No fatalities

13 Nov 2015: BEECH A36 (N78CR) — Lancaster, CA

Lancaster, CA, United States

On 13 Nov 2015, a BEECH A36 UNDESIGNAT (registration N78CR) was involved in an aviation accident near Lancaster, CA. No fatalities were reported. Investigators recorded the probable cause as: The flight instructor's failure to comply with published instrument approach procedures during an instrument approach in dark night, visual meteorological conditions, which resulted in impact with terrain. This summary draws on records from NTSB; 12 related events involving the same aircraft type or operator are linked below.

SourcesNTSBPrimary reportUpdated 1778583330Data APIEditorial standards

On November 12, 2015, a Beech A36, N78CR, struck mountainous terrain during a practice RNAV approach to Fox Field in Lancaster, California. The private pilot and CFI were seriously injured; the aircraft was substantially damaged.

History of Flight

On November 12, 2015, at 1930 Pacific standard time, a Beech A36 airplane, N78CR, impacted mountainous terrain while conducting a practice instrument approach to General William J. Fox Airfield (WJF), Lancaster, California. The private pilot and a certified flight instructor (CFI) were seriously injured, and the airplane was substantially damaged. The airplane was registered to TA Services LLC and operated under 14 CFR Part 91. Night visual meteorological conditions prevailed, and an instrument flight plan was filed. The flight originated from Bakersfield, California at 1900.

The pilot stated he was receiving instrument flight instruction from the CFI and they were conducting a three-leg cross-country flight. The first leg departed Camarillo, California at 1805 and landed in Bakersfield at 1845. The second leg departed Bakersfield at 1900 en route to WJF. The pilot reported they were cleared for the RNAV Runway 6 approach. They crossed HONUL, a waypoint fix 3.5 miles west of the final approach fix, about 1,900 feet below the minimum crossing altitude, and impacted trees in the mountainous area 10 miles southwest of the airport.

A Los Angeles County Fire Department helicopter located the accident site, and a sheriff deputy arrived about 45 minutes after the accident. At the scene, the pilot stated he thought he was flying too high but instead was too low, then collided with terrain. He reported no mechanical malfunctions, only pilot error.

Certified voice recordings from the FAA and OpsVue radar data were reviewed. A partial transcript was produced by an NTSB ATC investigator. Radar data indicated the pilot checked in with Joshua Control Facility (JCF) about 34 miles northwest of WJF at 11,300 ft and 151 knots. At 1938:15, the pilot requested the RNAV RWY 06 approach; at 1939:31, the controller cleared the flight direct to JILMU. At 1941:32, the controller instructed a descent to 7,000 ft. The pilot continued southeast for about 6 miles before turning south toward JILMU. At 1944:38, the controller instructed a right 15° turn; radar showed the airplane turned left about 10° to a 180° heading.

At 1946:52, the controller cleared the pilot direct to HONUL with an altitude restriction of at or above 7,000 ft until reaching it. The pilot read back what sounded like "JOEL" and then turned right toward JILMU again. At 1949:24, the pilot reported JILMU inbound at 7,250 ft and 96 knots. The controller was on a landline with Fox Field tower. The airplane continued south through JILMU and the final approach course. At 1950:20, the pilot recalled for approach clearance; at 1950:27, the controller cleared the approach with no supplemental information. Radar showed the airplane turned right back north/northwest and then onto the final approach course about 1.5 miles from HONUL, well below the published altitude. During a position relief briefing, it was mentioned the pilot was struggling with the approach. At 1953:05, the controller asked if the pilot had terrain in sight (airplane about 900-1,000 ft below approach altitude); the pilot first responded with the airport in sight, then confirmed terrain in sight. At 1953:18, the controller instructed to contact Fox Field tower; the airplane was at 5,325 ft and 88 knots.

At 1953:54, the pilot checked in with Fox Field tower about 3/4 mile from HONUL on the RNAV RWY 6 for a full stop, at 4,775 ft and 72 knots. The tower controller instructed to report 3 miles out; the pilot acknowledged at 1954:17. This was the last transmission. At 1954:33, the airplane crossed HONUL at about 4,225 ft and 69 knots. At 1954:35 and 1954:37, two clicks were heard; at 1954:38, the last radar data showed an altitude of 4,150 ft and 71 knots, approximately coincident with the accident location.

Meteorological Information

At 1956, Fox Field ASOS reported: wind from 300° at 3 knots, 10 statute miles visibility, sky clear, temperature 4°C, dew point -11°C, altimeter 30.14 inHg. The U.S. Naval Observatory database for November 12, 2015, shows for Lancaster, CA: sunset at 1650, moonrise at 0708, moonset at 1755, and 0% moon illumination.

Wreckage and Impact Information

The wreckage was located toward the top of a shallow ridge on the up-slope side. The terrain had brush and a wide distribution of dead pine trees. The debris path contained broken tree branches and ground gouges leading to the airplane. The engine was separated from the firewall and displaced under the nose. The landing gear was extended. The cockpit and fuselage were intact. Both wings had leading edge damage consistent with multiple tree impacts. The tail was intact but displaced to the right about 20 degrees. The propeller had separated from the engine, with leading edge blade damage and tip curling on all three blades.

Additional Information

FAA Order JO 7110.65, Air Traffic Control, specifies safety alert procedures for terrain/obstruction proximity, including issuing a low altitude alert with recommended phraseology. It also requires controllers to ensure pilots acknowledge clearances and instructions with correct readbacks. The order notes that altitudes contained in charted procedures need not be read back unless specifically stated by the controller, and that a pilot's acknowledgment is required to confirm compliance.

Contributing factors

Causes

PilotAltitude — Not attained/maintained

Other contributing factors

Effect on personnelInstructor/check pilotATC personnel