This space for binding 04/24/1990. Occurrence Date: Accident. Occurrence Type: Off Airport/Airstrip. Model/Series. Air Medical Transport Flight:
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1 Aircraft Registration Number: N976R Occurrence Date: 4/4/99 Most Critical Injury: Fatal Occurrence Type: Accident Investigated By: NTSB Location/Time Nearest /Place WEST BEND Zip Code Local Time Time Zone WI Airport Proximity: Off Airport/Airstrip Distance From Landing Facility: Direction From Airport: Aircraft Information Summary Aircraft Manufacturer BELLANCA Model/Series 8KCAB Type of Aircraft Sightseeing Flight: No Narrative Air Medical Transport Flight: No Brief narrative statement of facts, conditions and circumstances pertinent to the accident/incident: - Page
2 Landing Facility/Approach Information Airport Name Airport ID: Airport Elevation Runway Used Runway Length Runway Width Ft. MSL Runway Surface Type: Runway Surface Condition: Type Instrument Approach: NONE VFR Approach/Landing: Aircraft Information Aircraft Manufacturer BELLANCA Model/Series 8KCAB Serial Number 64-8 Airworthiness Certificate(s): Acrobatic Landing Gear Type: Tailwheel Homebuilt Aircraft? No Number of Seats: Certified Max Gross Wt. 8 LBS Number of Engines: Engine Type: Reciprocating Engine Manufacturer: LYCOMING Model/Series: AEIO-36-HA Rated Power: 8 HP - Aircraft Inspection Information Type of Last Inspection Date of Last Inspection Time Since Last Inspection Airframe Total Time Annual /99 5 Hours 775 Hours - Emergency Locator Transmitter (ELT) Information ELT Installed? Yes ELT Operated? ELT Aided in Locating Accident Site? No Owner/Operator Information Registered Aircraft Owner Street Address Zip Code Operator of Aircraft GRAN-AIRE, INC. Operator Does Business As: - Type of U.S. Certificate(s) Held: Air Carrier Operating Certificate(s): On-demand Air Taxi Street Address L.J. TIMMERMAN AIRPORT MILWAUKEE WI Operator Designator Code: AZOA Zip Code 537 Operating Certificate: Regulation Flight Conducted Under: Part 9: General Aviation Type of Flight Operation Conducted: Instructional Operator Certificate: - Page
3 First Pilot Information Name Date of Birth Age 47 Sex: M Seat Occupied: Unknown Principal Profession: Civilian Pilot Certificate Number: Certificate(s): Flight Instructor; Commercial Rating(s): Multi-engine Land; Single-engine Land Rotorcraft/Glider/LTA: Instrument Rating(s): Instructor Rating(s): Multi-engine; Single-engine; Instrument Type Rating/Endorsement for Accident/Incident Aircraft? No Current Biennial Flight Review? Medical Cert.: Class Medical Cert. Status: Valid Medical--w/ waivers/lim. Date of Last Medical Exam: /989 - Flight Time Matrix All A/C This Make and Model Single Engine Mult-Engine Night Actual Instrument Simulated Rotorcraft Glider Lighter Than Air Total Time 6 4 Pilot In Command(PIC) Instructor 56 4 Last 9 Days Last 3 Days 5 5 Last 4 Hours 5 5 Seatbelt Used? Yes Shoulder Harness Used? Yes Toxicology Performed? Yes Second Pilot? Yes Flight Plan/Itinerary Type of Flight Plan Filed: Departure Point Airport Identifier Departure Time Time Zone MILWAUKEE WI MWC 33 Destination Airport Identifier Local Flight Type of Clearance: Type of Airspace: Weather Information Source of Briefing: No record of briefing Method of Briefing: - Page 3
4 Weather Information WOF ID Observation Time Time Zone WOF Elevation WOF Distance From Accident Site Direction From Accident Site MWC Ft. MSL 5 NM 8 Deg. Mag. Sky/Lowest Cloud Condition: Scattered 4 Ft. AGL Condition of Light: Day Lowest Ceiling: Ft. AGL Visibility: 7 SM Altimeter: 9. "Hg Temperature: 8 C Dew Point: 3 C Wind Direction: Density Altitude: Ft. Wind Speed: Gusts: Weather Condtions at Accident Site: Visual Conditions Visibility (RVR): Ft. Visibility (RVV) SM Intensity of Precipitation: Unknown Restrictions to Visibility: Type of Precipitation: Accident Information Aircraft Damage: Destroyed Aircraft Fire: Aircraft Explosion Classification: U.S. Registered/U.S. Soil - Injury Summary Matrix First Pilot Second Pilot Student Pilot Flight Instructor Check Pilot Flight Engineer Cabin Attendants Other Crew Passengers Fatal Serious Minor TOTAL - TOTAL ABOARD - Other Ground - GRAND TOTAL - - Page 4
5 Administrative Information Investigator-In-Charge (IIC) MARK E. DOUB Additional Persons Participating in This Accident/Incident Investigation: EFRAIM ARROYO - Page 5
FACTUAL REPORT AVIATION
Aircraft Registration Number: N38DM Occurrence Date: Occurrence Type: 4/6/ Accident Most Critical Injury: Serious Investigated By: NTSB Location/Time Nearest /Place IMMOKALEE Zip Code Local Time Time Zone
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NTSB ID: MIALA257 Aircraft Registration Number: N53SP Occurrence Date: Occurrence Type: 9//2 Accident Most Critical Injury: Serious Investigated By: NTSB Location/Time Nearest /Place CANTON Zip Code Local
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Aircraft Registration Number: N542 Occurrence Date: Occurrence Type: /26/993 Accident Most Critical Injury: Minor Investigated By: NTSB Location/Time Nearest /Place BUCKEYE Zip Code Local Time Time Zone
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NTSB ID: FTW97LA83 Aircraft Registration Number: N562P Occurrence Date: Occurrence Type: /5/997 Accident Most Critical Injury: Minor Investigated By: NTSB Location/Time Nearest /Place LAPORTE Zip Code
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Aircraft Registration Number: N235BW Occurrence Date: Occurrence Type: 0/0/2003 Accident Most Critical Injury: Minor Investigated By: NTSB Location/Time Nearest /Place Melbourne Zip Code Local Time Time
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NTSB ID: LAX94LA6 Aircraft Registration Number: N89AC Occurrence Date: Occurrence Type: 3/2/994 Accident Most Critical Injury: Fatal Investigated By: NTSB Location/Time Nearest /Place MARANA Zip Code Local
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Aircraft Registration Number: NJA Occurrence Date: Occurrence Type: //2 Accident Most Critical Injury: Serious Investigated By: NTSB Location/Time Nearest /Place LINDRITH Zip Code Local Time Time Zone
More informationFACTUAL REPORT AVIATION. Location/Time. Aircraft Information Summary. Revenue Sightseeing Flight: No Narrative. Air Medical Transport Flight:
Printed on : /4/ :39:46 PM NTSB ID: MIA88LA Aircraft Registration Number: N4GK Occurrence Date: /8/987 Most Critical Injury: ne Occurrence Type: Accident Investigated By: NTSB Location/Time Nearest /Place
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Location/Time Aircraft Registration Number: Most Critical Injury: Serious Investigated By: NTSB N52705 Nearest /Place Zip Code Local Time Time Zone GAHANNA OH 43230 1541 EDT Airport Proximity: Off Airport/Airstrip
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NTSB ID: LAXLA3 Aircraft Registration Number: N2233F Occurrence Date: Occurrence Type: //2 Accident Most Critical Injury: Minor Investigated By: NTSB Location/Time Nearest /Place GRAND CANYON Zip Code
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Printed on : 4/8/0 :37:4 PM Aircraft Registration Number: PH-RUL Occurrence Date: Occurrence Type: 0/6/009 Accident Most Critical Injury: Fatal Investigated By: Foreign Location/Time Nearest /Place Weert
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