DEN93FA043

NTSB accident investigation · Piper PA-28-181 · Elbert, CO · April 17, 1993

Accident · FatalField investigationFinal report
Date
April 16, 1993, 21:00 local (Apr 17, 1993, 03:00 UTC)
Place
Elbert, CO
Injuries
2 fatal
Damage
Destroyed
Phase of flight
Enroute
Aircraft
N38481Piper PA-28-181
Weather
Instrument (IMC) · Night/dark
Status
Completed · report June 17, 1994
Report
Approved by Office Director
FAA report
19930416009569A
Case key
11074

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 inadvertent VFR flight into IMC. Factors were his lack of instrument training/experience, existing weather, and dark night conditions.

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 encounter with weatherCruise - normal
Light condition - dark nightFactor
Weather condition - obscurationFactor
Weather condition - rainFactor
Weather condition - snowFactor
Vfr flight into imc - inadvertentPilot in commandCause
Lack of total instrument timePilot in commandFactor
Loss of control - in flightCruise - normal
In flight collision with terrain/waterDescent - uncontrolled
Terrain condition - mountainous/hilly

Analysis

While on a cross country flight in dark night conditions, the non instrument rated pilot inadvertently encountered instrument meteorological conditions while in cruise flight. The aircraft collided with the ground on a heading opposite the intended direction of travel. Although VMC prevailed at the destination airport 28 miles south of the site, local residents reported reduced visibility with rain and snow showers in the vicinity.

Factual narrative

History of flight

On Friday, April 16, 1993, at approximately 2100 mountain daylight time, (all times are adjusted to mountain daylight time unless otherwise noted), a Piper PA-28-181, N38481,

impacted the ground approximately five miles east of Elbert, Colorado. The private, non instrument rated pilot and passenger received fatal injuries and the aircraft was destroyed. Instrument meteorological conditions prevailed at the

accident site and no flight plan was filed for this personal cross country flight to Colorado Springs, Colorado, which originated from Waterloo, Iowa.

On April 15, 1993, at 2137, the pilot of N38481, received an outlook briefing from Fort Dodge, Iowa, Automated Flight Service Station (AFSS) for a flight from Waterloo, Iowa, (ALO),to Grand Island, Nebraska, (GRI), direct to Colorado Springs,(COS). On April 16th, at 0909, the same person received a full brief for the flight. On the same date, at 1127, an updated briefing was given.

At 1636 on April 16, the pilot of N38481 called Columbus, Nebraska, AFSS by telephone, and obtained a pre flight brief for a VFR flight from GRI to COS.

According to the attached fueling order, N38481, stopped for fuel at Central Nebraska Regional Airport, Grand Island, Nebraska, where 29.4 gallons of 100LL aviation grade fuel was purchased. The time stamp on the fuel ticket was 1743. According to persons at the fueling facility, the aircraft departed 10 to 15 minutes after fueling was completed.

At 1812, N38481 made initial contact with Minneapolis, Minnesota, Air Route Traffic Control Center, (ARTCC), and requested VFR flight following to Colorado Springs, at 6,500 feet above mean sea level, (msl). The controller issued the aircraft a discreet transponder beacon code of 2625, and at 1818 Denver ARTCC accepted handoff of N38481 from Minneapolis.

At 1940, N38481 was issued a frequency change to another Denver ARTCC transmitter. The pilot reported on the new frequency and was given the Goodland, Kansas, altimeter setting. During this interchange, the pilot of N38481 reported a "little bit choppy ride and a little precipitation." This interchange was followed by Denver ARTCC advising N38481 that there were no current weather reports between the aircraft's position and Colorado Springs.

At 1951, Denver ARTCC advised N38481 of poor radar coverage for a portion of the flight. Denver ARTCC terminated radar coverage and suggested contact with Denver ARTCC on frequency 134.92 in the vicinity of Hugo, Colorado.

At 2031, N38481 reported on Denver ARTCC frequency VFR, three miles west of Limon, Colorado, at 8,000 feet msl. Denver ARTCC issued the Limon altimeter and advised the aircraft that it would be a little longer before radar contact could be established.

No evidence of further radio contact between N38481 and any facility was found.

Personnel information

According to the pilot's log and license, he received his student pilot certificate on February 6, 1989, and his private pilot certificate on April 14, 1989. According to a "shared time" log found in the aircraft, this pilot last flew the aircraft, prior to the accident flight, on January 1, 1993, for 3.1 hours on a flight from Waterloo, Iowa, to Saint Louis, Missouri, and return.

Meteorological information

Four observations by the Colorado Springs Automated Weather Observation System (AWOS) are detailed below.

1858 - ceiling clear below 12,000 feet, visibility greater than 10 miles, temperature 37 degrees Fahrenheit, dew point 31 degrees Fahrenheit, wind 360 degrees at 6 knots, altimeter 30.04.

1956 - Measured clouds at 7,000 feet broken and 9,000 feet overcast, visibility 10 miles plus, temperature 47, dew point 34, wind 360 degrees at 9 knots, altimeter 29.93.

2056 - Measured clouds at 3,400 feet broken and 4,900 feet overcast, visibility 10 miles in rain, temperature 41, dew point 35, wind 010 degrees at 9 knots with gusts to 16 knots, altimeter 30.00. Remarks - Rain began at 05 minutes past the hour and the pressure rising.

2156 - Measured clouds at 4,400 feet overcast, visibility 10 miles plus, temperature 41, dew point 34, wind 360 degrees at 9 knots, altimeter 30.03. Remarks - Rain ended at 59 past the hour.

Another aircraft accident occurred at approximately 2217, eleven miles south of this accident the same evening. A witness in the area of that accident stated that the visibility at the time was 10 to 20 feet with snow showers and fog.

The National Weather Service observations taken at 2056 were similar to the 2058 AWOS but contained the remarks, "lower clouds obscuring mountain tops southwest through northwest with VIRGA present in all quadrants."

Attached is information provided by a witness who was proceeding south on Interstate Highway 25 from Denver to Colorado Springs on the evening the accident occurred. This witness has a background in meteorology, as evidenced by his cover letter, and his observations provide information concerning weather in the accident area which is north of a east/west ridge line known as Palmer Divide. This ridge line separates the Colorado Springs area from the accident area. The observations provide evidence of rain and snow showers in the accident area.

Several local residents were interviewed during the investigation and provided observations of low clouds, reduced visibility with rain and snow showers during the evening when the accident occurred.

At 2025, Limon, Colorado, radar, which is approximately 50 miles east of the accident site, had a level four thunderstorm in progress containing snow showers.

At 2125, the Limon radar indicated a thunder storm was occurring over Limon and was moving to the northeast at 15 knots, and at 2225, the radar was showing a level four thunderstorm containing snow showers.

Communications

All known radio communications with the accident aircraft were conducted on Minneapolis Flight Watch and Denver Flight Watch radio frequencies. Communications with AFSS facilities were primarily via telephone.

Wreckage and impact information

The aircraft impacted the ground on a northerly track with initial impact on the south bank of a stream oriented east and west. (See attached wreckage diagram.) The initial impact point contained fragments of red glass and wing tip material. Approximately 15 feet along the impact track, a deep gouge was present on the downward slope of the creek bank. This impact point contained pieces of the forward portion of the engine and propeller spinner.

At a point 70 feet from the initial impact point, the pr

Aircraft

Registration
N38481
Reported as
Piper PA-28-181
Category
Airplane
Serial number
28-7790555
Airframe hours
1,801
Engine
Lycoming IO-360-B1E, 180 horsepower, reciprocating
Damage
Destroyed
Flight
Personal · Part 91
Registered owner
Educational Consultants, Inc.
Airworthiness certificate
Standard, Normal
Last inspection
Annual · May 7, 1992
Departed
GRI · Grand Island, NE
Destination
COS · Co Springs, CO

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
48
Certificate
Private
Airplane ratings
Single-engine land
Medical
Class 3, Valid Medical--w/ waivers/lim
Seat
Left
Toxicology
Performed
Flight hours
561 total · 552 in this make and model · 548 as pilot in command

Weather

Conditions
Instrument (IMC) · Night/dark
Visibility
-99 statute miles
Lowest ceiling
200 ft
Altimeter
30.00 inHg

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 N38481 · 1

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