# NTSB LAX91LA071: Piper PA-28-181, N8309H, Ramona, CA, January 10, 1991

- Type: NTSB accident investigation
- Classification: Accident · No injuries · Limited investigation · Final report
- Date: January 10, 1991, 11:15 local (19:15 UTC)
- Place: Ramona, CA
- Coordinates: 33.070503, -116.829414 (estimated)
- Nearby events: https://openairdocs.org/map.md?lat=33.0705&lon=-116.8294&mi=10
- Phase of flight: [Takeoff](https://openairdocs.org/ntsb-phases/300) (OpenAirDocs' grouping)
- Highest injury: No injuries
- Injuries: 1 uninjured
- Status: Completed, report May 7, 1993
- Report: Approved by Office Director
- NTSB case key (mKey): 27091
- NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=LAX91LA071
- NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/27091/pdf
- Page: https://openairdocs.org/ntsb/LAX91LA071

## Probable cause

THE PILOT'S FAILURE TO MAINTAIN DIRECTIONAL CONTROL OF THE AIRPLANE DURING AN ATTEMPTED TAKEOFF.  A CONTRIBUTING FACTOR WAS RELATED TO THE STUDENT'S IMPROPER USE OF RUDDER CONTROL.

## Sequence of events

In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf).

- Loss of control - on ground/water, takeoff - roll/run
  - rudder - improper use of, pilot in command (contributing factor)
  - directional control - not maintained, pilot in command (cause)
- On ground/water encounter with terrain/water, takeoff - roll/run
  - terrain condition - berm

## Analysis

THE STUDENT PILOT HAD SUCCESSFULLY MADE TWO PRACTICE TAKEOFFS AND LANDINGS ON A 150-FOOT WIDE BY 4,000-FOOT LONG RUNWAY.  DURING THE PILOT'S THIRD ATTEMPTED TAKEOFF THE AIRPLANE VEERED OFF THE SIDE OF THE RUNWAY AND COLLIDED WITH A SMALL HILL.  THE STUDENT REPORTED THAT WHILE ROLLING FOR TAKEOFF HE HAD ATTEMPTED TO CORRECT THE AIRPLANE'S COURSE BY APPLYING 'MORE THAN NORMAL' RUDDER PRESSURE, BUT HE WAS NOT SUCCESSFUL.  THE AIRPLANE WAS EXAMINED AND ITS BRAKES AND FLIGHT CONTROLS WERE FOUND CAPABLE OF FUNCTIONING NORMALLY.

## Aircraft

- Registration: [N8309H](https://openairdocs.org/deregistered/N8309H-1993-11-29), registration cancelled 1993-11-29, S/N 288390014 (OpenAirDocs)
- Reported make and model: PIPER PA-28-181
- Registry model: [Piper PA-28-181](https://openairdocs.org/model/piper-pa-28-181) (registry code 7102807) (OpenAirDocs)
- Category: Airplane
- Serial number: 288390014
- Engines: LYCOMING O-360-A4M 180 horsepower reciprocating
- Damage: Substantial damage
- Flight: Instructional, Part 91
- Operator: Four Winds Aviation
- Airport: L39, Ramona, runway 27, 4,000 × 150 ft, asphalt

## Flight crew

As NTSB recorded them. NTSB leaves out names.

- Pilot; age 56; student; medical: class 3, valid medical--w/ waivers/lim; flight hours: 83 total, 80 in this make and model, 22 in the last 90 days, 6 in the last 30 days, 1 in the last 24 hours

## Weather

- Conditions: Visual (VMC), Day
- Wind: calm
- Visibility: 50 statute miles
- Lowest ceiling: none
- Temperature: -0 °F, dew point -0 °F

## FAA reports on this event (1)

The FAA's own accident and incident reports, matched to the aircraft by N-number and date (OpenAirDocs).

- [Accident 19910110003519A](https://openairdocs.org/incident/19910110003519A), Jan 10, 1991: Piper PA28181, Ramona, CA, Substantial damage. Lost directional control on takeoff skidded off runway and struck a dirt berm.

From the NTSB's public API. Aircraft are matched to registry aircraft by N-number and event date, checked against the reported serial number, make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model.

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