What happened
On November 24, 1995, at approximately 08:45 PM, a Cessna 210 N, registration PT-OLD, departed from runway 12 at Campo de Marte Aerodrome (SBMT) bound for Sorocaba. The aircraft was carrying six occupants. During the takeoff roll, witnesses reported hearing engine explosions and irregular noises. Although the aircraft required only 530 meters to lift off, it utilized approximately 1,000 meters of the runway.
Immediately after liftoff, the pilot began retracting the landing gear. During this process, the aircraft's performance was compromised, causing it to sink and resulting in the propeller blades striking the runway. Following the impact, the aircraft entered an extreme pitch-up attitude and began a descending right-hand turn. The aircraft subsequently struck a low-voltage utility pole, which caused wires to entangle the propeller hub. The aircraft then struck the ground and collided with two vehicles on a nearby avenue, resulting in a post-crash fire that completely destroyed the aircraft.
The investigation
The CENIPA investigation focused on the engine's performance and the pilot's pre-flight procedures. Laboratory tests conducted on the fuel revealed the presence of water within the fuel system. Investigators also examined the pilot's decision-making regarding the extended takeoff roll and the retraction of the landing gear. The investigation noted that while the aircraft's maintenance and the pilot's certifications were valid, the pilot had failed to drain the ventral fuel reservoir during the pre-flight inspection. Additionally, the investigation highlighted that the airport's firefighting unit lacked adequate personal protective equipment and sufficient water capacity to effectively combat the resulting fire.
Findings
- Water in the fuel system caused engine malfunctions and audible explosions during the takeoff roll.
- The pilot failed to drain the ventral fuel drain, allowing water to remain in the system.
- Deficient judgment was a contributing factor, as the pilot failed to abort the takeoff despite the engine's irregular operation and the significantly increased takeoff distance.
- Deficient emergency planning contributed to the inability to manage the takeoff failure.
- The aircraft's weight and center of gravity were within safe operating limits.