Crash of a Piper PA-31T3-T1040 Cheyenne in Kotzebue

Date & Time: Feb 21, 2000 at 1123 LT
Type of aircraft:
Operator:
Registration:
N219CS
Survivors:
Yes
Schedule:
Point Lay - Kotzebue
MSN:
31-8275005
YOM:
1982
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
13500
Captain / Total hours on type:
4900.00
Aircraft flight hours:
11098
Circumstances:
The airplane collided with frozen pack ice, three miles from the airport, during a GPS instrument approach. Instrument conditions of 3/4 mile visibility in snow and fog were reported at the time of the accident. The pilot stated that he began a steep descent with the autopilot engaged. He indicated that as the airplane crossed the final approach course, the autopilot turned the airplane inbound toward the airport. He continued the steep descent, noted the airplane had overshot the course, and the autopilot was not correcting very well. He disengaged the autopilot and manually increased the correction heading to intercept the final approach course. During the descent he completed the landing checklist, extended the landing gear and flaps, and was tuning both the communications and navigation radios. The pilot said he looked up from tuning the radios to see the sea ice coming up too quickly to react, and impacted terrain. The pilot relayed there were no pre accident anomalies with the airplane, and that he 'did not stay ahead of the airplane.'
Probable cause:
The pilot descended below the minimum descent altitude. Factors associated with this accident were the task overload of the pilot during the instrument approach, and not performing a level off.
Final Report:

Crash of a Piper PA-31T3-T1040 Cheyenne in Wales

Date & Time: Feb 9, 2000 at 1205 LT
Type of aircraft:
Operator:
Registration:
N110JK
Survivors:
Yes
Schedule:
Nome – Wales
MSN:
31-8375005
YOM:
1983
Location:
Crew on board:
1
Crew fatalities:
Pax on board:
8
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
4600
Captain / Total hours on type:
195.00
Aircraft flight hours:
12385
Circumstances:
The airline transport certificated pilot was landing a twin-engine turboprop airplane at a remote airport on a scheduled air taxi flight. Rising hilly terrain is located east of the airport. The pilot said that during the approach for landing, he noticed the airport wind sock indicating a wind from the east about 25 knots. When the pilot descended to 500 feet, about mid-base, the airplane encountered moderate turbulence and an increased rate of descent. He added engine power to arrest the descent. As he turned toward the runway, the airplane encountered 3 to 4 rolling oscillations with a bank angle up to 90 degrees while descending toward the runway. According to a company mechanic who traveled to the scene, it appeared that the airplane struck the runway about 1,200 feet from the approach end with the left wing and left elevator, while yawed about 45 degrees to the left of the runway centerline. The airplane then slid off the left side of the runway. After the collision, the pilot evacuated the passengers, and noticed the airport wind sock was indicating a tailwind. The Airport/Facility Directory contains the following in the airport remarks: 'Unattended. Easterly winds may cause severe turbulence in vicinity of runway.'
Probable cause:
The pilot's inadequate evaluation of the weather conditions, and his inadvertent flight into adverse weather conditions. Factors in the accident were terrain induced turbulence and a tailwind.
Final Report:

Crash of a Piper PA-31T Cheyenne I in Santa Fe

Date & Time: Dec 16, 1999 at 1515 LT
Type of aircraft:
Registration:
N919RD
Flight Phase:
Flight Type:
Survivors:
Yes
Schedule:
Santa Fe - Olathe
MSN:
31-8104037
YOM:
1981
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
1098
Captain / Total hours on type:
401.00
Aircraft flight hours:
3558
Circumstances:
On takeoff during the initiation of a cross-country flight, the pilot raised the landing gear following liftoff and the aircraft settled back onto the ground off the end of the runway. According to the pilot and the FAA inspector who examined the aircraft, both engines were producing normal power. The elevator trim was set at 12 degrees nose up vice 3-6 degrees required, and the aircraft was within weight and balance limits. The pilot lowered the landing gear prior to impact. According to information provided by the aircraft manufacturer, induced drag increases during landing gear retraction and extension due to the landing gear doors being extended into the air stream as the landing gear cycles.
Probable cause:
The pilot initiating lift off at an airspeed insufficient to maintain flight and retracting the landing gear prematurely resulting in a stall mush. A factor was the pilot incorrectly setting the elevator trim.
Final Report:

Crash of a Piper PA-31T Cheyenne II in Deerfield: 1 killed

Date & Time: Jul 1, 1999 at 1402 LT
Type of aircraft:
Operator:
Registration:
N602RM
Flight Phase:
Flight Type:
Survivors:
No
Site:
Schedule:
Jonesboro – Weyers Cave
MSN:
31-7920081
YOM:
1979
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
1
Captain / Total flying hours:
1857
Captain / Total hours on type:
24.00
Aircraft flight hours:
4852
Circumstances:
The pilot was descending the airplane from 23,000 feet for an instrument approach. All communications were normal until after he acknowledged an instruction to contact approach control, when radio contact was lost. Radar contact ceased at 11,300 feet due to radar signal reception difficulties. Contact was lost almost directly over the eventual impact site, which was on the eastern side of a small valley. Witnesses on the western side of the valley had seen the airplane flying near them, at treetop level, eastbound, and clear of clouds. About the same time, on the eastern side of the valley where the airplane would impact trees, then terrain, there was heavy rain. The commercial pilot had about 1,850 total flight hours, and had completed a 'Wings III' flight proficiency program and an instrument proficiency program about two months earlier. The airplane had been on a continuous maintenance program. At the accident site, all of the airplane's control surfaces were found, and the engines and propellers displayed signatures consistent with being under power at impact. There were insufficient remains to conduct an autopsy or toxicological testing. Previously, the pilot's father, two uncles, and a male cousin had suffered fatal heart attacks.
Probable cause:
Loss of control of the airplane due to pilot incapacitation following a heart attack.
Final Report:

Crash of a Piper PA-31T Cheyenne II in São Francisco do Sul: 3 killed

Date & Time: Oct 30, 1998 at 2036 LT
Type of aircraft:
Operator:
Registration:
PT-WHI
Survivors:
No
Schedule:
Rio de Janeiro – Joinville
MSN:
31-7920077
YOM:
1979
Country:
Crew on board:
1
Crew fatalities:
Pax on board:
2
Pax fatalities:
Other fatalities:
Total fatalities:
3
Captain / Total flying hours:
2420
Captain / Total hours on type:
603.00
Circumstances:
Following an uneventful flight from Rio de Janeiro-Santos Dumont Airport, the pilot started the descent to Joinville Airport by night and marginal weather conditions. He was informed about the visibility at destination being 2 km with ceiling at 650 feet. At 2032LT, he initiated the approach and reported to ATC that if it was raining, he would divert to Curitiba. Four minutes later, on final approach, the twin engine aircraft struck trees and crashed about 15 km southeast of runway 33 threshold. The aircraft was destroyed by impact forces and a post crash fire and all three occupants were killed.
Probable cause:
The following findings were identified:
- There was the participation of psychological variables at individual level, related to the profile of the pilot, such as excessive self-confidence in assuming that he always reached his destination, the knowledge of the region and probably the self-induced pressures by the situation in the cabin, combined with the prevailing meteorological condition, as well as the fact that he made a mistake with the procedure he was performing, demonstrating the adoption of an inadequate decision, excessive motivation for landing and lack of attention to the correct procedure.
- It was not possible to perform an effective analysis on the parts and instruments of the aircraft, in view of their degree of destruction, thus the contribution of this factor to the accident could not be determined.
- Weather conditions at destination were fickle and deteriorated during the execution of the descent procedure of the aircraft, contributing to the accident.
- The pilot failed to comply with the planned descent profile in use.
- Despite being aware of the meteorological conditions at destination, the pilot did not adequately plan the accomplishment of the procedure of descent by instruments, coming to throw out of the established profile, suggesting that he did not undertake the briefing of descent.
- The performance of the procedure outside the foreseen profile and in instrument flight conditions, determine the participation of this aspect in the occurrence.
Final Report:

Crash of a Piper PA-31T Cheyenne I near Baker: 3 killed

Date & Time: Aug 8, 1998 at 1149 LT
Type of aircraft:
Operator:
Registration:
N6JM
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Santa Rosa - Wichita
MSN:
31-7904011
YOM:
1979
Location:
Crew on board:
1
Crew fatalities:
Pax on board:
2
Pax fatalities:
Other fatalities:
Total fatalities:
3
Captain / Total flying hours:
2950
Aircraft flight hours:
4821
Circumstances:
The pilot had filed an instrument flight rules (IFR) flight plan for 25,000 feet mean sea level (MSL), and he amended it to 27,000 feet MSL en route. About 36 minutes after the altitude change to 27,000 feet, the pilot advised air traffic control (ATC) that he had lost cabin pressurization and needed an immediate descent. About 20 seconds later he was cleared to 25,000 feet, then 15 seconds later to 15,000 feet. Shortly after the pilot acknowledged the lower altitudes, the radio communications deteriorated to microphone clicks with no carrier. The aircraft started a shallow descent with slight heading changes, then was observed to make a rapid descent into desert terrain. About 10 months prior to the accident the aircraft had been inspected in accordance with the Piper Cheyenne Progressive Inspection 100-hour Cycle, event No. 1. According to the servicing agency, the aircraft inspection was completed and the aircraft was returned to service with a 12,500 feet MSL altitude restriction due to unresolved oxygen system issues. The last oxygen bottle hydrostatic check noted on the bottle was October 1989. The oxygen system was in need of required maintenance and the masks were in a rotted condition. The pilot failed to report his severe coronary artery disease condition, medications, and other conditions to his FAA medical examiner for the required flight physical.
Probable cause:
The pilot's failure to comply with a 12,500-foot altitude restriction placed on the aircraft by an FAA approved maintenance facility due to unresolved oxygen system issues. Contributing to the accident was the pilot's failure to divulge his true physical condition and need for medication during his application for an Airman Medical Certificate.
Final Report:

Crash of a Piper PA-31T Cheyenne I in Great Falls: 2 killed

Date & Time: May 19, 1998 at 1536 LT
Type of aircraft:
Registration:
N121BE
Flight Type:
Survivors:
No
Schedule:
Great Falls - Great Falls
MSN:
31-8004036
YOM:
1980
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
2
Captain / Total flying hours:
2347
Aircraft flight hours:
2226
Circumstances:
The flight was on a practice nondirectional beacon (NDB) approach to Great Falls runway 34 in visual conditions. Abeam the final approach fix, the aircraft was 4 miles right of course. Upon being advised of this by ATC, the pilot corrected back to final with a 60-degree intercept angle, rolling out on course 3 miles from the runway. When the pilot called missed approach, the local controller (a trainee) instructed the pilot to make a 360-degree right turn to enter right downwind for runway 3, and the pilot acknowledged. The controller trainee then amended this instruction to a 180-degree right turn to enter right downwind for runway 21, then to a 180- degree right turn to enter right downwind for runway 3. The crew did not acknowledge the amended instruction. Controllers then observed the airplane had crashed. Witnesses reported the airplane entered a steep descent from a right turn and impacted the ground at a steep angle. The flight was described as recurrent training required by the owner's insurance; however, the second aircraft occupant's airline transport pilot and flight instructor certificates had been revoked, and he held only a private pilot certificate. Investigators found no evidence of aircraft malfunctions.
Probable cause:
The flight crew's failure to maintain aircraft control.
Final Report: