NTSB Factual Report

HISTORY OF FLIGHT

On January 21, 2004, at 0845 Pacific standard time, a Piper PA-32R-300, N8701E, impacted mountainous terrain near Big Pine, California. Ameriflight, Inc., operated the airplane as AMF flight 132 under the provisions of 14 CFR Part 135 as a nonscheduled cargo flight. The airplane was destroyed in the post-impact fire. The airline transport pilot (ATP), the sole occupant, sustained fatal injuries. The cross-country flight departed the Burbank-Glendale-Pasadena Airport (BUR), Burbank, California, at 0640. The flight was scheduled to terminate at the Mammoth Airport, Mammoth, California. Planned stops were at the Inyokern Airport, Inyokern, California, and the Bishop Airport, Bishop, California. Day visual meteorological conditions prevailed, and a visual flight rules (VFR) company flight plan had been filed.

Witnesses in the accident area stated that there was no significant weather at the time of the accident, and that it was "clear blue skies." One witness stated that he was outside at the time, and did not hear the airplane because he was listening to the radio. However, when he looked up from what he was doing he saw a black cloud of smoke and called the Inyo County Sheriff's Department to report a possible downed aircraft.

There were no reports of communications between the pilot and the controlling Federal Aviation Administration (FAA) facilities. According to the FAA, their radar coverage is not available below 10,000 feet in the Owens Valley area where the accident occurred.

PERSONNEL INFORMATION

A review of the FAA airman records revealed the pilot held an airline transport pilot certificate with a rating for airplane multiengine land. The ATP certificate also contained commercial privileges for airplane single engine. The pilot held a certified flight instructor certificate with ratings for airplane single engine land, multiengine land, and instrument airplane. The pilot also held a mechanic certificate with ratings for airframe and powerplant.

The pilot held a first-class medical certificate that was issued on December 19, 2003, with a limitation that the pilot must wear corrective lenses.

According to Ameriflight paperwork, the pilot was hired on November 3, 2003. According to the pilot's personnel records from Ameriflight, the pilot had a total flight time of 1,884 hours. He logged 115 hours in the accident airplane make and model. The pilot's Part 135 check ride was conducted on November 11, 2003.

An examination of the pilot's logbook indicated a total flight time of 1,842.4 hours. He logged 86.0 hours in the last 90 days, and 28.4 in the last 30 days.

According to the pilot's sister, his normal workweek was Monday through Friday. He would leave his residence each day around 0530 and return home around 2030 each evening; going to bed around 2300. The week of the accident, she indicated was a short week for him. Monday, January19th was a holiday, January 20th the pilot returned home early due to bad weather, and January 21st was the accident. She further reported that the pilot had not been sick in the recent past.

The National Transporation Safety Board investigator-in-charge (IIC) interviewed several personnel from Ameriflight. A captain who had flown with the accident pilot during the pilot's initial training indicated that during two flights, both from Inyokern to Bishop, the accident pilot had fallen asleep. The first time the accident pilot stated that he was tired and asked if it would be okay if slept for a little bit. The second time, the captain said there was no warning that the accident pilot wanted to take a nap. Both naps lasted between 20-30 minutes. He further reported that the evening flights (cargo/training flights) were uneventful, and he did not recall the accident pilot sleeping or acting fatigued.

According to the company's operations supervisor, the pilot had arrived late on a couple of occasions for his morning flights. In accordance with company procedures, all flight crews are required to be at their aircraft 45 minutes prior to their scheduled departure time. The pilots are required to file a flight plan with the local Flight Service Station. The operation's supervisor further reported that the pilots also have the option to file a flight-locating plan with dispatch, but dispatch still has to wait for phone calls from the pilots indicating that they have arrived at their scheduled destination.

A dispatcher working the night shift on January 20th reported that the accident pilot was 2.5 hours late returning to Burbank. The pilot was scheduled to be back at 1700, but had encountered adverse weather at Mammoth. The dispatcher reported that the pilot was going to stay in Mammoth until the weather cleared. Later that evening the weather cleared, and the accident pilot arrive in Burbank at 1930. The dispatcher reported that the accident pilot looked "beat up," like he had had a rough flight. The accident pilot commented to the dispatcher that the weather had been "rough" at Inyokern.

AIRCRAFT INFORMATION

The airplane was a Piper PA-32R-300, serial number 32R-7680160. A review of the airplane's logbooks revealed a total airframe time of 11,246.3 hours at the operator's last Approved Aircraft Inspection Program (AAIP) completed on January 19, 2004.

The airplane was equipped with a Textron Lycoming IO-540-K1G5 engine, serial number L-6470-48A. Engine maintenance records recorded a total engine time of 11,104.0 hours; 3,819.0 hours at the last inspection, and 142 hours since overhaul.

According to the operator, all of their PA-32R-300 airplane's were equipped with autopilot.

A review of the maintenance and flight department records revealed no unresolved maintenance discrepancies against the airplane prior to departure. Maintenance personnel reported that during the last inspection, a visual inspection of the exhaust system was conducted with no leaks or cracks observed.

METEOROLOGICAL CONDITIONS

Reported weather from IYK at 0645 was: winds from 050 degrees at 10 knots; visibility 20 miles; sky conditions clear with no clouds; temperature 48 degrees Fahrenheit; and altimeter 30.22 inHg. At 0845, winds were from 050 degrees at 13 knots; visibility 20 miles; sky conditions clear with no clouds; temperature 46 degrees Fahrenheit; and altimeter 30.24 inHg.

Reported weather from BIH at 0756 was: winds from 350 degrees at 15 knots gusting to 20 knots; visibility 10 miles; temperature 39 degrees Fahrenheit; dew point 15 degrees Fahrenheit; and altimeter 30.33 inHg. At 0856, winds were from 350 degrees at 12 knots; visibility 10 miles; temperature 38 degrees Fahrenheit; dew point 14 degrees Fahrenheit; and altimeter 30.35 inHg.

WRECKAGE AND IMPACT INFORMATION

Investigators from the Safety Board, the FAA, New Piper Aircraft, and Textron Lycoming examined the wreckage at the accident scene. The wreckage was at 37 degrees 06.379 minutes north latitude and 118 degrees 17.886 minutes west longitude.

The accident site was located on the eastern side of the Sierra Nevada mountain range in the Owens Valley, on Crater Mountain near the Big Pine Fish Hatchery. Crater Mountain is at an elevation of 5,860 feet, and is located about 5 miles west of Interstate 395. The uneven terrain consisted of lava rocks, and desert scrub. A post impact fire destroyed the forward fuselage and cockpit.

Investigators noted that the tachometer and Hobbs hour meter were destroyed.

The main wreckage came to rest in a level upright position on top of a flat spot on a ridgeline, and oriented on a magnetic bearing of 335 degrees. The first identified point of impact (FIPC) was about 10 feet below where the wreckage came to rest. Portions of the center section of the airplane (nose landing gear, fuselage skin, and stringers) were located in the debris path. On each side of the FIPC, at a distance approximately the length of the airplane's wings, were the wing tip fiberglass casings. Portions of broken green lens were downslope of the main wreckage near the FIPC. The red lens was intact near the front left side of the airplane. Investigators surmised that the autopilot was thermally destroyed in the post-impact fire.

The airframe representative established flight control continuity from the T-bar assembly inside the cockpit to the wings and tail section of the airplane. The flight control cables remained attached at their respective attach fittings. Both wings exhibited uniform crush damage from the leading to trailing edges. The lower wing surface of both wings exhibited fragmentation from ground impact damage. The left aileron and flap assembly remained partially attached; the right aileron remained attached to the wing. Both wings' aileron control cables remained attached to their respective bellcrank assemblies.

Visual examination of the engine revealed no obvious preimpact anomalies. The engine separated from the firewall but remained attached to the engine mounts. The bottom and aft portion of the engine exhibited thermal damage.

The propeller separated from the crankshaft. The propeller blades remained attached at the hub. Both propeller blades exhibited leading and trailing edge gouges, S-bending, and chordwise scratching.

MEDICAL AND PATHOLOGICAL INFORMATION

The Inyo County Coroner in Bishop conducted an autopsy on the pilot on January 23, 2004.

The FAA Bioaeronautical Sciences Research Laboratory, Oklahoma City, Oklahoma, performed a toxicological analysis from samples obtained during the autopsy. The toxicological results were negative for carbon monoxide, ethanol, and tested drugs. The results of analysis of the specimens were positive for cyanide, 0.31 detected in blood.

TESTS AND RESEARCH

The wreckage was examined under the supervision of the Safety Board IIC at Aircraft Recovery Service, Littlerock, California, on August 25, 2004.

Investigators removed the top spark plugs, which were light gray in color. The coloration corresponded to normal operation according to the Champion Aviation Check-A-Plug AV-27 Chart. A borescope inspection revealed no mechanical deformation to the valves, cylinder walls, or internal cylinder heads. Investigators noted no foreign object debris inside the engine.

The Lycoming representative removed the accessory case, and noted no preimpact damage to the crankshaft gear, and the bolt and dowel. The crankshaft was manually rotated via the flange. Thumb compression was obtained on cylinders 1, 3, and 6. Varying degrees of impact damage and thermal damage were noted on cylinders 2, 4, and 5. Investigators were able to establish mechanical continuity of the valve train during manual rotation of the crankshaft.

The left magneto remained secured at the mounting pad; however it sustained thermal damage. The right magneto was displaced from its mounting pad, and exhibited thermal and impact damage. Both magnetos could not be functionally checked due to thermal and impact damage.

No discrepancies were noted with the airframe or engine that would have precluded normal operation.

ADDITIONAL INFORMATION

The IIC released the wreckage to the owner's representative.

NTSB Probable Cause

failure of the pilot to maintain clearance with mountainous terrain for undetermined reasons.