Crash of an Antonov AN-12BP near Biega: 27 killed

Date & Time: May 25, 2005
Type of aircraft:
Registration:
9Q-CVG
Flight Phase:
Survivors:
No
Site:
Schedule:
Goma – Kindu – Kongolo
MSN:
4 3 424 04
YOM:
1964
Location:
Region:
Crew on board:
5
Crew fatalities:
Pax on board:
22
Pax fatalities:
Other fatalities:
Total fatalities:
27
Circumstances:
The aircraft departed Goma on a charter flight to Kongolo with an intermediate stop in Kindu, carrying 22 passengers and five crew members for the Maniema Union Company. About 30 minutes into the flight, the aircraft crashed in a mountainous terrain. The wreckage was found the following day some 10 km from Biega. All 27 occupants were killed.

Crash of a Mitsubishi MU-2B-25 Marquise in Hillsboro: 4 killed

Date & Time: May 24, 2005 at 1752 LT
Type of aircraft:
Registration:
N312MA
Flight Phase:
Survivors:
No
Schedule:
Hillsboro – Salem
MSN:
266
YOM:
1973
Crew on board:
1
Crew fatalities:
Pax on board:
3
Pax fatalities:
Other fatalities:
Total fatalities:
4
Captain / Total flying hours:
2170
Captain / Total hours on type:
551.00
Aircraft flight hours:
3970
Circumstances:
Witnesses observed the aircraft perform a rolling takeoff and it was airborne by the crossing runway (1,300 feet down the 6,600 foot runway). The aircraft entered an approximate 40 degree nose high climb rate to about 1,000 feet. The aircraft then entered a steep left hand banking turn. The nose dropped and the aircraft rotated up to about 4 times before colliding with the flat terrain adjacent to the departure end of the runway threshold. On site documentation of the airframe found no evidence of a flight control malfunction. An engine examination and teardown found that the gearbox section of the left engine experienced a high cycle fatigue failure of the high speed pinion journal bearing oil supply tube and subsequent degradation of the high speed pinion journal bearings. This failure resulted in a partial power loss to the left engine. The pilot had recently purchased this aircraft and he had accumulated approximately 11 hours since the purchase. The pilot had stated to personnel at the place where he purchased the aircraft that he had not received, nor did he need recurrent training in this aircraft as he had several thousand hours in the aircraft. Flight logs provided by the family indicated that the pilot had accumulated about 551 hours in a Mitsubishi, however, the last time that the pilot had flown this make and model was 14 years prior to the accident. Logbook entries indicated that only a few hours of flight time had been accumulated in all aircraft during the approximately 2 years prior to the accident. Personnel that flew with the pilot in the make and model aircraft involved in the accident described the pilot as "proficiency lacking." Normal takeoff calculations for the aircraft with the flaps configured to 5 degrees, indicated a ground run of 2,900 feet, with a rotation speed of 106 KCAS, and 125 KCAS for the climb out. A maximum pitch attitude of 13 degrees maximum is indicated. Performance calculations indicated that the aircraft was capable of lifting off where the witnesses observed and climbing to 1,000 feet agl by the end of the runway. To achieve this performance the aircraft would have rotated at approximately 84 KCAS and climbed at an airspeed below Vmc (100 KCAS) and close to power-off stall speed (86 KCAS) with 5 degrees of flaps. The airplane's flight manual indicated that if an engine failure occurs in the takeoff climb and the landing gear is fully retracted, the emergency procedures is to maintain 140 KCAS, flaps to 5 degrees, the failed engine condition lever to EMERGENCY STOP, and failed engine power lever to TAKEOFF. On site documentation found the left side condition lever in the takeoff/land position and the power lever was found half-way between takeoff and flight idle.
Probable cause:
The pilot's failure to obtain minimum controllable airspeed during the takeoff climb, which resulted in a loss of aircraft control when the left engine lost partial power. A fatigue failure to an oil tube, which resulted in the partial power loss to the left engine, procedures/directives not followed by the pilot, and the pilot's lack of recent experience and no recurrent training in the type of aircraft were factors.
Final Report:

Crash of a Dassault Falcon 20C in Moscow

Date & Time: May 20, 2005
Type of aircraft:
Operator:
Registration:
RA-09007
Survivors:
Yes
MSN:
136
YOM:
1968
Country:
Region:
Crew on board:
0
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
Aircraft lost power on both engines while on approach to Moscow-Vnukovo airport. The crew decided to divert to Sheremetievo Airport when the undercarriage collapsed on landing. The aircraft veered off runway and slid in a grassy area before coming to rest. Nobody was injured but the aircraft was damaged beyond repair.
Probable cause:
It is believed that the engine lost power on approach because of the poor fuel quality.

Crash of a Beechcraft 65-A80 Queen Air in Meseta del Guenguel: 10 killed

Date & Time: May 16, 2005 at 1326 LT
Type of aircraft:
Operator:
Registration:
CC-CFS
Flight Phase:
Survivors:
No
Schedule:
Coihaique – Balmaceda – Chile Chico
MSN:
LD-220
YOM:
1965
Country:
Crew on board:
1
Crew fatalities:
Pax on board:
9
Pax fatalities:
Other fatalities:
Total fatalities:
10
Captain / Total flying hours:
2609
Captain / Total hours on type:
1235.00
Circumstances:
The twin engine aircraft was completing a charter flight from Coyhaique to Chile Chico with an intermediate stop in Balmaceda where six additional passengers boarded. The airplane departed Balmaceda Airport runway 27 at 1310LT for the second leg to Chile Chico. About 16 minutes into the flight, while cruising in marginal weather conditions, radar contact was lost after the airplane crashed in an uninhabited area. The wreckage was found in the late afternoon in Meseta del Guenguel. The aircraft was totally destroyed and all 10 occupants were killed.
Probable cause:
It is believed that the accident was the consequence of a loss of control following an excessive accumulation of ice on the airplane.
Final Report:

Crash of a Britten-Norman BN-2A-26 Islander in Moss Town

Date & Time: May 16, 2005 at 1230 LT
Type of aircraft:
Operator:
Registration:
C6-ASA
Survivors:
Yes
Schedule:
Freeport – South Bimini – Moss Town
MSN:
599
YOM:
1970
Location:
Country:
Crew on board:
1
Crew fatalities:
Pax on board:
2
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
6000
Aircraft flight hours:
16711
Circumstances:
On May 16, 2005 about 1230EST (1845Z), a Britten Norman Islander aircraft, registration C6-ASA crashed approximately 3nm northeast of the Moss Town International Airport. The Pilot reported, “about 35 minutes south of Nassau International Airport [MYNN] I noticed that my ground speed was very low. I continued with my flight to MYEF because I should have had 1 hour and 30 minutes of fuel. About 10 miles from MYEF my right engine quit then 2 minutes later my left engine quit. I then look a suitable place to land three miles from the airport.” The one (1) pilot and two (2) passengers received no serious injuries. The aircraft was destroyed from impact sustained as it contacted the trees. The accident flight originated from Freeport, Grand Bahama, Bahamas to Moss Town, Exuma, Bahamas with an intermediate stop in South Bimini, Bahamas. Visual Flight Rules Conditions existed at the time of the accident. The aircraft was operated by Flamingo Air Limited, a Bahamian Air Operator Certificate holder. Flamingo Air Limited operated as a Commuter, Unscheduled / On Demand Operator in commercial air transport. Flamingo Air Limited operated under the provision of the Bahamas Aviation Safety Regulations (BASR 2001). Its aircraft are maintained under the provision of Bahamas Aviation Safety Regulations (BASR 2001). The aircraft had flown a total of 2 flights including the accident flight. The pilot flew both flights [the same pilot later flew the accident flight]. The pilot reported no problems with the aircraft prior to the accident. There were no open MEL items. There were no open (uncorrected) mechanical irregularities written in the Technical and Journey Log. On May 15, 2005 the pilot uplifted a total of 130 gallons of fuel, which is the maximum capacity for this aircraft. Prior to the accident flight, the aircraft completed two flights, MYAM to MYGF [flown on May 15, 2005] which lasted 45 minutes and MYGF to MYBS [flown on May 16, 2005] which lasted 30 minutes. No fuel was uplifted prior to the next flight which was MYBS to MYEF, the accident flight [flown on May 16, 2005]. During post accident interviews, the pilot confirmed that he had not noticed anything unusual about the airplane. The pilot later surmised that he had simply run out of fuel.
Probable cause:
The Flight Standards Inspectorate determined that the probable cause of this accident as Fuel Exhaustion. The Pilot could not calculate the fuel for the intended journey. The Pilot used poor judgment when he elected to continue on to Moss Town International Airport rather than returning back to Nassau International Airport when he first experienced the problem.
Final Report:

Crash of a Piper PA-31-350 Navajo Chieftain in Córdoba: 6 killed

Date & Time: May 8, 2005 at 1926 LT
Registration:
LV-LXO
Survivors:
Yes
Schedule:
San Juan – Córdoba
MSN:
31-7552076
YOM:
1975
Country:
Crew on board:
2
Crew fatalities:
Pax on board:
7
Pax fatalities:
Other fatalities:
Total fatalities:
6
Captain / Total flying hours:
5914
Captain / Total hours on type:
240.00
Copilot / Total flying hours:
485
Copilot / Total hours on type:
24
Circumstances:
The twin engine aircraft was completing a charter flight from San Juan to Córdoba with seven passengers and two pilots on board. On approach to Córdoba-Ambrosio Taravella Airport by night, the crew encountered limited visibility due to poor weather conditions. The aircraft descended below the glide and collided with the inner marker antenna located about 700 metres short of runway 18 and crashed. Both pilots and four passengers were killed while three other passengers were seriously injured. Among those killed were the Argentinian racer Nicolas Vuyovich and Gustavo Ramonda, Director of the Toyota Corolla Racing Team who just won a race at the San Juan's autodrome.
Probable cause:
During a night approach in IMC conditions, the aircraft collided with the antenna of the inner marker after the crew descended below the MDA and deviated from the approach pattern. The following contributing factors were identified:
- The adverse weather conditions probably produced an optical illusion among the crew,
- The crew had only little training in instrument flights,
- Wrong altimeter setting,
- Absence of crew resources management,
- Poor crew coordination.
Final Report:

Crash of an Antonov AN-24RV in Varandey: 28 killed

Date & Time: Mar 16, 2005 at 1353 LT
Type of aircraft:
Registration:
RA-46489
Survivors:
Yes
Schedule:
Ufa - Perm - Usinsk - Varandey - Naryan Mar
MSN:
2 73 081 07
YOM:
1972
Flight number:
RL9288
Country:
Region:
Crew on board:
7
Crew fatalities:
Pax on board:
45
Pax fatalities:
Other fatalities:
Total fatalities:
28
Captain / Total flying hours:
14221
Captain / Total hours on type:
9833.00
Copilot / Total flying hours:
517
Copilot / Total hours on type:
60
Circumstances:
The aircraft was completing a charter flight from Ufa to Naryan Mar with intermediate stops in Perm, Usinsk and Varandey under contract of Naryanmarneftyegaz, a sister company of Lukoil. On final approach under VFR mode in good weather conditions, at a speed of 170 km/h, the aircraft stalled, causing the left wing to struck a sand dune (3 metres high). The aircraft crashed 4,217 metres short of runway, bursting into flames. The captain, the navigator and 26 passengers were killed while 24 other people were injured. The aircraft was totally destroyed by impact forces and a post crash fire. OAT was -24° C. at the time of the accident and the visibility was good.
Probable cause:
The accident was the consequence of an aerodynamic stall that occurred on short final at low height due to the combination of the following factors: the aircraft was in a critical angle of attack and its speed was insufficient because both engines run at low regime for a period of more than 20 seconds. Possible errors in the reading of certain instruments such as the speed indicator and the angle of attack indicator remain a contributing factor.

Crash of a Mitsubishi MU-2B-26A Marquise in Blythe

Date & Time: Mar 11, 2005 at 1720 LT
Type of aircraft:
Registration:
N333WF
Survivors:
Yes
Schedule:
Banning – Blythe
MSN:
387
YOM:
1978
Crew on board:
1
Crew fatalities:
Pax on board:
3
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
3900
Captain / Total hours on type:
942.00
Circumstances:
The pilot failed to lower the landing gear prior to touching down on the runway. The pilot said that during the approach into the airport, the flaps would not lock into the 20-degree extended position. The pilot decided to execute a no-flap landing and referred to the emergency checklist. The checklist advised the pilot to extend the landing gear; however, the pilot skimmed over the information thinking that the gear was already down and locked, and focused on the stabilized approach into the airport. The airplane touched down with the gear in the retracted position. No mechanical malfunctions were noted with the landing gear system on the airplane and a ground test run of the flaps did not reproduce the failure encountered during flight.
Probable cause:
The pilot's failure to lower the landing gear prior to landing. A factor to the accident was the pilot's diverted attention due to the flap system anomaly.
Final Report:

Crash of a De Havilland DHC-2 Beaver off Quadra Island: 5 killed

Date & Time: Feb 28, 2005 at 1916 LT
Type of aircraft:
Operator:
Registration:
C-GAQW
Flight Phase:
Survivors:
No
Schedule:
Campbell River – Frances Bay – Knight’s Inlet – Frances Bay – Campbell River
MSN:
1353
YOM:
1959
Country:
Crew on board:
1
Crew fatalities:
Pax on board:
4
Pax fatalities:
Other fatalities:
Total fatalities:
5
Circumstances:
The single engine aircraft departed Campbell River on a night flight to Knight's Inlet with four passengers and one pilot on board. As it failed to arrive at destination, SAR operations were initiated by RCAF & RCMP but no trace of the airplane and its occupants was found. On 15 of July 2005, the wreckage was found at a depth of 260 metres of Quadra Island by the families of the victims. TSB did not proceed to any investigations for this occurrence.

Crash of a Rockwell Shrike Commander 500S in San Juan

Date & Time: Feb 28, 2005 at 1120 LT
Operator:
Registration:
N97VB
Flight Phase:
Survivors:
Yes
Schedule:
San Juan – Tortola
MSN:
500-3233
YOM:
1975
Country:
Crew on board:
1
Crew fatalities:
Pax on board:
6
Pax fatalities:
Other fatalities:
Total fatalities:
0
Captain / Total flying hours:
1038
Captain / Total hours on type:
282.00
Aircraft flight hours:
6943
Circumstances:
The non-Spanish speaking commercial pilot was preparing for a Title 14, CFR Part 135 on-demand charter flight in a twin-engine airplane with gasoline engines. A non-English speaking fuel truck operator inadvertently serviced the accident airplane with 120 gallons of Jet-A turbine fuel. In the pilot's written statement he reported that just after takeoff, with six passengers aboard, both engines began to lose power, and the airplane subsequently descended and collided with tree-covered terrain at the departure end of the runway. An on-site examination of the fuel vender's Jet-A fuel truck disclosed that the dispensing nozzle installed on the truck was the same nozzle as a typical gasoline nozzle. An examination of the accident airplane's fuel caps and fueling ports disclosed that the accident airplane was equipped with round, fuel tank inlet restrictors, that would prevent fueling from a jet fuel nozzle of the appropriate size, but the fueling ports were not placarded with the required statement indicating that only gasoline (av-gas) should be used.
Probable cause:
The fuel truck operator's improper refueling of a gasoline engine powered airplane with jet (turbine) fuel, and the pilot's inadequate preflight, which resulted in a loss of power in both engines and subsequent collision with trees. Factors associated with the accident were the unclear communications between the Spanish-speaking fuel truck operator and the English speaking pilot, and the uel truck operator's lack of familiarity with the accident airplane's fueling requirements. An additional factor was the absence of the required placards adjacent to the fuel filler caps indicating that only gasoline (av-gas) should be used.
Final Report: