# NTSB LAX94LA144: Cessna 421C, N7039T, Tulare, CA, February 23, 1994 - Type: NTSB accident investigation - Classification: Accident · No injuries · Limited investigation · Final report - Date: February 22, 1994, 19:15 local (Feb 23, 1994, 03:15 UTC) - Place: Tulare, CA - Coordinates: 36.179027, -119.360511 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=36.1790&lon=-119.3605&mi=10 - Phase of flight: [Taxi](https://openairdocs.org/ntsb-phases/250) (OpenAirDocs' grouping) - Highest injury: No injuries - Injuries: 2 uninjured - Status: Completed, report November 14, 1994 - Report: Approved by Office Director - NTSB case key (mKey): 28682 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=LAX94LA144 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/28682/pdf - Page: https://openairdocs.org/ntsb/LAX94LA144 ## Probable cause the pilot's use of an excessive taxi speed, and his misjudgment of the distance to the approaching intersection. A factor in the accident was the dark night lighting conditions which effected the pilot's perception of the taxiway layout. ## Sequence of events In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf). - Loss of control - on ground/water, taxi - to takeoff - light condition - dark night (contributing factor) - taxispeed - excessive, pilot in command (cause) - visual/aural detection, pilot in command (contributing factor) - distance - misjudged, pilot in command (cause) - On ground/water encounter with terrain/water, taxi - to takeoff - terrain condition - soft - terrain condition - ditch ## Analysis The pilot stated that when he had previously taxied to the ramp after landing he had noticed that his right brake felt 'mushy', and he had had a 'little problem' in making two 90-degree right turns. As he made two more 90-degree right turns, however, his brakes began to function normally. The pilot stated that before departure he checked the braking action of both his right and left brakes, and they responded normally. He then taxied toward runway 13 along a parallel taxiway. He stated that as he reached a 45-degree intersecting taxiway connecting with the approach end of runway 13, he applied his brakes to make the turn, without effect. The aircraft continued straight ahead, off the end of the taxiway and into a ditch, sustaining substantial structural damage. An inspection of the brakes revealed no discrepancies. ## Factual narrative On February 22, 1994, at 1915 Pacific standard time, a Cessna 421C, N7039T, sustained structural damage to the forward fuselage and nose gear trunion when the aircraft ran off the runway while taxiing for takeoff at Tulare, California. The aircraft was owned by Van Ryn Feed Company Inc., of Corona, California, and was on a cross-country personal flight conducted under 14 CFR Part 91. Visual meteorological conditions prevailed at the time and no flight plan had been filed for the operation. The certificated private pilot and the passenger on board were not injured. The flight originated at Chino, California, at 1730 on the day of the mishap. Federal Aviation Administration inspectors reported that during the hours of darkness the pilot was preparing to make a right turn onto the approach end of runway 13 from a parallel taxiway when he lost control of the aircraft and ran off the taxiway into a ditch. The force of the impact drove the nose gear back into the fuselage causing substantial structural damage. In his written statement, the pilot reported that he had landed at Mefford Field to drop off three of his four passengers. As he taxied to the ramp, he noticed that his right brake felt "mushy" and he had a "little problem" in making two 90-degree right turns. As he continued to make two more 90-degree right turns, his brakes began to function normally. After deplaning his passengers, the pilot checked the braking action of both his right and left brakes and they responded normally. He proceeded to taxi back to runway 13 along a parallel taxiway until he reached a 45-degree intersecting taxiway connecting the parallel taxiway with the approach end of runway 13. He stated that as he applied his brakes to make the turn, he obtained no braking action. The aircraft continued straight ahead off the end of the taxiway and into a ditch where it impacted soft terrain. The force of the impact collapsed the nose gear and allowed both propellers to contact the ground. A postaccident technical inspection of the brake system revealed no discrepancies or abnormalities. ## Aircraft - Registration: N7039T (not matched to a registry record) - Reported make and model: CESSNA 421C - Category: Airplane - Serial number: 421C0465 - Airframe hours: 2400 - Engines: CONTINENTAL GTSI0-520L 375 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Operator: Arie Van Ryn, doing business as Van Ryn Feed Company Inc - Registered owner: Van Ryn Feed Company Inc. - Airworthiness certificate: Standard, Normal - Last inspection: Annual, August 30, 1993, 10 hours before - Departed: BFL, BAKERSFIELD, CA - Destination: CNO, CHINO, CA - Airport: TLR, Mefford Field, runway 13, 3,914 × 75 ft, asphalt ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 55; private; airplane ratings: multi-engine land, single-engine land; instrument ratings: airplane; medical: class 3, valid medical--w/ waivers/lim; seat: left; flight hours: 1,677 total, 840 in this make and model, 1,483 as pilot in command, 22 in the last 90 days, 10 in the last 30 days, 4 in the last 24 hours ## Weather - Conditions: Visual (VMC), Night/bright - Wind: 250° at 3 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 50 °F, dew point 43 °F - Altimeter: 30.00 inHg - Observed at: VIS, 11 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 19940222003169A](https://openairdocs.org/incident/19940222003169A), Feb 22, 1994: Cessna 421C, Tulare, CA, Substantial damage. Taxied off end of taxiway into a ditch while taxiing for takeoff. Impact collapsed the nose gear. Props hit ground. 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. --- OpenAirDocs.org is an independent research project of [Contrail Labs](https://contraillabs.com/). It is not affiliated with the FAA or the NTSB. Source documents are U.S. government works in the public domain.