Melbourne International Airport
Aircraft Accident/Incident Report

Melbourne, Florida 32935
Wednesday, February 29, 2012 17:01 EST

NTSB Narrative Summary Released at Completion of Accident

Several airplanes and a helicopter were in the traffic pattern at the tower-controlled airport performing simultaneous operations to parallel runways (9L and 9R) around the time of the accident. The accident pilot contacted the tower air traffic controller while south of the airport requesting a full-stop landing; the controller advised the pilot to report when the airplane entered the downwind leg of the traffic pattern. The controller subsequently cleared the accident airplane to land and expected the pilot complete a "normal" downwind traffic pattern and land behind the airplane already established on final approach for runway 9R; however, the controller did not provide sequencing instructions. The accident airplane proceeded directly to a tight right-base entry into the traffic pattern for landing on runway 9R, contrary to the controller’s original expectation but permissible based on the clearance to land. The controller radioed the accident pilot to confirm that he had visual contact with the airplane on a 1-mile final approach for runway 9R (the traffic was 300 feet below and 1 mile west). This was the first indication by the controller to the accident pilot that there was additional landing traffic sequenced to the same runway he had been cleared to land on. The accident pilot replied that he was on a "real short base" for runway 9R, and the controller responded, "no sir, I needed you to extend to follow the [airplane] out there on a mile final, cut it in tight now, cut it in tight for nine right." The two airplanes had closed within 1/2 mile of each other, but were still separated by 300 feet altitude. The pilot of the airplane on short final for 9R maintained situational awareness throughout, perceived the conflict before the controller or the accident pilot, and responded calmly and benignly to the conflict. The accident pilot needed only to arrest his descent, at a minimum, to avoid any collision. A flight instructor and an airline pilot both described seeing the accident airplane pitch up, bank left, then roll inverted. The flight instructor stated that this action occurred as the controller was "yelling at" the pilot. Both witnesses described what they saw as "an accelerated stall." Data extracted from the multifunction and primary flight displays revealed that the airplane pitched up and rolled inverted to the left at the same time that engine power was increased rapidly. When engine power is increased, a pilot must apply sufficient right rudder to counteract the left-rolling tendency, particularly if the airspeed is slow and the angle of attack is high, as it would be during landing. When instructed by the controller to "cut it in tight," the accident pilot over-controlled the airplane, lost control, and impacted terrain. Contributing to the traffic conflict was the controller’s lack of upfront sequencing instructions or subsequent sequencing instructions when the accident aircraft was cleared to land. Examination of the data and a postaccident examination of the wreckage revealed no preimpact mechanical anomalies that would have precluded normal operation.

NTSB Probable Cause Narrative

The pilot's abrupt maneuver in response to a perceived traffic conflict, which resulted in an accelerated stall and a loss of airplane control at low altitude. Contributing to the accident was the air traffic controller's incomplete instructions, which resulted in improper sequencing of traffic landing on the same runway.

Event Information

Type of Event Accident
Event Date 2/29/2012
Event Day of the Week Wednesday
Time of Event 1701
Event Time Zone Eastern Standard Time
Event City Melbourne
Event State FLORIDA
Event Country --
Zipcode of the event site 32935
Event Date Year 2012
Event Date Month 2
MidAir Collision Indicator No
On Ground Collision occurred ? No
Event Location Latitude 280534N
Event Location Longitude 0803935W
Event Location Airport Melbourne International
Event Location Nearest Airport ID MLB
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 33
Weather Briefing Completeness --
Investigator's weather source Weather Observation Facility
Time of the weather observation 1653 Eastern Standard Time
Direction of event from weather observation facility (degrees) 270
Weather Observation Facility ID MLB
Elevation of weather observation facility 33
Distance of event from weather observation facility (units?) 1
Time Zone of the weather observation EST
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) 24
Dew Point at event time (in degress fahrenheit) 20
Wind Direction (degrees magnetic) 130
Variable Wind Indicator Wind direction could be determined
Wind Speed (knots) 13
Wind Velocity Indicator --
Wind Gust Indicator Gusting
Wind Gust (knots) 18
Altimeter Setting at event time (in. Hg) 30.11
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 3
Injury Total Minor --
Injury Total None --
Injury Total Serious --
Injury Total All 3
Investigating Agency NTSB
NTSB Docket Number (internal use) 30774
NTSB Notification Source FAA Southern C-ROC
NTSB Notification Date --
NTSB Notification Time --
Fiche Number and/or location -used to find docket information --
Date of most recent change to record Nov 27 2012 1:16PM
User who most recently changed record kenj
Basic weather conditions Visual Meteorological Cond
FAA District Office --

Aircraft Involved

Aircraft #1

Aircraft Registration Number N544SR
NTSB Number ERA12FA196
Missing Aircraft Indicator --
Federal Aviation Reg. Part Part 91: General Aviation
Type of Flight Plan filed None
Flight plan Was Activated? No
Damage Substantial
Aircraft Fire None
Aircraft Explosion None
Aircraft Manufacturer's Full Name CIRRUS DESIGN CORP
Aircraft Model SR22
Aircraft Series Identifier --
Aircraft Serial Number 2559
Certified Max Gross Weight 3400
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 4
Number of Engines 1
Fixed gear or retractable gear Fixed
Aircraft, Type of Last Inspection Annual
Date of Last Inspection Aug 30 2011 12:00AM
Airframe hours since last inspection --
Airframe Hours 1250
ELT Installed Yes
ELT Activated Yes
ELT Aided Location of Event Site No
ELT Type Unknown
Aircraft Owner Name THOMAS VERNON E
Aircraft Owner Street Address --
Aircraft Owner City SATELLITE BCH
Aircraft Owner State FL
Aircraft Owner Country USA
Aircraft Owner Zipcode 32937-4714
Operator is an individual? No
Operator Name THOMAS VERNON E
Operator Same as Owner? Yes
Operator Is Doing Business As --
Operator Address Same as Owner? Yes
Operator Street Address --
Operator City SATELLITE BCH
Operator State FL
Operator Country USA
Operator Zip code 32937-4714
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) Personal
Second Pilot on Board No
Departure Point Same as Event No
Departure Airport Code X59
Departure City Valkaria
Departure State FL
Departure Country USA
Departure Time 1655
Departure Time Zone EST
Destination Same as Local Flt dest & departure same, accident can occur anywhere
Destination Airport Code MLB
Destination City Melbourne
Destination State FL
Destination Country USA
Specific Phase of Flight --
Report sent to ICAO? --
Evacuation occurred --
Date of most recent change to record Nov 27 2012 1:16PM
User who most recently changed record kenj
Since inspection or accident Last Inspection
Event Location Runway Number and Location 09R
Runway Length 10181
Runway Width 150
Sight Seeing flight No
Air Medical Flight No
Medical Flight --