# NTSB WPR19FA163: Piper PA28, N7943C, Antioch, CA, June 10, 2019 - Type: NTSB accident investigation - Classification: Accident · Fatal · Class 3 · Field · Final report - Date: June 9, 2019, 17:32 local (Jun 10, 2019, 00:32 UTC) - Place: Antioch, CA - Coordinates: 38.044166, -121.83889 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=38.0442&lon=-121.8389&mi=10 - Phase of flight: [Maneuvering](https://openairdocs.org/ntsb-phases/450) (OpenAirDocs' grouping) - Defining event: [Maneuvering-low-alt flying: Loss of control in flight](https://openairdocs.org/ntsb-events/240) - Highest injury: Fatal - Injuries: 1 fatal - Status: Completed - Report: Approved by Office Director - Investigation class: Class 3 - NTSB office: Western Pacific Region - Parties: Lycoming Engines, Oakland FSDO, Piper Aircraft - NTSB case key (mKey): 99577 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=WPR19FA163 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/99577/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=99577 - Page: https://openairdocs.org/ntsb/WPR19FA163 ## Probable cause A loss of control while conducting low-altitude, high-speed maneuvers. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Use of equip/info: aircraft control](https://openairdocs.org/ntsb-findings/02063040): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Piper PA-28-151, 10 cases](https://openairdocs.org/ntsb-findings/02063040/cases.md?model=7102805), [All aircraft, 9,295 cases](https://openairdocs.org/ntsb-findings/02063040/cases.md) - [Info processing/decision: decision making/judgment](https://openairdocs.org/ntsb-findings/02041520): Personnel issues › Action/decision · Pilot (probable cause); cases with it: [Piper PA-28-151, 11 cases](https://openairdocs.org/ntsb-findings/02041520/cases.md?model=7102805), [All aircraft, 3,098 cases](https://openairdocs.org/ntsb-findings/02041520/cases.md) - [Performance/control parameters: altitude](https://openairdocs.org/ntsb-findings/01062012): Aircraft › Aircraft oper/perf/capability · Not attained/maintained (probable cause); cases with it: [Piper PA-28-151, 3 cases](https://openairdocs.org/ntsb-findings/01062012/cases.md?model=7102805), [All aircraft, 1,310 cases](https://openairdocs.org/ntsb-findings/01062012/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Maneuvering-low-alt flying: Low altitude operation/event](https://openairdocs.org/ntsb-events/220); cases with it: [Piper PA-28-151, 2 cases](https://openairdocs.org/ntsb-events/220/sequence.md?model=7102805), [All aircraft, 780 cases](https://openairdocs.org/ntsb-events/220/sequence.md) - [Maneuvering-low-alt flying: Loss of control in flight](https://openairdocs.org/ntsb-events/240) (defining event); cases with it: [Piper PA-28-151, 9 cases](https://openairdocs.org/ntsb-events/240/sequence.md?model=7102805), [All aircraft, 5,002 cases](https://openairdocs.org/ntsb-events/240/sequence.md) ## Analysis The newly certificated private pilot rented the airplane to continue building flight experience in preparation for future flight training. Radar data showed that the airplane departed normally and proceeded to an area that the pilot had used as a practice area during his flight training. The airplane began to maneuver within this area, climbing to a maximum altitude of 5,300 ft mean sea level before it descended over a river and below radar coverage. Two witnesses in the area of the accident site saw the airplane “performing tricks,” during which it descended toward the surface of the water and pulled up abruptly. The airplane then entered a nose-low descent that continued until impact with the water. Both witnesses reported that the airplane impacted the river in a nose-low attitude at high speed. Examination of the recovered wreckage revealed no mechanical failures or anomalies that would have precluded normal operation. The circumstances of the accident are consistent with the pilot’s loss of control while maneuvering at high speed and low altitude. ## Factual narrative On June 9, 2019, about 1732 Pacific daylight time, a Piper PA 28-151 airplane, N7943C, was destroyed when it was involved in an accident near Antioch, California. The private pilot was fatally injured. The airplane was operated as a Title 14 Code of Federal Regulations Part 91 personal flight. According to the employees of Sterling Flight Training Center, the pilot had recently received his private pilot certificate and rented the airplane on the day of the accident to continue building flight experience in preparation for instrument training. Review of recorded radar data showed a primary target, consistent with the accident airplane, depart from Buchanan Field Airport (CCR), Concord, California, while climbing continuously. The first radar target was identified at 17:17:58 about 1.5 miles northeast of CCR. About 5 miles northeast of the airport, the airplane turned east and flew another 7 miles into a practice area that the pilot used during his flight training. As the airplane approached the northwest end of Winter Island, it turned southeast and reached a maximum altitude of about 5,300 ft mean sea level (msl) at 17:26:27. The airplane remained on a southeast heading until nearing the south end of Winter Island, when it entered a descent and turned to the northeast. The airplane continued northeast while descending to about 4,500 ft msl; its groundspeed increased to 145 kts. The airplane then completed a right, 360° descending turn to an altitude of 2,100 ft msl and groundspeed of 163 knots. The last radar target, at 17:27:25, showed the airplane on a westerly heading at 2,100 ft msl, about .16-mile northeast of the estimated accident site. A witness located near the accident site reported that their attention was drawn to the airplane due to the “strained” and “variable” sound of its engine. He and his wife saw the airplane maneuvering above their location, “performing tricks” during which the airplane was maneuvering near the surface of the water. They stated that the airplane impacted the water in a nose-low attitude at a high speed. Figure 1 is an estimate of the flight path, based on the recorded radar data. Figure 2 is an estimate of the final minutes of the flight, based on radar data. Figure 1. Estimated flight route. Points are based upon radar data. Figure 2. Estimated flight path after achieving maximum altitude near south end of Winter Island. Points are based on radar data. Other pilots who rented the airplane earlier on the day of the accident reported no anomalies that would have precluded normal operation. The 22-year-old pilot held a private pilot certificate with a rating for airplane single-engine land, which was issued on May 31, 2019, nine days before the accident. The airplane impacted the San Joaquin River, in the Broad Slough area. Search and rescue personnel reported that the wreckage was located along the river bottom, contained within an area of about 120 ft by 180 ft at a depth of about 20 ft. Portions of thewreckage were recovered from the water on June 13, 2019. The recovered wreckage included the engine, empennage, the aft fuselage, left wing, left aileron and flap, fragments of the right wing, both main landing gear, the firewall, and portions of the interior, including the rear seat bench. For additional information, refer to the airframe and engine examination report in the public docket. Examination of the recovered wreckage revealed no anomalies which would have precluded normal operation. ## Aircraft - Registration: [N7943C](https://openairdocs.org/deregistered/N7943C-2022-10-01), registration cancelled 2022-10-01, S/N 28-7615068, built 1975 (OpenAirDocs) - Reported make and model: Piper PA28 (151) - Registry model: [Piper PA-28-151](https://openairdocs.org/model/piper-pa-28-151) (registry code 7102805) (OpenAirDocs) - Registry engine: [Lycoming 0-320 series](https://openairdocs.org/engine/lycoming-0-320-series) (registry code 41508, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 28-7615068 - Year built: 1976 - Airframe hours: 13870.3 - Engines: Lycoming O-320 SERIES 160 horsepower reciprocating - Damage: Destroyed - Flight: Personal, Part 91 - Airworthiness certificate: Standard, Normal - Last inspection: Annual, January 15, 2019 - Departed: KCCR, Antioch, CA - Destination: KCCR, Antioch, CA - Equipment: None ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 22; injuries: fatal; private; airplane ratings: single-engine land; medical: class 1, with waivers/limitations; last flight review May 31, 2019; seat: left; toxicology performed; flight hours: 82.9 total, 82.9 in this make and model, 13.6 as pilot in command ## Weather - Conditions: Visual (VMC), Day - Wind: 360° at 7 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 93 °F, dew point 39 °F - Altimeter: 29.95 inHg - Observed at: KCCR, 12 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 20190609006289A](https://openairdocs.org/incident/20190609006289A), Jun 9, 2019: Piper PA-28-151, Antioch, CA, Destroyed, 1 fatal. While on a local VFR flight, the aircraft crashed into the san joaquin river near Antioch , CA. The pilot, sole occupant was fatally injured. The pilot… ## Docket (9 files) The files NTSB released with the investigation on March 25, 2021, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=99577. 6.1 MB in all. - Pilot/operator aircraft accident report, NTSB form 6120.1 (item 1, PDF, 9 pages, 571 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=9333842&FileExtension=pdf&FileName=6120.1%20Pilot_Operator%20Aircraft%20Accident_Incident%20Report_Redacted-Rel.pdf - Witness statements (item 2, PDF, 8 pages, 85 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=9380913&FileExtension=pdf&FileName=Witnesses%20WPR19FA163%20(Redacted)-Rel.pdf - Raw radar data (kmz file) (item 3, KMZ, 14 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=9381580&FileExtension=kmz&FileName=1200-Rel.kmz - Recorded air traffic control radar data (plot) (item 4, PDF, 21 pages, 240 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=11611461&FileExtension=pdf&FileName=Radar%201200_10Jun_Class_7_data-Rel.pdf - Airframe and engine examination report (item 5, PDF, 12 pages, 4.2 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=11660623&FileExtension=pdf&FileName=Airframe%20and%20Engine%20Examination%20WPR19FA163-Rel.pdf - Evidence control form (item 6, PDF, 3 pages, 45 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=9379542&FileExtension=pdf&FileName=Chain%20of%20Custody-Rel.pdf - Toxicological report (item 7, PDF, 1 page, 800 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=11488210&FileExtension=pdf&FileName=Tox%20Redacted-Rel.pdf - Memo for record autopsy (item 8, PDF, 1 page, 47 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=11488029&FileExtension=pdf&FileName=Memo%20for%20Record%20Autopsy-Rel.pdf - Statement of party representatives to NTSB investigation (item 9, PDF, 2 pages, 183 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=12750325&FileExtension=pdf&FileName=Party%20Member%20Forms_Redacted-Rel.pdf 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.