Crash of a Piper PA-31-350 Navajo Chieftain in Weston

Date & Time: Oct 26, 2015 at 1233 LT
Operator:
Registration:
N55GK
Survivors:
Yes
Schedule:
Jacksonville – Fort Lauderdale
MSN:
31-7852013
YOM:
1978
Location:
Crew on board:
1
Crew fatalities:
Pax on board:
2
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
11000
Captain / Total hours on type:
105.00
Aircraft flight hours:
6003
Circumstances:
The airline transport pilot of the multiengine airplane had fueled the main (inboard) fuel tanks to capacity before the cross-county flight. As the flight approached the destination airport, an air traffic controller instructed the pilot to turn right for a visual approach, and the pilot acknowledged. Subsequently, the pilot reported that he might have to land on a highway. The airplane impacted a marsh area about 15 miles from the destination airport. Review of data downloaded from an onboard engine monitor revealed that the right engine momentarily lost and regained power before experiencing a total loss of power. Examination of the wreckage revealed that the left propeller was feathered and that the right propeller was in the normal operating range. Sufficient fuel to complete the flight was drained from the left wing fuel tanks. Although the right wing fuel tanks were compromised during the impact, sufficient fuel was likely present in the right main fuel tanks to complete the flight before impact because both the left and right main fuel tanks were fueled to capacity concurrently before the flight, but it likely was in a low fuel state due to fuel used during the flight. The right wing main fuel tank was not equipped with a flapper valve, which should have been located on the baffle nearest the wing root where the fuel pickup was located. The flapper valve is used to trap fuel near the fuel pickup and prevent it from flowing outboard away from the pickup. The maintenance records did not indicate that the right main fuel tank bladder had been replaced; however, the manufacture year printed on the bladder was about 20 years before the accident and 16 years after the manufacture of the airplane, indicating that the bladder had been replaced at some point. When the right main fuel tank bladder was replaced, the flapper valve would have been removed. Based on the evidence, it is likely that maintenance personnel failed to reinstall the flapper valve after installing the new fuel bladder. This missing valve would not affect operation of the fuel system unless the right main fuel tank was in a low fuel state, when fuel could flow outboard away from the fuel pickup (such as in a right turn, which the pilot was making when the engine lost power), and result in fuel starvation to the engine.Toxicology testing of the pilot revealed that his blood alcohol level during the flight was likely between 0.077 gm/dl and 0.177 gm/dl, which is above the level generally considered impairing. Therefore, it is likely that, during the right turn, the fuel in the right main fuel tank moved outboard, which resulted in fuel starvation to the right engine. When the right engine lost power, the pilot should have secured the right engine by feathering the propeller to reduce drag and increase single-engine performance; however, given the position of the propellers at the accident site, the pilot likely incorrectly feathered the operating (left) engine, which rendered the airplane incapable of maintaining altitude. It is very likely that the pilot's impairment due to his ingestion of alcohol led to his errors and contributed to the accident.
Probable cause:
The pilot's feathering of the incorrect propeller following a total loss of right engine power due to fuel starvation, which resulted from maintenance personnel's failure to reinstall the flapper valve in the right main fuel tank. Contributing to the accident was the pilot's impairment due to alcohol consumption.
Final Report:

Crash of a Piper PA-31-350 Navajo Chieftain in Thompson

Date & Time: Sep 15, 2015 at 1821 LT
Operator:
Registration:
C-FXLO
Flight Phase:
Survivors:
Yes
Schedule:
Thompson – Winnipeg
MSN:
31-8052022
YOM:
1980
Flight number:
KEE208
Country:
Crew on board:
2
Crew fatalities:
Pax on board:
6
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
2000
Captain / Total hours on type:
1000.00
Copilot / Total flying hours:
446
Copilot / Total hours on type:
120
Circumstances:
At 1817 Central Daylight Time, the Keystone Air Service Ltd. Piper PA-31-350 (registration C-FXLO, serial number 31-8052022) departed Runway 06 at Thompson Airport, Manitoba, on an instrument flight rules flight to Winnipeg/James Armstrong Richardson International Airport, Manitoba, with 2 pilots and 6 passengers on board. Shortly after rotation, both engines began to lose power. The crew attempted to return to the airport, but the aircraft was unable to maintain altitude. The landing gear was extended in preparation for a forced landing on a highway southwest of the airport. Due to oncoming traffic, the forced landing was conducted in a forested area adjacent to the highway, approximately 700 metres south of the threshold of Runway 06. The occupants sustained varying serious injuries but were able to assist each other and exit the aircraft. The emergency locator transmitter activated, and there was no fire. Emergency services were activated by a 911 call and by the Thompson flight service station. Initial assistance was provided by sheriffs of the Manitoba Department of Justice after a crew member flagged down their vehicle on the highway.
Probable cause:
Findings as to causes and contributing factors:
1. Delivery of the incorrect type of aircraft fuel caused loss of power from both engines, necessitating a forced landing.
2. The fueling operation was not adequately supervised by the flight crew.
3. A reduced-diameter spout was installed that enabled the delivery of Jet-A1 fuel into the AVGAS fuel filler openings.
4. The fuel slip indicating that Jet-A1 fuel had been delivered was not available for scrutiny by the crew.

Findings as to risk:
1. If administrative and physical defences against errors in aviation fuel operations are circumvented or disabled, there is a risk that the incorrect type of fuel will be delivered.
2. If a reduced-diameter spout is available to accommodate non-standard fuel filler openings, there is an increased risk that Jet-A1 fuel can be dispensed into an aircraft that requires AVGAS.

Other findings:
1. Aircraft that were manufactured prior to the current airworthiness standards, or that have been modified by the installation of turbine engines, may have fuel filler openings that do not meet the dimension requirements.
2. The airworthiness standards for rotorcraft do not specify the size of fuel filler openings.
3. The use of all of the available restraint systems in the aircraft contributed to the survival of the occupants.
4. There was no post-crash fire, likely due to the separation of the battery from the aircraft and to the rain-saturated crash site.
5. The absence of a post-impact fire contributed to the survival of all of the aircraft's occupants.
Final Report:

Crash of a Piper PA-31-350 Navajo Chieftain in Mariquita: 10 killed

Date & Time: Dec 3, 2014 at 0931 LT
Operator:
Registration:
HK-4464
Survivors:
No
Schedule:
Bogotá-Guaymaral – Bahía Solano
MSN:
31-7952229
YOM:
1979
Country:
Crew on board:
2
Crew fatalities:
Pax on board:
8
Pax fatalities:
Other fatalities:
Total fatalities:
10
Captain / Total flying hours:
2190
Captain / Total hours on type:
392.00
Copilot / Total flying hours:
302
Copilot / Total hours on type:
302
Aircraft flight hours:
10091
Circumstances:
The twin engine aircraft departed Bogotá-Guaymaral Airport on a charter flight to Bahía Solano, carrying eight passengers and two pilots. En route, while in cruising altitude, the crew contacted ATC and reported engine trouble. He was then cleared to divert to Mariquita-José Celestino Mutis Airport for an emergency landing. On final approach to runway 19, the aircraft stalled and crashed on hilly and wooded terrain, bursting into flames. The aircraft was totally destroyed by impact forces and a post crash fire and all 10 occupants were killed.
Probable cause:
The accident was the consequence of the malfunction of the right engine in flight, causing a loss of speed and a subsequent stall.
The following contributing factors were identified:
- Limited operation of the aircraft due to an inoperative engine,
- Low speed,
- When the aircraft stalled, the distance with the ground was insufficient to expect recovery,
- The maintenance services were not performed according to the manufacturer when the aircraft was parked for almost six months.
Final Report:

Crash of a Piper PA-31-350 Navajo Chieftain off Nassau: 1 killed

Date & Time: Dec 2, 2014 at 0845 LT
Operator:
Registration:
C6-REV
Flight Phase:
Survivors:
Yes
Schedule:
Governor’s Harbour – Nassau
MSN:
31-7652062
YOM:
1976
Flight number:
302
Country:
Crew on board:
1
Crew fatalities:
Pax on board:
10
Pax fatalities:
Other fatalities:
Total fatalities:
1
Captain / Total flying hours:
7650
Aircraft flight hours:
11744
Circumstances:
On Tuesday December 2nd, 2014 at approximately 8:45 am (1345Z) a Ferg’s Air Limited, Piper PA-31-350 Navajo aircraft, registration C6-REV, operated as Southern Air Limited Flight 302, ditched in waters approximately 6nm from shore in the southwestern district of New Providence. The flight originated at Governor’s Harbour, Eleuthera (MYEM) with 10+1 persons on board at approximately 8:15 am in Visual Meteorological Conditions (VMC). At around 8:30am, the aircraft 15 nautical miles east of Lynden Pindling International Airport at 4,500 feet contacted Nassau Air Traffic Control Tower. The aircraft was instructed that runway 09 was in use and they can expect a landing on that runway. Upon final approach to runway 09, with the landing gears selected to the “EXTEND” position, only the nose and right main landing gear lights indicated the “down and locked” position. The left main landing gear light did not illuminate to indicate the “down and locked” position, so the landing was aborted and the pilot requested to go around so he could recycle and troubleshoot the landing gear issue. The pilot made a left turn, flew over the north western shoreline and recycled the landing gears a few times and also tried the emergency hand pump in an attempt to extend the gear. Despite all efforts, the left main landing gear light still did not illuminate to indicated the gear was in the safe “down and locked” position. At this time the aircraft was allowed to fly by the tower so that the controller may make a visual check of the landing gears to see if they were in the extended position. The controller advised the pilot that all gears “appeared to be extended”. Once again the pilot proceeded outbound to make another attempt for landing. For this approach the pilot made a right turn over the southwestern shoreline and proceeded downwind to runway 09. While on the downwind to runway 09 the pilot stated he began to experience problems with the right engine. The engine eventually stopped and all attempts to restart were unsuccessful. As a result of single engine operation, level flight could not be maintained even after retracting the gears and cleaning up the airplane. The decision was made by the pilot to ditch in the water vs. attempting to make the airport where numerous trees and obstacles would make the landing more difficult if the runway could not be made. After touching down on the water the most of the occupants were able to evacuate the aircraft through the normal and emergency exits before the aircraft sank into the ocean. One passenger died during the process. Witness stated that “the plane skipped across the water three times before rotating and hitting with a severe impact. The port (left) tail section received the bulk of the impact as did the port side of the plane.” Eye witness further stated that the passenger that died and “luggage from the baggage compartment were ejected from the rear of the plane on the port side.” “Multiple passengers could not swim or were extremely limited in their ability to swim.” Despite the plane having the full complement of survival equipment (life vests), only two were taken out of the aircraft. Passengers were holding on to bags and other debris that floated out of the aircraft as it submerged. Passengers helped each other until rescuers arrived to assist. Estimates from eye witness were that “the entire plane disappeared under water from 30 to 60 seconds after impact.” The depth where the aircraft came to rest on the water was reported as in excess of 6,500 feet. Once the aircraft settled, it submerged and was not able to be recovered. Safety concerns raised by eye witness could not be confirmed as the plane was never recovered.
Probable cause:
The AAIPU determines that the probable causes of this accident as:
- Engine failure and the inability of the aircraft to maintain a safe altitude.
Contributing Factors includes:
- Failure of the left main landing gear.
The following findings were identified:
1. Weather was not a factor in the accident.
2. Air Traffic Services were proper and did not contribute to the cause of the accident.
3. The pilot was properly certified, trained and qualified for the flight.
4. The loss of power on the right engine resulted in the aircraft inability to maintain a safe altitude.
5. The Police and other emergency services response were timely and effective.
6. The depth of the water where the aircraft came to rest made it impossible for the aircraft to be recovered.
7. The aircraft was properly maintained in accordance with Bahamas and United States regulations and maintenance practices.
Final Report:

Crash of a Piper PA-31-350 Navajo Chieftain in Araracuara: 10 killed

Date & Time: Sep 6, 2014 at 1505 LT
Operator:
Registration:
HK-4755
Flight Phase:
Survivors:
No
Schedule:
Araracuara – Florencia
MSN:
31-7952044
YOM:
1979
Country:
Crew on board:
2
Crew fatalities:
Pax on board:
8
Pax fatalities:
Other fatalities:
Total fatalities:
10
Captain / Total flying hours:
792
Captain / Total hours on type:
523.00
Copilot / Total flying hours:
211
Aircraft flight hours:
14601
Circumstances:
The twin engine aircraft departed Araracuara Airport runway 09 at 1503LT on a charter flight to Florencia, carrying eight passengers and two pilots. During initial climb, the right engine failed. The crew lost control of the airplane that stalled and crashed in a wooded area. The wreckage was found 8,2 km from the airport. The airplane disintegrated on impact and all 10 occupants were killed, among them a Swiss citizen.
Probable cause:
Loss of control during initial climb following the failure of the right engine for undetermined reasons.
The following contributing factors were identified:
- The crew failed to follow the published procedures when the right engine failed,
- The aircraft was likely operated with a total weight above MTOW,
- A poor risk assessment while performing an operation outside of the aircraft's performance limits.
Final Report: