FTW95FA112

NTSB accident investigation · Piper PA-32R-300 · Conroe, TX · February 10, 1995

Accident · FatalField investigationFinal report
Date
February 9, 1995, 20:28 local (Feb 10, 1995, 02:28 UTC)
Place
Conroe, TX
Injuries
5 fatal, 1 minor
Damage
Destroyed
Phase of flight
Approach
Aircraft
N5373FPiper PA-32R-300
Weather
Instrument (IMC) · Night/dark
Status
Completed · report January 19, 1996
Report
Approved by Office Director
Case key
19210

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 follow published IFR procedures. Factors were the weather conditions, the dark night, and the pilot's failure to activate the approach lighting system.

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.

In flight collision with terrain/waterApproach
Weather condition - low ceilingFactor
Weather condition - fogFactor
Weather condition - below approach/landing minimumsFactor
Light condition - dark nightFactor
Airport facilities,instrument approach lights - not operatingFactor
Procedures/directives - not followedPilot in commandFactor
Ifr procedure - improperPilot in commandCause
Lack of familiarity with geographic areaPilot in commandFactor

Analysis

The flight had been cleared for an ILS rwy 14 approach. Weather conditions provided to the pilot was 100 feet obscured, visibility 1/2 mile in fog. The flight called the FBO for field conditions, and about 15-20 minutes later the airplane came over the field and made a turn to the right. The wreckage was located approx 1/2 mile short, and 1/4 mile left, of the extended centerline of rwy 14. Witnesses in the FBO office stated they did not hear any 'clicks' over the radio normally heard when a pilot activates the approach lighting system. The pilot was in the right seat. This was the pilot's first flight into the airport.

Factual narrative

History of flight

On February 9, 1995, at 2028 central standard time (all times in this report will remain in central standard time), a Piper PA- 32R-300, N5373F, was destroyed during a VFR approach to the Montgomery County Airport, near Conroe, Texas. The instrument rated commercial pilot and four of his passengers were fatally injured; however, a 4-year old child received minor injuries. The aircraft was being operated under Title 14 CFR Part 91. Instrument meteorological conditions prevailed throughout the area for the personal flight.

According to the Federal Aviation Administration (FAA) records, the pilot obtained a weather briefing and filed an instrument flight plan from the Point Lookout Airport, near Branson, Missouri, to Conroe, Texas. The flight departed at 1730 with five hours of fuel on board for the estimated three hour flight. The FAA records further indicate that the pilot was cleared to execute an ILS approach to runway 14 at the Montgomery County Airport, Conroe, Texas.

Witnesses at the fixed base operations (FBO) office reported that the aircraft called for "field conditions" at approximately 2020. One of these witnesses further reported that at "about 15 to 20 minutes after I talked to him, he came over the field, and he made a turn to the right."

There is a published missed approach procedure for this airport, physical evidence and witnesses established that the pilot elected not to execute this published procedure.

Personnel information

The owner of the airplane, who was not a certificated pilot, was seated on the left front seat. Friends and relatives of the owner stated that he had been taking flying lessons en route during his business flights. He was reported to have accumulated approximately 60 hours of flight time.

The pilots log book indicates that this was the first time for him to fly an instrument approach into Conroe or to land at Conroe.

Aircraft information

The airplane was topped off with 8 gallons of 100LL aviation fuel prior to departure. An estimate of the weight of the airplane at the time of the accident places the airplane within its limits. A review of the airframe and engine records by the FAA inspector, did not reveal any anomalies or uncorrected maintenance defects prior to the flight.

Meteorological information

The weather at Houston Intercontinental Airport, at 1950, was a measured 300 overcast, light rain and fog, temperature was 63 and the dew point was 62, wind was from 150 degrees at 9 knots, and Runway 26 was reporting a visual range of 6000 feet plus. Conroe weather was provided to the pilot at 2000 was indefinite 100 feet overcast, sky obscured, visibility 1/2 mile with fog, temperature was 57 with a dew point of 57, calm wind, and the barometric pressure was 30.00 inches.

A witness driving past the approach end of the runway after 2000 noted the fog had decreased his forward visibility to "about 50 feet." Another witness driving past the approach end of the runway at about 2025 reported "barely" being able to see the dim threshold lights through the fog. One more witness reported that about 2010 the Flight Service Station at Conroe told him that the weather was 100 feet overcast with 1/4 mile visibility. The above three witness are all certified flight instructors.

Aids to navigation

A flight check of the Montgomery County Airport ILS to runway 14 was requested and performed by a FAA Flight Inspection crew. All parameters were found within limits. See the enclosed copy of the published ILS approach to Runway 14 at Conroe.

Aerodrome information

The airport is equipped with a radio frequency activated runway/approach lighting system. The runway, taxiway, and threshold lights are on dim all the time at night. A pilot can control the approach lighting system and the intensity of all the runway/approach lights by activating a series (7) radio transmissions (depressing the press to talk button). Witnesses in the FBO office did not hear the radio transmitted "clicks" which they normally hear when a pilot activates the approach lighting system. Another witness, who was driving past the end of the runway 2 to 5 minutes before the accident, noted that the approach lighting system was not on.

Wreckage and impact information

Airplane debris was found on a heading of 085 degrees leading to the airplane wreckage. The trees along this debris path were missing limbs and branches starting at 50 feet above the ground to 20 feet above the ground which corresponded with the airplanes estimated flight path. The fuselage of the airplane came to rest on the shoulder of FM (farm road) 1484 in the inverted position, and approximately a half mile short and a quarter mile left of the centerline for Runway 14.

All flight controls surfaces were accounted for, and continuity established. Fuel was found in the fuel spider valve, and fresh oil was observed leaking from the propeller shaft. Both propeller shafts were found separated from the hub. One propeller blade was found near the point of initial impact, while the other one was found at the farthest point from the wreckage. Both propeller blades had evidence of S-type bending and striations.

During an examination of the engine at the accident site, continuity from the propeller to the aft section of the engine was established, including all accessory drives. The spark plugs displayed no abnormalities. The left and right magnetos were removed and sparks were observed at every post when the magnetos were rotated.

Medical and pathological information

The autopsy was performed by the Harris County Medical Examiner's Office in Houston, Texas, on February 10, 1995. Toxicological tests were negative.

Additional data

The wreckage was released to the owner's representative.

Aircraft

Registration
N5373F
Reported as
Piper PA-32R-300
Category
Airplane
Serial number
32R-7680512
Airframe hours
2,320
Engine
Lycoming IO-540-KIA5D, 300 horsepower, reciprocating
Damage
Destroyed
Fire
On-Ground
Flight
Personal · Part 91
Registered owner
Henry J. Rhodes
Airworthiness certificate
Standard, Normal
Last inspection
Annual · December 22, 1994 · 70 hours before
Departed
PLK · Point Lookout, MO
Destination
CXO
Flight plan
IFR

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
21
Certificates
Flight instructor, Commercial
Airplane ratings
Single-engine land, Multi-engine land
Instrument ratings
Airplane
Medical
Class 2, Valid Medical--no waivers/lim.
Seat
Right
Toxicology
Performed
Flight hours
674 total · 25 in this make and model · 605 as pilot in command · 147 in the last 90 days · 84 in the last 30 days · 4 in the last 24 hours

Weather

Conditions
Instrument (IMC) · Night/dark
Wind
Calm
Visibility
0.5 statute miles
Lowest ceiling
100 ft overcast
Temperature
57 °F, dew point 57 °F
Altimeter
30.00 inHg
Observed at
CXO, 1 nm away