Green Bay

The airline transport pilot and two passengers departed in the twin-engine, pressurized airplane on a business flight in night instrument meteorological conditions. Shortly after takeoff, the airplane began to deviate from its assigned altitude and course. The controller queried the pilot, who responded that the airplane was "… a little out of control." After regaining control of the airplane, the pilot reported that he had experienced a "trim issue." The airplane continued on course and, about 13 minutes later, the pilot again reported a trim malfunction and said that he was having difficulty controlling the airplane. The flight's heading and altitude began to deviate from the course for the last 8 minutes of radar data and became more erratic for the last 2 minutes of radar data; radar and radio communication were subsequently lost at an altitude of about 18,300 ft in the vicinity of the accident site. Several witnesses reported hearing the airplane flying overhead. They all described the airplane as being very loud and that the engine sound was continuous up until they heard the impact. The airplane impacted a field in a relatively level attitude at high speed. The wreckage was significantly fragmented and the wreckage path extended about 1/4 mile over several fields. Examination of the available airframe and engine components revealed no anomalies that would have precluded normal operation of the airplane. The accident airplane was equipped with elevator, rudder, and aileron trim systems; however, not all components of the trim system and avionics were located or in a condition allowing examination. Although the airplane was equipped with an electric elevator trim and autopilot that could both be turned off in an emergency, the investigation could not determine which trim system the pilot was reportedly experiencing difficulties with. It is likely that the pilot was unable to maintain control of the airplane as he attempted to address the trim issues that he reported to air traffic control.

Witnesses reported that the airplane appeared to be making a normal approach for landing when it suddenly rolled to the left, descended, and impacted the terrain about one-half mile from the runway. On arrival at the scene, the witnesses saw the airplane fully engulfed in flames. The flight was operating in night visual meteorological conditions and the runway lights were illuminated at the time of the accident. The pilot communicated no problems or difficulties while in contact with air traffic control (ATC) during the accident flight. A postaccident examination of the airframe and engine did not reveal any anomalies associated with a pre-impact failure or malfunction. Radar track data and weather observations indicated that the pilot climbed through an overcast cloud layer without the required ATC clearance, en route to his intended destination. The pilot previously had been issued a private pilot certificate with single and multi-engine airplane ratings upon successful completion of the prescribed practical tests. He was subsequently issued a commercial pilot certificate, which included the addition of an instrument airplane rating, based on military flight experience. However, a review of military records and statements from his family indicated that the pilot had never served in the military. The pilot's medical history and toxicology testing showed he had a history of back pain and was taking medication for that condition that commonly causes impairment. However, the time proximity for the pilot having taken the medication prior to the accident flight and any possible impairment, could not be determined.

The twin-engine airplane was damaged during a precautionary landing following a reported loss of power to the right engine on takeoff. The pilot reported that the right engine lost power as the landing gear was retracting after takeoff. He stated that he elected to land the airplane on the remaining runway and selected gear down. The pilot stated, "I then flew the aircraft maintaining directional control and landed on runway 24 however due to the short time between selecting gear down and landing the landing gear had not extended and the aircraft landed gear up." No anomalies were found with respect to the right engine or fuel controls during the on-scene or follow-up examination. Examination of the right propeller indicated that it was not in the feather position. The pilot reported that the autofeather system did not engage. The airplane came to rest on the runway with approximately 2000 feet of the runway surface remaining.

At 1623:41, the pilot requested taxi clearance. The Green Bay (GRB) tower (ATCT) told the pilot to taxi to runway 18. At 1626:47 the pilot said that he was ready for takeoff. The ATCT local controller (LC) told the pilot, "proceed on course, cleared for takeoff". At 1627:33, radar showed the airplane began to accelerate down runway 18. At 1628:17 the LC told the pilot to contact departure control. The pilot responded, "ah papa charlie we have a little problem here we're going to have to come back." The LC asked the pilot, "what approach would you like?" The pilot responded, "like to keep the vis." At 1628:35, the LC asked the pilot, "like the contact approach that what you're saying?" There was no response from the pilot. At 1628:50, GRB radar showed the airplane on a heading of 091 degrees, at an altitude of 855 feet msl (160 feet agl), and at an airspeed of 206 knots. The airplane was 1.28 miles southeast of the airport radar. Radar contact with the airplane was lost at 1628:55. A witness to the accident said, "It was snowing moderately at that time. The road was wet but not slippery. Crossing the intersection of Morning Glory Rd. & Main St., I noted a white private jet flying from the south. It was flying at approximately a 75-80 degree angle perpendicular to the ground with its left wing down & teetering slightly." The witness said, "It then crossed Main Street with the lower wing tip approximately 20 to 30 feet above the power wires. The plane became more perpendicular to the ground at a 90 degree angle with the left wing down & (and) lost altitude crashing into the Morning Glory Dairy warehouse building." An examination of the airplane revealed no anomalies. At 1638, GRB weather was reported as ceilings of 200 feet broken, 800 feet overcast, visibility 1/2 statute mile with snow and fog, temperature 32 degrees F, dew point 32 degrees F, winds 120 degrees at 3 knots, and an altimeter setting of 29.99 inches Hg. Witnesses at the FBO said the pilot arrived to pick up the airplane after 1600. The pilot was briefed by the mechanic as he did his walk around inspection of the airplane. The pilot then
got into the airplane. The airplane was towed out and the tow bar removed. About two minutes later, the engines started. Less than five minutes after the engines started, the airplane taxied. The NTSB Audio Laboratory reviewed radio communications between ATCT and the pilot to determine from the speech evidence the pilot's level of psychological stress and workload. The examination indicated the pilot's speech characteristics were consistent with an increased stress/workload that might accompany a developing emergency. Referring to the pilot's final transmissions, "His unusually long reaction time suggests that he was distracted by competing cockpit priorities and/or was having a difficult time determining his answer, while his fast speech and microphone keying provide further evidence of an urgency to return to other cockpit activities." The report states that the pilot's statements remained rational and showed good word choice and grammar. "These factors, along with the relatively small change in fundamental frequency, suggest that the pilot did not reach an extreme level of stress."

The airplane was on its way from Green Bay to Oshkosh, flying at an altitude of 2,500 feet in relative good weather conditions when it collided with an Air Wisconsin De Havilland DHC-6 Twin Otter 200 registered N4043B. En route from Sheboygan to Appleton with six passengers and two pilots on board, the Twin Otter was descending to Appleton Airport. At the time of the accident, both airplanes were flying under VFR in an uncontrolled airspace. Following the collision, both aircraft crashed into Lake Winnebago, some five miles southeast of Appleton Airport. Debris were found floating on water, both airplanes were totally destroyed and all 13 occupants were killed.