Aviation Accident Summaries

Aviation Accident Summary NYC99FA123

WEST DOVER, VT, USA

Aircraft #1

N717AV

Piper PA-28-161

Analysis

The Piper PA-28-161, was landing to the north, at night, touched down on the runway and then became airborne at the end of the runway over lower terrain. A witness saw the airplane in a nose high attitude with the engine running, after which it struck trees, and descended onto a golf course. A mountain ridge was located 3 miles to the northwest, with winds from the northwest. The airport was noted for variable winds and the VASI lights listed for the airport were inoperative. No malfunction was found with the airplane or engine. The pilot owned a multi-engine airplane that was not available. He checked out in a PA-28-236, and completed an equipment exam on the airplane. The PA-28-236 was not available and the pilot the PA-28-161. No evidence of any single engine flying in the preceding year, other than the checkout was found. The operator's rules allowed a person to take a less complex airplane (PA-28-161), in place of a more complex airplane (PA-28-236), but did not require an equipment exam on the less complex airplane.

Factual Information

HISTORY OF FLIGHT On May 28, 1999, about 2045 eastern daylight time, a Piper PA-28-161, N717AV, was destroyed when it struck terrain during an aborted landing at Mount Snow Airport (4V8), West Dover, Vermont. The certificated private pilot and two passengers were fatally injured. Visual meteorological conditions prevailed for the personal flight, which originated from Republic Airport (FRG), Farmingdale, New York. No flight plan had been filed for the flight that was conducted under 14 CFR Part 91. The pilot lived on Long Island, New York, and maintained a separate residence in Mount Snow, Vermont. Interviews disclosed that the pilot was a frequent flyer to 4V8; however, the persons interviewed also added that the pilot had not flown into the airport at night. A line person at FRG reported that he observed the pilot loading items in the airplane as he filled the fuel tanks to capacity. He then watched the occupants board the airplane and depart. According to the Federal Aviation Administration (FAA) Air Traffic Control Tower at FRG, the pilot departed at 1910. The airplane was next observed on Runway 1 at Mount Snow. A witness reported seeing the airplane on the runway, traveling toward the north end of the runway, at what she described as a speed slower than normal and she did not hear any engine noise. The airplane disappeared from view behind some trees and she did not see it again. In addition, she said she thought the airplane had landed, and was not departing. One witness reported the winds were calm at the airport, while another witness reported the winds were gusty. A witness at the Mount Snow Golf Course clubhouse saw the airplane as it departed Runway 1. He identified the airplane by observing the landing and navigation lights. He reported the airplane was below the level of the surrounding trees, and climbing. He could hear the engine, which sounded "OK" to him. He said the airplane was climbing in a wings level attitude when he heard what he thought was a momentarily power interruption. This was followed by a high nose up pitch attitude of about 30 degrees or slightly higher, after which, the airplane disappeared from view. The witness reported the winds at his location were calm at the time of the accident, but a few minutes later became gusty with changing direction. The accident occurred during the hours of night at 42 degrees, 56.04 minutes north latitude and 72 degrees, 52.19 minutes west longitude. PERSONNEL INFORMATION The pilot held a private pilot certificate with ratings for airplane single and multi-engine land, and instrument airplane. He was issued a Second Class FAA airman medical certificate on May 3, 1999, which contained a limitation to wear corrective lenses for near and distant vision. The pilot's logbook was complete through December 30, 1998. After that, one flight was listed on May 22, 1999, which was a 1.4 hour checkout in a Piper PA-28-236. According to the pilot's log book, he had logged a total time of 3,157 hours, over 2,000 hours in multi-engine airplanes and 48 hours in preceding 12 months. Other than the checkout on May 22, and the accident flight on May 28, there were no records that the pilot flew any single engine airplanes within the past year. Since no flights were listed after December 30, 1998 except for the checkout, the pilot's recency of experience was not able to be determined. METEOROLOGICAL INFORMATION The winds aloft forecast for 1,000 MB (sea level) 850 MB (4,800 feet), and 700 MB (9,900 feet) revealed winds from the southwest at 1,000 MB, from the northwest at 15 knots at 850 MB, and from the northwest at 20 knots at 700 MB. AIRDROME INFORMATION (Destination) According to records from the FAA, Runway 1 at Mount Snow was 2,650 feet long, 75 feet wide, had an asphalt surface, and the airport elevation was 1,953 feet high. A further check of the airport data revealed that each end of Runway 1/19 was equipped with a tri-color VASI on the left side of the runway. A check of the runway on the night following the accident, revealed that the visual approach slope indicators (VASI)VASI located at the approach end of each runway were not operative. For threshold identification of Runway 1, there were two green lights on the right side of the runway aligned with the runway lights. There were no corresponding green threshold lights on the left side. WRECKAGE AND IMPACT INFORMATION The terrain beyond the departure end of the runway was lower than the airport. A tree located on a heading of 350 degrees, about 1,200 feet from the departure end of Runway 1 had fresh breaks on its upper branches about 48 feet above the ground. The accident site was located 217 feet from the tree strikes on a heading of 310 degrees. Small pieces of plastic similar to the left wing plastic wing tip were in the wooded area and trailed out about 100 feet from the tree with the broken branches. Small broken branches were on the ground along the trail of broken plastic. The airplane came to rest on the left side of the 10th fairway, and 36 feet from the initial ground impact. A ground scar was found adjacent to the ground impact crater. Paint chips were along the length of the ground scar, and green glass was at the end opposite of the impact crater. Compression wrinkles were orientated vertically on the fuselage, 90 degrees to the longitudinal axis of the airplane. Fuel was found in both wing tanks, in the carburetor and line leading to the carburetor. There were no obstructions in the main jet of the carburetor. The engine was rotated and compression was present in all cylinders. The magnetos were rotated and spark was obtained from all terminals. The engine suction screen contained small pieces of carbon. MEDICAL AND PATHOLOGICAL INFORMATION The toxicological testing report from the FAA Toxicology Accident Research Laboratory, Oklahoma City, Oklahoma, was negative for drugs and alcohol for the pilot. Autopsies on the pilot and passengers were conducted by the Chief Medical Examiner, in Burlington, Vermont, on May 30, 1999. ADDITIONAL INFORMATION The runway and accident site were viewed from the location of the witness at the club house at the same time on the night following the accident. The sun had already set and was calculated to be about 4 degrees below a level horizon. Higher terrain prevailed to the west, with the horizon about six degrees above a level horizon. The moon was about 20 degrees above the horizon in the east, and was about 98 percent illuminated. Although major terrain features were visible, details of the terrain features were not always visible. Interviews with several pilots disclosed the winds at Mount Snow were inconsistent. During the investigation the investigative team went to the airport. While standing on the right side of Runway 1, periods of calm air, followed by winds of varying strength from both directions were observed. The airport manager reported there were two windsocks on the field because there were times when the wind would blow from both directions at the same time on opposite ends of the runway. The departure of a single engine, four place, high wing, retractable landing gear airplane was observed while standing about 1,800 to 2,000 feet from the approach end of Runway 1, and about 50 feet to the right side of the runway. The winds at this location were calm; however, as the airplane passed the departure end of Runway 1, the climb was observed to flatten momentarily, the airplane took on a nose left yaw of about 20 degrees, and the wings rocked from side to side about 15 to 20 degrees. After several seconds, the wing rocking stopped, and the airplane resumed climbing. During the time at the airport, the winds were observed to blow from both directions, interspersed with periods of calm winds. A pilot who landed about 15 minutes after the accident reported the he had departed Groton, Connecticut about 1945. En route he flew at 6,500 feet, and had a 24 knot head wind. He noticed that there was little change in the descent and said the winds were quartering from the northwest to west. At the traffic pattern altitude, he encountered some shear, and then lower to runway 1, he encountered a tail wind. He had already set full flaps. When the airplane was about 10-15 feet above the ground, he initiated a go-around and kept the nose down. He reported that he had a hard time keeping 60 knots as he accelerated. During the go-around, he looked at the windsock on the north end and it showed a head wind. On his second approach, he felt a push as he neared the runway and flew a lower approach to achieve his touchdown point. A mountain ridge, orientated north/south, was located about 3 1/2 miles to the west of the airport. The high point of the ridge was about 45 degrees left of the runway centerline. People familiar with the local terrain reported that the prevailing wind was normally from the northwest, across Mount Snow and toward the airport. The pilot owned a Beech B-60 airplane, which was undergoing maintenance. He had received a checkout in a Piper PA-28-236 (235 horse power) from a local fixed base operator at FRG. The checkout was accomplished with two people onboard and full fuel tanks. When the pilot attempted to schedule the accident flight in the PA-28-236, he found out it was not available. He then attempted to schedule the accident flight in a Piper PA-28-180 (180 horse power), and that airplane was also not available. He then elected to take the Piper PA-28-161 (160 horse power), N717AV, the accident airplane. The operator reported that they had a policy in effect which allowed a person to take a less complex airplane (PA-28-180 & PA-28-161) if they were checked out in a more complex airplane (PA-28-236). A review of the documents completed during the checkout in the PA-28-236 revealed the pilot completed an open book exam on the equipment. Included were such items as the airspeeds for best angle of climb (Vx), and best rate of climb (Vy). A check of PA-28-236 revealed that those speed were 73 and 85 knots respectively. For the PA-28-161, the speeds were 63 and 79 knots respectively. No additional equipment exam was given when the pilot received the keys for N717AV. It was estimated that N717AV departed at or near gross weight and had burned about 120 pounds of fuel at the time of the accident. The aircraft wreckage was released to the insurance adjuster on May 30, 1999.

Probable Cause and Findings

Was the failure of the pilot to maintain control of the airplane during an aborted landing. Factors were the pilot's lack of familiarity with the airplane, the variable winds, and night conditions.

 

Source: NTSB Aviation Accident Database

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