# NTSB LAX92LA074: Piper PA32RT-300, N39459, Big Bear City, CA, December 31, 1991

- Type: NTSB accident investigation
- Classification: Accident · Minor injuries · Limited investigation · Final report
- Date: December 30, 1991, 20:10 local (Dec 31, 1991, 04:10 UTC)
- Place: Big Bear City, CA
- Coordinates: 34.260318, -116.840835 (estimated)
- Nearby events: https://openairdocs.org/map.md?lat=34.2603&lon=-116.8408&mi=10
- Phase of flight: [Takeoff](https://openairdocs.org/ntsb-phases/300) (OpenAirDocs' grouping)
- Highest injury: Minor injuries
- Injuries: 2 minor, 2 uninjured
- Status: Completed, report April 23, 1993
- Report: Approved by Office Director
- NTSB case key (mKey): 27526
- NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=LAX92LA074
- NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/27526/pdf
- Page: https://openairdocs.org/ntsb/LAX92LA074

## Probable cause

THE FAILURE OF THE PILOT TO MAINTAIN DIRECTIONAL CONTROL AND IMPROPER USE OF THE RUDDER.  CONTRIBUTING TO THE ACCIDENT WAS THE IMPROPER INSTALLATION BY THE COMPANY OF A HAND CONTROL MECHANISM THAT REQUIRED THE PILOT TO OPERATE THE AIRPLANE CONTROLS WITH ONE HAND AND RESTRICTED VISUAL OUTLOOK DUE TO THE EXISTING INSTRUMENT METEOROLOGICAL CONDITIONS.

## 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
  - light condition - dark night (contributing factor)
  - visual lookout - restricted, pilot in command (contributing factor)
  - weather condition - obscuration (contributing factor)
  - directional control - not maintained, pilot in command (cause)
  - weather condition - fog (contributing factor)
  - rudder - improper use of, pilot in command (cause)
  - flt control syst,rudder - improper (contributing factor)
  - acft/equip,inadequate control location, company/operator management (contributing factor)
- On ground/water encounter with terrain/water, takeoff - roll/run
  - terrain condition - snowbank

## Analysis

THE CERTIFICATED COMMERCIAL PILOT AND THREE PASSENGERS WERE DEPARTING ON A NIGHT VISUAL FLIGHT RULES CROSS COUNTRY FLIGHT IN INSTRUMENT METEOROLOGICAL CONDITIONS. THE AIRPLANE WAS EQUIPPED WITH A HAND CONTROL MECHANISM MOUNTED ON THE RIGHT SIDE OF THE CENTER CONTROL CONSOLE. THIS REQUIRED THE PILOT TO MANIPULATE ALL OF THE AIRPLANE CONTROLS, WITH THE EXCEPTION OF THE CONTROL COLUMN, WITH THE RIGHT HAND. DURING THE TAKE-OFF ROLL, THE PILOT FAILED TO PROPERLY USE THE RUDDER CONTROL BY RELAXING RIGHT RUDDER CONTROL PRESSURE.  THE AIRPLANE DRIFTED TO THE LEFT AND STRUCK AN 8 INCH BERM OF SNOW LOCATED ALONG THE SIDE OF THE RUNWAY. THE PREVAILING VISIBILITY CONDITIONS VARIED FROM 3/4 OF A MILE, DOWN TO 50 FEET WHICH RESTRICTED THE PILOT'S VISUAL ACUITY. THE PILOT REPORTED THAT THE RUNWAY LIGHTS WERE OBSCURED BY SNOW.

## Aircraft

- Registration: [N39459](https://openairdocs.org/aircraft/N39459), registered now, S/N 32R-7885219, built 1978 (OpenAirDocs)
- Reported make and model: PIPER PA32RT-300
- Registry model: [Piper PA-32RT-300](https://openairdocs.org/model/piper-pa-32rt-300) (registry code 7103215) (OpenAirDocs)
- Registry engine: [Lycoming IO-540 series](https://openairdocs.org/engine/lycoming-io-540-series) (registry code 41530, reciprocating) (OpenAirDocs)
- Category: Airplane
- Serial number: 32R-7885219
- Airframe hours: 1179
- Engines: LYCOMING IO-540-K1G50 300 horsepower reciprocating
- Damage: Substantial damage
- Flight: Personal, Part 91
- Operator: Aero Haven, Inc.
- Registered owner: Aero Haven, Inc.
- Airworthiness certificate: Standard, Normal
- Last inspection: 100 hour, September 13, 1991, 92 hours before
- Destination: LAS, LAS VEGAS, NV
- Airport: L35, Big Bear City, runway 25, 5,850 × 75 ft, asphalt

## Flight crew

As NTSB recorded them. NTSB leaves out names.

- Pilot; age 42; flight instructor, commercial; airplane ratings: single-engine land; instrument ratings: airplane; medical: class 2, valid medical--w/ waivers/lim; seat: left; flight hours: 807 total, 38 in this make and model, 733 as pilot in command, 108 in the last 90 days, 38 in the last 30 days, 6 in the last 24 hours

## Weather

- Conditions: Visual (VMC), Night/dark
- Wind: calm
- Temperature: 21 °F, dew point 19 °F
- Altimeter: 30.00 inHg
- Observed at: L35, 1 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 19911231058009A](https://openairdocs.org/incident/19911231058009A), Dec 31, 1991: Piper PA32RT300, Big Bear, CA, Substantial damage. Lost control on takeoff. Struck snowbank on runway edge. Non approved hand and brake controls for paraplegic.

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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