Aviation Accident Summaries

Aviation Accident Summary LAX03FA090

Santa Susana, CA, USA

Aircraft #1

N65005

Cessna 172P

Analysis

The airplane collided with mountainous terrain in a box canyon while attempting a course reversal. According to statements from both the Certified Flight Instructor (CFI) and the student pilot, they approached a 3,400-foot-mountain ridgeline at a cruising altitude of 3,000 feet mean sea level. To keep the most altitude between the airplane and the ground they flew up the center of a box canyon that approached the mountain ridge. The CFI initiated a climb to 3,500 feet. Upon observing that they were not going to clear the ridge, the CFI made a left turn and intentionally stalled the airplane in an attempt to make a survivable landing on the mountain slope. Examination of the airframe and engine revealed no preimpact mechanical malfunctions or failures.

Factual Information

HISTORY OF FLIGHT On February 18, 2003, about 1335 Pacific standard time, a Cessna 172P, N65005, impacted rising terrain while maneuvering in the mountains near Santa Susana, California. The Aero Club, based in Van Nuys, California, operated the airplane under the provisions of 14 CFR Part 91. The airplane was destroyed. The certified flight instructor (CFI) and a student pilot sustained serious injuries. Visual meteorological conditions prevailed and no flight plan had been filed. The instructional flight departed Camarillo, California, about 1314. The CFI stated to the National Transportation Safety Board investigator-in-charge (IIC) that they performed a downwind departure out of Camarillo and proceeded to climb to 3,000 feet mean sea level (msl) on a easterly route the CFI commonly takes over the Santa Susana Mountains. As they approached the mountain ridgeline in a box-like canyon they attempted a climb to 3,500 feet mean sea level (msl). In order to keep the most altitude between the aiplane and the ground, they flew up the center of the canyon valley. Upon observing that they were not going to clear the ridge, the CFI made a left turn and intentionally stalled the airplane in an attempt to make a survivable landing on the mountain slope. Federal Aviation Administration (FAA) radar data was obtained from Southern California Terminal Area Radar Control (TRACON) and a track plot was generated. A copy of the plot is included in the docket for this report. It shows an airplane departing Camarillo airport at the time the tower cleared N65005 for takeoff on an easterly heading. The highest mode C reported altitude before coverage was lost was 3,100 feet. PERSONNEL INFORMATION Review of FAA airman record files disclosed that on May 22, 2001, the CFI was issued a private pilot certificate based on a foreign certificate (Belgium). On September 13, 2002, the pilot was issued a commercial pilot certificate, and on April 13, 2002, she received a flight instructor certificate. The CFI was issued a second-class aviation medical certificate on October 11, 2001. There were no limitations or restrictions listed on the medical certificate. An examination of the CFI's logbook revealed 738.8 hours of total flight time and 98 hours of dual instruction given. The CFI stated that she had flown over the southern California area frequently during the last 2 1/2 years. The route they took between Camarillo and Van Nuys was one the CFI had flown before. AIRCRAFT INFORMATION An examination of the airplane logbook revealed that the last inspection of the airframe and engine occurred on December 18, 2002, and was listed as an annual/100-hour inspection at an engine tachometer time of 501.3 hours. The total airframe hours at this time was approximately 12,598. METEROROLOGICAL INFORMATION The closest aviation weather reporting observation station to the accident site was located at Van Nuys Airport, 12 nm southeast of the accident site. A routine weather report (METAR) for Van Nuys airport was issued at 1351. It stated: skies scattered at 20,000 feet; visibility 10 miles; winds from 030 degrees at 10 knots; temperature 68 degrees Fahrenheit; dew point 42 degrees Fahrenheit; and altimeter setting 30.04 inHg. Data from the National Weather Service recorded at 1300 was winds aloft for 998 meters (3,274 ft msl) and 1218 meters (3,996 ft msl) to be 141degrees true at 5 knots and 343 degrees true at 3 knots, respectively. At 1400, the winds were 001 degrees true at 1 knot and 352 degrees true at 2 knots for the same respective altitudes. WRECKAGE AND IMPACT INFORMATION The on scene examination revealed that the airplane impacted on upsloping terrain in a box canyon, in the Santa Susana Mountains (34 degrees 20.082 minutes north latitude and 118 degrees 36.108 minutes west longitude). The approximate location of the accident site is 11.5 miles northwest of the Van Nuys airport at an approximate elevation of 3,400 feet msl, 50 feet below the ridgeline. The fuselage was oriented on a magnetic bearing of about 322 degrees in an estimated 20 degrees nose down and a 15-degree left wing low attitude. The airplane was observed on its main landing gear with the nose gear buckled and rotated aft beneath the engine compartment. The propeller and spinner were found against the 40-degree upsloping dirt and bouldered mountain side. The cockpit windscreen fragmented into portions which scattered 30 feet forward of the cockpit. One 20-inch-long portion of the propeller blade was found approximately 15 feet ahead of the airplane. The engine was attached to the firewall and displaced clockwise about 20 degrees from the airplane's longitudinal axis. There was no evidence of fire damage. TESTS AND RESEARCH The IIC examined the wreckage at the accident site, following its recovery at Van Nuys airport, and at Aircraft Recovery Services, Pearblossom, California. Airframe: An examination of the airframe revealed that all control cables and control surfaces were attached to their respective pulleys and hinges. The continuity of the flight control system was verified. The fuel lines and vent tubes were intact and no obstructions or blockages were found. The flaps were observed in the fully retracted position as indicated by the position of the flap jackscrew. Fuel was found in the gascolator and the inlet line to the carburetor. Engine: A partial teardown and examination of the engine was performed. Both magnetos produced a spark from the terminals when the drive gear was hand rotated, and the spark plug firing order was verified. All eight spark plugs had no visible damage. The spark plug electrodes were gray in color, which corresponded to normal operation according to the Champion Check-a-Plug AV-27 chart. Thumb compression was felt on all four cylinders. Camshaft, pushrods, and the accessory gear drives functioned during crankshaft rotation. Under the Safety Board investigator's supervision the following discrepancies were identified by the Lycoming and Cessna participants: (1) the engine mounted vacuum pump was missing its cover plate screws; (2) all engine fuel primer lines were either crimped closed or capped off; (3) tubing, that was not recognized as an appropriate airplane component, was used as vacuum pump drain hose; and (4) a fuel cap safety chain found loose inside the right fuel tank. Carburetor: The carburetor was flow tested and disassembled at Precision Airmotive, under the supervision of the IIC. The fuel inlet screen was clear; no debris or deposits were observed throughout the carburetor; float needle/valve seat surfaces were smooth with no visible wear markings; the throttle and mixture control rotated freely with no binding. The carburetor flow test revealed that the accident carburetor flowed up to a 4 lb/hr richer mixture than that of the master factory carburetor at the highest tested air flow rate of 230 cubic feet per minute. At the minimum flow rate of 11 cubic feet per minute, the accident carburetor matched the master. According to Precision Airmotive, this flow rate would not adversely affect the engine's performance. SURVIVAL ASPECTS The on board emergency locator transmitter operated and assisted in locating the accident site by personnel from the Los Angeles County Sheriff's Department. The CFI contacted emergency services using a personal cell phone from the accident location. ADDITIONAL INFORMATION The wreckage was released to the owner on February 22, 2003.

Probable Cause and Findings

The flight instructor's inadequate in-flight decision to cross mountainous terrain at a inadequate altitude to guarantee terrain clearance.

 

Source: NTSB Aviation Accident Database

Get all the details on your iPhone or iPad with:

Aviation Accidents App

In-Depth Access to Aviation Accident Reports