# NTSB LAX01FA178: Beech D45, N8NV, Julian, CA, May 18, 2001 - Type: NTSB accident investigation - Classification: Accident · Fatal · Field investigation · Final report - Date: May 18, 2001, 10:32 local (17:32 UTC) - Place: Julian, CA - Coordinates: 32.995555, -116.659164 - Nearby events: https://openairdocs.org/map.md?lat=32.9956&lon=-116.6592&mi=10 - Phase of flight: [Maneuvering](https://openairdocs.org/ntsb-phases/450) (OpenAirDocs' grouping) - Highest injury: Fatal - Injuries: 2 fatal - Status: Completed, report March 2, 2004 - Report: Approved by Office Director - Parties: FAA WP-FSDO, Raytheon Aircraft Company (Beech) - NTSB case key (mKey): 52304 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=LAX01FA178 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/52304/pdf - Page: https://openairdocs.org/ntsb/LAX01FA178 ## Probable cause The pilot's selection of an insufficient altitude over rising mountainous terrain and his failure to maintain adequate terrain clearance. ## Sequence of events In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf). - In flight collision with terrain/water, maneuvering - in-flight planning/decision - improper, pilot in command (cause) - terrain condition - rising (contributing factor) - altitude - inadequate, pilot in command (cause) - clearance - not maintained, pilot in command (cause) ## Analysis The pilot attempted to fly a military flying club airplane up a valley at a low altitude. The airplane was unable to outclimb the rising terrain, and it impacted the rocky hillside at an elevation of 3,400 feet mean sea level (msl). About 8 minutes after initiating the cross-country flight, and while en route to the planned destination airport, the pilot flew over a residence less than 400 feet above the ground, as evidence by the airplane's Mode C transponder. A witness, who was at the residence and who recognized the airplane, estimated its altitude as 500 feet above ground level. Thereafter, the pilot continued flying at a low altitude above ground level. The airplane's radar track disappeared as the pilot headed toward higher elevation terrain. The lowest altitude at which targets are observed on radar 1 mile south of the accident site area is between 3,600 and 3,700 feet msl. The accident airplane's track as it approached the accident site was not detected. The terrain leading to the accident site varies from 490 to 3,400 feet msl. The pilot was familiar with the accident site terrain, having flown over the terrain in military helicopters. No evidence of preimpact mechanical malfunction was found during the wreckage examination. ## Factual narrative HISTORY OF FLIGHT On May 18, 2001, at an undetermined time between 1032 and 1109 Pacific daylight time, a Beech D45, N8NV, impacted rising terrain while maneuvering at a low altitude up a valley about 5.8 nautical miles (nm) south (197 degrees, magnetic) of Julian, California. The airplane was owned by the United States Navy and operated by the North Island Navy Flying Club, San Diego, California. Visual meteorological conditions prevailed at the time of the personal flight, and a visual flight rules flight plan was filed. The flight was performed under 14 CFR Part 91. The airplane was destroyed by impact forces and a post impact fire. The front seated private pilot and the rear seated pilot-rated passenger were fatally injured. The operator reported that the front seated pilot was the pilot-in-command during the accident flight, which originated from the NAS North Island Airport at 1011. In accordance with Navy directives, prior to the pilot's departure for the cross-country flight, a person at the airport who had flight clearance authority with the military flying club reviewed his qualifications, planning procedures, and documents. Thereafter, the pilot was released for the flight. The last recorded radio communication with the pilot was at 1015:38, at which time the pilot informed the NAS North Island tower controller that he was proceeding outbound (from the airport). The controller responded and informed the pilot to change radio frequencies. A North Island flying club member reported that his brother, who was in the city of Chula Vista, observed a T34 flying over his location on the morning of the accident. The Safety Board investigator interviewed the brother. The brother reported that between 1000 and 1030 he had been at a house in a residential area of the city. The brother stated that he had observed an airplane passing nearly overhead. He recognized the airplane as being a T34 that he had flown in. The airplane was flying below a marine layer of clouds. The cloud layer was starting to breakup. The brother further stated that he also heard the airplane's engine, and nothing unusual was noted. The brother stated that, at the time of the overflight, he estimated that the airplane was approximately 500 feet above ground level. Thereafter, the airplane proceeded flying in an easterly and then a northeasterly direction until he lost sight of it. The Safety Board investigator subsequently determined that the brother/eyewitness was about 12 nm and 093 degrees, magnetic, from the NAS North Island Airport. This location is about 32 degrees 38.72 minutes north latitude by 116 degrees 59.34 minutes west longitude. At this location, the elevation is about 490 feet mean sea level (msl). The route of flight that the accident pilot flew between the eyewitness's location and the accident site was not determined. No persons were identified as having witnessed the accident. The accident pilot's flight planned destination was the airport at Agua Caliente, California. This airport is located about 18.6 nm east (084 degrees, magnetic) of the accident site. PERSONNEL INFORMATION The pilot was on active duty in the United States military service. According to his supervisor, the pilot had acquired all his flight training through civil aviation sources. By the accident date, the pilot's total flight time was approximately 220 hours. He had 19 hours of flight time in the accident make and model of airplane, of which 14 hours were acquired as its pilot-in-command. During the preceding 90-day period, the pilot had flown the accident model airplane for 8.4 hours. The pilot possessed airplane single engine land and multiengine land ratings. The supervisor additionally reported that the pilot had acquired 868.5 hours of flight time as a crew chief in the UH-1N "Huey" helicopter and maintenance in-flight tester on the AH-1W "Super Cobra" helicopter. The pilot was familiar with the accident site area, and he had traveled over the scene of the mishap extensively while performing duties as a UH-1N helicopter crew chief. AIRCRAFT INFORMATION The airplane was maintained by contract mechanics certificated by the Federal Aviation Administration (FAA). The airplane was classified as a civil aircraft, and it was maintained on a program of annual and 100-hour inspections. METEOROLOGICAL INFORMATION A San Diego County deputy sheriff, who responded to the accident site at 1220, reported that upon his arrival there were no clouds in the area. There was a light wind. WRECKAGE AND IMPACT INFORMATION The global positioning satellite coordinates for the estimated 3,400-foot msl accident site are about 32 degrees 59.730 minutes north latitude by 116 degrees 39.553 minutes west longitude. The airplane was found in an upright attitude. It was on a 345-degree magnetic heading on the rocky, mountainous terrain. The terrain's upslope angle on the hillside was estimated at 15 degrees. Both pilots were found in the cockpit. No evidence of parachutes was found. The terrain's elevation to the north, east, and west sides of the accident airplane was higher than the elevation of the terrain where the airplane had crashed. The terrain elevation was lower south of the airplane down the valley. The estimated height of the hill north of the airplane was 3,700 feet msl. The engine, with one attached propeller blade, was found separated from the fuselage. It was located about 115 feet west-southwest (246 degrees, magnetic) from the airplane's left wing. The other propeller blade was located about 70 feet east-southeast (145 degrees, magnetic) behind the airplane. The right magneto was found about 100 feet southwest (232 degrees, magnetic) of the engine. Engine accessories and related items were located in a debris field between the main wreckage and the engine. MEDICAL AND PATHOLOGICAL INFORMATION On May 21, 2001, an autopsy was performed by the Naval Medical Center Laboratory Department, San Diego, California 92134. The Department of Defense, Armed Forces Institute of Pathology, Washington, DC 20306, performed toxicology tests on specimens from the pilot. No evidence was found of screened drugs including ethanol and cyanide. The carboxyhemoglobin saturation in the blood was 1 percent. TESTS AND RESEARCH Airframe and Propeller Examination. The structural examination of the airframe, which was equipped with dual flight controls, revealed that the fuselage was disintegrated from the floor level to the roof. The fuselage and empennage had burned predominantly to ashes. All flight control surfaces were found with the main wreckage. The left and right wings were found attached to the fuselage. The left wingtip was found about 25 feet north of the main wreckage. The right wingtip remained attached to the wing. The leading edges of the wings did not display evidence of deformation in an aft direction. The wings appeared positioned at right angles to the airplane's longitudinal axis. The wing flaps and the landing gear was found in the retracted position. The fuel tank selector was found positioned to the BOTH tank position. Both propeller blades were observed deformed into an "S" shape. The leading edge of each blade was observed gouged and the blade tips were broken off. Engine Examination. The engine sustained impact damage and the case was cracked in several locations. No evidence of preimpact oil or fuel leakage was noted from the engine or accessories. All upper spark plugs were removed and examined. According to an FAA airworthiness inspector, they exhibited normal wear indications. Also, the electrode gap in all plugs appeared normal. The crankshaft was rotated and the continuity of the valve and gear train was confirmed. The FAA also indicated that compression was noted in all cylinders except number six, which was impact damag ## Aircraft - Registration: [N8NV](https://openairdocs.org/deregistered/N8NV-2002-01-11), registration cancelled 2002-01-11, S/N BG-358, built 1957 (OpenAirDocs) - Reported make and model: Beech D45 - Registry model: [Beech D-45](https://openairdocs.org/model/beech-d-45) (registry code 1152012) (OpenAirDocs) - Registry engine: [Continental O-470 series](https://openairdocs.org/engine/continental-o-470-series) (registry code 17026, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: BG-358 - Airframe hours: 9360 - Engines: Continental O-470-4 225 horsepower reciprocating - Damage: Destroyed - Fire: On-Ground - Flight: Personal, Part 91 - Operator: North Island Navy Flying Club - Registered owner: Groton Navy Navy Flying Club - Airworthiness certificate: Standard, Normal - Last inspection: Annual, April 19, 2001, 25 hours before - Departed: NZY, NAS NorthIsland, CA - Destination: L54, Agua Caliente, CA - Flight plan: VFR ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 22; injuries: fatal; private; airplane ratings: single-engine land; medical: class 2, valid medical--no waivers/lim.; last flight review April 26, 2001; seat: front; toxicology performed; flight hours: 220 total, 19 in this make and model, 140 as pilot in command, 8 in the last 90 days, 8 in the last 30 days ## Weather - Conditions: Visual (VMC), Day - Wind: 30° at 4 knots - Visibility: 9 statute miles - Lowest ceiling: none - Temperature: 70 °F, dew point 55 °F - Altimeter: 29.94 inHg - Observed at: RNM, 13 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 20010518014199A](https://openairdocs.org/incident/20010518014199A), May 18, 2001: Beech D45, Julian, CA, No damage. (.19)On may 18, 2001, at an undetermined time between 1030 and 1115 hours pacific daylight time, a Beech D45, N8NV, owned by the united states navy and… 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.