Aviation Accident Summaries

Aviation Accident Summary LAX94FA005

KERNVILLE, CA, USA

Aircraft #1

N4018W

PIPER PA-32-300

Analysis

The recently certificated commercial pilot was attending a junior college flying team orientation session and practice safety and flight evaluation conference with two student passengers. At the completion of the event, all aircraft departed in VFR flight conditions for the same destination. Several different routes were flown by the different aircraft through the mountainous terrain. There were three canyon type routes on a more direct course toward the destination. All three had a road in the center of the canyon. On the sectional chart, the preferred canyon route with the lowest terrain was the only one shown with a road depicted. After takeoff, the accident flight followed a road and entered a canyon immediately to the north of the preferred route. The canyon gradually narrowed and eventually ended with an abrupt rise in terrain into a box canyon. The wreckage was found about 2,000 feet below the top of the surrounding terrain.

Factual Information

On October 3, 1993, about 1415 hours Pacific daylight time, a Piper PA-32-300, N4018W, collided with mountainous terrain near Kernville, California. The airplane was destroyed. The commercial pilot and the two passengers received fatal injuries. Visual meteorological conditions prevailed for the personal cross-country flight and no flight plan was filed. The flight was originating at the Kern Valley Airport, California, as a return flight to Long Beach, California, with a planned stop at La Verne, California. All three individuals were reportedly sharing the expense of the airplane. The purpose of the flight was to participate in a Mount San Antonio College Flying Team orientation session and practice safety and flight evaluation conference (SAFECON) at the Kern Valley Airport beginning the afternoon of October 1, 1993. The pilot's stated intentions on the day of the accident were to fly to La Verne to drop off his passengers and then proceed to Long Beach where the airplane had been rented by the pilot. The pilot of one of the ten airplanes participating in the conference departed behind the accident airplane. He observed the airplane climbing normally and then turn left toward the east branch of Lake Isabella. Another flying team member stated that the pilot of the accident airplane had indicated that he planned to fly toward the Mojave Desert and then southwest over the Mojave Desert to La Verne. Prior to departure, a formal preflight briefing for the return flight from Kern Valley Airport was conducted at the airport campground parking area by eight college staff members. Six of the staff members are certified flight instructors. The items briefed included weather, routing, and density altitude considerations. An interactive discussion with the students was also conducted. The discussion items were flight safety, human factors, and a general open discussion. All ten pilots of the aircraft involved in the weekend SAFECON meeting, their passengers, and the college staff members were present at the briefing. During the briefing, various routes home were discussed with the students, with consideration of the individual aircraft performance capabilities. Based on weather briefings obtained from the Riverside Flight Service Station, all flights were conducted under visual meteorological conditions. PERSONNEL INFORMATION Left Seat Pilot According to Federal Aviation Administration records, the pilot received his commercial certificate on June 29, 1993; at that time he reported a total flight time of 226 flight hours. He was rated for single-engine and multiengine land airplanes and held an advanced and instrument ground instructor certificate. According to FAA medical records, the pilot received a second- class flight physical on December 12, 1992. At that time, he reported a total flight time of 265 flight hours with 65 hours in the previous 6 months. The pilot's logbook for the period of July 15, 1988, through September 9, 1993, was obtained and reviewed. According to the last page totals, the pilot documented 351.4 hours for his total duration of flight, of which 122.4 hours were listed as synthetic trainer time. According to the pilot's logbook and records obtained from the aircraft operator, of the 229 hours, 1.1 were flown in the accident aircraft during his formal checkout on July 16 and July 22, 1993. According to the airplane operator, on July 15, 1993, the pilot had taken a written examination on the systems and operation of a Piper PA-32-260 airplane. Right Seat Occupant According to a witness, the passenger who occupied the right front seat held a student pilot certificate and had approximately 15 hours of flight time. AIRCRAFT INFORMATION The Piper PA-32-300 was manufactured as a 1966 year model. At the beginning of airframe logbook No. 2, 2,921.6 hours was listed as the total flight time with a current tachometer reading of 134 hours. During the May 5, 1993, annual inspection, the tachometer reading was recorded as 1,664.1 hours, for an approximate grand total of 4,451.7 hours. A review of the engine logbook at the time of the last annual revealed an entry stating that the time since major overhaul was 1,540.4 hours with a total time since new of 2,962.4. METEOROLOGICAL INFORMATION A weather study of the accident area was prepared by a Safety Board staff meteorologist. According to his factual report, pertinent satellite imagery and surface weather observations indicate mostly clear to scattered cloud conditions over the interior of southern California and show no clouds in the accident area at the time of the accident. Light to moderate turbulence had been reported below 10,000 feet msl by other aircraft for the proposed routes of flight from Kernville to Brackett Field. Airmet Tango advised of possible light to occasional moderate thermal turbulence below 16,000 feet over Arizona and southern California. Density altitude was calculated by the meteorologist for the accident site using estimated temperature, dew point, and a pressure at 6,500 feet. The calculated density altitude was 8,183 feet msl. WRECKAGE AND IMPACT INFORMATION On October 5, 1993, the wreckage was located by a newswatch helicopter. According to U.S. Forest Service personnel, the wreckage was located in a section of the Sequoia National Forest on the west side of the Piute Mountain Range about 1 1/2 miles southeast of Liebel Peak at an estimated elevation of 6,080 feet msl. The accident site is in a canyon known as Erskine Creek. Examination of the Los Angeles sectional aeronautical chart for the accident area revealed three similar canyon routes south from the Kernville/Lake Isabella area, two of which were paralleling the accident flight area. Only one depicted a road running from the north to the south from highway 178, or from the Lake Isabella/Kernville area to the Kelso Valley area. The Erskine Creek Road was not depicted on the chart. The Erskine Creek canyon narrows and abruptly rises in elevation near the accident site into a box canyon. The mountainous terrain around the accident site rises in excess of 8,000 feet mean sea level. On-scene examination of the wreckage revealed a path of disturbed vegetation on a measured heading of 130 degrees through an oak tree into a sheer rock wall. The wreckage was located on a ledge about twenty feet below impact signatures on the rock wall. The wall was covered with black smoke and soot deposits. There was a postcrash fire. Most of the left wing, cabin area, and center section aft midway to the empennage was consumed by postcrash fire with only steel components remaining. On-scene control continuity was not possible due to the extent of the fire and the location of the wreckage. A later examination of the airframe did establish control cable continuity from the fuselage midpoint to the entire tail group. The right wing was observed in an inaccessible area below the ledge about 100 feet below the main wreckage. The right wing, and the associated flap and aileron were not recovered. The empennage overhanging the canyon was intact with heavy tree damage signatures to all surfaces. The stabilator trim appeared to be near neutral. An empty ELT rack was observed forward of the empennage in a partially burnt section of the aft fuselage. The engine and the propeller were located in the center of the wreckage mass. Most of the engine accessories were consumed by the postcrash fire. The propeller revealed aft "S" bending with chordwise striations and leading edge damage. An examination of the engine was conducted after the wreckage was removed to a storage area. Finger compression was established on all engine cylinders except cylinder No. 2. That cylinder was removed and inspected. Examination revealed that crankcase damage was preventing the valve push tubes on the cylinder from obtaining full travel, which held the valves partially open. All spark plugs were examined and found to be within normal wear limits based on the Champion Spark Plug wear chart. Both magnetos were destroyed by the postcrash fire. The steel components of the drives were examined. The left side magneto had an impulse coupling which was intact and appeared normal. The right side magneto drive coupling was intact and appeared normal. The engine accessory section case was removed. All accessory gears were in position and appeared normal except for fire damage. Gear and valve train rotation was established from propeller rotation. The oil pump housing was removed from the accessory case. The oil pump gears appeared normal except for the fire damage. The engine oil suction screen was removed from the oil pan and found to be free from contaminants. The primary engine oil filter had previously been examined on scene. The element was fire damaged, but revealed no steel contaminates. The exhaust muffler was examined. Portions of the flame cone interior were missing or eroded away. The exhaust tail pipe was free from overboard obstructions. MEDICAL AND PATHOLOGICAL INFORMATION An autopsy was not performed on the pilot. According to the Kern County Medical Examiner, the cause of death was attributed to multiple injuries due to blunt force trauma. No suitable specimens were available for toxicological tests. ADDITIONAL INFORMATION The airframe wreckage was released to representatives of the owner after completion of system documentation. The engine was released on May 10, 1994, at the conclusion of the engine examination.

Probable Cause and Findings

the pilot's inadvertent flight into a box canyon and his failure to attain a safe altitude. A factor in the accident was the pilot's lack of familiarity with the geographic area.

 

Source: NTSB Aviation Accident Database

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