| Type of Event | Accident |
| Event Date | 5/16/2004 |
| Event Day of the Week | Sunday |
| Time of Event | 2040 |
| Event Time Zone | Pacific Daylight Time |
| Event City | Tenino |
| Event State | WASHINGTON |
| Event Country | -- |
| Zipcode of the event site | 98589 |
| Event Date Year | 2004 |
| Event Date Month | 5 |
| MidAir Collision Indicator | Yes |
| On Ground Collision occurred ? | No |
| Event Location Latitude | 464740N |
| Event Location Longitude | 1224638W |
| 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 | Not pertinent |
| Investigator's weather source | Weather Observation Facility |
| Time of the weather observation | 2054 Pacific Daylight Time |
| Direction of event from weather observation facility (degrees) | 318 |
| Weather Observation Facility ID | OLM |
| Elevation of weather observation facility | 213 |
| Distance of event from weather observation facility (units?) | 14 |
| Time Zone of the weather observation | PDT |
| Lighting Conditions | Day |
| Lowest Ceiling Height | 7150 |
| Lowest Non-Ceiling Height | -- |
| Sky/Lowest/Cloud Conditions | -- |
| Sky Condition for Lowest Ceiling | Overcast |
| Visibility Runway Visual Range (Feet) | -- |
| Visibility Runway Visual Value (Statute Miles) | -- |
| Visibility (Statute Miles) | 10 |
| Air Temperature at event time (in degrees celsius) | 15 |
| Dew Point at event time (in degress fahrenheit) | 9 |
| Wind Direction (degrees magnetic) | -- |
| Variable Wind Indicator | -- |
| Wind Speed (knots) | -- |
| Wind Velocity Indicator | Calm |
| Wind Gust Indicator | Not Gusting |
| Wind Gust (knots) | -- |
| Altimeter Setting at event time (in. Hg) | 30 |
| Density Altitude (feet) | -- |
| Intensity of Precipitation | -- |
| METAR weather report | -- |
| Event Highest Injury | Fatal |
| On Ground, Fatal Injuries | -- |
| On Ground, Minor Injuries | -- |
| On Ground, Serious Injuries | -- |
| Injury Total Fatal | 1 |
| Injury Total Minor | 1 |
| Injury Total None | -- |
| Injury Total Serious | -- |
| Injury Total All | 2 |
| Investigating Agency | NTSB |
| NTSB Docket Number (internal use) | 18346 |
| NTSB Notification Source | FAA Regional Operations Center |
| NTSB Notification Date | May 16 2004 12:00AM |
| NTSB Notification Time | 2050 |
| Fiche Number and/or location -used to find docket information | DMS |
| Date of most recent change to record | Sep 13 2005 12:54PM |
| User who most recently changed record | NTSB\JOHB |
| Basic weather conditions | Visual Meteorological Cond |
| FAA District Office | Seattle, Washington |
Aircraft Involved |
||
|---|---|---|
Aircraft #1 |
Aircraft #2 |
|
| Aircraft Registration Number | N3510D | N3329S |
| NTSB Number | SEA04FA083A | SEA04FA083B |
| Missing Aircraft Indicator | -- | -- |
| Federal Aviation Reg. Part | Part 91: General Aviation | Part 91: General Aviation |
| Type of Flight Plan filed | None | None |
| Flight plan Was Activated? | No | No |
| Damage | Destroyed | Destroyed |
| Aircraft Fire | None | None |
| Aircraft Explosion | None | None |
| Aircraft Manufacturer's Full Name | Cessna | Cessna |
| Aircraft Model | 170B | 210J |
| Aircraft Series Identifier | -- | -- |
| Aircraft Serial Number | 27053 | 21059129 |
| Certified Max Gross Weight | 2200 | 3400 |
| Aircraft Category | Airplane | Airplane |
| Aircraft Registration Class | U.S. Registered/U.S. Soil | U.S. Registered/U.S. Soil |
| Aircraft is a homebuilt? | No | No |
| Flight Crew Seats | -- | -- |
| Cabin Crew Seats | -- | -- |
| Passenger Seats | -- | -- |
| Total number of seats on the aircraft | 4 | 6 |
| Number of Engines | 1 | 1 |
| Fixed gear or retractable gear | Fixed | Retractable |
| Aircraft, Type of Last Inspection | Annual | Annual |
| Date of Last Inspection | May 22 2003 12:00AM | Mar 4 2002 12:00AM |
| Airframe hours since last inspection | 33.7 | -- |
| Airframe Hours | 2318.9 | -- |
| ELT Installed | Yes | Yes |
| ELT Activated | No | No |
| ELT Aided Location of Event Site | No | No |
| ELT Type | -- | -- |
| Aircraft Owner Name | Sale Reported | Barbara A. Eichman |
| Aircraft Owner Street Address | -- | -- |
| Aircraft Owner City | Vashon | Arvada |
| Aircraft Owner State | WA | CO |
| Aircraft Owner Country | USA | USA |
| Aircraft Owner Zipcode | 98070 | 80004 |
| Operator is an individual? | No | No |
| Operator Name | Ghyrn E. Loveness | Scott C. Devlin |
| Operator Same as Owner? | No | No |
| Operator Is Doing Business As | -- | -- |
| Operator Address Same as Owner? | No | No |
| Operator Street Address | -- | -- |
| Operator City | Vashon | Camas |
| Operator State | WA | WA |
| Operator Country | USA | USA |
| Operator Zip code | 98070 | 98607 |
| Operator Code | -- | -- |
| Owner has at least one certificate | None | None |
| Other Operator of large aircraft? | -- | -- |
| 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) | Personal | Positioning |
| Second Pilot on Board | No | No |
| Departure Point Same as Event | No | No |
| Departure Airport Code | RBG | 1W1 |
| Departure City | Roseburg | Camas |
| Departure State | OR | WA |
| Departure Country | USA | USA |
| Departure Time | 1820 | 1930 |
| Departure Time Zone | PDT | PDT |
| Destination Same as Local Flt | -- | -- |
| Destination Airport Code | WA69 | PAE |
| Destination City | Vashon | Everett |
| Destination State | WA | WA |
| Destination Country | USA | USA |
| Specific Phase of Flight | Cruise | Cruise |
| Report sent to ICAO? | No | No |
| Evacuation occurred | No | No |
| Date of most recent change to record | Jun 29 2005 4:53PM | Jun 29 2005 4:53PM |
| User who most recently changed record | STAM | STAM |
| Since inspection or accident | Time of Accident | -- |
| Event Location Runway Number and Location | NA | NA |
| Runway Length | -- | -- |
| Runway Width | -- | -- |
| Sight Seeing flight | No | No |
| Air Medical Flight | No | No |
| Medical Flight | -- | -- |