CHI02FA200

NTSB accident investigation · Piper PA-20 · Oshkosh, WI · July 21, 2002

Accident · No injuriesField investigationFinal report
Date
July 21, 2002, 15:20 local (20:20 UTC)
Place
Oshkosh, WI
Injuries
2 uninjured
Damage
Substantial damage
Phase of flight
Landing
Aircraft
N1592APiper PA-20
Weather
Visual (VMC) · Day
Status
Completed · report April 18, 2003
Report
Approved by Office Director
Parties
FAA, Milwaukee, WI FSDO
FAA report
20020721038009A
Case key
55284

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

On this page

Probable cause

Inadequate visual lookout by both the accident pilot and the pilot of the other airplane. An additional cause is the arrival procedure used which resulted in a congested traffic pattern and the subsequent inadequate visual separation of the airplanes. Factors associated with the accident are the gusty crosswind, the pilot of the other aircraft landed longer than ATC expected, and the stall/spin encountered during the pilot's attempted remedial action.

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.

Near collision between aircraftLanding
Visual lookout - inadequatePilot in commandCause
Visual lookout - inadequatePilot of other aircraftCause
Proper touchdown point - exceededPilot of other aircraftFactor
Traffic pattern procedure - congestedCause
Visual separation - inadequateFaa(other/organization)Cause
Abrupt maneuverLanding - flare/touchdown
Remedial action - attemptedPilot in command
Loss of control - in flightLanding
Weather condition - crosswindFactor
Weather condition - gustsFactor
Stall/spin - encounteredFactor
In flight collision with terrain/waterDescent - uncontrolled

Analysis

The PA-20 collided with the runway following an abrupt maneuver to avoid another airplane. The accident occurred during EAA AirVenture 2002, at Oshkosh, Wisconsin. The PA-20 pilot was cleared to land on the "orange dot" (1,500 from the threshold) on runway 27. A Cessna 172 was cleared to land on the numbers of runway 27. The PA-20 pilot reported that during his landing flare, he saw the Cessna 172 underneath his airplane. He pulled up and to the right to avoid a collision with the other Cessna 172. He stated he added full throttle and leveled the nose, but a strong wind from the left rolled the airplane to the left and "without enough airspeed for effective aileron" he could not reverse the roll. The airplane stalled and spun into the runway from an altitude of about 120 feet. The pilot of the Cessna 172 reported that there was a fairly strong left crosswind and that his airplane floated a little on the runway before touching down. Neither pilot reported seeing the other. The Cessna 172 pilot reported that he was unaware that an accident had occurred. Winds at the time of the accident were from 230 degrees at 12 knots gusting to 22 knots. As announced on the airport terminal information service (ATIS), the VFR Oshkosh Arrival, Yellow Flow procedures were in effect at the time of the accident. The Yellow Flow instructs pilots to join the other traffic over over a VFR checkpoint. The traffic then travels around the northwest side of the airport, entering a right base leg for either runway 18L or 18R. In addition to landing VFR traffic on runway 18L and 18R, air traffic control (ATC) was landing VFR traffic on runway 27. This was accomplished by having the VFR traffic extend their base leg for the 18 runways, putting them on a right downwind for runway 27. The VFR landings on runway 27 were not outlined as part of the Yellow Flow procedures. The only landings on runway 27 that are a part of the procedure were IFR arrivals approaching the airport from the east and warbirds who were to approach the airport from the southeast. Neither airplane was issued go-around procedures from ATC. The PA-20 pilot reported that his passenger recalled hearing an ATC transmission about an airplane underneath them, but by this time he had already pulled up and it was too late.

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Factual narrative

On July 21, 2002, at 1520 central daylight time, a Piper PA-20, N1592A, collided with the runway following an abrupt maneuver and loss of control while avoiding another airplane during a landing on runway 27 (6,178 feet by 150 feet, dry asphalt) at Wittman Regional Airport (OSH), Oshkosh, Wisconsin. The private pilot and a passenger on board were not injured. The airplane was substantially damaged. The Title 14 CFR Part 91 flight was operating in visual meteorological conditions and a visual flight rules flight plan had been filed.

The purpose of the flight was for the pilot to attend Experimental Aircraft Association (EAA) AirVenture 2002, Oshkosh, Wisconsin. The pilot reported the last stop on the cross-country flight was at Mount Pleasant, Michigan. He reported that they departed there about 1315 for OSH. He reported he entered the OSH traffic at Rippon where he was identified as the "high wing tail dragger." He was instructed to follow a Bonanza along the tracks to Fisk. At Fisk, he was instructed to change to the tower frequency and to follow the Bonanza for a landing on runway 27.

The pilot stated he flew the approach at 1,800 feet mean sea level at an airspeed of 90 knots. The pilot reported that while on final approach, he had to "roll hard left" to avoid a twin-engine airplane that was landing on runway 18. The pilot reported he was cleared to land on the "orange dot" on runway 27. He stated, "I was preparing to land on orange dot with full flaps, throttle back when an all metal tricycle geared plane possibly a 172 Cessna appeared directly under my nose." The pilot reported that he pulled up and to the right to avoid a collision with the other airplane. He added full throttle and leveled the nose, but a strong wind from the left rolled the airplane to the left and "without enough airspeed for effective aileron" he could not reverse the roll. The pilot reported the airplane stalled and spun into the runway from an altitude of about 120 feet above the runway.

The pilot reported that the airplane that appeared under him was already on the runway, and that he did not hear any radio calls regarding this airplane. He was on the tower frequency of 118.5. The pilot reported that his passenger later stated that he recalled a radio transmission about an airplane being underneath them, but by that time he already had pulled up and it was too late. He stated that it was his impression that this airplane that appeared underneath him had landed on the numbers.

Weather conditions reported at OSH, 27 minutes prior to the accident, consisted of clear skies with the winds from 230 degrees at 12 knots gusting to 22 knots.

A transcript of the OSH Air Traffic Controller Tower communications is attached to this report. It should be noted that during EAA AirVenture VFR aircraft are not identified by N-number. They are identified by make and model, color, wing configuration, or any combination thereof. IFR aircraft are identified by N-number or a portion thereof. The color of N1592A is a yellowish cream with dark blue strips. The controller who was responsible for working runway 27 at the time of the accident was designated as the south local controller (SLC). The transcript states in part:

At 1515:33 SLC cessna one sierra papa you're following a twin cessna

runway runway two seven cleared to land on the ah green

dot.

At 1515:38 N1SP cleared to land green dot we're following we're looking one sierra

papa.

At 1516:03 SLC november one sierra papa you're going to be following a cherokee

ah just turning base ah just around the terminal building at this time.

At 1516:10 N1SP following the cherokee one sierra papa.

At 1517:16 SLC aircraft on the the cessna on a two mile final ah traffic off your

right side we're not talking to him.

At 1517:22 SLC vee tail to the (unintelligible) ah to the numbers to the numbers

runway two seven cleared to land.

At 1517:28 N1SP cleared to land one sierra papa

At 1517:43 SLC cessna on final cessna one sierra papa your cleared to land on the

numbers runway two seven.

At 1517:47 N1SP on the numbers two seven one sierra papa

At 1517:49 SLC and be ah be advised you do have traffic coming in off your right

we're not talking to him

At 1517:56 SLC yellow and black tail on the base follow the cessna mile and a half

final rock your wings

At 1518:04 SLC all aircraft landing two seven exit ah into the grass the left side as

soon as feasible.

At 2018:12 SLC red and white low wing on the right base ah enter a mile and a half

final and rock you're wings

At 2018:19 SLC ok cessna you're following traffic on ah on about a half mile final

additional traffic is a black tail dragger off your right side we're

not talking to him

At 2018:27 Cessna roger

At 2018:28 SLC the black ah tail dragger on final for two seven rock your wings

At 2018:33 SLC vee tail keep it going keep it going down to the green dot you're

cleared to land on the green dot

At 2018:37 SLC vee tail bonanza on two seven keep it up and go down to the green

dot cleared to land

At 2018:43 SLC one sierra papa do you have the tail dragger off your right side

ahead and to your right

At 2018:48 SLC one sierra papa do you have the tail dragger ahead and to your

right

At 2018:51 N1SP one sierra papa has the tail dragger

At 2018:53 SLC ok we're not talking to him and follow him if he lands two seven

you're cleared to land on the numbers the ah black tail dragger

we're not talking to I've got three other aircraft inbound to two seven

At 2019:07 SLC the ah high wing cessna on a right base your following a cessna

low a cessna low on runway two seven

At 2019:17 SLC twin cessna you're cleared to land on the numbers runway two

seven

At 2019:20 SLC tail dragger if you're listening land on the orange dot you've got

traffic landing on the numbers two seven underneath you

At 2019:49 SLC cessna on the ah cessna one sierra papa exit immediately to the

left if feasible

At 2019:54 N1SP one sierra papa

At 2019:55 SLC thank you

At 2019:56 SLC the tail dragger you're ah

At 2020:01 SLC twin Cessna go around

Airport information

Runways 09/27 and 18/36 are the main runways used at the OSH during AirVenture. In addition to these runways, taxiway Alpha that parallels runway 36 is also used for takeoffs and landings. This surface is designated as runway 18L/36R. The permanent runway 18/36 is designated as runway 18R/36L.

The Federal Aviation Administration (FAA) institutes special air traffic control procedures for the AirVenture fly-ins. These procedures are published in a notice to airmen (NOTAM). The NOTAM states in part:

Enter transition over Ripon. Maintain 90 knots (or maximum cruise speed if below 90

knots) and 1,800 MSL. If unable, maintain 135 knots and 2,300 MSL.

Proceed single file over the railroad tracks toward FISK (FISK can be identified by

railroad track/road intersection and white strobe lights.) Fly over the railroad tracks;

do not fly over the strobe lights.

Listen for controller instructions as you approach FISK. Controller will use color and type

of aircraft at FISK. Pilots should vigorously rock wings to acknowledge ATC instructions

and refrain from verbal responses unless requested.

Controller will advise your assigned runway and when to monitor Oshkosh Tower

on 118.5 or 126.6.

As announced on the airport terminal information service (ATIS), the VFR Oshkosh Arrival, Yellow Flow procedures were in effect at the time of the accident. These procedures show VFR traffic arriving from the west over FISK. The traffi

Aircraft

Registration
N1592A
Reported as
Piper PA-20
Category
Airplane
Serial number
20-829
Airframe hours
2,258
Engine
Lycoming O-290-D2, 135 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Registered owner
Bruce M. Clark
Airworthiness certificate
Standard, Normal
Last inspection
Annual · October 18, 2001 · 100 hours before
Departed
MOP · Mount Pleasant, MI
Destination
OSH · Oshkosh, WI
Flight plan
VFR
Airport
OSH · Oshkosh, runway 27, 6,178 × 150 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
73
Injuries
None
Certificate
Private
Airplane ratings
Single-engine land
Medical
Class 3, Valid Medical--w/ waivers/lim
Last flight review
September 16, 2000
Seat
Left
Flight hours
3,800 total · 300 in this make and model

Weather

Conditions
Visual (VMC) · Day
Wind
230° at 12 knots, gusting 22
Visibility
10 statute miles
Lowest ceiling
None
Temperature
95 °F, dew point 91 °F
Altimeter
29.80 inHg
Observed at
OSH

Docket · 6

The files NTSB released with the investigation on February 27, 2003, on NTSB’s docket system: statements, records, photos and specialists’ reports. 2.1 MB in all.

FAA reports on this event · 1

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

Other investigations on N1592A · 1

Matched to the same aircraft by N-number and date.