Aviation Accident Summaries

Aviation Accident Summary MIA95FA023

DAYTONA BEACH, FL, USA

Aircraft #1

N9420J

PIPER PA-28-180

Analysis

The pilot was cleared by ATC for an ILS approach in instrument flight conditions. ATC terminated the approach when the airplane was observed on radar below the minimum altitude for that segment of the approach and 'S' turning through the final approach course. The pilot was vectored and cleared for an ASR approach. The airplane was observed on radar turning through the final approach course, and the pilot was provided with heading corrections which were not acknowledged. The airplane continued turning through the approach course, and radar contact was lost. The pilot's last recorded instrument flight was on September 15, 1989, an his last recorded night flight was on February 18, 1989.

Factual Information

HISTORY OF FLIGHT On November 20, 1994, about 1755 eastern standard time, a Piper PA-28-180, N9420J, registered to Herbie Corporation, operating as a 14 CFR Part 91 personal flight, crashed while maneuvering during an airport surveillance radar approach (ASR)to runway 7 left at the Daytona Beach Regional Airport. The airplane was destroyed, and the private pilot was fatally injured. Instrument meteorological conditions prevailed, no flight plan was filed, and no preflight weather briefing was obtained. The flight originated from Fort Pierce, Florida, about 1 hour 54 minutes before the accident. Review of communications on November 20, 1994, for the time period 2227 UTC (1922 EST) to 2302 UTC (2002 EST) between Daytona Beach ATCT Local Control (LC1), Daytona Beach ATCT North Arrival Radar (N-AR), Daytona Beach ATCT South Arrival Radar (S-AR), and N9420J revealed the pilot of N9420J called Daytona Beach Tower at 2232:15, (1932:15 EST) requesting vectors to the airport. The pilot stated he was located over the shoreline just north of the airport. The pilot was instructed by Daytona Beach Tower to contact Daytona Beach Approach Control. The pilot contacted Daytona Beach Approach Control at 2232:58 (1932:58 EST). He stated he was northwest of the airport over the shoreline requesting vectors to the airport. He was informed the weather at Daytona Beach, Florida, was IFR: 400 scattered, measured ceiling 2,500 overcast, visibility 1 1/2 with fog. The pilot informed ATC the airplane was equipped with a glideslope, and that he was IFR rated. A transponder code was assigned, and the pilot was asked if he was requesting IFR. The pilot stated affirmative. ATC informed the pilot he was radar contact 5 miles southeast of Ormond VOR. He was cleared to Daytona airport via radar vectors, to climb and maintain 1,600 feet. At 2234:47 (1734:47 EST) N9420J was instructed to turn right to a heading of 250 for a vector to the ILS seven left final approach course. The pilot was asked by ATC at 2236:02 (1736:02 EST) and again at 2236:37 (1736:37 EST) if he had current ATIS information. The pilot replied, "Uh, I'm uh, negative. I haven't had a chance. I'm a little bit busy up here right now. A little bit, uh maybe you can just handle me in." N9420J was informed at 2243:29, (1742:29 EST) that he was 5 miles from TOMOK, maintain 1,600 til established on the localizer, and cleared for the ILS approach. The air traffic control specialist stated he observed N9420J on radar deviate to the north and south of the final approach course, 3 miles west of the outer marker. Two miles west of the locator outer marker the airplane was observed on radar flying southeast away from the final approach course. At 2247:00 (1745:00 EST) N9420J was asked to say altitude and heading. N9420J stated, "altitude one thousand, heading uh, I'm on the ... right on the localizer." N9420J was informed by ATC at 2247:17, (1947:17 EST), you're still 2 miles outside the marker, low altitude alert, climb immediately to 1,600. At 2249:05, (1749:05 EST), N9420J was instructed by ATC to expect a surveillance approach to runway 7 left, and was provided with the minimum descent altitude and missed approach point. In addition the pilot was instructed when assigned a heading to turn to it and stay on it. N9420J began the ASR approach at 2253:16 (1753:16 EST) 5 miles from the end of the runway. The airplane was observed on radar drifting right of course and the pilot was instructed to make a shallow turn to the left to a heading of zero six five. The airplane was observed turning through the assigned heading. The pilot was instructed to make a slow turn to the right and informed that he was 2 miles from the runway. The pilot did not acknowledge the radio transmission, the airplane continued the turn to the left, and radar contact was lost. The airplane wreckage was located by hunters at 2030, about 3 miles west of Daytona Beach Regional Airport. PERSONNEL INFORMATION Review of the pilot's logbook revealed the pilot had recorded as logged 1,442.5 total hours with 489.4 hours recorded as logged in the PA-28-180. The pilot had recorded as logged 103.1 hours of hooded flight with the last recorded flight being conducted on September 19, 1991. The pilot had recorded as logged 152.9 hours of actual instrument flight with the last recorded flight being conducted on September 15, 1989. The pilot had recorded as logged 109.8 hours of night flight with the last recorded flight being conducted on February 18, 1989. The pilot did not have his airman certificate or medical certificate in his possession at the time of the accident. Additional information pertaining to the pilot, Constantine J. Eugenides, is contained in NTSB Form 6120.4. AIRCRAFT INFORMATION Review of airframe maintenance records revealed the static pressure system test was recorded as logged on September 12, 1983. (For additional information pertaining to aircraft information see NTSB Form 6120.4). METEOROLOGICAL INFORMATION Instrument meteorological conditions prevailed at the time of the accident. Official sunset was at 1728 with the end of twilight at 1753. The altitude of the moon was -18.4 degrees. Witnesses stated it was very dark with little or no ambient light, light rain and no visible horizon. The ceiling was overcast estimated between 400 to 500 feet with fog. WRECKAGE AND IMPACT INFORMATION The wreckage of N9420J was located 1 1/2 miles north of highway U.S. 92 and 1 mile east of Indian Lake Road, Daytona Beach, Florida. Examination of the crash site revealed the airplane collided with numerous 60-foot trees while descending on a heading of about 083 degrees. The airplane continued forward and the left wing separated from the fuselage in three sections. The left wing tip separated from the left wing 65 inches inboard from the wing tip, 81 inches outboard of the wing root, and at the wing root. The airplane rolled left, the right main landing gear, and the right wing tip separated 101 inches outboard from the wing root after colliding with trees. The left and right elevator assembly, and rudder assembly collided with trees. The rudder assembly separated from the airplane. The left and right fuel tanks ruptured. The airplane collided with the terrain inverted, in a nose-down attitude coming to rest on a heading of 059 degrees about 342 feet from the initial point of impact. Torsional twisting and chordwise scarring was present on both propeller blades. Examination of the airframe, flight controls, engine assembly and accessories revealed no evidence of a precrash mechanical failure or malfunction. The lower lord mounts on the engine assembly were installed backwards. Cracks were present in the muffler baffle assembly. The rotator caps on the No 1. and No.2 cylinder exhaust valves were not installed. Corrosion and rust were present on the carburetor fuel screen. Gasket material was present inside the oil suction screen. Visual inspection of the turn and slip indicator, attitude gyro, and directional gyro after disassembly revealed the rotor in the turn and slip indicator was found in the normal position in the housing. The gyro rotors in the attitude gyro and the directional gyro were found in their normal position in the housing. No impact marks or evidence of scoring was present on the gyro rotors. MEDICAL AND PATHOLOGICAL INFORMATION Post-mortem examination of the pilot, Constantine J. Eugenides, was conducted by Dr. Ronald L. Reeves, Medical Examiner, District 7, Daytona Beach, Florida, on November 21, 1994. The cause of death was multiple blunt force trauma. Postmortem toxicology studies of specimens from the pilot was performed by the Forensic Toxicology Research Section, Federal aviation Administration, Oklahoma City, Oklahoma. These studies were negative for acidic, and basic drugs. Verapamil 0.085 ug/ml, and norverapamil 0.093 was detected in the blood. Review of airman records on file with the Aeromedical Certification Division, Oklahoma City, Oklahoma, revealed the pilot recorded on his application for a third class medical certificate, dated April 5, 1993, that he had no history of high or low blood pressure. The pilot recorded that he was currently using the prescription drug proscar. TEST AND RESEARCH Advisory Circular 60-4 describes spatial disorientation, and is included as a part of this report. A flight check of ILS runway 7 left and ASR 7 left at the Daytona Beach Regional Airport, Daytona Beach, Florida, was requested and conducted by the FAA Atlanta Flight Inspection Field Office on November 22, 1994, and November 23, 1994, with no deficiencies noted. ADDITIONAL INFORMATION The Air Traffic Manager for Daytona Beach Airport Traffic Control Tower stated, the base of the radar coverage in the vicinity of Daytona Beach Regional Airport is about 3,000 feet msl. Instrument flight publications (U.S. Terminal Procedures Southeast, and Enroute Low Altitude-U.S. L-19/L-20) found in the airplane wreckage were expired. The airplane wreckage was released to Detective Steven J. Beres, Daytona Beach Police Department, Daytona Beach, Florida, on November 21, 1994. The airplane engine was released to Mr. James W. Grasmick, Daytona Beach Jet Center, Daytona Beach, Florida, on November 22, 1994. The airplane logbooks were released to Mr. Richard K. Sheppard, FAA North Florida Flight Standards District Office, Orlando, Florida, on November 23, 1994.

Probable Cause and Findings

The pilot's failure to maintain aircraft control while maneuvering in instrument flight conditions during an instrument approach, resulting in the pilot becoming spatially disoriented, and a subsequent in-flight collision with terrain. Contributing to the accident was the pilot's lack of recent experience in instrument and night flight conditions.

 

Source: NTSB Aviation Accident Database

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