Baltimore/Washington Internati Airport
Aircraft Accident/Incident Report

Baltimore, Maryland 21240
Monday, January 30, 2012 18:43 EST

NTSB Narrative Summary Released at Completion of Accident

The airplane was approaching the destination airport in night visual meteorological conditions. The pilot-in-command (PIC) was the pilot flying and was not familiar with the destination airport. The second-in-command (SIC) was the pilot monitoring and was familiar with the destination airport. While the airplane was at 2,000 feet mean sea level, about 10 miles from the airport, the PIC did not see the airport; however, the SIC observed the airport beacon, but not runway 33R. The controller then offered either a clearance for a visual approach to runway 33R or a vector for the runway 33R instrument landing system (ILS) approach. The PIC indicated to the SIC that he wanted the ILS; however, the SIC stated that he saw runway 33R and asked the PIC if he saw it, to which he replied no. The SIC then told the controller that they had the runway in sight. The PIC subsequently stated to the SIC that he saw runway 33R, but he confused it with runway 28. About 2 minutes later, with the SIC assisting, the PIC visually acquired the correct runway. At that time, the airplane was about 6 miles from the runway, at 1,400 feet msl. The airplane made a left turn, followed by a right turn, which positioned it from a final approach to runway 28, to a final approach to runway 33R. The airplane was lined-up for runway 33R about 4 miles from the runway threshold, at 1,000 feet and 145 knots groundspeed. While on short final approach, about 300 feet agl, the airspeed went below the landing reference speed (Vref) by about 3 to 5 knots. The SIC responded by emphasizing "below Vref" two times, followed by "power" four times. The PIC added power and the airplane's speed went above Vref by about 10 knots. The airplane touched down about halfway down the 5,000 foot-long runway, about 140 knots groundspeed with an approximate 5-knot tailwind. Although the flight crew did not believe the thrust reversers activated, non-volatile memory (NVM) of the engine controls revealed that they deployed for 13 seconds; however, the airplane still traveled off the end of the runway and came to rest in mud about 200 feet from the departure end. Examination of the airplane and its other NVM did not reveal any preimpact mechanical malfunctions. The flight crew did not report any additional anomalies, including the breaking system, and 226 feet of pulsing skid marks were identified near the departure end of the runway.

NTSB Probable Cause Narrative

The pilot-in-command's failure to obtain the proper touchdown point or landing reference speed and failure to initiate a go-around when it became evident that the airplane was landing long and fast. Contributing to the incident was a lack of effective flight crew coordination and communication.

Event Information

Type of Event Incident
Event Date 1/30/2012
Event Day of the Week Monday
Time of Event 1843
Event Time Zone Eastern Standard Time
Event City Baltimore
Event State MARYLAND
Event Country --
Zipcode of the event site 21240
Event Date Year 2012
Event Date Month 1
MidAir Collision Indicator No
On Ground Collision occurred ? No
Event Location Latitude 391031N
Event Location Longitude 0764006W
Event Location Airport Baltimore/Washington Internati
Event Location Nearest Airport ID BWI
Indicates whether the acc/inc occurred off or on an airport On Airport
Distance from airport in statute miles 1
Degrees magnetic from airport --
Airport Elevation 146
Weather Briefing Completeness --
Investigator's weather source Weather Observation Facility
Time of the weather observation 1850 Eastern Standard Time
Direction of event from weather observation facility (degrees) 0
Weather Observation Facility ID BWI
Elevation of weather observation facility 146
Distance of event from weather observation facility (units?) 0
Time Zone of the weather observation EST
Lighting Conditions Night
Lowest Ceiling Height 25000
Lowest Non-Ceiling Height 10000
Sky/Lowest/Cloud Conditions Few
Sky Condition for Lowest Ceiling Broken
Visibility Runway Visual Range (Feet) --
Visibility Runway Visual Value (Statute Miles) --
Visibility (Statute Miles) 10
Air Temperature at event time (in degrees celsius) 4
Dew Point at event time (in degress fahrenheit) -11
Wind Direction (degrees magnetic) 140
Variable Wind Indicator Wind direction could be determined
Wind Speed (knots) 4
Wind Velocity Indicator --
Wind Gust Indicator Not Gusting
Wind Gust (knots) --
Altimeter Setting at event time (in. Hg) 30.3
Density Altitude (feet) --
Intensity of Precipitation --
METAR weather report --
Event Highest Injury None
On Ground, Fatal Injuries --
On Ground, Minor Injuries --
On Ground, Serious Injuries --
Injury Total Fatal --
Injury Total Minor --
Injury Total None 2
Injury Total Serious --
Injury Total All --
Investigating Agency NTSB
NTSB Docket Number (internal use) 29958
NTSB Notification Source FAA Eastern ROC
NTSB Notification Date --
NTSB Notification Time --
Fiche Number and/or location -used to find docket information --
Date of most recent change to record Jan 28 2013 10:33AM
User who most recently changed record broda
Basic weather conditions Visual Meteorological Cond
FAA District Office --

Aircraft Involved

Aircraft #1

Aircraft Registration Number N272CB
NTSB Number ERA12IA166
Missing Aircraft Indicator --
Federal Aviation Reg. Part Part 91: General Aviation
Type of Flight Plan filed IFR
Flight plan Was Activated? Yes
Damage Minor
Aircraft Fire None
Aircraft Explosion None
Aircraft Manufacturer's Full Name GULFSTREAM
Aircraft Model G150
Aircraft Series Identifier --
Aircraft Serial Number 262
Certified Max Gross Weight 21100
Aircraft Category Airplane
Aircraft Registration Class --
Aircraft is a homebuilt? No
Flight Crew Seats 2
Cabin Crew Seats --
Passenger Seats 7
Total number of seats on the aircraft 9
Number of Engines 2
Fixed gear or retractable gear Retractable
Aircraft, Type of Last Inspection AAIP
Date of Last Inspection Jul 18 2011 12:00AM
Airframe hours since last inspection --
Airframe Hours 494
ELT Installed Yes
ELT Activated No
ELT Aided Location of Event Site No
ELT Type Unknown
Aircraft Owner Name CHATTEM INC
Aircraft Owner Street Address --
Aircraft Owner City CHATTANOOGA
Aircraft Owner State TN
Aircraft Owner Country USA
Aircraft Owner Zipcode 37409-1248
Operator is an individual? No
Operator Name CHATTEM INC
Operator Same as Owner? Yes
Operator Is Doing Business As --
Operator Address Same as Owner? Yes
Operator Street Address --
Operator City CHATTANOOGA
Operator State TN
Operator Country USA
Operator Zip code 37409-1248
Operator Code --
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) Positioning
Second Pilot on Board Yes
Departure Point Same as Event No
Departure Airport Code MPO
Departure City Mount Pocono
Departure State PA
Departure Country USA
Departure Time 1808
Departure Time Zone EST
Destination Same as Local Flt crash at destination city
Destination Airport Code BWI
Destination City Baltimore
Destination State MD
Destination Country USA
Specific Phase of Flight --
Report sent to ICAO? --
Evacuation occurred --
Date of most recent change to record Jun 25 2012 12:57PM
User who most recently changed record broda
Since inspection or accident Time of Accident
Event Location Runway Number and Location 33R
Runway Length 5000
Runway Width 100
Sight Seeing flight No
Air Medical Flight No
Medical Flight --