# NTSB ERA15LA319: Head AX9 118, N40104, New Holland, PA, August 16, 2015 - Type: NTSB accident investigation - Classification: Accident · Serious injuries · Limited investigation · Final report - Date: August 15, 2015, 20:00 local (Aug 16, 2015, 00:00 UTC) - Place: New Holland, PA - Coordinates: 40.125556, -76.105834 - Nearby events: https://openairdocs.org/map.md?lat=40.1256&lon=-76.1058&mi=10 - Phase of flight: [Standing](https://openairdocs.org/ntsb-phases/150) (OpenAirDocs' grouping) - Defining event: [Standing: Loss of control on ground](https://openairdocs.org/ntsb-events/230) - Highest injury: Serious injuries - Injuries: 2 serious, 1 minor - Status: Completed, report March 2, 2016 - Report: Approved by Office Director - NTSB office: Eastern Region Aviation - Parties: FAA- Flight Standards District Office - NTSB case key (mKey): 91807 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=ERA15LA319 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/91807/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=91807 - Page: https://openairdocs.org/ntsb/ERA15LA319 ## Probable cause The pilot's failure to adequately secure the vent line, which resulted in the premature deflation of the balloon’s envelope and its subsequent contact with power lines. Contributing to the accident were the pilot's choice of an unsuitable landing area, which had power lines opposite the approach end, and his subsequent failure to maintain adequate clearance from the lines during the landing. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Use of equip/info: use of equip/system](https://openairdocs.org/ntsb-findings/02063015): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Head Balloons AX9-118, 1 case](https://openairdocs.org/ntsb-findings/02063015/cases.md?model=4280102), [All aircraft, 1,391 cases](https://openairdocs.org/ntsb-findings/02063015/cases.md) - [Attention/monitoring: monitoring environment](https://openairdocs.org/ntsb-findings/02021545): Personnel issues › Psychological · Pilot (probable cause); cases with it: [Head Balloons AX9-118, 1 case](https://openairdocs.org/ntsb-findings/02021545/cases.md?model=4280102), [All aircraft, 809 cases](https://openairdocs.org/ntsb-findings/02021545/cases.md) - [Performance/control parameters: altitude](https://openairdocs.org/ntsb-findings/01062012): Aircraft › Aircraft oper/perf/capability · Not attained/maintained (probable cause); cases with it: [Head Balloons AX9-118, 1 case](https://openairdocs.org/ntsb-findings/01062012/cases.md?model=4280102), [All aircraft, 1,310 cases](https://openairdocs.org/ntsb-findings/01062012/cases.md) - [Object/animal/substance: wire](https://openairdocs.org/ntsb-findings/03022032): Environmental issues › Physical environment · Decision related to condition (probable cause); cases with it: [Head Balloons AX9-118, 2 cases](https://openairdocs.org/ntsb-findings/03022032/cases.md?model=4280102), [All aircraft, 588 cases](https://openairdocs.org/ntsb-findings/03022032/cases.md) - [Planning/preparation: flight planning/navigation](https://openairdocs.org/ntsb-findings/02061025): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Head Balloons AX9-118, 1 case](https://openairdocs.org/ntsb-findings/02061025/cases.md?model=4280102), [All aircraft, 179 cases](https://openairdocs.org/ntsb-findings/02061025/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Standing: Flight control sys malf/fail](https://openairdocs.org/ntsb-events/333); cases with it: [Head Balloons AX9-118, 1 case](https://openairdocs.org/ntsb-events/333/sequence.md?model=4280102), [All aircraft, 410 cases](https://openairdocs.org/ntsb-events/333/sequence.md) - [Standing: Loss of control on ground](https://openairdocs.org/ntsb-events/230) (defining event); cases with it: [Head Balloons AX9-118, 1 case](https://openairdocs.org/ntsb-events/230/sequence.md?model=4280102), [All aircraft, 4,585 cases](https://openairdocs.org/ntsb-events/230/sequence.md) ## Analysis The commercial pilot reported that he chose to land the balloon about 45 minutes into the planned 1-hour flight because sunset was approaching. The pilot chose an approximate 150-ft wide, 500 ft-long field for the landing. The pilot advised the ground crew, who were in radio and visual contact, of the intended landing zone, and he was aware of the power lines opposite the approach end of the field. During the final approach to the field, the basket grazed several rows of corn. It then struck the ground and bounced along it for about 50 ft before the ground crew was able to grab the basket and stop it. The pilot then began the shutdown procedures, and the ground crew informed him that the envelope was deflating prematurely. The pilot then noted that the vent line, which was normally secured to the basket, had loosened from its anchoring point and gotten caught between the ground and the basket during the landing sequence, allowing the envelope to deflate. He pulled the vent line free, but the envelope continued to collapse as the wind blew it toward the power lines; the basket remained stationary with the passengers still inside. The top third of the envelope draped over the power lines, which resulted in electrocution-related injuries to the passengers and pilot. ## Factual narrative HISTORY OF FLIGHTOn August 15, 2015, at 2000 eastern daylight time, a Head AX9-118 hot air balloon, N40104 incurred minor damage when it collided with powerlines after landing in a field, near New Holland, Pennsylvania. The commercial pilot sustained minor injuries, and the two passengers were seriously injured. The local sightseeing flight was conducted under the provisions of Title 14 Code of Federal Regulations Part 91. Visual meteorological conditions prevailed, and no flight plan was filed for the flight that originated at the operator's base in Intercourse, Pennsylvania about 1855. Approximately 45 minutes into the sightseeing, the pilot asked the two passengers if they would mind landing about ten minutes early, as the sun was beginning to set. He proceeded to scan the area for a suitable landing spot and selected a hay field as the most appropriate place. He stated he did not see any other landing spots and he had approximately 50% fuel remaining. The pilot then informed the ground crew via radio of the location, and they acknowledged and proceeded to the location. During final approach, he stated "everything looked good for landing." The basket grazed the last few rows of corn before touching down in an open field where it bounced and continued north-northeast for approximately 50 feet. As the basket was secured by the ground crew, the pilot started the shutdown procedures and was told that the envelope was deflating. The pilot noticed the vent line had detached from the basket and was pinched between the ground and the basket as it drug along the ground. He tugged on it and pulled it free. As the envelope lost air, it began to elongate and blow downwind where it draped over the powerlines paralleling the field. The result was an electrical arc that went from the powerlines through the balloon cables to the basket, and electrocuted the pilot and passengers. According to the passenger, he and his fiancé arrived at the balloon launch location at approximately 1800 and waited for about 45 minutes before they took off. The takeoff and flight were uneventful. They stayed relatively low, never getting above 1,000 feet and the pilot took them down lower a few times so he could check the ground wind speed, but nothing seemed out of the ordinary. The pilot asked the passengers if they could land 10 minutes early; assuming because it was starting the get dark. He also heard the pilot radio the ground crew and directed them to a specific location; to which the ground crew acknowledged. As they were descending, the passenger stated he saw the field where they were going to land and it looked a little narrow and had powerlines on the far side, but the pilot did not seem concerned. As they landed they bounced and the basket tipped slightly forward, but neither he nor his fiancé remember anything after landing. Eyewitnesses parked on the adjacent road south of the field, reported that the accident balloon approached the intended landing area from thesouth-southwest. As the balloon approached the landing site, it grazed the last few rows of corn before bouncing along the ground several times before the people on the ground chased the basket and grabbed onto it; As the basket was secured, with the passengers still inside, the balloon draped over the powerlines and started to smoke. PERSONNEL INFORMATION The pilot, age 52, held a commercial pilot certificate, with a rating for lighter-than-air free balloon. He did not hold, nor was he required to maintain, a Federal Aviation Administration (FAA) medical certificate. The pilot reported 519 hours of total flight experience in lighter than air aircraft and 31of those hours were in the same make and model as the accident balloon. AIRCRAFT INFORMATION According to FAA records and the balloon manufacturer, the balloon was manufactured in 1999, and was equipped with four propane tanks, a wicker basket, and an 119,544 cubic-foot envelope. The inflated envelope with basket was approximately 79 feet tall, and the inflated diameter was 62 feet. The most recent annual inspection was performed on June 24, 2015, and at that time the balloon had accumulated 81.5 hours of total time in service. METEOROLOGICAL INFORMATION At the time of departure and during the approximate 50-minute flight, weather observations from Lancaster Airport (LNS), Lancaster, Pennsylvania, located approximately 9 miles to the west of the accident site, recorded wind from 190 degrees at 6 knots, 10 miles visibility and clear skies, temperature 29 ° C with a dew point 17 °C. The barometric altimeter setting was 30.09 inches of mercury. During a telephone interview, when asked about the wind conditions, the pilot stated that the wind was 6 to 8 knots at the takeoff location. However, when they got to the launch site, the wind speed appeared to be "a little higher" than that, so they waited about 45 minutes for the winds to decrease before departing. WRECKAGE AND IMPACT INFORMATION According to an FAA inspector who travelled to the accident site, the envelope, lines, basket and all major components were accounted for at the scene. The envelope was oriented on a northeast heading where it impacted the electrical power lines that were about 30 feet above ground level (agl) on the north side of the field. The field was a symmetrical rectangle, approximately 500 feet long on the west-east side and 150 feet wide on the border of a road running roughly north/south. The eastern portion of the field was bordered by farm buildings and a residential structure. The south portion of the field was bordered by mature corn. The envelope remained undamaged and the stitching was intact. Several cables coming from the envelope to the basket and the skirt exhibited damage consistent with electrical arcing. The basket, instrumentation and components were not damaged. Examination of the power lines revealed that they were not damaged during the accident. ADDITIONAL INFORMATION Witness Photographs and VideoSeveral photos and a video were submitted by witnesses who were parked in a car on an adjacent road, approximately 600 feet south of the accident location. The witness photographed the balloon coming from the south southwest at about 200 feet agl through touchdown and subsequent powerline contact. Review of the sequential photographs and video showed the balloon descending onto the last few rows of corn, bouncing on the ground, before ground personnel secured the basket. Once the basket was secured, the envelope continued to collapse and drift into the powerlines. As the balloon draped over the powerlines, smoke began emanating from the area around the basket. FAA-H-8083-11A Balloon Flying Handbook Chapter 8, "Landing and Recovery," stated, "Having the skill to predict the balloon's track during the landing approach, touching down on the intended landing target and stopping the balloon basket in the preferred place can be very satisfying. It requires a sharp eye trained to spot the indicators of wind direction on the ground. Dropping bits of tissue, observing other balloons, smoke, steam, dust, and tree movement are all ways to predict the balloon track on its way to the landing site. During the approach, one of the pilot's most important observations is watching for power lines." The chapter further stated "When selecting a landing site, three considerations in order of importance are: safety of passengers, as well as persons and property on the ground; landowner relations; and ease of recovery." Some questions the pilot should ask when evaluating a landing site were: "• Is it a safe place for my passengers and the balloon? • Would my landing create a hazard for any person or property on the ground? • Will my presence create any problems (noise, startling animals, etc.) for the landowner?" ## Aircraft - Registration: [N40104](https://openairdocs.org/aircraft/N40104), registered now, S/N 439 (OpenAirDocs) - Reported make and model: HEAD AX9 118 - Registry model: [Head Balloons AX9-118](https://openairdocs.org/model/head-balloons-ax9-118) (registry code 4280102) (OpenAirDocs) - Registry engine: [NONE](https://openairdocs.org/engine/none) (registry code 00000, none) (OpenAirDocs) - Category: Balloon - Serial number: 439 - Year built: 2014 - Damage: Minor damage - Flight: Other work use, Part 91 - Airworthiness certificate: Standard, Balloon - Last inspection: Annual, June 24, 2015, 82 hours before - Departed: Intercourse, PA - Destination: New Holland, PA - Equipment: None ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 52; injuries: serious; commercial; last flight review June 22, 2015; seat: none; restraint: none; flight hours: 519 total, 31 in this make and model, 519 as pilot in command, 18 in the last 90 days, 9 in the last 30 days, 0 in the last 24 hours ## Weather - Conditions: Visual (VMC), Dusk - Wind: 190° at 6 knots - Visibility: 10 statute miles - Lowest ceiling: 10,000 ft broken - Temperature: 81 °F, dew point 66 °F - Altimeter: 30.09 inHg - Observed at: KLNS, 11 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 20150815013719A](https://openairdocs.org/incident/20150815013719A), Aug 15, 2015: Head Balloons Inc AX9-118, New Holland, PA, Minor damage. After balloon landing event, PIC failed to control envelope deflation. Deflating balloon envelope contacted electrical power lines adjacent to landing site.… ## Docket (6 files) The files NTSB released with the investigation on January 15, 2016, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=91807. 3.1 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 817 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40435680&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Master.PDF - NTSB Record of Conversation with Pilot (item 2, .PDF, 98 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40435681&FileExtension=.PDF&FileName=NTSB%20Record%20of%20Conversation%20with%20Pilot-Master.PDF - FAA Record of Interview with Pilot (item 3, .PDF, 453 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40435682&FileExtension=.PDF&FileName=FAA%20Record%20of%20Interview%20with%20Pilot-Master.PDF - Witness Interview Summary (item 4, .PDF, 97 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40435683&FileExtension=.PDF&FileName=Witness%20Interview%20Summary-Master.PDF - Photographs (item 5, .PDF, 1.6 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40435684&FileExtension=.PDF&FileName=Photographs-Master.PDF - Video File of Approach and Landing (item 6, .PDF, 38 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40435685&FileExtension=.PDF&FileName=Video%20File%20of%20Approach%20and%20Landing-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.