ERA19FA170

NTSB accident investigation · Piper PA 30 · Naples, FL · May 11, 2019

Accident · FatalClass 3 · FieldFinal report
Date
May 11, 2019, 15:30 local (19:30 UTC)
Place
Naples, FL
Injuries
1 fatal
Damage
Destroyed
Phase of flight
Approach
Aircraft
N7650YPiper PA 30
Defining event
Approach-IFR final approach: Birdstrike
Weather
Visual (VMC) · Day
Status
Completed
Report
Approved by Office Director
Investigation class
Class 3
NTSB office
Eastern Region Aviation
Parties
Piper Aircraft, FAA/FSDO
FAA report
20190511004489A
Case key
99411

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

Incapacitation of the pilot due to a birdstrike through the windshield in front of the pilot's position, while on approach to land.

Findings · 4

NTSB’s coded findings. Those marked are part of the probable cause; the rest are factors or other findings. Under each, the cases with the same finding.

Windows-windshield system: flight compartment windowsAircraft › Aircraft structures · Capability exceededPiper PA-30: 1 caseAll aircraft: 42 casesProbable cause
Object/animal/substance: animal(s)/bird(s)Environmental issues › Physical environment · Contributed to outcomePiper PA-30: 1 caseAll aircraft: 358 casesProbable cause
Selection/certification/testing: equip certification/testingOrganizational issues › Development · FAA/RegulatorPiper PA-30: 1 caseAll aircraft: 21 casesProbable cause

Sequence of events

The events NTSB coded, in order, by phase of flight. The defining event is the one that best describes the accident. Under each, the cases with the same event anywhere in their sequence.

Analysis

While on approach to the destination airport in visual meteorological conditions, the airplane deviated unannounced from its intended flight path, descended, and impacted the ground. Postaccident examination of the airframe, flight controls, engines, engine systems, and propellers revealed no evidence of preimpact failure or malfunction. Remains of a 3.8-pound Black Vulture was found in the wreckage. A rear seat headrest and two inflatable lift vests located about 440 ft from the main wreckage were found to contain either DNA and/or microscopic feathers from a Black Vulture. Because the Black Vulture was located among the wreckage and because the airplane’s flight path deviation was unannounced, it is likely that the Black Vulture directly impacted and then penetrated the windshield in front of the pilot's position, which incapacitated him, resulting in an uncontrolled descent. The airplane was certificated in accordance with Civil Air Regulation 3, which specified no minimum standard for window or windshield structure strength, or bird penetration.

Factual narrative

The airplane was certificated in accordance with Civil Air Regulation 3, which specified no minimum standard for window or windshield structure strength, or bird penetration. The regulation specified windshields must be comprised of non-splintering safety glass. At the time of manufacture, the airplane was equipped with a two-piece windshield that was 0.125-inch thick. Subsequently, on January 15, 1979, a one-piece windshield was installed in accordance with Supplemental Type Certificate (STC) SA-209GL. As part of the STC, the center post was removed and not re-installed. According to the designer and manufacturer of the STC windshield, the design criteria consisted of testing loads by using the dynamic pressures and projected frontal area. There was no requirement for bird strike resistance; therefore, bird penetration testing was not performed.. HISTORY OF FLIGHT On May 11, 2019, about 1530 eastern daylight time, a Piper PA-30, N7650Y, was destroyed when it was involved in an accident near Naples, Florida. The pilot was fatally injured. The airplane was operated as a Title 14 Code of Federal Regulations Part 91 personal flight. According to Federal Aviation Administration (FAA) communication and radar data, the airplane departed from Key West International Airport (EYW) for a cross-country flight to Naples Municipal Airport (APF). At 1513, the pilot established contact with the Southwest Florida International Airport (RSW) air traffic control tower and advised the controller that the airplane was at an altitude of 4,000 ft, with automated terminal information service tango. The controller advised the pilot to expect the RNAV runway 23 approach to APF, which he acknowledged. The flight continued toward APF, and at 1518, the pilot was advised that he would be vectored onto the downwind leg of the airport traffic pattern and would be following a Cessna Citation. Three minutes later, the pilot advised the controller that APF was in sight, and he requested a lower altitude. The pilot was instructed to descend and maintain 3,100 ft, followed by 2,000 ft, which he acknowledged. At 1527, the pilot was cleared for a visual approach to runway 23 and instructed to contact the APF air traffic control tower, which he did. About 1528, while flying at an altitude of about 2,185 ft mean sea level, the pilot advised the APF controller that he was on a 5.5-mile final, which was his last communication. The airplane continued toward APF and its altitude varied around 2,200 feet until 1529:42, at which time a gradual, arcing, left descending turn occurred. The last radar target was recorded at 1529:55, when the airplane was less than 0.25 nautical mile from the accident site at an altitude of 750 ft. The airplane impacted a residential area, immediately adjacent to a home, about 4.3 miles and 052° from the approach end of runway 23. According to a deputy with the Collier County Sheriff Department (CCSD) who was on a traffic stop with another CCSD employee about1,900 ft east-southeast of the accident site, he reported hearing a loud sound then a "thud." He looked up and saw something like silver Christmas tinsel floating. He never saw the airplane, and he did not hear any "clunking" sound from the engine(s). The other CCSD employee reported he too heard a thud sound, which he thought was a truck passing over a road. He did not see the airplane and did not hear any "sputter" sound. According to the home owner, he heard the noise from an airplane getting closer and swooping over his house, then he felt the house shake. He estimated that he heard the airplane for about 8 to 10 seconds; during that time he did not hear any abnormal sounds, and he did not hear any sputtering. He equated the sound to something similar to a mosquito-control airplane. A postmortem examination of the pilot was performed by the District Twenty Medical Examiner's Office, Collier County, Naples, Florida. The cause of death was listed as airplane crash. The autopsy noted the presence of black bird feathers. Forensic toxicology was performed on specimens of the pilot by the FAA Forensic Sciences Laboratory, Oklahoma City, Oklahoma, and also by the Miami-Dade County Medical Examiner’s Department. According to FAA's toxicology report, testing for carbon monoxide and cyanide was not performed. The results were negative for volatiles and tested for drugs. According to Miami-Dade ME's Department the results were negative for all tested for drugs. Several tree limbs immediately adjacent to the house were damaged; the highest was about 30 ft above ground level. Numerous tree limbs, 4 to 7 inches in diameter, exhibited 45° cuts consistent with propeller contact. A 14-ft-long ground scar, oriented on a magnetic heading of 172° was observed adjacent to the house, and was associated with both wing leading edges. Within the ground scar were two craters associated with each engine. The left crater contained a separated propeller blade, propeller hub with attached propeller blade, and a portion of crankshaft. The right crater contained a piece of flap, wing skin, engine nacelle, and part of a fuel bladder tank. Further examination of the accident site revealed fragmented parts of the airplane, including and windshield and other window pieces. All structural components necessary to sustain flight, and all primary and secondary flight controls remained attached or were located at the accident site. All primary flight control surfaces’ counterweights were accounted for except the right aileron. Examination of the right aileron bellcrank revealed neither stop was damaged. Examination of the flight control cables for roll, pitch, and yaw revealed they exhibited either tension overload or were cut for recovery; there was no evidence of preimpact failure or malfunction. The pitch trim actuator was extended 8 threads from the bottom which equated to full airplane nose down trim. The rudder trim actuator was separated, and the actuator rod was fracturedat the actuator. The flap actuator was separated from the airplane and the jackscrew was extended 1.750 inches, or 11 threads, which equated to between 0° and 10° of flap extension. Both main landing gear were retracted in their wheel wells; the nose landing gear actuator position could not be determined due to impact damage. Examination of the lower front window retainer revealed it was fragmented in three pieces. Screws were observed in place in the retainer. Examination of the upper window retainer revealed it was fractured and four screws were missing; however, the full span was accounted for. No window pieces were noted in either upper or lower retainer channel, and sealant was noted in the lower and upper channels. Recovered windshield pieces were examined and the maximum thickness was 0.250 inch. A dead bird weighing 3.8 pounds was located among the wreckage. Feathers were found adhering to a blanket located near the separated inboard section of the right wing. The bird and feathers were retained for analysis by the Smithsonian Institution Museum of Natural History. The rear seat headrest and two inflatable life vests were located about 440 ft north-northwest from the accident site. These items were swabbed for analysis by the Smithsonian Institution Museum of Natural History. Additionally, swabs from the upper surface of the glare shield and also from the interior portion of the upper headliner were also analyzed. According to a report from The Smithsonian Institution Museum of Natural History, the bird was a Black Vulture, and the swabs from the glare shield and the headliner, did not contain bird DNA or feathers. The swabs from the headrest and life vests contained either DNA and/or microscopic feathers from a Black Vulture. Examination of both engines and propellers revealed no evidence of preimpact failure or malfunction.

Aircraft

Registration
N7650Y
Reported as
Piper PA 30 (No Series)
Category
Airplane
Serial number
30-729
Built
1965
Airframe hours
4,681
Engines
Lycoming IO-320-B1A, 160 horsepower, reciprocatingLycoming IO-320-B1A, 160 horsepower, reciprocating
Damage
Destroyed
Flight
Personal · Part 91
Airworthiness certificate
Standard, Normal
Last inspection
Annual · May 15, 2019 · 89 hours before
Departed
EYW · Key West, FL
Destination
APF · Naples, FL
Flight plan
IFR
Airport
APF · Naples Municipal Airport
Equipment
Auto-pilot, Handheld GPS, Stall warning system

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
71
Injuries
Fatal
Certificate
Private
Airplane ratings
Single-engine land, Multi-engine land
Instrument ratings
Airplane
Medical
Class 3, Without waivers/limitations
Last flight review
February 22, 2018
Seat
Left
Restraint
Lap only
Toxicology
Performed
Flight hours
2,419 total

Weather

Conditions
Visual (VMC) · Day
Wind
200° at 14 knots
Visibility
10 statute miles
Lowest ceiling
None
Temperature
88 °F, dew point 72 °F
Altimeter
29.92 inHg
Turbulence
Unknown
Observed at
APF, 5 nm away

Docket · 16

The files NTSB released with the investigation on December 9, 2021, on NTSB’s docket system: statements, records, photos and specialists’ reports. 135 MB in all.

FAA reports on this event · 1

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