WPR17FA170

The pilot's controlled flight into terrain for reasons that could not be determined based on the available evidence. Contributing to the accident was the pilot's decision to fly at low altitude in close proximity to the rising terrain.

The private pilot and three passengers departed on a local flight in day visual meteorological conditions. Radar data identified the flight shortly after takeoff at 1,800 ft mean sea level (msl), traveling on a northwesterly heading. As the flight continued, the altitude varied between about 1,100 ft and 1,800 ft as the airplane conducted three 360° turns. Following the third turn, the airplane was heading west, climbing from 1,800 ft to 2,000 ft msl as it approached a ridgeline that ran perpendicular to its flight path. Data indicated that the airplane then entered a left turn; the data ended in the vicinity of the accident site at an altitude about 1,900 ft msl. The wreckage was located on steep, mountainous terrain at an elevation about 1,900 ft msl. The airplane collided with the densely-vegetated terrain in a nearly wings-level attitude about 50 ft below a ridge that ran perpendicular to the main north/south running ridgeline. The highest point of the ridge line near the accident site was about 2,800 ft.  The accident site was located south of a pass in an area commonly used by pilots to transition the inland mountains of the island. The lowest point of the pass was about 2,100 ft. Postaccident examination of the wreckage did not reveal evidence of any mechanical failures or malfunctions that would have precluded normal operation, and a witness reported that the engine was producing power until impact. It is unknown if the pilot was attempting to cross the ridge through the pass, was planning to fly along the ridgeline when the impact occurred, or was going to attempt to climb over the higher ridge. Regardless, the pilot decided to fly at low altitude, providing him little margin for error and he failed to maintain sufficient altitude above the mountainous terrain.

An automated surface weather observation at HNL (elevation 13 ft msl, 12 miles southeast of accident site) was issued 1 minute after the accident. It indicated wind from 060° at 12 knots gusting to 23 knots, 10 miles visibility, few clouds at 2,500 ft and 3,600 ft, scattered clouds at 7,500 ft and 20,000 ft, temperature 27°C, dew point 20°C, and an altimeter setting of 29.96 inches of mercury. An automated surface weather observation at Wheeler Army Airfield (HHI), Wahiawa, Hawaii (elevation 843 ft msl, 5 miles northeast of accident site), was issued 1 minute after the accident. It indicated wind from 070° at 3 knots, 10 miles visibility, scattered clouds at 2,000 ft, temperature 25°C, dew point 21°C, and an altimeter setting of 29.97 inches of mercury. A review of FAA airman records revealed that the 29-year-old pilot held a private pilot certificate with a rating for airplane single-engine land, which was issued on May 4, 2017. The pilot held an FAA first-class medical certificate issued in August 2012 with no waivers or limitations. The logbook indicated that his first flight in the Beech 19A was a checkout flight with a flight instructor on June 8, 2017, for a total of 1.3 hours. The airplane flight time log indicated that this flight was actually recorded on July 8, 2017. Three other flights in the Beech 19A were identified in the pilot's logbook, with the last logged flight on July 19, 2017. The airplane flight time log indicated that the pilot also flew on July 21, 2017 for a total time of 0.9 hour; this flight was not logged in the pilot's logbook. Based on the entries in both logbooks, the pilot had accumulated about 6.3 hours in the Beech 19A. The pilot's total flight experience was about 127.5 hours. He logged 9.1 hours in the previous 90 days, and 5.1 hours in the previous 30 days. The wreckage was located on steep mountainous terrain at an elevation of about 1,900 ft. The airplane collided with densely-vegetated terrain in a nearly wings-level attitude about 50 ft below a ridge that ran perpendicular to the main north/south-running ridgeline. The highest point of the ridge line near the accident site was about 2,800 ft. The accident site was located south of Pohakea Pass (2,100 ft), an area commonly used by pilots to transition the inland mountains of O'ahu (see figure 2). Figure 2. Accident Site Location All major components of the airplane were located and identified in the immediate area of the main wreckage. The outboard section of the right wing, with aileron attached, separated from the inboard section at the aileron/flap junction and was located about 30 ft below the main wreckage. The inboard section of the right wing remained attached at the wing root. The right flap separated from the inboard wing section and was also located below the main wreckage. The left wing remained attached to the airframe wing root, and the aileron and flap remained intact and attached to the wing. Extensive compression-like impact damage was noted to the outboard section of the wing assembly. The tail cone was compressed and buckled to the left. The vertical stabilizer, rudder, horizontal stabilizers, and elevators remained attached to the tail. The elevator control cables and rudder cables remained attached to the flight control surfaces in the tail. Extensive impact-related damage was noted to the cockpit and cabin area. The inboard attachment points of the two front seats were impact-separated from the floor assembly. The engine remained attached to the airframe by the engine mount and was displaced upward and aft toward the firewall. The vacuum pump and drive coupler were visible from the top rear section of the engine. The carburetor was not visible due to the engine positioning and surrounding terrain. The spark plugs were secure, and their respective leads were attached. The top spark plugs were removed. The spark plug electrodes remained undamaged and displayed normal operating signatures when compared to the Champion Spark Plugs "Check-a-Plug" chart AV-27. Both magnetos appeared to be securely mounted at their respective mounting pads with their harnesses secured. The rocker box covers at cylinder Nos. 1, 2, and 4 were removed. The No. 3 cover was not removed due to corrosion of the cover screws. The rocker boxes and valve train components appeared undamaged with no evidence of oil contamination or foreign objects. The combustion chamber of each cylinder was examined through the spark plug holes via a lighted borescope. The chambers remained mechanically undamaged with no evidence of foreign object ingestion or detonation. The valves were intact and undamaged. The fixed-pitch, metal propeller blades remained partially attached to the crankshaft flange. Complete rotation of the crankshaft was not possible due to the engine position; however, partial rotation was obtained, and continuity to the vacuum pump drive was confirmed. The propeller blades displayed leading edge gouging, torsional twisting, chordwise striations across the cambered surface, and trailing edge "S" bending. The signatures were consistent with rotational forces applied at the crankshaft at the time of impact. The wreckage was not recovered and remained at the accident site. The 4-seat, low-wing, fixed-gear airplane, serial number MB-413, was manufactured in 1969 and was powered by a 150-horsepower Lycoming O-320-E2A engine, serial number L-24212-27A. A review of the maintenance logbooks showed that the airplane had accumulated a total airframe and engine time of 5,072.11 hours at the most recent annual inspection, dated February 1, 2017. The engine time since major overhaul was 1,613.51 hours, with 153.61 hours since top overhaul. Weight and Balance A current weight and balance calculation form was located within the wreckage. The form indicated a maximum gross weight of 2,250 lbs, and an empty weight of 1,436.40 lbs. Additional paperwork located within the wreckage addressed the fuel capacity for the airplane. A highlighted section of the Beechcraft Shop Manual indicated that each of the 2 fuel tanks contained a visual measuring tab in the filler neck; the lower tab indicated 15 gallons, and the upper tab indicated 20 gallons. The owner of the airplane reported that he checked the fuel level before the accident flight and that each tank indicated about 17.5 gallons of fuel. The occupant seating locations and their weights were verified by an investigator for the Department of the Medical Examiner. The gross weight at the time of departure was estimated at 2,311 lbs, 61 lbs over the airplane's maximum certificated gross weight. Per the center of gravity envelope graph for the airplane, it was loaded near its forward center-of-gravity (CG) limit at takeoff. On July 28, 2017, about 1852 Hawaii-Aleutian standard time, a Beech BE-19A airplane, N6142N, collided with terrain near Waipi'o, Hawaii. The private pilot and three passengers were fatally injured. The airplane was substantially damaged. The airplane was privately owned and operated under the provisions of Title 14 Code of Federal Regulations Part 91. Visual meteorological conditions prevailed, and no flight plan was filed for the local personal flight, which departed Daniel K. Inouye International Airport (HNL), Honolulu, Hawaii, about 1837. A review of recorded air traffic control communications indicated that the airplane departed HNL runway 04R. Although the airplane was not in contact with air traffic control after departure from HNL, recorded radar data displayed the airplane's secondary transponder beacon code as it departed and made a left turn to the northwest. At 1843, radar data showed the airplane at 1,800 ft mean sea level (msl) about 4 miles north of the airport and on a northwesterly heading (see figure 1). For the next 2 minutes, the airplane's altitude varied and descended to 1,500 ft when it turned west. About 1 minute lat