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Accidents: February 2016
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Preliminary, final and factual reports
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Preliminary, final and factual reports
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PRELIMINARY REPORTS


Towel Fouls EC135 Fenestron on Training Flight


Airbus Helicopters EC135, Apple Valley, Calif., Nov. 19, 2015–Foreign object debris (FOD) downed a medevac training flight in November at Victor Valley College Regional Public Safety Training Center, according to investigators. The commercial pilot and four passengers were not injured. The turbine-powered helicopter had conducted a series of takeoffs and landings at the training center and was on approach to make its third landing in day VMC when the pilot felt the aircraft “shudder unexpectedly” while at approximately 2 to 3 feet agl. The pilot immediately landed and shut down the helicopter without further incident.


Post-flight inspection revealed that a towel ingested into the Fenestron tail rotor assembly had substantially damaged the Fenestron blades and the tail rotor housing. The pilot said the towel came from an unsecured storage container near the landing site.


Skydiving Airplane Damaged in Engine-out Landing


Pacific Aerospace 750XL, in Raeford, N.C., Dec. 3, 2015–The fixed-gear turboprop single received substantial damage on landing following a precautionary engine shutdown. A nearby recording station noted VFR conditions prevailed during the skydiving flight, which had departed from P K Airpark (5W4) in Raeford at approximately 11 a.m. EST.


While preparing to release the skydivers at 13,000 feet msl, the pilot noticed the engine torque gauge in the red arc, indicating 70 psi, far above the normal level of 25 psi and beyond the maximum allowed indication of 64.5 psi. The pilot directed the skydivers to jump, then descended to return to 5W4.


The torque gauge continued to indicate 80 psi at engine idle, which led the pilot to shut down the Pratt & Whitney Canada PT6A-34 turboprop at 9,000 feet. The pilot told investigators that the airplane landed fast and touched down approximately halfway down the 3,400-foot runway at 5W4. Despite heavy braking, the aircraft departed the runway and came to rest approximately 1,000 feet beyond the departure end with a collapsed left main gear.


Witnesses: Smoke, Flashes Preceded L-39 Crash


Aero Vodochody L-39C, Apple Valley, Calif., Dec. 6, 2015–The pilot (a well known ATP-rated airshow performer) and the pilot-rated passenger was killed when the aircraft collided with terrain during takeoff in daytime VMC from Runway 18 at Apple Valley Airport, reportedly for a familiarization flight ahead of the passenger’s intended purchase of a similar aircraft.


One witness observed “dark blackish/gray exhaust” from the exhaust nozzle before takeoff, and several witnesses told investigators they heard “pop pop pop” sounds as the aircraft climbed through approximately 125 feet agl, immediately followed by bright orange flashes from the exhaust nozzle. The aircraft continued to fly down the runway at an approximate 20-degree nose-up attitude before it rolled left and struck flat terrain approximately 800 feet from the departure end of Runway 18.


Investigators reported no evidence of an internal catastrophic failure of the single Ivchenko AI25TL turbofan following visual examination of the engine case and exhaust shaft, and inspection of Runway 18/36 after the accident showed no evidence of FOD. The aircraft had been fueled with 131 gallons of jet-A before the accident flight, and a sample taken from the fuel facility showed it to be clear of contaminants.


Piper Meridian Hits Power Lines in Fatal Accident


Piper PA-46-500TP, Council Bluffs, Iowa, Dec. 10, 2015–The turboprop single had just departed from Runway 32R at Eppley Airfield (OMA) in daytime VMC when the pilot informed the tower controller that he needed to return to the airport, after which he was instructed to enter a right traffic pattern for the departure runway.


ATC asked if he required assistance, and the pilot replied “negative,” adding a few seconds later that his AHRS (attitude and heading reference system) had a “miscommunication.” The pilot subsequently accepted a request from ATC for a short approach to Runway 32R to accommodate inbound traffic, adding that he would look for the traffic.


ATC received no further communications from the accident pilot, who perished when the aircraft struck a highway median approximately 0.7 miles east of the runway approach threshold. Investigators noted the aircraft had struck power lines about 400 feet east-northeast of the accident site at approximately 75 feel agl, and a power-line pole support. Fragments of the right wing were found near the power lines, with the bulk of the wreckage coming to rest inverted.


Reported weather conditions at OMA at the time of the accident included wind from 290 degrees at 16 knots, gusting to 23 knots; 10 miles visibility, with few clouds at 1,500 feet agl; temperature 13 degrees Celsius; dew point 3 degrees Celsius; and altimeter 29.65 inches. The aircraft was bound for Perry Stokes Airport (TAD) in Trinidad, Colo.


Medevac Flight Strikes Terrain on Nighttime Flight


Bell 407, McFarland, Calif., Dec. 10, 2015–The commercial pilot, flight paramedic, flight nurse and patient on board an aeromedical transport flight perished when their helicopter struck open, hilly terrain at 7:08 p.m. The cross-country flight had departed Porterville Municipal Airport (PTV) at 6:51 p.m. with an intended destination of San Joaquin Memorial Hospital in Bakersfield. Nighttime VMC prevailed during the flight, which had repositioned earlier to Porterville from Visalia, Calif., to pick up the patient.


The helicopter was the subject of an FAA Alert Notification following repeated attempts by company personnel to establish contact with the accident flight beginning at 7:18 p.m. The wreckage was subsequently located by aerial law enforcement search crews at 8:54 p.m. All major structural components of the helicopter were located within a debris path 465 feet in length oriented on a heading of 037 degrees magnetic.


Two Lost, One Injured in AS350 Accident


Airbus Helicopters AS350B3, Superior, Ariz., Dec. 15, 2015–The helicopter collided with mountainous terrain approximately 18 minutes after departing in VMC from Phoenix-Mesa Gateway Airport (IWA) in Mesa, Ariz., at 5:05 p.m. with an intended destination of Globe, Ariz. The commercial pilot and flight nurse on board were killed, and the flight paramedic received serious injuries.


Company operations monitored the flight through their flight management system backed by satellite tracking, which lost contact with the helicopter at 5:23 p.m. Aerial search crews located the wreckage at 8:54 p.m. All major structural components of the helicopter were accounted for within the wreckage debris path, which was 380 feet in length and oriented on a heading of 200 degrees magnetic.


The operator told investigators the helicopter had transported a patient from Globe earlier in the day to a Mesa hospital. The helicopter then repositioned to IWA to refuel, after which it was to return to the company’s base of operations in Globe.


Snowplow Collision Fells Hawker 400


Hawker 400, Telluride, Colo., Dec. 23, 2015–The Mexican-registered Hawker 400 struck snow removal equipment while landing in day IMC at Telluride Regional Airport (TEX). The pilot, copilot and five passengers were not injured, but the aircraft was substantially damaged in the accident, including separation of its right wing from the fuselage.


The Part 129 air-taxi flight had reportedly departed from El Paso, Texas, bound for TEX. Initial statements indicate that ATC cleared the aircraft for approach to the non-tower airport, after which time the pilot cancelled his IFR flight plan with the airport in sight. The airport’s single runway had reportedly been closed for snow removal by a Notam before the Hawker arrived.


Unsecured Inspection Door Preceded Meridian Crash


Piper PA-46-500TP, Corinth, Miss., Dec. 24, 2015–The Piper Meridian collided with a tree and terrain during an attempted return to the airport shortly after takeoff from Roscoe Turner Airport (CRX) in Corinth in daytime VMC. The intended destination for the Part 91 personal flight was Ocean Reef Club Airport (07FA) in Key Largo, Fla.


The certified private pilot told investigators that following a normal preflight inspection and engine run-up a right-side engine cowling door opened partially after takeoff, “flopping” up and down. While the airplane was turning left to return to CRX, the panel “came completely open” and the pilot said he could not keep the aircraft flying even with “full power” and lowering the nose. The aircraft subsequently struck a tree and the front lawn of a home, catching fire.


The three passengers were seriously injured in the crash. Investigators determined from photographs of the accident site taken by local EMS personnel that the inspection door for the aircraft’s battery compartment, located just forward of the leading edge of the aircraft’s right wing, had separated from the fuselage.


FACTUAL


FO’s Check Flight Ends in Gear-Up Landing


Short Brothers SD-360-100, near Kapolei, Hawaii, June 29, 2015–A first officer’s scheduled check flight ended with an inadvertent gear-up landing at Kalaeloa Airport-John Rogers Field (JRK) in Kapolei, resulting in substantial damage to the nose of the aircraft but no injuries to the two pilots on board.


Nighttime VMC prevailed at the time of the accident flight, which departed Honolulu International Airport (PHNL) at approximately 6:50 p.m. The check flight encompassed several approaches and landings at JRK, and the accident occurred during the final landing before the two-person flight crew planned to return to Honolulu.


The captain and first officer told investigators they thought they had completed the before-landing checklist, which includes verifying that the partially retractable main landing gear and fully retractable nose gear are down and locked; however, the airplane’s nose contacted the runway a few hundred feet after the retracted mainwheels touched down.


Both pilots stated that the aircraft’s landing gear warning horn did not activate. They were flying a partial-flaps approach and the horn is designed to activate only if the engine power levers are reduced to flight idle. The pilots also told investigators that they were not distracted or rushed during the approach, with the captain requesting clearance from ATC for the flight to HNL while the aircraft was on downwind at JRK.


FINAL


NTSB: Incorrect EDM Settings Led to AT-602 Takeoff Accident


Air Tractor AT-602, near Slaton, Texas, Feb. 5, 2015–Improper settings on a newly installed digital engine data monitor (EDM), which may have been identified and fixed through compliance with required post-installation checklists, contributed to the takeoff crash of an aerial application aircraft, according to the NTSB.


Daytime VMC prevailed at the time of the accident, which occurred following takeoff on a planned cross-country flight that was also the aircraft’s first flight after installation of the EDM six days earlier. The uninjured pilot, who reported three hours of flight time in the accident aircraft, said the initial takeoff seemed normal, but that red warning lights illuminated on the EDM while the airplane was halfway down the runway.


The pilot continued with the takeoff. The aircraft climbed to 150 feet agl before losing altitude and nosed over in a field when its landing gear dug into soft dirt. The pilot later told investigators that the engine never developed full power. He said he had advanced the throttle to full, and noted that he thought the acceleration was slow as he began the takeoff.


Post-accident examinations revealed no apparent anomalies that would have affected the engine’s ability to develop full power, and that the EDM’s engine operating range for the propeller was correctly set for a maximum of 1700 rpm; however, investigators believe it’s likely that the aircraft manufacturer set the maximum propeller rpm higher than that threshold, based on readings from the airplane’s analog instrumentation, which allowed the propeller’s maximum rpm to exceed 1700.


A review of the aircraft’s maintenance records showed the EDM was installed under a supplemental type certificate (STC) that included installation instructions, as well as initial setup and installation checklists. The maintenance entry noted that ground runs and leak checks were completed with no defects found, but investigators could not locate completed copies of either checklist that, according to the NTSB, would likely have revealed the RPM discrepancy had they been performed correctly. Investigators also found that the pilot reduced engine torque several times during the accident flight, consistent with the pilot’s reaction to the EDM warnings in the context of his lack of experience in the aircraft make and model.

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