NTSB Factual Report

HISTORY OF FLIGHT

On July 26, 2000, at 0028 Eastern Daylight Time, a Cessna 210D, N3894Y, was destroyed when it struck the ground after takeoff from the Hanover County Airport (OFP), Ashland, Virginia. The certificated private pilot was fatally injured. Instrument meteorological conditions prevailed for the flight destined for Linden, New Jersey. The flight was operated on an instrument flight rules (IFR) flight plan that was conducted under 14 CFR Part 91.

The pilot had flown in earlier the same evening from Linden, New Jersey, at 1815. He was met by friends and attended a local seminar. Following the seminar, while being driven back to the airport, the pilot called the Federal Aviation Administration (FAA), Leesburg Automated Flight Service Station (AFSS) for a weather briefing.

According to transcripts from the FAA, initial contact was at 2312, and was terminated by the pilot after 1 minute due to poor reception. A second contact occurred at 2331, at which time the pilot asked for a standard weather briefing. He was given conditions of low ceilings, reduced visibility, and rain in his departure area, and improving conditions toward his destination.

At 2359, the pilot again established telephone contact with the Leesburg AFSS, and filed an IFR flight plan. His filed route of flight was Hanover Airport, direct to EPICS intersection, then via VICTOR 376 to IRONS intersection, direct NOTTINGHAM VOR, VICTOR 433, direct to APPLE intersection, direct Linden, New Jersey. There was then a discussion between the pilot and weather briefer about the route, and the route was amended to go direct from the NOTTINGHAM VOR to Linden Airport. The pilot told the briefer that the airplane was equipped with a global positioning navigation system (GPS), and used suffix G to describe the installed equipment.

At 0013:30, on July 26, 2000, while still on the ground at Hanover, the pilot established radio contact with Richmond Approach Control, and requested his IFR clearance. The controller stated:

"november three eight nine four yankee, you're cleared to lima delta juliet, via victor sixteen to smyrna [VOR], victor twenty nine modena [VOR], direct yardley [VOR], victor two fourteen metro [intersection]...maintain two thousand, expect five thousand within ten minutes after departure, departure frequency will be one three four point seven, squawk two one six zero, and stand by for the rest of the routing if there is any."

The pilot read the clearance back to the controller. The controller then gave a correction to the pilot, and the pilot acknowledged the correction. The controller then told the pilot that his read-back of the clearance was correct.

At 0022:07, the pilot called for release, and was released at 0022:22. When the pilot did not reply to the controller's release, the controller made another radio call to the pilot and repeated the release, which was then acknowledged by the pilot. The pilot was subsequently given a current altimeter setting, which was also acknowledged.

At 0025:08, the pilot reported, "richmond departure, centurion three eight nine four yankee is with you at one thousand four hundred [feet], climb to five [5,000 feet]. The controller replied, "november three eight nine four yankee, departure's radar contact, you can proceed direct tappa [intersection], join victor sixteen, maintain five thousand." The pilot replied, "direct tappa, joining victor sixteen, maintaining five, nine four yankee."

At 0026:40, the controller stated, "november nine four yankee, verify you're in a turn towards tappa." The pilot replied, "ah, currently, I'm at ah....." After speaking, the radio recorded an increase in background noise, similar to engine sound and/or wind noise. At 0027:10, another transmission was received where background noise was heard, but no voice transmissions were heard.

At 0027:24, the controller stated, "nine four yankee, it appears you're southbound, why don't you make a turn heading of ah zero six zero and join victor sixteen. No reply was received from the pilot.

At 0027:40, the controller stated, "november nine four yankee, richmond." The pilot replied, "yes, nine four yankee," after which, the controller said, "nine four yankee, it appears you're ah circling around the airport, why don't you go ahead and turn zero six zero and join victor sixteen on that heading. At 0027:52, the pilot replied, "zero six zero, joining victor one six, nine four yankee."

No further transmissions were received from the airplane.

One witness reported:

"We...were sitting on the couch in the house and we heard a loud sound like a high-speed motorcycle for three or four seconds. Then we heard it hit the ground. We went to help look for the plane and it was about one hundred yards from my house. I could tell it was going very fast by the noise that it was making."

A second witness reported:

"I was driving home from work on Sliding Hill road, and as I approached the airport, I saw the aircraft descending at an angle toward the ground. It was perpendicular to the runway and parallel to the road I was on. It was 12:30 at night, raining, and I had the wipers and the car radio on. The aircraft engine is what caught my attention first because it was loud. The lights on the aircraft were on. The plane appeared to be in whole, not in pieces."

A third witness reported that he had lived near airports for many years and was familiar with the sound of departing airplanes. He said that he heard the takeoff and the engine was, "very powered up." He heard the airplane heading away from the airport, to the east, and the noise got fainter. The engine noise then got louder as the airplane returned, and the engine was screaming. He could hear the engine noise rise and fall three times before hearing a thud.

The accident occurred during the hours of darkness, at 37 degrees, 41.924 minutes north latitude, and 77 degrees, 26.016 minutes west longitude.

PERSONNEL INFORMATION

The pilot held a private pilot certificate with ratings for airplane single engine land and instrument airplane. He also held an FAA third class airman medical certificate, with a limitation to wear corrective lenses, issued on November 28, 1998.

The pilot lived by himself. According to his father, who made a search of his son's residence, he was unable to locate his son's flying logbook.

According to FAA records, the pilot initially took his private pilot flight test on December 19, 1997, and failed. He retook the checkride on December 23, 1997, and passed it.

On March 25, 1999, the pilot took his instrument rating checkride, and failed it. The notice of disapproval noted he would be retested on, air traffic control clearances and procedures, and instrument approach procedures. He retook the test on September 17, 1999, and passed. According to his pilot application for the retest on his instrument rating, he listed his total flight experience as 232 hours.

According to the pilot's insurance application dated February 7, 2000, his total flight experience was 260 hours. According to an unsigned aircraft checkout form, dated March 8, 2000, his total flight experience was 270 hours.

Interviews with the insurance adjustor and the Chief Flight Instructor at the facility where the pilot initially kept the airplane failed to disclose who initially checked out the pilot in the Cessna 210.

The pilot was estimated to have accumulated at least 24 additional hours, for an estimated total flight experience of about 300 hours, with 50 hours in make and model, at the time of the accident. The pilot's recency of experience with instrument and night flight operations was not determined.

Interviews were conducted with the check airmen who conducted the pilot's initial and recheck for his instrument rating. Neither person remembered the pilot. The recommending flight instructor for the recheck remembered the pilot as not having any particular problems. He described the pilot as a good student, who was attentive to instruction received.

AIRCRAFT INFORMATION

The airplane was manufactured in 1964. It was maintained under an annual inspection program.

According to records from the FAA, an Apollo SL-50 GPS was installed in the airplane on November 9, 1998, with limitation of "VFR only." On December 28, 1998, the system was upgraded to IFR usage for en route and terminal procedures. It was not approved for GPS approaches.

The airplane was not equipped with an autopilot.

The pilot's father reported that a search of son residence failed to locate the airplane maintenance logbooks. He did find records of maintenance performed on the airplane, which he forwarded to the Safety Board for review.

The airplane had last received an annual inspection on December 1, 1999, at 2,503 hours.

Recent maintenance had been performed by an independent mechanic. On July 7, 2000, at an airplane tachometer reading of 2,548.1 hours, he replaced the electric fuel pump.

According to a witness, the airplane had been refueled with 30.1 gallons of 100 LL aviation grade gasoline while on the ground at Ashland.

AIRPORT INFORMATION (Departure)

Hanover County Airport was an uncontrolled airport, located 13 nautical miles (NM) northwest of Richmond International Airport (RIC), Richmond, Virginia. The single runway 10/28, was equipped with medium intensity runway lights. The airport elevation was 205 feet. There was no published instrument departure procedure for the airport.

METEOROLOGICAL INFORMATION

The following visibilities, precipitation, and lowest ceilings were recorded at Hanover County Airport.

July 25, 2000

2154 8 Miles Light Rain 1,400 Feet Overcast 2254 9 Miles Light Rain 1,200 Feet Overcast 2354 7 Miles Light Rain 1,000 Feet Overcast

July 26, 2000

0008 6 Miles Light Rain, Mist 800 Feet Overcast 0054 4 Miles Light Rain, Mist 600 Feet Broken

RADAR AND OTHER REMOTELY RECORDED DATA

Radar data was received from the Richmond TRACON. The airplane was first observed at 0024:20.41, with an indicated altitude of 600 feet MSL, north of the airport. Subsequent radar contacts revealed the airplane's track was a climbing right turn. The airplane continued in a right turn until it reached a heading of about 190 degrees. When the airplane was about a mile south of the airport, it initiated another right turn toward the northwest. The airplane continued to climb, and reached an altitude of 4,300 feet, which was maintained for about 10 seconds, after which, the airplane entered a descending right turn. The following were the times and altitudes recorded for the last three-radar returns: 0028:01.75, 4,200 feet; 0028:06.25, 3,500 feet, and 0028:10.87, 2,100 feet. The descent rates between 4,200 feet and 3,500 feet, and 3,500 feet, and 2,100 feet were calculated to be in excess of 9,000 feet per minute, and 18,000 feet per minute respectively.

WRECKAGE AND IMPACT INFORMATION

The airplane was examined at the accident site on July 26 and 27, 2000. The impact site was dirt covered with grass, at the edge of a stand of trees. All flight control surfaces were identified at the accident site.

The impact crater, which measured 8 feet across, contained the fuselage and engine. Debris was scattered from the crater along a heading of 160 degrees for about 300 feet. A small depression was found leading to the main impact crater. At the start of the depression, fragments of fiberglass, identified to be from the right wing tip, and curved pieces of green glass were found.

Most of the debris outside of the impact crater consisted of wing parts. However, a few engine pieces and part of one propeller blade were also found outside of the crater. The backside of the engine was found 5 feet below the surface. The propeller blades were found about 8 feet below the surface, bent forward, with "S" bending on the trailing edges of the blades.

Filament stretch was found in the tail navigation light bulb. When the tail was lifted, the control cables between the elevator and rudder, and the cockpit controls were found attached. The control cables for the ailerons were fragmented into several pieces.

No documentation was recorded for the flight instruments or cockpit controls due to impact damage. The glass face on the vertical speed indicator was intact, and, as the instrument was moved, the rate of change needle inside the instrument was unrestrained and moved about freely.

Both vacuum gyros (attitude indicator and directional gyro), and the electric gyro (turn coordinator) were recovered. The gyros from the directional gyro and turn coordinator exhibited rotational scoring. The gyro from the attitude indicator was forwarded to the Safety Board Materials Laboratory for further examination.

Both wings were fragmented. Leading edge and surface skin were separated from the core wing structure. The ailerons and wing flaps, which were mounted on the trailing edge of the wings, were recovered. All exhibited compression wrinkling on their leading edges, which was aligned along the chord axis of the wings.

The magnetos and fuel control unit were separated from the engine and fragmented. The front cylinders on both sides of the engine were bent aft. The engine sump screen was absent of debris.

MEDICAL AND PATHOLOGICAL INFORMATION

The FAA Toxicology Accident Research Laboratory, Oklahoma City, Oklahoma, conducted the toxicological testing.

On July 26, 2000, the Office of the Chief Medical Examiner, Richmond, Virginia, conducted an autopsy on the pilot.

TESTS AND RESEARCH

According to the Safety Board Materials Laboratory Factual Report,

"... The rubbing damage [on the attitude indicator gyro rotor] was distributed around the circumference of the rotor, consistent with damage that occurred when the rotor was spinning...."

ADDITIONAL INFORMATION

Spatial Disorientation

A review of 14 CFR Part 61, "Certification: Pilots, Flight Instructors, and Ground Instructors," revealed that no specific training requirements exist regarding spatial disorientation. According to the FAA Practical Test Standards, an applicant for a private pilot rating must exhibit knowledge of spatial disorientation. In addition, the publication states that "the examiner shall also emphasize...spatial disorientation..." According to the FAA Practical Test Standards, an applicant for an instrument rating must exhibit flight proficiency in recovery from unusual attitudes (both nose high and nose low), and perform a non-precision [instrument] approach without the attitude indicator and/or the heading indicator.

According to an FAA Instrument Flying Handbook, Advisory Circular 61-27C (AC) (Section II, "Instrument Flying: Coping with Illusions in Flight"), one purpose for instrument training and maintaining instrument proficiency is to prevent a pilot from being misled by several types of hazardous illusions that are peculiar to flight. The AC states that an illusion or false impression occurs when information provided by sensory organs is misinterpreted or inadequate and that many illusions in flight could be created by complex motions and certain visual scenes encountered under adverse weather conditions and at night. It also states that some illusions may lead to spatial disorientation or the inability to determine accurately the attitude or motion of the aircraft in relation to the earth's surface. The AC also states that spatial disorientation as a result of continued VFR flight into adverse weather conditions is regularly near the top of the cause/factor list in annual statistics on fatal aircraft accidents.

The AC further states that the most hazardous illusions that lead to spatial disorientation are created by information received from motion sensing systems, which are located in each inner ear. The AC also states that the sensory organs in these systems detect angular acceleration in the pitch, yaw, and roll axes, and a sensory organ detects gravity and linear acceleration and that, in flight, the motion sensing system may be stimulated by motion of the aircraft alone or in combination with head and body movement. The AC

NTSB Probable Cause

The failure of the pilot to maintain control of the airplane due to spatial disorientation. Factors were the dark night, low ceiling and fog.