# NTSB LAX95LA038: Cessna T210H, N2221R, Mount Hamilton, CA, November 22, 1994 - Type: NTSB accident investigation - Classification: Accident · Minor injuries · Limited investigation · Final report - Date: November 22, 1994, 07:20 local (15:20 UTC) - Place: Mount Hamilton, CA - Coordinates: 37.680419, -121.749221 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=37.6804&lon=-121.7492&mi=10 - Phase of flight: [Initial climb](https://openairdocs.org/ntsb-phases/350) (OpenAirDocs' grouping) - Highest injury: Minor injuries - Injuries: 4 minor - Status: Completed, report June 19, 1995 - Report: Approved by Office Director - NTSB case key (mKey): 28982 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=LAX95LA038 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/28982/pdf - Page: https://openairdocs.org/ntsb/LAX95LA038 ## Probable cause the pilot's failure to obtain/maintain an adequate airspeed and inadvertent entry into a stall/mush condition during the initial climb due to frost on the airframe which impeded the airplane's climb performance. Contributing factors were the pilot's improper preflight inspection and inadequate frost removal procedures. ## Sequence of events In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf). - Loss of control - in flight, takeoff - initial climb - aircraft preflight - improper, pilot in command (contributing factor) - ice/frost removal from aircraft - inadequate, pilot in command (contributing factor) - airspeed - not obtained/maintained, pilot in command (cause) - stall/mush - inadvertent, pilot in command (cause) - In flight collision with terrain/water, descent - uncontrolled - terrain condition - open field ## Analysis THE PILOT PARKED THE AIRPLANE OVERNIGHT IN 20-DEGREE FAHRENHEIT WEATHER, AND THE TEMPERATURE WAS AROUND 32 DEGREES THE FOLLOWING MORNING AT THE TIME OF DEPARTURE. DURING THE PREFLIGHT INSPECTION, THE PILOT OBSERVED AN ACCUMULATION OF FROST ON THE FRONT WINDSHIELD. HE SCRAPED SOME OF IT OFF. THE PILOT REPORTED THAT HE DID NOT OBSERVE FROST ELSEWHERE ON THE AIRPLANE, BUT HE WAS UNABLE TO EXAMINE THE UPPER SURFACE OF THE WINGS. A PASSENGER STATED THAT HE OBSERVED FROST ON ALL EXPOSED UPPER AIRCRAFT SURFACES PRIOR TO THE TAKEOFF. DURING THE ENGINE RUN-UP AND THE GROUND ROLL PORTION OF THE TAKEOFF, ALL OF THE GAUGES INDICATED THAT NORMAL ENGINE OPERATION WAS BEING ACHIEVED. THE PILOT FURTHER REPORTED THAT WHEN HE ROTATED, THE WINDSHIELD BEGAN TO 'GLAZE OVER,' AND BY THE TIME HE HAD CLIMBED TO 100 FEET ABOVE GROUND LEVEL THE FORWARD VISIBILITY WAS ABOUT ZERO. THE PILOT STATED HE THEN RAISED THE AIRPLANE NOSE FOR A FEW SECONDS IN ORDER TO BE CERTAIN OF CLEARING THE OBSTACLES WHICH HE KNEW WERE LOCATED AT THE END OF THE RUNWAY. THE AIRPLANE WAS AT STALL SPEED AND DESCENDED INTO THE TERRAIN ADJACENT TO THE RUNWAY. ## Factual narrative On November 22, 1994, at 0720 Pacific standard time, a Cessna T210H, N2221R, operated by the pilot, collided with terrain during an initial climb from a private airstrip about 5 miles east of Mount Hamilton, California. Visual meteorological conditions prevailed at the time of the business flight, and no flight plan was filed. The private pilot and three passengers received minor injuries. The flight was originating at the time of the accident. On November 22, 1994, the National Transportation Safety Board interviewed the pilot via telephone. The pilot reported that the accident airplane had been parked overnight at the airstrip. The pilot stated that he did not have a ladder, and the airplane was not equipped with fuselage foot steps. However, during the preflight inspection, he did observe an accumulation of frost on the front windshield. So, prior to taking off, he scraped some of it off to enhance his visibility. The pilot further reported that during the ground engine run and ground roll portion of the takeoff, all of the gauges which he observed indicated that normal engine operation was being achieved. No backfiring or sputtering sounds were detected. According to the pilot, seconds prior to the crash, the engine was continuing to produce 29 inches of manifold pressure. The pilot stated that the airplane stopped climbing after reaching a maximum altitude between 100 and 200 feet above ground level. The engine then seemed to lose power. The airplane stalled and collided with terrain adjacent to the western side of the airstrip. The pilot estimated that when he commenced the takeoff the outside air temperature was between 30 and 32 degrees Fahrenheit. The wreckage was examined by the Federal Aviation Administration (FAA) coordinator who responded to the accident site. Fuel was observed in the airplane's fuel tanks. The coordinator reported finding the engine's propeller blades impact damaged, and they had been torsionally bent. The FAA coordinator also reported that a resident of the area had indicated to him that, during the morning hours of November 22, frost was observable on the ground and the temperature was estimated at 20 degrees Fahrenheit. In the pilot's completed "Aircraft Accident Report," NTSB Form 6120.1, he reported that during his preflight inspection, "there was ice buildup on the windshield," and " . . . no noticeable ice on the flaps, horizontal stabilizer or on the fuselage . . . . " During the takeoff roll, "there was no ice formation on the windshield or anything unusual at that time." The pilot provided the following additional chronology of events regarding the start of the accident flight: "I held the aircraft on the ground for until (sic) I reached about 80 MPH and then I rotated. I established a normal rate of climb. At the time of rotation the windshield began to glaze over and by the time I had climbed to approximately 100 feet AGL my forward visibility was about zero. I raised the nose for a few seconds in order to be sure to clear the obstacles that I knew were at the end of the runway. There was no stall warning nor did the aircraft attitude seem to be too high to me. At this time the engine seemed as if it were only performing at approximately sixty (60%) of its power capability." According to the FAA coordinator, one of the passengers reported that the engine sound did not change from the time full power was applied, at the beginning of the takeoff, until ground impact. Also, the airplane's takeoff seemed normal until reaching an altitude of approximately 100 feet when he felt the airplane was sinking from under him. The passenger reported that he observed frost on the exposed upper surfaces of the aircraft in addition to the front and rear windshields prior to takeoff. ## Aircraft - Registration: [N2221R](https://openairdocs.org/deregistered/N2221R-1996-04-23), registration cancelled 1996-04-23, S/N T2100371 (OpenAirDocs) - Reported make and model: CESSNA T210H - Registry model: [Cessna T210H](https://openairdocs.org/model/cessna-t210h) (registry code 2073438) (OpenAirDocs) - Category: Airplane - Serial number: T210-0371 - Airframe hours: 2468 - Engines: CONTINENTAL TSIO-520-C 285 horsepower reciprocating - Damage: Substantial damage - Flight: Business, Part 91 - Operator: Donald E. Huntley - Registered owner: Mcm Diversified, Inc. - Airworthiness certificate: Standard, Normal - Last inspection: Annual, April 1, 1994, 198 hours before - Destination: SJC, SAN JOSE, CA - Airport: NONE, Isabel Valley, runway 36, 3,000 × 35 ft, dirt ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 47; private; medical: class 3, valid medical--w/ waivers/lim; seat: left; flight hours: 751 total, 24 in this make and model, 694 as pilot in command, 11 in the last 90 days, 2 in the last 30 days, 1 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: calm - Visibility: 30 statute miles - Lowest ceiling: none - Temperature: 32 °F ## 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 19941122038789A](https://openairdocs.org/incident/19941122038789A), Nov 22, 1994: Cessna T210H, Mt Hamilton, CA, Substantial damage. Noted frost on windshield but failed check wings. Stalled on climbout due low speed and lift. Parked out overnight. ## Other investigations on N2221R (2) 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. - [NTSB OAK74FXQ12](https://openairdocs.org/ntsb/OAK74FXQ12), Sep 14, 1973: Cessna T210H (N2221R), Susanville, CA, substantial damage - [NTSB SEA72DYC48](https://openairdocs.org/ntsb/SEA72DYC48), Jun 7, 1972: Cessna 210 (N2221R), Unity, OR, substantial damage 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.