Aircraft Incident/Accident Report
Arriba, Colorado 80804
Thursday, May 5, 2011 17:30 MDT
|
| Event Information | |
| Type of Event | Accident |
| Event Date | 5/5/2011 |
| Event Day of the Week | Thursday |
| Time of Event | 1730 |
| Event Time Zone | Mountain Daylight Time |
| Event City | Arriba |
| Event State | COLORADO |
| Event Country | -- |
| Zipcode of the event site | 80804 |
| Event Date Year | 2011 |
| Event Date Month | 5 |
| MidAir Collision Indicator | No |
| On Ground Collision occurred ? | No |
| Event Location Latitude | -- |
| Event Location Longitude | -- |
| Event Location Airport | -- |
| Event Location Nearest Airport ID | -- |
| Indicates whether the acc/inc occurred off or on an airport | Off Airport/Airstrip |
| Distance from airport in statute miles | -- |
| Degrees magnetic from airport | -- |
| Airport Elevation | -- |
| Weather Briefing Completeness | -- |
| Investigator's weather source | Weather Observation Facility |
| Time of the weather observation | 1755 Mountain Daylight Time |
| Direction of event from weather observation facility (degrees) | -- |
| Weather Observation Facility ID | KLIC |
| Elevation of weather observation facility | -- |
| Distance of event from weather observation facility (units?) | 25 |
| Time Zone of the weather observation | MDT |
| Lighting Conditions | Day |
| Lowest Ceiling Height | -- |
| Lowest Non-Ceiling Height | -- |
| Sky/Lowest/Cloud Conditions | Clear |
| Sky Condition for Lowest Ceiling | None |
| Visibility Runway Visual Range (Feet) | -- |
| Visibility Runway Visual Value (Statute Miles) | -- |
| Visibility (Statute Miles) | 10 |
| Air Temperature at event time (in degrees celsius) | 18 |
| Dew Point at event time (in degress fahrenheit) | -3 |
| Wind Direction (degrees magnetic) | 160 |
| Variable Wind Indicator | Wind direction could be determined |
| Wind Speed (knots) | 10 |
| Wind Velocity Indicator | -- |
| Wind Gust Indicator | Not Gusting |
| Wind Gust (knots) | -- |
| Altimeter Setting at event time (in. Hg) | 30.09 |
| Density Altitude (feet) | -- |
| Intensity of Precipitation | -- |
| METAR weather report | -- |
| Event Highest Injury | Serious |
| On Ground, Fatal Injuries | -- |
| On Ground, Minor Injuries | -- |
| On Ground, Serious Injuries | -- |
| Injury Total Fatal | -- |
| Injury Total Minor | -- |
| Injury Total None | -- |
| Injury Total Serious | 1 |
| Injury Total All | 1 |
| Investigating Agency | NTSB |
| NTSB Docket Number (internal use) | -- |
| NTSB Notification Source | Lincoln Co Sheriff |
| NTSB Notification Date | -- |
| NTSB Notification Time | -- |
| Fiche Number and/or location -used to find docket information | -- |
| Date of most recent change to record | Mar 27 2012 2:43PM |
| User who most recently changed record | bowl |
| Basic weather conditions | Visual Meteorological Cond |
| FAA District Office | -- |
| Aircraft Involved | |
| Aircraft #1 | |
| Aircraft Registration Number | N5192F |
| NTSB Number | CEN11LA323 |
| Missing Aircraft Indicator | -- |
| Federal Aviation Reg. Part | Part 137: Agricultural |
| Type of Flight Plan filed | None |
| Flight plan Was Activated? | -- |
| Damage | Substantial |
| Aircraft Fire | None |
| Aircraft Explosion | None |
| Aircraft Manufacturer's Full Name | AIR TRACTOR INC |
| Aircraft Model | AT-402A |
| Aircraft Series Identifier | -- |
| Aircraft Serial Number | 402A-1093 |
| Certified Max Gross Weight | -- |
| Aircraft Category | Airplane |
| Aircraft Registration Class | -- |
| Aircraft is a homebuilt? | No |
| Flight Crew Seats | -- |
| Cabin Crew Seats | -- |
| Passenger Seats | -- |
| Total number of seats on the aircraft | 1 |
| Number of Engines | 1 |
| Fixed gear or retractable gear | Fixed |
| Aircraft, Type of Last Inspection | Annual |
| Date of Last Inspection | Oct 10 2010 12:00AM |
| Airframe hours since last inspection | -- |
| Airframe Hours | 2249 |
| ELT Installed | No |
| ELT Activated | No |
| ELT Aided Location of Event Site | Unknown |
| ELT Type | -- |
| Aircraft Owner Name | KOCH BERNARD L |
| Aircraft Owner Street Address | 44010 COUNTY ROAD 3H |
| Aircraft Owner City | ARRIBA |
| Aircraft Owner State | CO |
| Aircraft Owner Country | USA |
| Aircraft Owner Zipcode | 80804-9523 |
| Operator is an individual? | Yes |
| Operator Name | KOCH BERNARD L |
| Operator Same as Owner? | Yes |
| Operator Is Doing Business As | -- |
| Operator Address Same as Owner? | Yes |
| Operator Street Address | 44010 COUNTY ROAD 3H |
| Operator City | ARRIBA |
| Operator State | CO |
| Operator Country | USA |
| Operator Zip code | 80804-9523 |
| Operator Code | ZJZG |
| Owner has at least one certificate | None |
| Other Operator of large aircraft? | No |
| Certified for Part 133 or 137 Operation | -- |
| Operator Certificate Number | -- |
| Indicates whether an air carrier operation was scheduled or not | -- |
| Indicates Domestic or International Flight | -- |
| Operator carrying Pax/Cargo/Mail | -- |
| Type of Flying (Per_Bus / Primary) | Aerial Application |
| Second Pilot on Board | No |
| Departure Point Same as Event | Yes |
| Departure Airport Code | -- |
| Departure City | Arriba |
| Departure State | CO |
| Departure Country | USA |
| Departure Time | 1630 |
| Departure Time Zone | MDT |
| Destination Same as Local Flt | dest & departure same, accident can occur anywhere |
| Destination Airport Code | -- |
| Destination City | Arriba |
| Destination State | CO |
| Destination Country | USA |
| Specific Phase of Flight | -- |
| Report sent to ICAO? | -- |
| Evacuation occurred | -- |
| Date of most recent change to record | Mar 12 2012 3:00PM |
| User who most recently changed record | hatc |
| Since inspection or accident | Last Inspection |
| Event Location Runway Number and Location | N/A |
| Runway Length | -- |
| Runway Width | -- |
| Sight Seeing flight | No |
| Air Medical Flight | No |
| Medical Flight | -- |
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