CHI01FA043

NTSB accident investigation · Piper PA-28R-180 · Danville, IL · November 27, 2000

Accident · FatalField investigationFinal report
Date
November 27, 2000, 16:50 local (22:50 UTC)
Place
Danville, IL
Injuries
4 fatal
Damage
Destroyed
Phase of flight
Approach
Aircraft
N4541JPiper PA-28R-180
Weather
Instrument (IMC) · Dusk
Status
Completed · report January 2, 2002
Report
Approved by Office Director
FAA report
20001127043099A
Case key
50686

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

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Probable cause

The pilot's failure to maintain altitude/clearance during the instrument approach. Factors were the low ceilings, the pilot's failure to maintain proper alignment and glidepath during the approach, his lack of recent instrument experience, and his failure to perform the missed approach.

Sequence of events

NTSB’s coding before 2008: each occurrence and phase of flight, and the causes and factors under it. The codes are defined in NTSB’s coding manual.

In flight collision with terrain/waterApproach
Weather condition - low ceilingFactor
Proper glidepath - not maintainedPilot in commandFactor
Lack of recent instrument timePilot in commandFactor
Missed approach - not performedPilot in commandFactor
Proper alignment - not maintainedPilot in commandFactor
Altitude/clearance - not maintainedPilot in commandCause

Analysis

The airplane was destroyed when it impacted the ground about 6 miles from the airport while on an ILS approach. The pilot was instrument rated. No logbook entry was found to indicate that the holding procedures requirements listed in FAR 61.57 (c) were performed. In addition, the pilot had only logged 1.3 hours of simulated instrument flight time and 0.9 hours of actual instrument flight time in the previous 6 months. No preexisting anomalies were found with respect to the accident airplane. Reported weather at the time of the accident was 500 foot overcast with 5 miles of visibility. Radar data along with voice transcripts show that the aircraft was given a right turn to a 180-degree heading to intercept the ILS 21 approach. The data shows that the aircraft turned left prior to intercepting the localizer course, and then proceeded through the localizer course before commencing a right turn to intercept the 209-degree approach bearing. The data indicates that when the aircraft was about 9.6 nautical miles from the localizer antenna, it was about 0.7 miles left of the localizer course. The aircraft altitude returns from the radar data indicate that the aircraft remained below the 3-degree glide slope path during the approach. The last radar return shows that the aircraft was about 400-feet below the standard 3-degree glide slope. The aircraft wreckage was located about 0.3 nautical miles and 196 degrees from the ILS outer marker antenna

Factual narrative

History of flight

On November 27, 2000, at about 1650 central standard time (cst), a Piper PA-28R-180, N4541J, piloted by a private pilot, was destroyed on impact with terrain about 6 nautical miles and 030 degrees magnetic from the Vermillion County Airport (DNV), Danville, Illinois. The aircraft had been cleared for the ILS approach to runway 21 at DNV. The 14 CFR Part 91 personal flight was on an instrument flight rules flight plan and was operating in instrument meteorological conditions. The pilot and three passengers received fatal injuries. The flight originated from the Maury County Airport, Mount Pleasant, Tennessee at about 1400 cst.

Personnel information

The pilot was the holder of a private pilot certificate with single engine land and instrument airplane ratings. He was also the holder of a second-class aviation medical certificate issued on December 28, 1998.

According to the pilot's logbook, he had accumulated the following flight times as of the last entry dated November 19, 2000:

Total Time 499.8 Pilot in Command 440.6 Single-Engine Land 499.8 Night 68.2 Actual Instrument 40.3 Simulated Instrument 71.3

The logbook indicates that the pilot accumulated 1.3 hours simulated instrument flight time and 0.9 hours of actual instrument flight time within the 6 months preceding the accident. The logbook entry dated November 11, 2000 indicates that the pilot accumulated 1.0 hours simulated instrument flight time with a safety pilot, 1.4 hours total flight time, 3 landings, and 6 instrument approaches. No logbook entry was found to indicate that the holding procedures requirements listed in FAR 61.57 (c) were performed. The flight dated November 11, 2000 was performed in the accident airplane.

FAR 61.57 (c) states: 61.57 (c) Instrument experience. Except as provided in paragraph (e) of this section, no person may act as pilot in command under IFR or in weather conditions less than the minimums prescribed for VFR, unless within the preceding 6 calendar months, that person has: (1) For the purpose of obtaining instrument experience in an aircraft (other than a glider), performed and logged under actual or simulated instrument conditions, either in flight in the appropriate category of aircraft for the instrument privileges sought or in a flight simulator or flight training device that is representative of the aircraft category for the instrument privileges sought - (i) At least six instrument approaches; (ii) Holding procedures; and (iii) Intercepting and tracking courses through the use of navigation systems.

A written endorsement within the pilot logbook indicates that the pilot completed the flight review requirements of FAR 61.56 on October 09, 1999.

A review of FAA records shows that the pilot received two disapprovals prior to the issuance of his private pilot certificate on August 03, 1995. The records also show that the pilot received 3 disapprovals prior to the issuance of his instrument rating on June 16, 1997.

The first disapproval notice for the instrument rating, dated March 06, 1997, indicated the following items for reexamination:

Preflight preparation - Cross-country flight planning

The second disapproval notice for the instrument rating, dated April 04, 1997, indicated the following items for reexamination:

Flight by reference to instruments - Steep turns Flight by reference to instruments - Recovery from unusual flight attitudes Instrument approach procedures - Precision ILS instrument approach Instrument approach procedures - Missed approach

The third disapproval notice for the instrument rating, dated May 13, 1997, indicated the following items for reexamination:

Flight by reference to instruments - Change of airspeed Flight by reference to instruments - Constant airspeed climbs and descents Flight by reference to instruments - Rate climbs and descents Flight by reference to instruments - Steep turns Instrument approach procedures - Precision ILS instrument approach Instrument approach procedures - Missed approach

Aircraft information

The airplane was a Piper PA-28R-180, serial number 28R-30400. A Lycoming IO-360-B1E engine that produced 180 horsepower powered it. The aircraft logbooks indicate that the last annual inspection was performed on January 22, 2000. At the time of the accident, the airframe had accumulated 8,363.9 hours time in service. The engine had accumulated 328.5 hours time in service since it's last major overhaul on December 18, 1996. The airframe logbook indicates that the most recent altimeter, static and transponder inspection, as required by FAR 91.411, was performed on September 05, 1998.

FAR 91.411 states: 91.411 Altimeter system and altitude reporting equipment tests and inspections. (a) No person may operate an airplane, or helicopter, in controlled airspace under IFR unless - (1) Within the preceding 24 calendar months, each static pressure system, each altimeter instrument, and each automatic pressure altitude reporting system has been tested and inspected and found to comply with appendix E of part 43 of this chapter

Meteorological information

The weather reporting station located at DNV recorded the following:

Time 2245 UTC (1645 cst) Wind direction 240 degrees magnetic Wind speed 8 knots Visibility 5 statute miles Ceiling 500 feet, overcast Temperature 29 degree Fahrenheit Dewpoint 29 degree Fahrenheit Altimeter setting 29.98 inches of mercury

Communications

The aircraft was in communication with the Champaign, Illinois, Air Traffic Control Tower, East Radar position (ER). The following excerpts are from transcripts of the recorded conversations between ER and N4541J. All times listed below are UTC. The full transcripts are appended to this report.

2223:59 N4541J five four juliet with you at four

2224:01 ER november four one juliet champaign approach altimeter two niner niner five

2224:05 N4541J altimeter two niner niner five

2234:57 ER november four one juliet fly heading three six zer zero vector i l s two one approach

2235:05 N4541J three six zero

2235:08 ER november four one juliet affirmative three six zero for the heading

2235:11 N4541J roger three six zero for four one juliet

2235:41 ER november four one juliet descend and maintain three thousand

2235:45 N4541J roger four one juliet descend and maintain three thousand

2236:09 ER arrow four five four one juliet advise you have danville weather

2236:16 N4541J four one juliet has the danville weather

2236:21 ER november four one juliet thank you

2236:51 ER November four one juliet turn right heading zero correction turn right heading one zero zero

2236:57 N4541J repeat one zero zero four one juliet

2238:21 ER arrow four one juliet eight miles form julip turn right heading one eight zero maintain three thousand till established on the localizer cleared i l s runway two (unintelligible) two one approach

2238:36 ER arrow four one juliet eight miles form julip fly heading one eight zero maintain three thousand till established on the localizer cleared i l s runway two --- runway two one approach

2238:54 ER arrow four one juliet champaign approach

2239:35 ER arrow four one juliet if you hear this transmission ident

2240:10 ER arrow four one juliet report cancelling your i f r on the ground through one two one point seven change to advisory approved if you understand this transmission ident

2241:24 ER arrow four one juliet if you sh

Aircraft

Registration
N4541J
Reported as
Piper PA-28R-180
Category
Airplane
Serial number
28R-30400
Airframe hours
8,364
Engine
Lycoming IO-360-B1E, 180 horsepower, reciprocating
Damage
Destroyed
Flight
Personal · Part 91
Registered owner
Dennis M. Kriewaldt
Airworthiness certificate
Standard, Normal
Last inspection
Annual · January 22, 2000 · 85 hours before
Departed
MRC · Mount Pleasant, TN
Destination
DNV
Flight plan
IFR
Airport
DNV · Vermillion County Airport, runway 21, 5,399 × 100 ft, asphalt

Matched to the registry by N-number and the event date; the registry’s history has gaps, so older matches can be wrong. Compare the reported make and model.

Flight crew

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
50
Certificate
Private
Airplane ratings
Single-engine land
Instrument ratings
Airplane
Medical
Class 2, Valid Medical--w/ waivers/lim
Seat
Left
Toxicology
Performed
Flight hours
500 total · 405 in this make and model · 441 as pilot in command · 16 in the last 90 days · 9 in the last 30 days

Weather

Conditions
Instrument (IMC) · Dusk
Wind
240° at 8 knots
Visibility
5 statute miles
Lowest ceiling
500 ft overcast
Temperature
84 °F, dew point 84 °F
Altimeter
29.00 inHg
Observed at
DNV, 6 nm away

FAA reports on this event · 1

The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.