Aircraft Accident/Incident Report

Ellendale, North Dakota 58436
Friday, August 19, 1994 9:30 CDT

NTSB Narrative Summary Released at Completion of Accident

See attached copy of NTSB Form 6120.1/2 as required by PL 100-233.

NTSB Probable Cause Narrative

Not Yet Reported

Event Information

Type of Event Accident
Event Date 8/19/1994
Event Day of the Week Friday
Time of Event 930
Event Time Zone Central Daylight Time
Event City ELLENDALE
Event State NORTH DAKOTA
Event Country --
Zipcode of the event site 58436
Event Date Year 1994
Event Date Month 8
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 Unknown
Distance from airport in statute miles --
Degrees magnetic from airport --
Airport Elevation --
Weather Briefing Completeness Unknown
Investigator's weather source Unknown
Time of the weather observation 950
Direction of event from weather observation facility (degrees) 0
Weather Observation Facility ID JMS
Elevation of weather observation facility 0
Distance of event from weather observation facility (units?) 0
Time Zone of the weather observation
Lighting Conditions Not Reported
Lowest Ceiling Height 0
Lowest Non-Ceiling Height 25000
Sky/Lowest/Cloud Conditions Scattered
Sky Condition for Lowest Ceiling None
Visibility Runway Visual Range (Feet) 0
Visibility Runway Visual Value (Statute Miles) 0
Visibility (Statute Miles) 10
Air Temperature at event time (in degrees celsius) 17
Dew Point at event time (in degress fahrenheit) 13
Wind Direction (degrees magnetic) 0
Variable Wind Indicator Unknown
Wind Speed (knots) 0
Wind Velocity Indicator Unknown
Wind Gust Indicator Unknown
Wind Gust (knots) 0
Altimeter Setting at event time (in. Hg) 29
Density Altitude (feet) --
Intensity of Precipitation Unknown
METAR weather report --
Event Highest Injury None
On Ground, Fatal Injuries 0
On Ground, Minor Injuries 0
On Ground, Serious Injuries 0
Injury Total Fatal --
Injury Total Minor --
Injury Total None 2
Injury Total Serious --
Injury Total All --
Investigating Agency Unknown
NTSB Docket Number (internal use) 9000
NTSB Notification Source --
NTSB Notification Date Aug 19 1994 12:00AM
NTSB Notification Time 1300
Fiche Number and/or location -used to find docket information IMAGE
Date of most recent change to record May 17 2001 5:02AM
User who most recently changed record dbo
Basic weather conditions Visual Meteorological Cond
FAA District Office --

Aircraft Involved

Aircraft #1

Aircraft Registration Number N8621V
NTSB Number CHI94T#A03
Missing Aircraft Indicator N
Federal Aviation Reg. Part Public Use
Type of Flight Plan filed Company VFR
Flight plan Was Activated? --
Damage Destroyed
Aircraft Fire Unknown
Aircraft Explosion Unknown
Aircraft Manufacturer's Full Name BELLANCA
Aircraft Model BL28
Aircraft Series Identifier BL28
Aircraft Serial Number
Certified Max Gross Weight --
Aircraft Category Airplane
Aircraft Registration Class Unknown
Aircraft is a homebuilt? No
Flight Crew Seats --
Cabin Crew Seats --
Passenger Seats --
Total number of seats on the aircraft --
Number of Engines --
Fixed gear or retractable gear Fixed
Aircraft, Type of Last Inspection Unknown
Date of Last Inspection --
Airframe hours since last inspection --
Airframe Hours --
ELT Installed Unknown
ELT Activated Unknown
ELT Aided Location of Event Site Unknown
ELT Type --
Aircraft Owner Name
Aircraft Owner Street Address
Aircraft Owner City
Aircraft Owner State
Aircraft Owner Country
Aircraft Owner Zipcode
Operator is an individual? --
Operator Name U.S. DEPARTMENT OF AGRICULTURE
Operator Same as Owner? No
Operator Is Doing Business As --
Operator Address Same as Owner? No
Operator Street Address 12345 W ALAMEDA PKWY
Operator City LAKEWOOD
Operator State CO
Operator Country
Operator Zip code 80228
Operator Code
Owner has at least one certificate None
Other Operator of large aircraft? No
Certified for Part 133 or 137 Operation Unknown
Operator Certificate Number --
Indicates whether an air carrier operation was scheduled or not Unknown
Indicates Domestic or International Flight Unknown
Operator carrying Pax/Cargo/Mail Unknown
Type of Flying (Per_Bus / Primary) Public Use
Second Pilot on Board Unknown
Departure Point Same as Event No
Departure Airport Code JMS
Departure City JAMESTOWN
Departure State ND
Departure Country
Departure Time 0
Departure Time Zone
Destination Same as Local Flt dest & departure same, accident can occur anywhere
Destination Airport Code JMS
Destination City
Destination State
Destination Country
Specific Phase of Flight --
Report sent to ICAO? --
Evacuation occurred --
Date of most recent change to record Feb 11 2002 12:12PM
User who most recently changed record dbo
Since inspection or accident --
Event Location Runway Number and Location 0
Runway Length 0
Runway Width --
Sight Seeing flight No
Air Medical Flight No
Medical Flight --