Controller Issued Repeated Low Altitude Warnings

Editor's Note: Below is the National Transportation Safety Board's preliminary report on the August 12 downing of a Beechcraft G35 Bonanza near Boston, MA. As ANN reported, the pilot and his two passengers onboard were killed when the aircraft spiraled out of the clouds, and impacted a strip mall parking lot...

NTSB Identification: MIA08FA163
14 CFR Part 91: General Aviation
Accident occurred Tuesday, August 12, 2008 in South Easton, MA
Aircraft: Beech G35, registration: N4615D
Injuries: 3 Fatal.

This is preliminary information, subject to change, and may contain errors. Any errors in this report will be corrected when the final report has been completed.

On August 12, 2008, about 1017 eastern daylight time, a Beech G35, N4615D, registered to a private individual, operated by the pilot as "Angel Flight 15 Delta" experienced an in-flight loss of control while maneuvering to re-intercept a localizer, and then crashed into a parking lot of a shopping center located in South Easton, Massachusetts. Instrument meteorological conditions prevailed at the time and an instrument flight rules (IFR) flight plan was filed for the 14 Code of Federal Regulations (CFR) Part 91 personal flight that departed Francis S. Gabreski Airport (FOK), Westhampton, New York, about 0910, destined for General Edward Lawrence Logan International Airport (BOS), Boston, Massachusetts. The airplane was destroyed, and the certificated commercial pilot and the two passengers were killed.

The purpose of the flight was to transport the passengers to BOS for planned medical treatment in the area. The pilot was a volunteer pilot for Angel Flight Northeast, which coordinated the flight. According to preliminary air traffic control (ATC) communications, after takeoff the flight proceeded towards BOS. About 1008, when the flight was approximately 10 nautical miles southwest of BOS flying at 5,000 feet, the pilot established contact with Boston Terminal Radar Approach Control (Boston TRACON) and advised he was turning right to heading 210 degrees. Recorded radar data depicted the airplane flying on a south-southwesterly heading, and about 1010, the controller instructed the pilot to turn 10 degrees to the right and descend to 4,000 feet, which was acknowledged. The controller then asked the pilot what speed he could maintain on final approach until reaching the outer marker. The pilot advised 130 knots, but added that he would have to slow when the flight was closer in. The flight continued on a south-southwesterly heading, and while descending to 4,000 feet, accelerated to approximately 170 knots ground speed.

The flight descended to 4,000 feet, and about 1013, when the flight was approximately 21 nautical miles southwest of BOS, the controller instructed the pilot to turn to heading 170 degrees, which was acknowledged. The controller then instructed the pilot to turn to heading 130 degrees, which was also acknowledged. Recorded radar data reflects the turn towards the southeast, and the pilot was then instructed to descend and maintain 3,000 feet, which was acknowledged. About 1014, when the flight was at 3,600 feet and approximately 1.3 nautical mile northwest of the localizer at 170 knots ground speed, the controller instructed the pilot to turn left heading 060 degrees and to intercept the localizer. The pilot acknowledged the instructions and recorded data indicates the flight turned to the left but crossed the localizer. About 1016, the controller advised the pilot that he had passed thru the localizer and to turn left heading 010 degrees to intercept the localizer. The pilot responded with "15 Delta."

After the pilot's truncated transmission, radar data indicated the flight turned to a heading of approximately 320 degrees and descended to 2,700 feet while flying towards the localizer. About 1017, the controller asked the pilot if he was joining the localizer; there was no response. The controller then advised the pilot that the altitude indicated 2,300 feet, then immediately informed him radar contact was lost. The controller then repeated the airplane's call sign and the pilot responded "5 Delta's with you." The controller advised the pilot that the airplane was at 1,200 feet, issued a low altitude alert, and instructed the pilot twice to "climb immediately." The pilot responded "5 Delta's climbing." The controller advised the pilot to maintain 3,000 feet; and to state his heading; a very short unintelligible transmission was heard. The recorded radar data indicated that the flight climbed to 2,700 feet at a ground speed of 85 knots. The controller again instructed the pilot to maintain 3,000 feet and to state heading; there was no response. The recorded radar data indicated the airplane then descended to 2,400 feet at a ground speed of 68 knots. There were no further radar returns with altitude depicted. The controller then broadcasted that "your altitude is going up and down are [you] all right sir." There was no response. The controller then issued a low altitude alert again, instructed the pilot to climb immediately, and that radar contact was lost. The controller asked nearby aircraft if they heard a signal from an emergency locator transmitter (ELT); no signal was heard.

A pilot-rated witness who was located .41 nautical mile and 288 degrees from the crash site reported hearing a low flying airplane, heading west to east, with high rpm. He ran outside but did not see the airplane. The noise faded then returned, and he observed the airplane descending vertically out of the clouds. The witness's first view of the airplane was the top of the airplane. He did not recall if he saw the landing gear, but did not see any smoke trailing the airplane during the time he saw it. The airplane spun 2.5 times to the left, went out of sight behind trees, and he heard an impact and saw smoke. He drove to the scene arriving there about 1 minute later. The witness added that the engine was running with a constant sound prior to impact, and that there was no missing or sputtering. The weather conditions at the time consisted of a ceiling at 800 feet, with no rain or wind.

Another witness who was on Route 106 reported to law enforcement seeing the airplane climbing and descending from the clouds. A witness who was located on the roof of a nearby store reported to law enforcement seeing the airplane flying low between their location and another nearby building. Numerous witnesses also reported to local law enforcement seeing the airplane circling and then nose diving into the parking lot.

The airplane impacted a parking lot during daylight conditions; the crash site was located approximately 212 degrees and 21 nautical miles from the center of BOS. There were no ground injuries or reported damage to any vehicles or equipment located in the parking lot.

A surface weather observation taken at BOS at 1015, or approximately 2 minutes before the accident, indicated the wind was from 350 degrees at 8 knots with gusts to 14 knots, the visibility was 8 statute miles with light rain, broken clouds existed at 1,100 and 2,000 feet, overcast clouds existed at 5,500 feet, the temperature and dew point were 17 and 15 degrees Celsius respectively, and the altimeter setting was 29.70 inches of mercury.

FMI: www.ntsb.gov