LAX04FA177

NTSB accident investigation · Piper PA-32R-301T · Ukiah, CA · April 4, 2004

Accident · FatalField investigationFinal report
Date
April 4, 2004, 08:10 local (15:10 UTC)
Place
Ukiah, CA
Injuries
1 fatal
Damage
Destroyed
Phase of flight
Initial climb
Aircraft
N4130DPiper PA-32R-301T
Weather
Instrument (IMC) · Day
Status
Completed · report December 28, 2004
Report
Approved by Office Director
Parties
Textron Lycoming, The New Piper Aircraft, Federal Aviation Administration
FAA report
20040404024729A
Case key
59004

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 non-instrument rated pilot's flight intentional flight into instrument meteorological conditions during takeoff-initial climb, which resulted in spatial disorientation, a subsequent loss of aircraft control, and an uncontrolled descent into terrain. A factor in the accident was the pilot's lack of an instrument rating and a low ceiling.

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 weatherTakeoff - initial climb
Weather condition - low ceiling
Lack of certificationPilot in commandFactor
Vfr flight into imc - initiatedPilot in commandCause
Loss of control - in flightTakeoff - initial climb
Spatial disorientationPilot in commandCause
Aircraft control - not maintainedPilot in commandCause
In flight collision with terrain/waterDescent - uncontrolled
Terrain condition - high vegetation
Terrain condition - roadway/highway

Analysis

The non-instrument rated private pilot attempted to depart an airport in instrument meteorological conditions. Prior to departure, the pilot talked to another, airborne pilot in the area, and confirmed the airport's reported conditions of an overcast layer at 100 feet above ground level (agl). The accident pilot indicated to the other pilot that he intended to depart VFR. Several witnesses reported that they observed the airplane departing to the south. It then turned toward the west at low level and subsequently turned back to the east. They further noted that the engine sound remained constant, continuing until the sound of a loud crash. The airplane contacted vegetation just prior to colliding with the ground, and the debris path continued along a southerly heading. Investigators examined the extensively crushed and fragmented wreckage, and identified no preimpact mechanical malfunctions or failures. The pilot had logged about 7 hours of simulated instrument time.

Factual narrative

History of flight

On April 4, 2004, about 0810 Pacific daylight time, a Piper PA-32R-301T Saratoga SP II, N4130D, experienced an in-flight collision with terrain about 2 minutes after departing from the Ukiah Municipal Airport, Ukiah, California. Gypsy Flyer, Inc., was operating the airplane under the provisions of 14 CFR Part 91. The private pilot, the sole occupant, sustained fatal injuries; the airplane was destroyed. The personal cross-country flight was en route to Willows, California. Instrument meteorological conditions prevailed, and a flight plan had not been filed. The primary wreckage was at 39 degrees 07.34 minutes north latitude and 123 degrees 11.605 minutes west longitude.

In an interview with the National Transportation Safety Board investigator-in-charge (IIC), an air ambulance helicopter pilot with an airline transport pilot rating stated that he was airborne and en route to Ukiah during the accident. While approaching the vicinity of the airport, he noted that visual meteorological conditions prevailed, but observed instrument conditions materializing. He monitored the Ukiah Automated Surface Observing System (ASOS), which reported conditions of 100 feet overcast, with visibility between 1 and 1 3/4 miles. After receiving a clearance from Air Route Traffic Control Center (ARTCC) Oakland Center, he attempted the localizer approach into Ukiah. While on the approach, over the Mendocino VOR (very high frequency omni-directional radio range), he noted that a layer of fog blanketed the valley, diminishing to clearer conditions to the north of town.

The air ambulance pilot maneuvered the helicopter to the edge of the fog bank and descended in an attempt to obtain visual contact with the airport. While descending, he concluded that the ASOS report was in all probability correct with the 100-foot ceiling observation. Fairly confident that he would be unable to land at the airport, he flew over the runway at 1,500 feet mean sea level (msl), navigating via the use of a global positioning system (GPS). During his pass over the airport he estimated that the top of the cloud layer was about 1,300 feet msl, and did not observe any holes or break in the layer.

As the air ambulance pilot continued flying over the runway, he heard a pilot on the UNICOM frequency announce that he was in a Piper Saratoga and preparing to depart runway 33. After the air ambulance pilot inquired about the weather conditions, the Saratoga pilot confirmed that there were no breaks in the cloud layer, and that the 100-foot ceiling appeared to be accurate. The Saratoga pilot further stated that he was intending to fly en route to Willows, where he planned on having coffee.

Several minutes later, with the air ambulance pilot remaining on the UNICOM frequency, he heard the Saratoga pilot announce that he was attempting to depart on runway 15. Looking for inbound traffic, the air ambulance pilot asked the Saratoga pilot if he had an instrument clearance from Oakland Center. The Saratoga pilot replied, informing the air ambulance pilot that he was departing under visual flight rules (VFR). The air ambulance pilot announced that he was unable to land at the airport, and subsequently departed to a helipad about 10 miles away. Upon landing at the helipad, the air ambulance pilot heard that an accident had just occurred.

The air ambulance pilot further noted that instrument flight rules (IFR) departures in Ukiah should be executed on runway 33.

Several witnesses reported to the IIC that they observed an airplane departing to the south. It turned toward the west at low level and subsequently turned back to the east. They further noted that the engine sound remained constant, continuing until the sound of a loud crash. One witness noted that the engine sounded the same from takeoff until the accident; another witness heard the engine cough three times.

Personnel information

A review of Federal Aviation Administration (FAA) airman records revealed that the pilot held a private pilot certificate with an airplane single-engine land rating. The pilot held a third class medical certificate issued on December 19, 2002, with the restriction that he must wear glasses for near vision. An examination of the pilot's logbook indicated that he had accumulated an estimated total flight time of 300 hours, of which 170 were in the same make and model. He logged about 30 hours in the last 90 days, and 5 in the last 30 days. The pilot had logged about 7 hours of simulated instrument time, but did not possess an instrument rating.

In an interview with the IIC, the operator of the flight school where the pilot received his primary training indicated that the pilot had been flying for a couple of years. He further stated that the pilot completed his primary training in a Cessna 172, and had purchased the Saratoga in 2001. The operator and his primary instructor had admonished the pilot for flying the Cessna on unapproved solo cross-country flights. The instructor authorized him to fly within the local Ukiah area; however, he had flown a couple of hundred miles over mountainous terrain to the northern California coast.

Aircraft information

The airplane was a Piper PA-32R-301T, Turbo Saratoga II SP, serial number 3257059. A review of the airplane's logbooks revealed a total airframe time of 545 hours. The airplane had undergone an annual inspection on January 20, 2004, at a total time of 513 hours. The engine was a Textron Lycoming TIO-540-AH1A, serial number L-10013-61A.

Meteorological information

ASOS issued a special aviation weather report for Ukiah at 0811 PDT. It stated: skies overcast at 100-feet above ground level (agl); visibility 2 statute miles; winds from 160 degrees at 3 knots; temperature 42 degrees Fahrenheit; dew point 43 degrees Fahrenheit; altimeter 30.01 inHg. From 0721 to 0856 the ASOS reported overcast conditions at 100 feet agl. At 0912 it reported overcast at 300 feet agl, and conditions continued to clear, where at 0840, ASOS reported broken clouds at 500 feet agl and 3,800 feet agl.

According to a Safety Board density altitude computer program, using the ASOS report of 6 degrees Fahrenheit and altimeter setting of 30.01 inHg, and the airport elevation, the density altitude was calculated at -319 feet mean sea level (msl).

Airport information

The Airport/ Facility Directory, Southwest U. S., indicates that the Ukiah Municipal Airport (elevation 614 feet msl), runway 15 is 5,000 feet long (which includes the displaced threshold of 585 feet) and is 150 feet wide. The runway surface is asphalt.

Wreckage and impact information

Investigators from the Safety Board and the FAA inspected the wreckage at the accident site. The first identified point of contact (FIPC) consisted of several broken tree limbs at the top of a 15-foot tall pear tree. About 10 feet from the tree were berry bushes that had a 1-foot wide by 1-foot deep grove running through them. The berry bushes ended at a creek that was about 50 feet from the FIPC. The principle impact crater (PIC) consisted of earth on the opposite side of the creek that contained ground scars and airplane parts. The debris path continued on a bearing of 190 degrees across the northbound lanes of Highway 101. As the debris path continued through the median, it turned to 180 degrees. The main wreckage was upright on both lanes of the southbound Highway 101; it was 192 feet from the FIPC. The highway ran 160/340 degrees.

The main wreckage consisted of all major components of the airframe, engine, and all of the control surfaces except the outboard section of the left wing and aileron. This piece of the left wing and the associated aileron piece separated at a production splice, and were on the highway surface near the PIC. The fuselage was on a heading of 360 degrees, and the engine was heading 020 degrees. The propeller hub separated at

Aircraft

Registration
N4130D
Reported as
Piper PA-32R-301T
Category
Airplane
Serial number
3257059
Airframe hours
522
Engine
Lycoming TIO-540-AH1A, 300 horsepower, reciprocating
Damage
Destroyed
Fire
On-Ground
Flight
Personal · Part 91
Registered owner
Gypsy Flyer Inc.
Airworthiness certificate
Standard, Normal
Last inspection
Annual · January 20, 2002
Departed
UKI · Ukiah, CA
Destination
WLW · Willows, CA
Airport
UKI · Ukiah, runway 15, 4,415 × 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
60
Injuries
Fatal
Certificate
Private
Airplane ratings
Single-engine land
Medical
Class 3, Valid Medical--w/ waivers/lim
Last flight review
May 9, 2003
Seat
Left
Toxicology
Performed
Flight hours
303 total · 170 in this make and model · 180 as pilot in command · 37 in the last 90 days · 5 in the last 30 days · 1 in the last 24 hours

Weather

Conditions
Instrument (IMC) · Day
Wind
160° at 3 knots
Visibility
2 statute miles
Lowest ceiling
100 ft overcast
Temperature
43 °F, dew point 43 °F
Altimeter
30.01 inHg
Observed at
UKI, 1 nm away

Docket · 4

The files NTSB released with the investigation on October 18, 2004, on NTSB’s docket system: statements, records, photos and specialists’ reports.

FAA reports on this event · 1

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