We now know what happened in a July, 2010 plane crash that killed a beloved Gatineau teacher and injured two Ottawa men.  The investigation report from the Transportation Safety Board of Canada outlines a series of massive problems that caused the float plane to crash shortly after takeoff.

Perhaps the biggest issue was that the plane was overloaded by more than one thousand pounds, with a canoe it wasn't supposed to be carrying and baggage that wasn't even tied down.

A photo, taken by investigators with the Safety Board tells the terrifying story on board the de Havilland Beaver float plane on July 24, 2010.

Gatineau teacher Michael Robinson and three friends were on the plane, on their way to a canoe trip to l’eau Claire Lake, Quebec, about 190 nautical miles north of the Grande-Riviere Airport.  It crashed shortly after taking off from the airport, breaking into three pieces.

Robinson and the pilot, Glen Arsenault, died in the crash. Noel Alfonso and Bernard Walke, both from Ottawa, and Bernard's twin brother Greg barely survived.

The Transportation Safety Board report says the plane was more than one thousand pounds overweight, with a canoe strapped to the float.  The pilot couldn't gain altitude.  At the end of the runway, 50 feet above ground, it pitched up, banked left then crashed straight down into a swamp.

Baggage wasn't tied down. It shifted during the crash, along with four containers of fuel that had been stowed behind the rear seat passengers.  All that weight broke the rear seat and threw the 3 survivors forward. Those three men lived mostly because of two airport workers, who waded into the swamp.  They pulled one man to safety, and then held the heads of the twin brothers above water until more help arrived.

In its report, the Transportation Safety Board notes that Transport Canada had investigated the aircraft's operator, Nordair Quebec 2000 Inc., several times in the past for similar problems. The audits, over a period of seven years, revealed 20 cases of operations non-conformance, 16 cases of maintenance non-conformance and 38 cases of non-conformance with respect to aircraft condition.  There were problems with personnel training and four instances where baggage wasn’t tied down.  The report says “each time, a corrective action plan was submitted to TC (Transport Canada) and each time, the plans were approved.  Nevertheless, subsequent inspections revealed that similar anomalies were recurring.

The company was even fined three times.  Still, these problems persisted.

In a telephone interview from Dorval, the lead investigator for the Transportation Safety Board, Denis Deroy, said “As an investigator, once we looked at that, it shouldn't happen for many years and many times.  It shouldn't happen so it's up to Transport Canada to react as the legislator because they're the ones who give them permission to operate.”  Deroy added, “It’s a fact for us that in this company it happened many times and nothing changed until, unfortunately, the accident happened and it cost the lives of two people.”

Transport Canada issued a notice of cancellation to Nordair Quebec 2000 Inc. on January 27, 2011, based on “public interest and the company’s operation history.”

“Transport Canada does not hesitate to take immediate action,” wrote Karine Martel, Media Relations Advisor for Transport Canada in an email, “including shutting down a company’s operation, in cases where there is sufficient evidence that an immediate threat to safety exists.”

Robinson, who taught math and coached soccer at Philemon Wright, was 40 years old. He left behind a wife and 4 year old son. The survivors of the crash wouldn't talk on the advice of their lawyers.