# NTSB LAX94FA171: Cessna 206, N5222U, Show Low, AZ, March 20, 1994 - Type: NTSB accident investigation - Classification: Accident · Fatal · Field investigation · Final report - Date: March 19, 1994, 21:45 local (Mar 20, 1994, 04:45 UTC) - Place: Show Low, AZ - Coordinates: 34.230449, -110.069084 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=34.2304&lon=-110.0691&mi=10 - Phase of flight: [Enroute](https://openairdocs.org/ntsb-phases/400) (OpenAirDocs' grouping) - Highest injury: Fatal - Injuries: 2 fatal - Status: Completed, report December 19, 1994 - Report: Approved by Office Director - NTSB case key (mKey): 28523 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=LAX94FA171 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/28523/pdf - Page: https://openairdocs.org/ntsb/LAX94FA171 ## Probable cause the pilot's intentional VFR flight into known adverse IMC weather conditions. Inadequate preflight planning, dark night operations, and weather conditions that included low ceilings and mountain obscuration were factors in the accident. ## Sequence of events In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf). - In flight collision with terrain/water, cruise - normal - terrain condition - mountainous/hilly - light condition - dark night (contributing factor) - preflight planning/preparation - inadequate, pilot in command (contributing factor) - weather condition - low ceiling (contributing factor) - flight into known adverse weather - intentional, pilot in command (cause) - weather condition - obscuration (contributing factor) ## Analysis THE FLIGHT DEPARTED ON A PERSONAL VFR CROSS-COUNTRY NIGHT FLIGHT TOWARD MOUNTAINOUS TERRAIN. THE PILOT RECEIVED A WEATHER BRIEFING THAT INDICATED VFR WAS NOT RECOMMENDED. THE DESTINATION WEATHER CONDITIONS CONSISTED OF RAIN, LOW CEILINGS AND LOW VISIBILITY, ICING CONDITIONS, AND MOUNTAIN OBSCURATION. THE PILOT DEPARTED ABOUT 1 1/2 HOURS AFTER THE BRIEFING AND DID NOT ARRIVE AT THE DESTINATION. AFTER BEING REPORTED OVERDUE, THE AIRCRAFT WAS LOCATED 2 DAYS LATER ABOUT 9 MILES EAST OF THE DESTINATION AIRPORT. THE PILOT WAS NOT INSTRUMENT CURRENT AND THE AIRCRAFT WAS NOT CERTIFICATED FOR INSTRUMENT FLIGHT. ## Factual narrative History of the Flight On March 19, 1994, about 2145 hours mountain standard time, a Cessna 206, N5222U, collided with terrain about 9 miles east of Show Low, Arizona. The airplane was being operated as a visual flight rules (VFR) cross-country personal flight under Title 14 CFR Part 91 when the accident occurred. The airplane, owned by Action Medical Service, Winslow, Arizona, was destroyed by impact. The certificated airline transport pilot and a passenger received fatal injuries. Instrument meteorological conditions prevailed in the area at the time of the accident. A flight plan was not filed. The flight originated at the Chandler Municipal Airport, Chandler, Arizona. The pilot contacted the Prescott Automated Flight Service Station (AFSS) about 1833 hours and obtained a weather briefing for an intended route of flight from Chandler to Show Low. The flight service station specialist indicated that VFR flight was not recommended. The time of departure from Chandler is not known; however, the pilot contacted Phoenix Terminal Radar Controllers (TRACON) about 2055 hours and reported that he had just departed Chandler. The pilot was provided with radar advisories until 2107:26 hours. At that time, the pilot was advised that flight following with the Albuquerque Air Route Traffic Control Center (ARTCC) was available. No further communication was received from the pilot. A ground witness near the area of the accident reported overcast cloud conditions, and rain with thunder and lightning. The operator reported that the pilot was authorized to utilize the aircraft for personal travel. The airplane was reported overdue when the pilot failed to report for work on March 21, 1994. Search personnel located the airplane visually about 1010 hours on March 23, 1994. No emergency locator transmitter signal was received from the airplane. The accident occurred during the hours of darkness at latitude 34 minutes, 14.31 minutes north, and longitude 109 degrees, 48.71 minutes west. Crew Information The pilot held an airline transport pilot certificate with an airplane multiengine land and instrument airplane ratings. The pilot also held a commercial pilot certificate with an airplane single-engine land rating. In addition, the pilot was a certified flight instructor with airplane single-engine, multiengine, and instrument airplane ratings. The most recent first-class medical certificate was issued to the pilot on December 7, 1993, and contained no limitations. No personal flight records were located for the pilot and the aeronautical experience listed on page 6 of this report was obtained as an estimate provided by the operator. The pilot's total aeronautical experience consisted of about 2,400 hours, of which about 100 hours were accrued in the accident aircraft make and model. In the preceding 30 days prior to the accident, the pilot accrued a total of 25 hours. The operator also indicated that the pilot was not current for flight in instrument conditions. Aircraft Information The recording hour meter in the tachometer gauge was destroyed. Examination of the maintenance records revealed that the last entry in the aircraft's logbook was February 6, 1994. As of that date, the airplane had accumulated a total time in service of 6,281 flight hours. The most recent annual inspection was accomplished on September 3, 1993, 161 flight hours before the accident. The operator reported that the aircraft was equipped for VFR flight only. The navigational equipment installed included two com/nav radios, a loran receiver, and an ADF receiver that was inoperative. The engine had accrued a total time in service of 6,031 hours of operation. The maintenance records note that a major overhaul was accomplished on September 5, 1986, 1,115 hours of operation before the accident. Meteorological Information The closest official weather observation station is Show Low, Arizona, which is located 9 nautical miles west of the accident site. The Federal Aviation Administration (FAA) reported that the airport is normally attended until 1800 hours; however, a surface observation at 1845 hours indicated in part: Sky condition and ceiling, estimated 2,000 feet broken clouds, 6,000 feet overcast; visibility, 10 miles in light rain; temperature, 47 degrees F; dew point, 45 degrees F; wind, 180 degrees at 12 knots, gusts to 22 knots; altimeter, 29.89 inHg; ceilings lower south through west, rain began at 1735 hours. The Show Low airport manager reported that at 1920 hours, a Beech Baron reported heavy icing conditions at 10,000 feet. At 2125 hours, the manager indicated that the weather remained poor; visibility varied from 1 to 4 miles; ceilings varied from 500 to 1,500 feet with areas to the north better than the south. Beginning at 1833:14 hours, the pilot requested and received a standard weather briefing from the Prescott AFSS. He indicated to the briefer that he was planning a VFR flight at 9,000 feet with a departure from Chandler in 1/2 hour to Show Low. The briefer advised that VFR flight was not recommended and included a synopsis of weather conditions that included: Occasional moderate turbulence below 18,000 feet, mountain obscuration along the route, and occasional moderate icing from 10,00 to 23,000 feet. The forecast included 8,000 to 9,000 feet scattered clouds, 12,000 feet broken, tops of the clouds to 23,000 feet and until 2100 hours, widely scattered light rain showers or thunderstorms. The briefer provided information contained in notices to airmen (NOTAMs) that the Scottsdale nondirectional beacon (NDB) was out of service. There was no indication of local (Show Low) NOTAMs. At 1837:38 hours, the pilot indicated that..."Ok, I probably won't be going." The briefer reiterated that the flight was not recommended due to darkness, low clouds, and possible rain shower activity. A transcript of the weather briefing is included in this report. A paramedic working at the Show Low airport reported low ceilings, rain, and windy conditions. Two aeromedical pilots operating flights between Phoenix, Arizona, and Show Low, reported thunderstorm activity and icing conditions between 9,000 to 13,000 feet. Aids to Navigation A low altitude airway (V 190) is located between the Phoenix VORTAC and the St. Johns VORTAC oriented on the Phoenix 054 degree radial. The St. Johns VORTAC is located about 44 nautical miles northeast of Show Low. The FAA reported that several aircraft reported the St. Johns VORTAC out of service on March 19, 1994. They noted that the Prescott AFSS published a NOTAM about the VORTAC at 1753 hours. One pilot operating into the Show Low airport reported that the St. Johns VORTAC azimuth indicating capability was inoperative. Communications Review of the air-ground radio communications tapes maintained by the FAA at the Phoenix TRACON facility revealed that the aircraft communicated with the positions of South and North Departure. No unusual communications were noted between the TRACON and the accident aircraft. At 2107:26 hours, radar contact with the aircraft was lost. The pilot was advised to squawk VFR (1200), a frequency change was approved, and that flight following advisories was available with Albuquerque ARTCC. The pilot acknowledged at 2107:33 hours. A transcript of communications is included in this report. National Track Analysis Program (NTAP) radar data from the Albuquerque ARTCC was requested by National Transportation Safety Board investigators to determine the flight track of the accident airplane. The FAA provided a computer print of the NTAP data in the vicinity of the accident from 2115 to 2200 hours. The print contained no data. The Arizona Wing of the Civil Air Patrol reported that during their search efforts for the aircraft, they were provided with NTAP data from the Air Force Rescue Coordination Center (AFRCC). The data reflected rad ## Aircraft - Registration: [N5222U](https://openairdocs.org/deregistered/N5222U-2013-06-18), registration cancelled 2013-06-18, S/N 2060222, built 1964 (OpenAirDocs) - Reported make and model: CESSNA 206 - Registry model: [Cessna 206](https://openairdocs.org/model/cessna-206) (registry code 2073302) (OpenAirDocs) - Registry engine: [Continental IO-520 series](https://openairdocs.org/engine/continental-io-520-series) (registry code 17032, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 2060222 - Airframe hours: 6281 - Engines: CONTINENTAL IO-520-A 285 horsepower reciprocating - Damage: Destroyed - Flight: Personal, Part 91 - Operator: Action Medical Service - Registered owner: Paul A. Wolfe - Airworthiness certificate: Standard, Normal - Last inspection: Annual, September 3, 1993, 161 hours before - Departed: P10, CHANDLER, AZ ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 29; flight instructor, commercial, airline transport; airplane ratings: single-engine land, multi-engine land; instrument ratings: airplane; medical: class 1, valid medical--no waivers/lim.; seat: left; toxicology performed; flight hours: 2,400 total, 100 in this make and model ## Weather - Conditions: Instrument (IMC), Night/dark - Wind: 270° at 20 knots - Visibility: 2 statute miles - Lowest ceiling: 1,000 ft overcast ## 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 19940319006489A](https://openairdocs.org/incident/19940319006489A), Mar 19, 1994: Cessna 206CESSNA, Show Low, AZ, Destroyed, 2 fatal. Lost control in IMC. En route. VFR not advised. Aircraft not IFR equipped. No gyro scoring. Pilot not IFR current. 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.