# NTSB NYC05LA012: Douglas Adventure Air Ampib, N469PD, Pawtucket, RI, October 29, 2004 - Type: NTSB accident investigation - Classification: Accident · Fatal · Limited investigation · Final report - Date: October 29, 2004, 17:00 local (21:00 UTC) - Place: Pawtucket, RI - Coordinates: 41.920555, -71.491111 - Nearby events: https://openairdocs.org/map.md?lat=41.9206&lon=-71.4911&mi=10 - Phase of flight: [Approach](https://openairdocs.org/ntsb-phases/500) (OpenAirDocs' grouping) - Highest injury: Fatal - Injuries: 1 fatal - Status: Completed, report October 31, 2006 - Report: Approved by Office Director - Parties: FAA/FSDO - NTSB case key (mKey): 60459 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=NYC05LA012 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/60459/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=60459 - Page: https://openairdocs.org/ntsb/NYC05LA012 ## Probable cause The pilot's failure to maintain aircraft control, which resulted in an inadvertent stall. ## Sequence of events In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf). - Loss of control - in flight, approach - vfr pattern - base turn - aircraft control - not maintained, pilot in command (cause) - stall/spin - inadvertent, pilot in command - In flight collision with terrain/water, descent - uncontrolled - terrain condition - ground ## Analysis The pilot had completed construction of the accident airplane, and an FAA inspector had approved it for flight and issued a special airworthiness certificate. On the day of the accident, which was the second flight conducted since the construction was completed, witnesses observed the airplane in the airport traffic pattern. As the airplane turned onto the base leg, about 500 feet above the ground, it suddenly "nosed over," and spiraled towards the ground. The witnesses also recalled that the engine "sputtered" just prior to it descending. An additional witness recalled that the engine was "revving at full power" as it descended. The airplane came to rest about 1 mile from the airport, where a post-crash fire consumed the wreckage. According to a statement posted by the accident owner/pilot on a website message board dedicated to Adventurer experimental amphibian airplanes, the pilot stated that he had modified the elevator of the airplane from a 3 degree maximum up angle, to a 18 degree maximum up angle for the accident flight, "to see if I have leveled out the wings, and if I can get sufficient elevator up travel to climb out of the airport at 90mph." Examination of the wreckage revealed that the airplane's automotive type engine was extensively damaged by the post-crash fire, and further examination could not be performed. Also noted were several socks filled with steel ball bearings, weighing approximately 25 pounds, and 1 or 2-50-pound bags of ballast in the wreckage. The exact location of where the socks and ballast were stationed during the flight could not be determined. ## Factual narrative On October 29, 2004, about 1700 eastern daylight time, an amateur built Adventure Air AMPIB, N469PD, was destroyed while landing at the North Central State Airport (SFZ), Pawtucket, Rhode Island. The certificated private pilot was fatally injured. Visual meteorological conditions prevailed, and no flight plan was filed for the local personal flight conducted under 14 CFR Part 91. According to a Federal Aviation Administration (FAA) inspector, the pilot had recently completed construction of the accident airplane. On September 21, 2004, an FAA inspector conducted an inspection of the airplane, approved it for flight, and issued a special airworthiness certificate. The accident flight was the second flight conducted since the construction was completed. On the day of the accident, witnesses observed the airplane in the airport traffic pattern, utilizing runway 23. As the airplane turned onto the base leg, about 500 feet above the ground, it suddenly "nosed over," and spiraled towards the ground. The witnesses also recalled that the engine "sputtered" just prior to it descending. An additional witness recalled that the engine was "revving at full power" as it descended. The airplane came to rest about 1 mile from runway 23, where a post-crash fire consumed the wreckage. According to a statement posted by the accident owner/pilot on October 25, 2004, on a website message board dedicated to Adventurer experimental amphibian airplanes, "I am happy to report that I took N469PD to the air for the first time, October 21...I set rudder trim two clicks to the right to compensate for prop wash, accelerated to 45-50, let tail come up, pushed nose over and down slightly, and lifted off at about 90 mph. Upon liftoff, I found that I was carrying a lot of right stick to try to get the 'heavy' left wing to come up. The stick was also all the way back, and I was in a climbing left turn (this is before I changed the elevator up angle, it was at 3 degrees max up for this first flight, now it is at 18 degrees max up)...Next sunny calm morning, will do another short flight to see if I have leveled out the wings, and if I can get sufficient elevator up travel to climb out of the airport at 90mph..." Examination of the wreckage by a FAA inspector revealed that the airplane's automotive type engine was extensively damaged by the post-crash fire, and further examination could not be performed. The inspector also noted several socks filled with steel ball bearings, weighing approximately 25 pounds, and 1 or 2 50-pound bags of ballast in the wreckage. The exact location of where the socks and ballast were stationed during the flight could not be determined. Examination of the tie-down area where the pilot kept the airplane revealed two additional 50-pound bags of ballast. The pilot reported 292 total hours of flight experience on his most recent application for an FAA third class medical certificate, which was dated July 22, 2004. The pilot did not hold an FAA mechanic certificate, nor did he hold the appropriate aircraft builder certificate. The weather recorded at the airport, about the time of the accident, included winds from 240 degrees at 3 knots, and clear skies. ## Aircraft - Registration: [N469PD](https://openairdocs.org/deregistered/N469PD-2018-01-23), registration cancelled 2018-01-23, S/N 102B, built 2004 (OpenAirDocs) - Reported make and model: Douglas Adventure Air AMPIB - Registry model: [Douglas Paul I ADVENTURE AIR AMPIB](https://openairdocs.org/model/douglas-paul-i-adventure-air-ampib) (registry code 05617ED) (OpenAirDocs) - Registry engine: [Amateur-built UNKNOWN ENG](https://openairdocs.org/engine/amateur-built-unknown-eng) (registry code 99999) (OpenAirDocs) - Category: Airplane, amateur-built - Serial number: 102B - Engines: Chevrolet ZZ4 333 horsepower reciprocating - Damage: Destroyed - Fire: On-Ground - Flight: Personal, Part 91 - Registered owner: Paul I. Douglas - Airworthiness certificate: Special, Experimental (Special) - Departed: SFZ, Pawtucket, RI - Airport: SFZ, North Central State Airport ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 53; injuries: fatal; private; airplane ratings: single-engine land; medical: class 3, with waivers/limitations; seat: left; toxicology performed; flight hours: 292 total ## Weather - Conditions: Visual (VMC), Day - Wind: 240° at 3 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 57 °F, dew point 43 °F - Altimeter: 29.97 inHg - Observed at: SFZ ## 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 20041029028879A](https://openairdocs.org/incident/20041029028879A), Oct 29, 2004: Dougla ADVENTUREAIR, Pawtucket, RI, Destroyed, 1 fatal. (-23) Pilot/builder was completing the second flight of homebuilt amphibious airplane. Aircraft was flying a standard left hand traffic pattern to runway 23 at… ## Docket (3 files) The files NTSB released with the investigation on August 8, 2006, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=60459. 1.6 MB in all. - Witness Statements (item 1, .PDF, 867 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40265159&FileExtension=.PDF&FileName=Witness%20Statements-Redacted.PDF - FAA Approval for Airworthiness Certificate (item 2, .PDF, 72 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40265160&FileExtension=.PDF&FileName=FAA%20Approval%20for%20Airworthiness%20Certificate-Master.PDF - Website Messageboard Excerpts (item 3, .PDF, 694 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40265161&FileExtension=.PDF&FileName=Website%20Messageboard%20Excerpts-Redacted.PDF 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.