LAX98FA282

NTSB accident investigation · Simons Lancair 235 · Llano, CA · September 4, 1998

Accident · FatalField investigationFinal report
Date
September 4, 1998, 07:58 local (14:58 UTC)
Place
Llano, CA
Injuries
1 fatal
Damage
Destroyed
Phase of flight
Enroute
Aircraft
N1142WSimons Lancair 235
Weather
Instrument (IMC) · Day
Status
Completed · report October 13, 2000
Report
Approved by Office Director
FAA report
19980904022639A
Case key
43925

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

Pilot's inadvertent VFR flight into instrument meteorological conditions , which resulted in spatial disorientation and a subsequent loss of aircraft control.

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 weatherCruise
Weather condition - clouds
Vfr flight into imc - inadvertentPilot in commandCause
Weather condition - obscuration
Loss of control - in flightManeuvering - turn to reverse direction
Aircraft control - not maintainedPilot in commandCause
Spatial disorientationPilot in commandCause
In flight collision with terrain/waterDescent - uncontrolled
Terrain condition - open field

Analysis

The non-instrument rated pilot received a weather briefing for his original route of flight the morning of the accident and was advised that IFR conditions existed along that route but that VFR conditions existed through the desert areas. The briefer told the pilot that mid level broken to scattered cloud layers were forecasted and that no thunderstorm activity was expected until after 1100. About 40 minutes into his flight, a pilot friend in a second airplane that was traveling to the same destination caught up with the pilot and they conversed via radio. The second pilot indicated that he filed an IFR flight plan due to the uncertain nature of the weather forecasts. The second pilot stated that the weather started to turn bad, and the accident pilot told him that he was going to turn back. The second pilot saw him make a 180-degree turn and descend into clouds; he did not receive any further communication from the accident pilot. Witnesses at the accident site stated that it had been raining and the clouds were all the way down to the ground, with one witness saying she could not see the neighbor's house 1/4-mile away. One witness stated that the airplane flew directly over her house no higher than 75 feet, made a tight right turn, and then crashed to the ground with a loud bang. The extensively fragmented wreckage was distributed over a distance of 718 feet. Examination of the airframe, engine, propeller, and avionics revealed no discrepancies. Review of the pilot's logbook revealed no evidence of instrument flight experience since 1958.

Factual narrative

History of flight

On September 4, 1998, at 0758 hours Pacific daylight time, a Simons Lancair 235, N1142W, collided with desert terrain under unknown circumstances in Llano, California. The experimental airplane, operated under the provisions of 14 CFR Part 91 by the owner, was destroyed. The private pilot, the sole occupant who was also the builder of the airplane, was fatally injured. Instrument meteorological conditions existed at the accident site. The personal flight departed the Chino, California, airport at 0707 with an intended destination of Redmond, Oregon. No flight plan was filed.

The aviation surface weather report from nearby Palmdale, California, at the time of the accident was: visibility 1 1/4 mile with rain showers; the lowest cloud condition was reported as few clouds at 700 feet mean sea level (msl); and the lowest ceiling was reported as 2,600 feet msl.

Another airplane took off from Chino approximately 30 minutes after the accident airplane, and filed an Instrument Flight Rules (IFR) flight plan for the same destination. Approximately 10 minutes after takeoff the second airplane caught up with the accident airplane. The pilot of the second airplane stated that he spoke to the pilot of N1142W and said that he sounded in good spirits, but was disappointed because he had to turn around and go back to Chino due to the weather conditions. He stated that he saw N1142W make a 180-degree turn and descend into the clouds, and that was the last that he saw or heard of him.

Recorded radar data for the area was reviewed, with a primary 1200 VFR beacon code noted in the vicinity of the accident location from 0736:03 to 0755:56. During this time frame, the target was established on V137 traveling towards Palmdale, California. The target made a 180-degree turn heading in a southwesterly direction. The target then made a 540-degree turn near Crystal airport and continued on a south bound heading before initiating a 180-degree turn to the north. The target again crossed over V137 at 0750:54. For the next 2 minutes, the target was in a turn to the north-northwest with mode C reported altitudes varying from 10,500 feet to 10,100 feet.

At 0752:06, a turn to the west was initiated with a loss in mode C reported altitude from 10,500 feet to 9,000 feet. From 0752:06 to 0753:31, the target made two 360-degree turns with altitudes ranging from 9,200 feet at 0752:06 to 7,800 feet at 0753:31. From 0753:31 to the last recorded radar return at 0754:31, the target was on a southwesterly direction, then turned to a northwest heading, initiated a turn to the east, and the last recorded heading was northwest. During this time the altitude ranged from 8,700 feet to 7,300 feet.

One witness, who lives approximately 10 miles east of the accident site, stated that about 0800 that morning she watched a red airplane fly over. What drew her attention was the sound of the airplane. It sounded like the engine was "racing," and she expected it to be moving "really fast." When she looked up, it was moving very slowly. She stated that the airplane was in straight and level flight, with no erratic movements or swerving. She further reported that it was very cloudy and overcast, but not windy.

Two witnesses that live next to the accident site reported a loud noise overhead. One of the witnesses stated that he only heard the airplane fly overhead. He stated that it sounded like it was flying low, close to the roof. Due to the sound, he thought that the airplane turned to the southwest and then the southeast, and then it was quiet. The other witness was outside of her house at the time of the accident. She saw the airplane make a tight right turn to reverse direction, right next to her house. She reported that the turn was made over telephone poles that she estimated to be about 75 feet tall. She then heard a loud impact and turned around and saw pieces of airplane and papers falling to the ground. She stated that her neighbor's house, about 1/4-mile away from her house, was not visible at the time of the accident due to clouds and rain.

Personnel information

The pilot's logbook was reviewed by a Safety Board investigator, who estimated the pilot's total flight time to be 243.4 hours. Review of the logbook revealed that the pilot received a foreign certificate from Denmark in 1958, and received his United States private pilot certificate in August 1970. His logbook indicated that there were no flights from May 1983, until June 1996. The last flight prior to the accident flight was on September 1, 1998. Based on entries in the logbook, it was estimated that he had approximately 57.3 hours in the accident airplane. Other than 2.0 hours of experience that he had accrued during his foreign certification in 1958, no other instrument flight time was found from 1958 to the day of the accident.

Aircraft information

The airplane was built by the owner from a Lancair 235 kit, serial number 235-114, purchased from Lancair International, Inc., in Redmond, Oregon in July 1996.

Review of the aircraft maintenance records disclosed that the initial Experimental Category airworthiness certificate was issued under 14 CFR 21.191(g) on September 26, 1997, and the maiden flight occurred on October 2, 1997. The initial 40-hour test period was completed on May 11, 1997. On August 19, 1998, the airplane was issued a Special Airworthiness Certificate in the Amateur-built Experimental Category. The next condition inspection was due in August of 1999.

A representative of the kit manufacturer stated that after the Federal Aviation Administration (FAA) and the Experimental Aircraft Association (EAA) has approved the airplane as being airworthy, upon the request of the owner, they will conduct an inspection on the airplane, and test fly it for the owner. In November 1997, this representative conducted the kit manufacturer's inspection of the airplane at the owner's request. He stated that he found a number of things still wrong with the airplane after it had been approved by the FAA and EAA (checklist appended to report). He stated that the pilot informed him that he accrued approximately 170 hours over the past 20 years. The kit manufacturer stated that he flew with the pilot in the accident airplane, and felt that the pilot was "behind the aircraft." He reported that he "recommended/urged" the pilot to locate a flight instructor to provide him with extra training. He attempted to do some follow-up work with the pilot, but did not receive any response from the pilot.

Meteorological information

Witnesses at the accident site reported that visibility the morning of the accident was poor. They could not see mountains located about 5 miles to the west of the accident site. They stated that it had been raining and the clouds were down to the ground.

Review of FAA records disclosed that the pilot received a weather briefing from the San Diego Flight Service Station (FSS) at 0540 the morning of the accident. According to a transcript of the recorded briefing, the pilot indicated that he wanted a weather briefing from Chino to Bakersfield via Van Nuys, California. The FSS briefer indicated that there were weather advisories for icing at 15,000 to 25,000 feet along the immediate coastal range, and Instrument Flight Rules (IFR) conditions existed due to low ceilings, stratus, and fog along his planned route. He further reported that between Chino and the Grapevine (a mountain pass) midlevel clouds existed between 8,000 feet to 12,000 feet and were broken to overcast.

The briefer indicated that Palmdale had visibility of 10 miles, with few clouds at 8,000, while the neighboring airport at Lancaster was reporting a broken layer at 10,000. The briefer stated that he should have enough clearance over the mountains if he wanted to depart VFR from Chino and go through Palmdale, because the other route would have lower c

Aircraft

Registration
N1142W
Reported as
Simons Lancair 235 (LANCAIR 23)
Category
Airplane, amateur-built
Serial number
235-114
Airframe hours
61
Engine
Lycoming O-235-L2C, 118 horsepower, reciprocating
Damage
Destroyed
Flight
Personal · Part 91
Registered owner
Frank A. Simons
Airworthiness certificate
Special, Experimental (Special)
Last inspection
Continuous airworthiness · August 19, 1998 · 61 hours before
Departed
CNO · Chino, CA
Destination
RDM · Redmond, OR

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
73
Certificate
Private
Airplane ratings
Single-engine land
Medical
Class 3, Valid Medical--w/ waivers/lim
Toxicology
Performed
Flight hours
234 total · 57 in this make and model

Weather

Conditions
Instrument (IMC) · Day
Wind
40° at 6 knots
Visibility
1.25 statute miles
Lowest ceiling
2,600 ft broken
Temperature
66 °F, dew point 66 °F
Altimeter
29.00 inHg
Observed at
PMD, 35 nm away

Docket · 29

The files NTSB released with the investigation on July 18, 2000, on NTSB’s docket system: statements, records, photos and specialists’ reports.

Supplement AItem 1 · .PDF · 243 KBSupplement BItem 2 · .PDF · 381 KBWitness StatementsItem 3 · .PDF · 286 KBWreckage DiagramItem 4 · .PDF · 155 KBLos Angeles Sheriff's DepartmentItem 5 · .PDF · 207 KBReports from kit manufacturerItem 6 · .PDF · 727 KBReport from Vision MicrosystemsItem 7 · .PDF · 124 KBStatement of Party RepsItem 8 · .PDF · 388 KBToxicological ReportItem 9 · .PDF · 68 KBPhoto 1. Accident Site (NTSB)Item 10 · .PDF · 47 KBPhoto 2. At furthest point of wreckage distribution looking back along the airplane's flight path.Item 11 · .PDF · 41 KBPhoto 3. Airplane reconstruction (NTSB)Item 12 · .PDF · 59 KBPhoto 4. Airplane reconstruction (NTSB)Item 13 · .PDF · 47 KBPhoto 5. Telephone pole that airplane overflew.Item 14 · .PDF · 31 KBPhoto 6. View from accident site of house and cluster of trees that witness could not see at time of accident due to clouds and rain. (NTSB)Item 15 · .PDFMeteorology 5 - Factual Report of Group ChairmanItem 16 · .PDF · 3.5 MBLos Angeles Sectional Aeronautical ChartItem 17 · .PDF · 259 KBReports from Textron - LycomingItem 18 · .PDF · 434 KBReport from Allied SignalItem 19 · .PDF · 78 KBRecord of inspection from InvopropItem 20 · .PDF · 58 KBRadar DataItem 21 · .PDF · 3.8 MBOperating LimitationsItem 22 · .PDF · 576 KBAirframe LogbookItem 23 · .PDF · 547 KBEngine LogbookItem 24 · .PDF · 666 KBPropeller LogbookItem 25 · .PDF · 2.2 MBFlight Planning DocumentsItem 26 · .PDF · 674 KBFuel ReceiptItem 27 · .PDF · 68 KBExcerpts from ATC ReportItem 28 · .PDF · 560 KBAudio Tape of WX BriefItem 29 · .PDF · 18 KB

FAA reports on this event · 1

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