NYC07FA065

NTSB accident investigation · Socata TBM 700 · Dartmouth, MA · February 3, 2007

Accident · FatalField investigationFinal report
Date
February 2, 2007, 19:40 local (Feb 3, 2007, 00:40 UTC)
Place
Dartmouth, MA
Injuries
3 fatal
Damage
Destroyed
Phase of flight
Approach
Aircraft
N944CASocata TBM 700
Weather
Instrument (IMC) · Night
Status
Completed · report December 20, 2007
Report
Approved by Office Director
Parties
EADS Socata, Massachusetts Aeronautics Commision, FAA/FSDO, Pratt & Whitney
FAA report
20070202001079A
Case key
65234

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

On this page

Probable cause

Both pilots' failure to maintain aircraft control during a missed approach.

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.

Loss of control - in flightMissed approach (ifr)
Aircraft control - not maintainedPilot in commandCause
Aircraft control - not maintainedCopilot/second pilotCause
In flight collision with terrain/waterDescent - uncontrolled
Terrain condition - ground

Analysis

During the flight, the private pilot/operator was most likely seated in the left seat. He obtained his instrument rating about 7 months prior to the accident, and had accumulated approximately 300 hours of flight experience; of which, about 80 hours were in the accident airplane. The commercial pilot/company pilot was most likely seated in the right seat. He had accumulated approximately 1,000 hours of flight experience; of which, about 125 hours were actual instrument experience, and 80 hours were in the accident airplane. The commercial pilot had filed a flight plan to the wrong airport, received a weather briefing for the wrong airport, and therefore was not aware of the NOTAM in effect for an out of service approach lighting system at the destination airport. When the commercial pilot realized his error, he changed the flight plan, but did not request another weather briefing. According to radar information, the airplane flew the instrument landing system runway 5 approach fast, performed a steep missed approach to 1,000 feet, and then disappeared from radar, consistent with a loss of control during the missed approach. No preimpact mechanical malfunctions were identified with the airplane during the investigation. The reported weather at the accident airport included an overcast ceiling at 200 feet, visibility 1 mile in light rain and mist, and wind from 160 degrees at 4 knots. The investigation could not determine which pilot was flying the airplane at the time of the accident.

Factual narrative

This report was modified on December 11, 2007.

History of flight

On February 2, 2007, about 1940 eastern standard time, a Socata TBM 700, N944CA, was destroyed when it impacted terrain in Dartmouth, Massachusetts, during a missed approach to New Bedford Regional Airport (EWB), New Bedford, Massachusetts. The certificated commercial pilot, certificated private pilot, and a passenger were fatally injured. Night instrument meteorological conditions prevailed for the flight that departed General Edward Lawrence Logan International Airport (BOS), Boston, Massachusetts, about 1917. An instrument flight rules (IFR) flight plan was filed for the business flight conducted under 14 CFR Part 91.

The airplane was based at Lehigh Valley International Airport (ABE), Allentown, Pennsylvania. The private pilot operated the airplane through his legal practice, and was visiting Massachusetts to meet colleagues. The commercial pilot was employed as a company pilot for the legal practice.

According to data from Lockheed Martin Corporation, the commercial pilot contacted the Williamsport Automated Flight Service Station (AFSS) about 0925 on the day of the accident. He filed an IFR flight plan for a trip from ABE to BOS, with a proposed departure time of 1300. The flight service specialist accepted the flight plan, and provided a standard weather briefing for the flight, which included Notices to Airmen (NOTAM). The airplane subsequently flew uneventfully from ABE to BOS.

The commercial pilot contacted the Williamsport AFSS again about 1600. He filed two IFR flight plans. The first flight plan was from BOS to "Bedford B-E-D," (erroneously, not New Bedford) with a proposed departure time of 1700. The second IFR flight plan was from Lawrence G. Hanscom Airport (BED), Bedford, Massachusetts, to ABE, with a proposed departure time of 2000. The commercial pilot requested a weather briefing for the flight from BOS to BED, and was provided a standard weather briefing, which included NOTAMs for BOS and BED.

The commercial pilot contacted the Williamsport AFSS a third time, about 1710, and advised that he needed to make changes to two IFR flight plans. First, he asked that the destination of his first flight plan be changed from "Bedford" to "New Bedford." The commercial pilot then asked if the flight service specialist knew the three-letter-identifier for New Bedford as the commercial pilot was not near a map or computer at the time. The flight service specialist then provided the correct "EWB" identifier for New Bedford. The commercial pilot also changed the departure time from 1700 to 1730.

For the second flight plan, the commercial pilot changed the departure point from BED to EWB, for the return flight to ABE. The flight service specialist then stated that he would change the flight plans. The commercial pilot thanked the specialist and ended the telephone call. The commercial pilot did not request a weather briefing for the flight to EWB.

While at BOS, the airplane was fueled, and then departed for EWB. According to radar and voice data provided by the Federal Aviation Administration (FAA), the flight proceeded toward the instrument landing system (ILS) approach for runway 5 at EWB.

At 1935, the flight intercepted the localizer course, about 3 miles prior to the NEFOR intersection. At that time the airplane's radar target indicated an altitude of 1,900 feet and a groundspeed of 180 knots. The flight was handed off from Providence Approach Control to New Bedford Tower, and subsequently cleared to land.

At 1936, the flight crossed NEFOR. At that time, the airplane's radar target indicated an altitude of 1,400 feet and a groundspeed of 200 knots. The EWB tower controller advised the flight that two preceding aircraft landed about 10 to 15 minutes prior, and "broke out" about 300 feet, which was acknowledged.

At 1937, the flight was approximately 1 mile from the runway 5 threshold at EWB. At that time, the airplane's radar target indicated an altitude of 300 feet and a groundspeed of 160 knots.

About 15 seconds later, the airplane's radar target indicated a left climbing turn to 1,000 feet, at a ground speed of 140 knots. The radar target was subsequently lost. During that time, one of the pilots reported a missed approach to EWB tower. No further transmissions were received from the accident airplane after the radar target was lost. The investigation could not determine which pilot was flying the airplane at the time of the accident.

The accident occurred during the hours of night; located about 41 degrees, 40.06 minutes north latitude, and 70 degrees, 58.57 minutes west longitude.

Personnel information

The commercial pilot, age 23, held a commercial pilot certificate, with ratings for airplane single engine land, airplane multiengine land, and instrument airplane. He also held a flight instructor certificate, with ratings for airplane single engine land and instrument airplane. The commercial pilot reported 1,700 hours of total flight experience on the application for his most recent FAA first class medical certificate, issued January 8, 2007.

The commercial pilot completed formal training for the make and model accident airplane in July 2006, at SIMCOM, Pan Am International Flight Academy.

The commercial pilot's logbook was recovered; however, the last entry was dated September 29, 2006. There was no record of all of his flight time between the last entry and the day of the accident. According to the logbook, as of the last entry, the commercial pilot had accumulated a total flight experience of approximately 1,037 hours; of which, about 113 hours were in multiengine airplanes, and 924 hours in single engine airplanes. The commercial pilot also recorded about 125 hours in actual instrument meteorological conditions, 91 hours in night conditions, and 65 hours in the accident airplane.

The private pilot, age 53, held a private pilot certificate, with a rating for airplane single engine land. He obtained his private pilot certificate in November 2005. The private pilot also obtained an instrument rating on July 24, 2006, and reported 300 hours of total flight experience on his most recent FAA third class medical certificate, issued on December 14, 2006. The private pilot's logbook was not recovered. According to a witness who spoke to the private pilot about 1 week prior to the accident, the private pilot reported 80 hours of flight experience in the accident airplane.

There was no record that the private pilot completed a formal training course for the make and model accident airplane.

According to a flight instructor that had flown with both pilots, during the month prior to the accident, the private pilot flew from the left seat, with the commercial pilot in the right seat. The flight instructor described the commercial pilot as a fantastic instrument pilot.

The flight instructor added that the private pilot flew during a 6-year period, about 10 years prior to the accident. He did not have a pilot license at the time, but flew about 600 to 700 hours as a student pilot receiving instruction, primarily in multiengine airplanes. The private pilot subsequently misplaced his logbook containing a record of that flight time. The private pilot did not count that time when applying for his private pilot or medical certificates. The flight instructor estimated that the private pilot had accumulated about 400 to 450 hours of flight experience since the lapse in flying. The flight instructor described the private pilot as a low experience instrument pilot, who occasionally became distracted or fixated on one instrument.

Aircraft information

The airplane was manufactured in 2001. The airplane's most recent annual inspection was completed on July 7, 2006. At that time, the airplane had accumulated 478.8 total hours of operation.

The airplane was equipped with an en

Aircraft

Registration
N944CA
Reported as
Socata TBM 700
Category
Airplane
Serial number
206
Airframe hours
479
Engine
Pratt & Whitney PT6A-64, 700 horsepower, turbo prop
Damage
Destroyed
Flight
Executive/Corporate · Part 91
Operator
Peter J Karoly
Registered owner
PK Leasing Llc.
Airworthiness certificate
Standard, Normal
Last inspection
Annual · July 1, 2006 · 168 hours before
Departed
BOS · Boston, MA
Destination
EWB · New Bedford, MA
Flight plan
IFR
Airport
EWB · New Bedford Regional Airport, runway 05, 4,997 × 150 ft, asphalt

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 · 2

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
23
Injuries
Fatal
Certificates
Flight instructor, Commercial
Airplane ratings
Multi-engine land, Single-engine land
Instrument ratings
Airplane
Medical
Class 1, With waivers/limitations
Last flight review
July 1, 2006
Seat
Right
Toxicology
Performed
Flight hours
1,037 total · 65 in this make and model
Role
Other flight crew
Age
53
Injuries
Fatal
Certificate
Private
Airplane ratings
Single-engine land
Instrument ratings
Airplane
Medical
Class 3, Without waivers/limitations
Seat
Left
Toxicology
Performed
Flight hours
300 total

Weather

Conditions
Instrument (IMC) · Night
Wind
160° at 4 knots
Visibility
1 statute miles
Lowest ceiling
200 ft overcast
Temperature
34 °F, dew point 34 °F
Altimeter
29.57 inHg
Observed at
EWB, 1 nm away

Docket · 30

The files NTSB released with the investigation on October 25, 2007, on NTSB’s docket system: statements, records, photos and specialists’ reports. 26.8 MB in all.

ATC 3 - N944CA PVD Radar StudyItem 1 · .PDF · 1.2 MBATC 3 - N944CA ILS Profile ViewItem 2 · .PDF · 461 KBATC 3 - N944CA ILS Trail ViewItem 3 · .PDF · 540 KBATC 3 - N944CA ILS Plan ViewItem 4 · .PDF · 2.1 MBATC 3 - PVD TRACON Radar Data FileItem 5 · .EXE · 7.2 MBATC 3 - N944CA ILS 5 Plan ViewItem 6 · .PDF · 3.8 MBGPS 17 - GPS StudyItem 7 · .PDF · 479 KBCommercial Pilot's First Conversation With Flight ServiceItem 8 · .PDF · 10 KBCommercial Pilot's Second Conversation With Flight ServiceItem 9 · .PDF · 10 KBCommercial Pilot's Third Conversation With Flight ServiceItem 10 · .PDF · 10 KBRecorded Communications Between N944CA and PVD ApproachItem 11 · .PDF · 9 KBRecorded Communications Between N944CA and EWB TowerItem 12 · .PDF · 9 KBTranscript of Recored Communications Between N944CA and EWB TowerItem 13 · .PDF · 74 KBInterview SummariesItem 14 · .PDF · 16 KBWitness StatementItem 15 · .PDF · 39 KBCompany Pilot's LogbookItem 16 · .PDF · 7.3 MBExcerpts From Maintenance RecordsItem 17 · .PDF · 538 KBExcerpts from Socata TBM 700 Pilot Information ManualItem 18 · .PDF · 738 KBEngine DataItem 19 · .PDF · 26 KBCopies of Flight PlansItem 20 · .PDF · 82 KBCopy of NOTAMItem 21 · .PDF · 249 KBFlight Inspection ReportItem 22 · .PDF · 213 KBFueling RecordItem 23 · .PDF · 65 KBWeather ReportItem 24 · .PDF · 78 KBToxicological ReportsItem 25 · .PDF · 110 KBStatement of Party Representatives to NTSB InvestigationItem 26 · .PDF · 74 KBRelease of Aircraft Wreckage, NTSB Form 6120.15Item 27 · .PDF · 49 KBPhoto 1 - Main WreckageItem 28 · .PDF · 477 KBPhoto 2 - PropellerItem 29 · .PDF · 472 KBPhoto 3 - EngineItem 30 · .PDF · 419 KB

FAA reports on this event · 1

The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.