# NTSB LAX92LA050: Speyer Avid Amphibian, N118A, San Ysidro, CA, November 22, 1991

- Type: NTSB accident investigation
- Classification: Accident · Fatal · Limited investigation · Final report
- Date: November 22, 1991, 10:24 local (18:24 UTC)
- Place: San Ysidro, CA
- Coordinates: 32.549873, -117.039222 (estimated)
- Nearby events: https://openairdocs.org/map.md?lat=32.5499&lon=-117.0392&mi=10
- Phase of flight: [Enroute](https://openairdocs.org/ntsb-phases/400) (OpenAirDocs' grouping)
- Highest injury: Fatal
- Injuries: 1 fatal
- Status: Completed, report April 27, 1993
- Report: Approved by Office Director
- NTSB case key (mKey): 27507
- NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=LAX92LA050
- NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/27507/pdf
- Page: https://openairdocs.org/ntsb/LAX92LA050

## Probable cause

FAILURE OF THE PILOT/BUILDER TO FOLLOW THE MANUFACTURER'S RECOMMENDED AIRFRAME MODIFICATION PROCEDURE TO PREVENT THE INFLIGHT LOSS OF A FLAPERON DUE TO FLUTTER.  CONTRIBUTING TO THE ACCIDENT WAS IN INFLIGHT SEPARATION OF THE WING WHEN THE DESIGN LIMITS OF THE AIRFRAME WERE EXCEEDED.

## Sequence of events

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

- Airframe/component/system failure/malfunction, cruise
  - flight control,aileron - flutter (cause)
  - flight control,aileron - separation (cause)
  - maintenance,modification - recommended, manufacturer
  - maintenance,modification - not performed, pilot in command (cause)
  - maintenance,service bulletin/letter - not followed, pilot in command (cause)
- Loss of control - in flight, descent - uncontrolled
  - wing - separation (contributing factor)
  - design stress limits of aircraft - exceeded, pilot in command (contributing factor)
  - evacuation - attempted, pilot in command
- In flight collision with terrain/water, descent - uncontrolled
  - terrain condition - ground

## Analysis

THE CERTIFICATED COMMERCIAL PILOT, THE SOLE OCCUPANT, WAS CONDUCTING FLIGHT TESTS ON A NEWLY MANUFACTURED EXPERIMENTAL, AMATEUR BUILT AIRPLANE. WHILE ORBITING OVER AN AIRPORT, THE PILOT DECLARED AN EMERGENCY AND WAS OBSERVED DESCENDING IN A LEFT SPIRALLING DIVE.  THE LEFT FLAPERON AND LEFT WING SEPARATED FROM THE FUSELAGE.  THE PILOT, WHO WAS WEARING A PARACHUTE, ATTEMPTED TO BAIL OUT OF THE AIRPLANE AT LOW ALTITUDE.  THE PARACHUTE FAILED TO SUFFICIENTLY OPEN DUE TO THE LOW ALTITUDE.  AN EXAMINATION OF THE SEPARATED FLAPERON DISCLOSED CYCLIC OVERLOAD AND OVERTRAVEL ATTRIBUTED TO FLUTTER.  FLAPERON COUNTER WEIGHTS WERE STRONGLY RECOMMENDED BY THE MANUFACTURER TO PREVENT FLUTTER.  THE PILOT ELECTED NOT TO INSTALL THE COUNTER WEIGHTS BECAUSE IT WOULD IMPOSE AN ADDITION OF WEIGHT, AND THE PILOT FELT THAT THEY WERE NOT NEEDED.

## Aircraft

- Registration: [N118A](https://openairdocs.org/deregistered/N118A-1993-12-28), registration cancelled 1993-12-28, S/N 6 (OpenAirDocs)
- Reported make and model: SPEYER AVID AMPHIBIAN (AVID AMPHI)
- Registry model: [Speyer James AVID AMPHIBIAN](https://openairdocs.org/model/speyer-james-avid-amphibian) (registry code 9570869) (OpenAirDocs)
- Category: Airplane, amateur-built
- Serial number: 6
- Airframe hours: 3
- Engines: ROTAX 582 65 horsepower reciprocating
- Damage: Destroyed
- Flight: Personal, Part 91
- Operator: James Speyer
- Registered owner: James Speyer
- Airworthiness certificate: Special, Experimental (Special)
- Last inspection: Unknown, October 22, 1991, 3 hours before
- Departed: SDM, SAN DIEGO, CA

## Flight crew

As NTSB recorded them. NTSB leaves out names.

- Pilot; age 41; flight instructor, commercial; airplane ratings: single-engine land, multi-engine land; instrument ratings: airplane; medical: class 2, valid medical--no waivers/lim.; seat: left; toxicology performed; flight hours: 2,600 total

## Weather

- Conditions: Visual (VMC), Day
- Wind: 310° at 5 knots
- Visibility: 25 statute miles
- Lowest ceiling: none
- Temperature: 64 °F, dew point 54 °F
- Altimeter: 30.00 inHg
- Observed at: SDM, 2 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 (OpenAirDocs).

- [Accident 19911122053329A](https://openairdocs.org/incident/19911122053329A), Nov 22, 1991: Amtr AVIDFLYER, San Diego, CA, Destroyed, 1 fatal. Left flaperon flutter and failure. Began descent left wing separated. Pilot jumped too low. No counter weights.

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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