination. A witness near the accident site stated she heard a "whining high speed sound" followed by a "thud." She noticed water splashing up from a lake, into the air, which was followed by silence. The airplane crashed into a private lake, and was located at a depth of approximately 16 feet and heavily fragmented, consistent with a high speed impact. Subsequent examination of the airframe and engine did not reveal any preimpact abnormalities. The pilot did not obtain a weather briefing prior to the flight. A witness near the accident site described the weather conditions at the time of the accident as "low cloud cover" with fog drifting across the surface of the lake, and "misty overcast." Another witness stated that conditions were "very foggy." The pilot had accumulated about 168 hours of total flight experience, which included about 70 hours as pilot-in-command, and 3.2 hours logged as "simulated instrument," and 0 hours logged in "actual instrument" meteorological conditions. ## Factual narrative HISTORY OF FLIGHT On March 8, 2009, about 0845 eastern daylight time, a Cessna 182P, N1913M, was destroyed when it impacted a lake in Carrollton, Georgia. The certificated private pilot and two passengers were killed. Instrument meteorological conditions prevailed and no flight plan had been filed for the flight that departed Cobb County Airport (RYY), Kennesaw, Georgia, about 0805, destined for the Clayton County Airport (4A7), Hampton, Georgia. The personal flight was conducted under the provisions of 14 Code of Federal Regulations (CFR) Part 91. The airplane was based at RYY. The pilot, his wife, and another passenger were en route to 4A7, and planned to attend a National Association for Stock Car Auto Racing (NASCAR) event at the Atlanta Motor Speedway. A witness near the accident site stated she heard a "whining high speed sound" followed by a "thud." She noticed water splashing up from the lake, into the air, which was followed by silence. The airplane crashed into a private lake and was located at a depth of approximately 16 feet. It was recovered on March 8 and 9, 2009. PERSONNEL INFORMATION The pilot, age 51, held a private pilot certificate for airplane single-engine land, which was issued on February 25, 2008. He did not possess an instrument rating. According to pilot's logbook, at the time of the accident, he had accumulated about 168 hours of total flight experience, which included about 130 hours in the same make and model as the accident airplane, 70 hours as pilot-in-command, 3.2 hours logged as "simulated instrument" and 0 hours logged in "actual instrument" meteorological conditions. He reported 114 hours of total flight experience on his most recent application for a Federal Aviation Administration (FAA) third-class medical certificate, which was issued on February 1, 2008. AIRCRAFT INFORMATION The four-seat, high-wing, fixed-gear airplane, serial number 18264478, was manufactured in 1975. It was powered by a Teledyne Continental Motors O-470-S series, 230-horsepower engine, equipped with a McCauley propeller. Review of maintenance records revealed that the airplane had been operated for about 65 hours since its most recent annual inspection, which was performed on July 18, 2008. The airplane's most recent pitot-static system test was conducted on May 24, 2006. METEOROLOGICAL INFORMATION A weather observation taken at RYY, located about 45 miles northeast of the accident site, at 0847, reported calm winds; visibility 7 statute miles, sky overcast at 1,200 feet; temperature 9 degrees Celsius (C), dew point 8 degrees C; altimeter 30.21 inches of mercury. A weather observation taken at the Newnan-Coweta County Airport (CCO), located about 26 miles southeast of the accident site, at 0840, reported calm winds; visibility 5 statute miles, sky overcast at 500 feet; temperature 9 degrees C, dew point 11 degrees C; altimeter 30.20 inches of mercury. A weather observation taken at CCO at 0900, reported wind from 280 degrees at 4 knots;visibility 1/4 statute mile, sky overcast at 300 feet; temperature 11 degrees C, dew point 11 degrees C; altimeter 30.21 inches of mercury. A witness near the accident site described the weather conditions at the time of the accident as "low cloud cover" with fog drifting across the surface of the lake, and "misty overcast." Another witness stated that conditions were "very foggy." According to an FAA inspector and a representative from Lockheed Martin flight services, there was no record of the pilot obtaining a weather briefing for the flight through flight service or Direct User Access Terminal Service (DUATS). WRECKAGE AND IMPACT INFORMATION The recovered wreckage was taken to a facility in Griffin, Georgia, for examination on March 10, 2009. The airplane was heavily fragmented. The main wreckage consisted of the empennage, which was distorted and included about 22 inches of the main cabin floor, forward of the rear door post. Both wings spars were fragmented and wing skin fragments associated with both wing leading edges displayed aft crushing damage to the main spar. The cabin and cockpit areas were destroyed. Both wing struts were separated at their respective attach points and were not located. All flight control surfaces were accounted for. Rudder and elevator flight control continuity was confirmed from their respective control surfaces to the forward cockpit area. Due to impact damage, aileron control continuity was only confirmed at their respective bellcranks. Measurement of the flap actuator jackscrew corresponded to a flap retracted position. The propeller remained attached to the engine, which was separated from its mounts. The propeller blades were beyond their respective low-pitch stops and were bent aft. One propeller blade contained "s" bending and the second propeller blade contained a leading edge gouge about mid-span. All engine accessories were separated from the engine except for the right magneto, propeller governor, and the vacuum pump. The carburetor was not located. All spark plugs were removed. Their electrodes were intact and contained gray deposits. The engine was rotated via the propeller flange. Valve train continuity was confirmed and thumb compression was attained on all cylinders; except for the No. 5 cylinder, which sustained impact damage. A lighted borescope examination of all cylinders did not reveal any preimpact malfunctions. It was noted that the No. 5 cylinder intake valve was displaced. Both magnetos contained impact damage and were rotated by hand. The right magneto sparked at all terminals simultaneously, and the left magneto did not produce a spark when rotated. Disassembly of both magnetos revealed water contamination; however, no preimpact failures were observed. Examination of the oil filter element did not reveal any evidence of metal contamination. The vacuum pump drive coupling was intact and it could not be rotated by hand. Internal examination of the vacuum pump revealed that the vaneswere intact and that the rotor block was cracked, consistent with impact damage. After the interior components were removed, the vacuum pump drive shaft rotated freely. MEDICAL AND PATHOLOGICAL INFORMATION An autopsy was performed on the pilot, on March 10, 2009, by the Georgia Bureau of Investigation Division of Forensic Sciences, Decatur, Georgia. The autopsy report indicated the cause of death as "multiple generalized blunt force injuries." Toxicological testing performed on the pilot by the FAA Bioaeronautical Science Research Laboratory, Oklahoma City, Oklahoma, was negative for drugs and alcohol. ADDITIONAL INFORMATION Federal Aviation Administration advisory circular 60-4A stated in part: "The attitude of an aircraft is generally determined by reference to the natural horizon or other visual references with the surface. If neither horizon nor surface references exist, the attitude of an aircraft must be determined by artificial means from the flight instruments. Sight, supported by other senses, allows the pilot to maintain orientation. However, during periods of low visibility, the supporting senses sometimes conflict with what is seen. When this happens, a pilot is particularly vulnerable to disorientation. The degree of disorientation may vary considerably with individual pilots. Spatial disorientation to a pilot means simply the inability to tell which way is up.…." ## Aircraft - Registration: [N1913M](https://openairdocs.org/deregistered/N1913M-2013-04-22), registration cancelled 2013-04-22, S/N 18264478, built 1975 (OpenAirDocs) - Reported make and model: CESSNA 182P - Registry model: [Cessna 182P](https://openairdocs.org/model/cessna-182p) (registry code 2075816) (OpenAirDocs) - Registry engine: [Continental O-470 series](https://openairdocs.org/engine/continental-o-470-series) (registry code 17026, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 18264478 - Airframe hours: 2765 - Engines: CONT MOTOR O-470 SERIES 230 horsepower reciprocating - Damage: Destroyed - Flight: Personal, Part 91 - Airworthiness certificate: Standard, Normal - Last inspection: Annual, July 18, 2008, 65 hours before - Departed: RYY, Kennesaw, GA - Destination: 4A7, Hampton, GA ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 51; injuries: fatal; private; airplane ratings: single-engine land; medical: class 3, with waivers/limitations; last flight review February 25, 2008; seat: left; toxicology performed; flight hours: 168 total, 126 in this make and model, 70 as pilot in command, 6 in the last 90 days, 6 in the last 30 days ## Weather - Conditions: Instrument (IMC), Day - Wind: 4 knots - Visibility: 0 statute miles - Lowest ceiling: 300 ft overcast - Temperature: 52 °F, dew point 52 °F - Altimeter: 30.20 inHg - Observed at: CCO, 26 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 20090308005809A](https://openairdocs.org/incident/20090308005809A), Mar 8, 2009: Cessna 182, Carrollton, GA, Destroyed, 3 fatal. (-23) Pilot and 2 passengers departed kryy (mccullum) in VFR weather at 0804 local time and proceeded to fly south into deteriorating wx conditions. Aircraft… ## Docket (14 files) The files NTSB released with the investigation on April 27, 2010, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=73450. 9.0 MB in all. - Witness Statements (item 1, .PDF, 152 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325894&FileExtension=.PDF&FileName=Witness%20Statements-Redacted.PDF - Airplane Usage Log (item 2, .PDF, 65 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325895&FileExtension=.PDF&FileName=Airplane%20Usage%20Log-Redacted.PDF - Weather Data (item 3, .PDF, 6.6 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325896&FileExtension=.PDF&FileName=Weather%20Data-Master.PDF - Pilot Logbook (excerpts) (item 4, .PDF, 365 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325902&FileExtension=.PDF&FileName=Pilot%20Logbook%20(excerpts)%20-Redacted.PDF - Refueling Records (item 5, .PDF, 91 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325897&FileExtension=.PDF&FileName=Refueling%20Records-Redacted.PDF - Maintenance Records (excerpts) (item 6, .PDF, 251 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325921&FileExtension=.PDF&FileName=Maintenance%20Records%20(excerpts)-Redacted.PDF - FAA Advisory Circular 60-4A (item 7, .PDF, 134 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325904&FileExtension=.PDF&FileName=FAA%20Advisory%20Circular%2060-4A-Master.PDF - FAA Forensic Toxixology Accident Report (item 8, .PDF, 162 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325905&FileExtension=.PDF&FileName=FAA%20Forensic%20Toxixology%20Accident%20Report-Redacted.PDF - Statement of Party Representatives to NTSB Investigation (item 9, .PDF, 59 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325906&FileExtension=.PDF&FileName=Statement%20of%20Party%20Representatives%20to%20NTSB%20Investigation-Redacted.PDF - Release of Aircraft Wreckage, NTSB Form 6120.15 (item 10, .PDF, 42 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325907&FileExtension=.PDF&FileName=Release%20of%20Aircraft%20Wreckage,%20NTSB%20Form%206120.15-Redacted.PDF - Photograph # 1 – View of accident site (Airplane crashed into the private lake shown) (item 11, .PDF, 112 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325911&FileExtension=.PDF&FileName=Photograph%20%23%201%20%E2%80%93%20View%20of%20accident%20site%20(Airplane%20crashed%20into%20the%20private%20lake%20shown)-Master.PDF - Photograph # 2 – View of engine (photograph taken at recovery facility) (item 12, .PDF, 286 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325913&FileExtension=.PDF&FileName=Photograph%20%23%202%20%E2%80%93%20View%20of%20engine%20(photograph%20taken%20at%20recovery%20facility)-Master.PDF - Photograph # 3 – View of propeller (photograph taken at recovery facility) (item 13, .PDF, 316 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325914&FileExtension=.PDF&FileName=Photograph%20%23%203%20%E2%80%93%20View%20of%20propeller%20(photograph%20taken%20at%20recovery%20facility)%20%20-Master.PDF - Photograph # 4 – View of fragmented airframe (photograph taken at recovery facility) (item 14, .PDF, 372 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325915&FileExtension=.PDF&FileName=Photograph%20%23%204%20%E2%80%93%20View%20of%20fragmented%20airframe%20(photograph%20taken%20at%20recovery%20facility)%20%20-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.