Aviation Accident Summaries

Aviation Accident Summary MIA98LA115

BAINBRIDGE, GA, USA

Aircraft #1

N6847Z

Piper PA-25-235

Analysis

According to the certified flight instructor (CFI), witness, the pilot was being trained in agricultural operations, and was in radio communications with the CFI who was supervising the operation. The witnesses said the airplane made a turn at the end of a field, appeared to stall, impacted the ground and burned. The airplane was last seen about 150 to 200 feet above the ground in a turn. The flight had departed with full fuel and 100 gallons of water. The CFI was to observe from the ground, the pilot fly a Piper Pawnee aircraft into a local farmers field, while he practiced simulated spray runs, aerial applicator maneuvers, back and forth across the field. According to the CFI, he had a two-way hand-held radio, and '...we each acknowledged a good radio check.' The CFI said he then told the pilot he should takeoff and fly to the field, and the CFI drove his truck to the field to observe his progress. As the CFI approached the edge of the field he said, the pilot was making his first pass into the field from east to west on the south side of the field, '...he looked steady and at a safe height of about 15-20 feet. He exited to the west end of the field correctly and turned 45 degrees to the left at an altitude of about 150-200 feet above the trees and extended in a southwesterly direction for about 4-5 seconds before initiating a right hand reversal back into the field. While his aircraft was in a right, medium-banked [sic] (30 degrees) level turn, I diverted my attention momentarily from the aircraft to park my truck. After only about 5 seconds, I looked back into the direction where I had last seen the plane, and observed a plume black smoke coming from behind the trees, rising up about 100 feet from ground level.' According to the FAA Inspector's statement, the on site investigation revealed that the hopper was intact and empty of water. The dump handle was found in the dump position. The leakage of water on the ground near the crash site. The elevator trim was found in the nose down position. The elevator, rudder, and aileron continuity was established. The seat belt was found in locked position [attached], on the ground, inside the cockpit, and the body of the pilot showed no evidence of the seat belt or harness being attached. The cockpit frame work, inertial reel gear shift, and shoulder harness attachment cable, were sent to the NTSB Materials Laboratory, Washington, DC, for examination. The examination revealed that the inertial reel retraction cable failed due to wearing of the cable, over an undetermined period of time, after which the remaining wires of the cables failed in tensile overstress. There was no evidence found to show that the cable was tied to the frame tube before or at the of the accident. Nor could it be confirmed that the marks on the frame tube were caused by the shoulder harness attachment cable. Three nearly equally spaced marks on the tube was suggestive of a series of ties, and not an individual tie for holding the separated cable to the framework. The pilot had first soloed the Pawnee, on April 1, 1998, and had logged 3.2 hours in preparation for the subject flight. There were no records found showing that the pilot had received any additional training in this make/model or category of airplane. In addition, the owner/operator of the airplane, and the provider of the training for this type of operation were the same. The training was conducted under the name of AG-FLIGHT Inc. There is nothing in their circular that says a person applying for training needs any special certificate, a minimum of flight time or special experience. The training program was not certified by the FAA, and it is not required to be certified. The pilot had a total of 165 hours of flight time, and a total of 3.3 hours in this make and model airplane at the time of the accident.

Factual Information

On April 2, 1998, about 0800 eastern standard time, a Piper PA-25-235 (Agricultural), N6847Z, registered to a private owner, crashed while maneuvering near Bainbridge, Georgia. Visual meteorological conditions prevailed at the time and no flight plan was filed for the Title 14 CFR Part 91, local training flight. The private-rated pilot was fatally injured. The airplane was destroyed. The flight had departed at 0745. The certified flight instructor (CFI), that witnessed the accident said, "...on April 2, 1998, I was to observe from the ground, [the pilot] fly a Piper Pawnee aircraft into a local farmers field, while he practiced simulated spray runs (aerial applicator maneuvers) back and forth across the field...[the pilot] first soloed the Pawnee on April 1, 1998, and logged 3.2 hours in preparation for the subject flight." The pilot arrived at the airplane about 0715, and the CFI said, "...I went outside and preflighted his airplane...I added one quart of oil to bring the total to 12 quarts...[the pilot] conducted a complete preflight of the aircraft himself...afterwards, I rebriefed him on how we would conduct the flight. I particularly emphasized that...he was not to fly low (4-6') over the field until he was comfortable to do so...that he was to extend his outbound leg and make shallow turns back into the field, and...if [he] sensed any sign of trouble, no matter what, to dump his load." According to the CFI, the pilot taxied the airplane over to the refueling/loading area, where the CFI said, "...I refueled the aircraft to the full position, loaded the hopper with100 gallons of water, and cleaned his windshield. I had a two-way hand-held radio, and we each acknowledged a good radio check." The CFI said he then told the pilot, "...he should takeoff and fly to the 'junkyard' field, a predetermined field approximately one to two miles west of the airport (a field that [the pilot] had flown in previously and was very familiar with), clear the field, and begin the proper maneuvers back and forth across the field. In the meanwhile, I would be driving my truck to the field to observe his progress." As the CFI approached the edge of the field he said, "...[the pilot] was making his first pass into the field from east to west on the south side of the field: he looked steady and at a safe height of about 15-20 feet. He exited to the west end of the field correctly and turned 45 degrees to the left at an altitude of about 150-200 feet above the trees and extended in a southwesterly direction for about 4-5 seconds before initiating a right hand reversal back into the field. While his aircraft was in a right, medium-banked [sic] (30 degrees) level turn, I diverted my attention momentarily from the aircraft to park my truck. After only about 5 seconds, I looked back into the direction where I had last seen the plane, and observed a plume black smoke coming from behind the trees, rising up about 100 feet from ground level. The CFI drove to the crash site and when he arrived he saw the pilot "laying about 5 feet from the plane on his back...his helmet was laying inches from his head...." According to the FAA Inspector's statement, during the on site investigation he had determined that "...the aircraft contacted the ground, left wing first, sheering the wing...the propeller and rupturing the fuel tank." In addition, he said he found, "...[the] hopper intact with no water on board. Dump handle in forward (dump) position. [The] ground from initial contact to fire damage area did not show that hopper contents had been dumped in this area...aircraft trim [found] in nose down position (Opposite of what Instructor says [he] taught)...elevator/rudder...aileron cable[s]...continuity [established]...seat belt was [found] in locked position [attached] on [the] ground inside cockpit...[and] the body of pilot showed no evidence of seat belt or harness [ever] being attached." According to the CFI, the pilot "first soloed the Pawnee on April 1, 1998, and logged 3.2 hours in preparation for the subject flight." There were no records found showing that the pilot had received any additional training in this make/model or category of airplane. In addition, the owner/operator of the airplane, and the provider of the training for this type of operation were the same. The training was conducted under the name of AG-FLIGHT Inc. There is nothing in their circular that says a person applying for training needs any special certificate, a minimum of flight time or special experience. The training program was not certified by the FAA, and it is not required to be certified. The pilot had a total of 165 hours of flight time, and a total of 3.3 hours in this make and model airplane at the time of the accident. An autopsy was performed on the pilot, on April 4, 1998, at the Medical Examiner's Office, Bainbridge, Georgia, by Dr. A.J. Clark. According to the autopsy report, the cause of death was, "...smoke and heat inhalation." Toxicological tests were conducted at the Federal Aviation Administration, Research Laboratory, Oklahoma City, Oklahoma, and revealed, "...no ethanol or drugs...19 percent Carbon Monoxide was detected in Blood." The cockpit frame work, inertial reel gear shift, and shoulder harness attachment cable, were sent to the NTSB Materials Laboratory, Washington, D.C., for examination. The examination revealed that the inertial reel retraction cable failed due to wearing of the cable, over an undetermined period of time, after which the remaining wires of the cables failed in tensile overstress. The wear was a result of the cable's tendency to straighten from the relatively tight curvature when wrapped around the inertial reel. A permanent curve was found in the shoulder harness attachment cable that approximately matched the diameter of the tube of the cockpit frame. There was no evidence found to show that the cable was tied to the frame tube before or at the time of the accident. Nor could it be confirmed that the marks on the frame tube were caused by the shoulder harness attachment cable. Three nearly equally spaced marks on the tube was suggestive of a series of ties, and not an individual tie for holding the separated cable to the framework [See NTSB Materials Laboratory Factual report].

Probable Cause and Findings

The pilot's failure to maintain adequate airspeed, which resulted in a stall. Contributing factors were the pilot's lack experience in this category of aircraft. An additional factor was the inadequate upgrade training provided by the company that owned the airplane and was providing training.

 

Source: NTSB Aviation Accident Database

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