LAX05FA026
LAX05FA026

HISTORY OF FLIGHT

On November 4, 2004, at 1734 Pacific standard time, a Cessna T210M, N732RW, collided with a series of obstacles in Lomita, California, during a forced landing following a loss of engine power. The airline transport pilot, the sole occupant, sustained serious injuries. The airplane was destroyed. The pilot was positioning the privately owned airplane under the provisions of 14 CFR Part 91. Night visual meteorological conditions prevailed and no flight plan was filed. The airplane departed John Wayne Airport/Orange County (SNA), Santa Ana, California, at 1722, and the pilot's destination was Zamperini Field (TOA), Torrance, California. The pilot succumbed to his injuries on November 16.

The airplane was for sale by Chuck Smith Aircraft Sales. According to a personal schedule contained on the pilot's personal computer, the pilot positioned the airplane from Montgomery Field (MYF), San Diego, California, on September 28. The flight time recorded was 0.8 flight hour. On October 31, the pilot positioned the airplane to John Wayne Airport to have the airplane's electrical system serviced. The flight time recorded was 0.6 flight hour.

A witness located in a nearby residence noticed a white flash. Shortly thereafter, he heard what he initially thought was the sound of thunder and saw a "massive ball of fire." He ran to the airplane and observed another resident attempting to extinguish the fire with a garden hose. The witness further stated that small puddles of fuel were burning around the airplane. With the assistance of others nearby, the witness pulled the pilot from the airplane.

An additional witness located in a residence near an open window heard a sound he associated with an airplane, but noted that the engine sound was quiet. He saw the airplane's lights disappear below a tree line, which was not normal. He then heard a "crunch" sound, followed by a series of impact sounds. A fireball approximately 50 feet tall and 30 feet in diameter then erupted.

Another witness stated that he was standing at his front door, when he saw sparks at the location of the utility lines, and then heard a series of loud impacts. A large fire shot into the air and he ran to the backyard from where the fire was emanating. Once he reached the backyard, he realized that an airplane had crashed. The day following the accident, the witness looked toward the area of the accident from his front porch, which faces south/southwest. He could see a large tree across the street from the residence and it had a noticeable portion of branches missing from its center. The tree was positioned on the eastern side of the utility lines.

PERSONNEL INFORMATION

Federal Aviation Administration (FAA) records indicated that the pilot held an airline transport pilot certificate for multiengine land airplane. The pilot held commercial privileges for airplane single-engine land and sea. He also held a flight instructor certificate for airplane single-engine and multi-engine, instrument. The pilot held a ground instructor certificate for advanced and instrument ground instruction. The pilot was type rated in the Cessna Citation (CE-500).

The pilot held a second-class medical issued on December 1, 2003. It had the restriction that the pilot must wear corrective lenses.

The pilot was employed as a positioning pilot and corporate pilot at Zamperini Field. He was well known at the airport and described by those who knew him as a high-time pilot with good flying skills.

No recent logbooks for the pilot were recovered. The pilot's acquaintances indicated that the pilot did not keep a logbook. Rather, he recorded his flights using a calendar. On the pilot's last insurance application obtained from a friend of the pilot, the pilot reported the following flight times: 13,000 hours total flight time; 4,000 total hours in multiengine aircraft; and, 4,000 total hours in retractable gear aircraft. The pilot flew 200 hours from October 2003, until September 2004. His last flight review was on October 6, 2004.

Interviews with friends of the pilot revealed that the pilot was to reposition the airplane over the previous days leading up to the accident, and that the owner had expressed his disapproval that the repositioning had not been done yet. According to the pilot's friends, the pilot had flown a twin-engine Cessna earlier in the day. That evening, the accident pilot was delayed while waiting for a ferry airplane and pilot to arrive, in order to fly him to pickup the accident airplane.

A certified flight instructor (CFI) flew with the pilot to John Wayne Airport. The CFI reported that the flight to John Wayne was uneventful. The CFI dropped the pilot off at the airplane and immediately made the return trip back to Torrance. During the return flight, the accident pilot was two airplanes behind the CFI. As the CFI was taxiing to parking, he saw a flash of fire in the direction of the accident site.

AIRPLANE INFORMATION

The single engine Cessna T210M (Serial Number (SN) 21061723) was manufactured in 1977. A review of maintenance records for the airplane revealed that the last annual inspection was completed on September 21, 2004. The tachometer recording was 2,200.8 hours and the Hobbs hour meter recording was 1,578.5 hours.

The Teledyne Continental engine (SN 294605-R), model TSIO-520-R9, was rebuilt/zero timed on March 2, 2002, by Teledyne Continental Motors. The last annual inspection was completed on September 15, 2003. However, the recorded Hobbs hour meter and tachometer hours recording were the same as those recorded in the airframe logbook for the annual inspection completed on September 21, 2004.

The three-bladed McCauley propeller, model D3A34C402, hub series 769452, was overhauled on April 3, 2002.

On October 27, 2004, an adjustment was made to the idle mixture at a tachometer time of 2,202.2. The adjustment changed the idle setting to 575-625 revolutions per minute (rpm). Based on interviews with the aviation maintenance technician (AMT) that performed the work, the purpose of the adjustment was to correct a loss of engine power at the idle setting. Interviews with the AMT revealed that he did not have the proper manual available to perform the work.

The airplane was last fueled on September 28, 2004, at Montgomery Field, with the addition of 40 gallons of fuel. The quantity of fuel onboard prior to the refueling was estimated through dialogue and correspondence with the airplane's owner, and was estimated close to empty when the 40 gallons of fuel were added.

The owner of the airplane submitted logbook entries and a signed statement describing the recent history of the airplane. The owner departed from La Paz, Mexico, with full fuel tanks to Montgomery Field and made two landings in between. He then flew from Montgomery Field to Gillespie Field Airport, El Cajon, California, for an annual inspection. After the completion of the annual inspection, the owner flew the airplane back to Montgomery Field. The total tachometer time was 4.8 hours. At Montgomery Field, he added 40 gallons of fuel.

The accident pilot ferried the airplane to Torrance on September 28. The airplane was then flown to John Wayne Airport for electrical work. The day of the accident, the pilot was returning the airplane to Torrance to be sold. The total tachometer time accumulated was 2.1 hours since the 40 gallons of fuel were added.

Montgomery Field to Torrance (0.8)

Estimated fuel burn calculations using generalized performance data and environmental conditions from the manufacturer's Federal Aviation Administration (FAA) approved Pilot's Operating Handbook indicated that using a 4,000-foot pressure altitude, 2,500 rpm, and 30 inches of manifold pressure at standard temperature, the airplane would burn about 106 pounds per hour (17.67 gallons). According to the Time, Fuel, and Distance to Climb Chart (Normal Climb), the airplane would consume 16 pounds of fuel (2.7 gallons) per start, taxi, and takeoff. From sea level to 4,000 feet, the airplane would consume 8 pounds of fuel (1.3 gallons). The total estimated fuel burn for this leg was 70 pounds of fuel (11.7 gallons).

Torrance to John Wayne Airport (0.6)

Estimated fuel burn calculations using generalized performance data and environmental conditions from the manufacturer's FAA approved Pilot's Operating Handbook indicated that using a 2,000-foot pressure altitude, 2,500 rpm, and 30 inches of manifold pressure at standard temperature, the airplane would burn about 105 pounds per hour (17 gallons). According to the Time, Fuel, and Distance to Climb Chart (Normal Climb), the airplane would consume 16 pounds of fuel (2.7 gallons) per start, taxi, and takeoff. From sea level to 2,000 feet, the airplane would consume 4.5 pounds of fuel (.75 gallons). The total estimated fuel burn for this leg was 52.5 pounds of fuel (8.75 gallons).


John Wayne Airport to Torrance (Accident Flight-total tachometer time remaining of 0.7)

The remaining tachometer time was not consistent with the flight time from John Wayne Airport to Torrance. Interviews with friends and acquaintances were not able to draw a conclusion as to the flight time excess so the remaining tachometer time of 0.7 was used to calculate the final fuel burn. Estimated fuel burn calculations using generalized performance data and environmental conditions from the manufacturer's FAA approved Pilot's Operating Handbook indicated that using a 2,000-foot pressure altitude, 2,500 rpm, and 30 inches of manifold pressure at standard temperature, the airplane would burn about 105 pounds per hour (17 gallons). According to the Time, Fuel, and Distance to Climb Chart (Normal Climb), the airplane would consume 16 pounds of fuel (2.7 gallons) per start, taxi, and takeoff. From sea level to 2,000 feet, the airplane would consume 4.5 pounds of fuel (.75 gallons). The total estimated fuel burn for this leg was 57.8 pounds of fuel (9.5 gallons).

The total estimated fuel burn for all three flights was about 30 gallons. The capacity of the fuel tanks is 90 gallons, with 1 gallon unusable. Using the 40 gallons of fuel given by the owner, the airplane would have had 9 gallons of usable fuel remaining in the airplane.

Prior to the airplane's departure from John Wayne Airport to Torrance, the owner checked the fuel gages and noted that each fuel gage read about 1/4 tank.

Chuck Smith Aircraft Sales had two other airplanes for sale at the time of the accident; one of these airplanes was a Cessna 210. About 2 weeks prior to the accident, the owner of the aircraft sales company and the accident pilot refueled these two airplanes. The accident airplane was not refueled.

A checklist found in the airplane noted the following procedures for ENGINE FAILURE DURING FLIGHT:

ENGINE FAILURE DURING FLIGHT
1. Airspeed-85 KIAS [knots indicated airspeed]
2. Fuel Quantity-Check
3. Fuel Selector Valve-Fuller Tank
4. Mixture-Rich
5. Auxiliary Fuel Pump-ON for 3-5 seconds with the throttle 1/2 open; then OFF
6. Ignition switch-BOTH (or START if propeller is stopped)
7. Throttle-SLOWLY ADVANCE

COMMUNICATION

The National Transportation Safety Board investigator reviewed recorded en route communications between the Torrance Air Traffic Control Tower and the accident pilot. The pilot initially called in and reported that he was a multiengine airplane. The controller unsuccessfully attempted to identify the airplane on radar. The pilot later informed the Torrance controller that the airplane was a single engine Cessna, and that he failed to change the discrete transponder code as given by the John Wayne tower controller. The Torrance controller cleared the pilot to land straight-in runway 29R. Review of the recordings did not reveal any distress calls from the pilot prior to the accident.

WRECKAGE AND IMPACT INFORMATION

The airplane came to rest inverted in the backyard of a residence. The location of the residence was directly below the final approach path and about 2,500 feet southwest of the runway 29R threshold at Zamperini Field, approximately 2,500 feet from the approach end of the runway. A residential street ran north and south on the eastern side of the residence. A 70-foot-tree was located on the eastern side of this street, approximately 80 feet from the wreckage site. Utility poles and lines were positioned about 20 feet west of the tree. The residence was 10 feet west of the utility poles and lines. A palm tree was positioned directly in front of the residence on its eastern side.

The wing tips and tree branches were on the western side of the tree, lying in the street. The ends of tree branches were cut at 45 degrees angles.

The 70-foot utility pole contained four main sets of wires. Six crossbars held the wires in place. The top three and lower two crossbar wires ran north and south along the street. The forth crossbar contained wires which ran from the pole, to a line of utility poles running from west to east. Directly above the forth crossbar was a white mark that ran along the diameter of the pole. The fifth crossbar, positioned 25 feet from the top of the pole and approximately 5 feet below the forth crossbar, was located on the roof of the residence.

A scrape mark was located approximately 20 feet up the southern side of the trunk of the palm tree. The roof of the residence was directly west of the palm tree. The front portion of the roof did not sustain noticeable impact damage. The rear portion of the roof was impacted and wooden beam shards and roofing tiles were strewn about the backyard. The residence structure directly below the impact sustained fire damage.

The airplane sustained considerable damage in the impact sequence. There was a 2-foot-deep crater directly in front of the airplane's nose. The nose of the airplane was positioned at a magnetic heading of approximately 170 degrees. The bottom portion of the engine cowling was crushed upward, just aft of the propeller attach point.

The wings remained attached to the fuselage. A 5-foot outboard section of the right wing was severed at the rivet line and was crushed upward at the tip. The left wing sustained fire and impact damage. The outermost leading edge of the wing had a semicircular impression approximately 17 inches in diameter. Oily brown colored marks were evident in the impression. The 6-foot outboard section, which included the semicircular impression was crushed aft approximately 70 degrees from the wing root. The wing fuel tank was breached where the outboard section curled aft. The inboard portion of the left wing was intact. The flaps were in the up position.

The odor of fuel was detected in the soil beneath the airplane's left wing. No fuel odor was present in the soil beneath the airplane's right wing.

The wings were removed from the airplane during recovery. Approximately 1 gallon of fuel was recovered from the left wing; approximately 8 ounces of fuel was recovered from the right wing. No fuel staining was evident on either wing or their structural components.

The empennage remained intact. The airplane rested on the top portion of the vertical stabilizer. The outboard 3 feet of the right elevator had separated and had torn from its hinges and bent upward.

The fuselage structure was dented and had brownish colored scratch marks along both the right and left side. Portions of roofing tile were embedded in the right side of the fuselage.

Two of the propeller blades were buried in the soil; the third blade had curled aft around the lower engine cowling.

The landing gear was in the extended position. The left main gear was down-and-locked. The right main gear and nose gear were bent aft and to the left.

An electrical arc mark was located on the left door, just below the window. Sooting was identified on the left wing and in the left cockpit area. When the crushed wing skins of the left wing were pried apart, no sooting was evident on the interior of the folds. The sooting was uniform in appearance over the rivet heads it covered. In the cockpit, the fire damage was confined to the left side seat upholstery and cabin linings, although the overhead linings were melted partially on the right.

The engine controls were set in the following positions:
Mixture, full forward (rich)
Propeller, full forward (low-pitch, high rpm)
Throttle; between ΒΌ open to closed.
The landing gear lever was in the DOWN position
The flap selector was in the UP position.
The fuel selector was positioned to the RIGHT fuel tank.
The auxiliary fuel pump was in the ON position.

METEOROLOGICAL INFORMATION

The closest official aviation weather reporting stating was Zamperini Field. An aviation routine weather report (METAR) was issued at 1755. The following conditions were reported: skies clear; visibility 30 nautical miles; temperature 57 degrees Fahrenheit; dew point 45 degrees Fahrenheit; altimeter 29.96 inHg; and wind from 230 degrees at 7 knots.

MEDICAL AND PATHOLOGICAL INFORMATION

The Los Angeles County Coroner completed an autopsy on the pilot. According to the coroner, the pilot's death was accidental as the result of burn injuries sustained in the accident. The FAA Bioaeronautical Sciences Research Laboratory completed toxicological testing.

TESTS AND RESEARCH

The Safety Board investigator-in-charge (IIC) and representatives from Cessna Aircraft Company and Teledyne Continental Motors, both parties to the investigation, examined the wreckage following the recovery on November 6, 2004.

The bottom spark plugs were removed from the engine. The electrodes were light grey in color, which corresponded to a lean operation when compared with a Champion Check-A-Plug chart AV-27. The numbers 4 and 6 cylinder spark plugs were oily in appearance; the remaining spark plugs were not oily. The electrodes were oval in shape and all of the gapping was similar. Manual rotation of the engine from the propeller produced thumb compression, and spark at the ignition p-leads in firing order. The fuel line from the fuel pump to the engine was removed and a residual amount of fuel was drained out.

Flight control continuity was obtained for all of the flight control surfaces. The left aileron control cable was broomstrawed approximately mid-wing. The flap actuator was measured at 4.4 inches which corresponded to 0 degrees of flaps. The elevator trim actuator measured 2 inches, which corresponded to 20 degrees up (nose-down) trim.

The fuel selector housing was removed from the fuel selector. The connection of the fuel selector level with the shaft appeared functional and correctly installed. The identification plate on the fuel selector was jammed into the lever so that the lever could not be moved. The fuel selector valve was removed from the airplane. The internal positioning of the fuel selector was set to the right fuel tank. The shaft of the fuel selector turned to the LEFT, RIGHT, and OFF positions when manually turned.

Fuel system continuity was established throughout the airframe. All fuel lines running from the engine, aft to the header tanks, and then to each wing were intact and the fittings were secure. The right header tank had dark blue staining around the drain; however, the areas immediately surrounding and below the drain had no evidence of staining. Fuel was drained from both header tanks; each tank had approximately 1 tablespoon of fuel that was light blue in color and had an odor of 100 Low Lead (100 LL) aviation fuel. No visible contaminants were evident.

The electric fuel pump operated when it was supplied with electricity. During examination, the venting system on the airplane was clear and free from obstruction.

The engine was test-run at Performance Aero, La Verne, California, on December 7, 2004. All accident party members were present during the test-run. The engine was secured to a stand and started. Investigators ran the engine for approximately 15 minutes. It idled at 900 rpm and a run-up was successfully completed to 2,700 rpm. The magneto check produced a 100-rpm drop on both the right and left magnetos with the engine operating at 1,700 rpm. As the throttle was opened from the idle position, the engine rpm fluctuated but did not lose power. With the throttle set to the idle position, the unmetered fuel pump pressure was 4 PSI (SID97-3B Standard 5.5-6.5 at idle of 600 rpm). With the throttle set to 2,700 rpm, the unmetered fuel pump pressure was 42 PSI (SID97-3B Standard 32.0-35.0); the metered nozzle pressure was 24 PSI (SID97-3B 16.9-19.9).

Continuous Data Recording (CDR), which is airplane radar track data, was obtained from the FAA Los Angeles ASR-9 site. The rate of rotation for that site's antenna was about 4.5 seconds. The track initialized from SNA at 1722:29, and showed a climb to 1,700 feet msl, with a shallow right turn toward TOA. The last hit was approximately 3 miles southeast of the accident site, at an elevation of 1,400 feet msl, and time of 1733:48.
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ADDITIONAL INFORMATION

The airplane, engine, and propeller were released to the owner's representative on February 2, 2005.

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