Crash of a Piper PA-46-310P Malibu in Lehman: 3 killed

Date & Time: Jun 18, 2014 at 1635 LT
Operator:
Registration:
N2428Q
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Aspen - Brenham
MSN:
46-8508088
YOM:
1985
Location:
Crew on board:
1
Crew fatalities:
Pax on board:
2
Pax fatalities:
Other fatalities:
Total fatalities:
3
Captain / Total flying hours:
2258
Captain / Total hours on type:
188.00
Aircraft flight hours:
4799
Circumstances:
The private pilot was conducting a personal flight during day, instrument flight rules (IFR) conditions. The pilot checked in with an air route traffic control center, and, after radar data showed multiple changes in altitude that were not in accordance with the assigned altitudes, an air traffic controller queried the pilot about the altitude changes. The pilot reported an autopilot problem and then later requested clearance to deviate around weather at a higher altitude. The airplane passed through several sectors and controllers, and it was understood that the pilot was aware of the adverse weather due to the deviation information in the flight strip. The air traffic controller did not provide additional adverse weather information and updates to the pilot, as required by a Federal Aviation Administration order; however, general broadcasts of this weather information were recorded on the frequency the pilot was using before the accident. Multiple weather resources showed rapidly developing multicellular to supercell-type convective activity with cloud tops near 48,000 ft. Forecasts and advisories warned of potential strong to severe thunderstorms with the potential for moderate-to-severe turbulence, hail, lightning, heavy rains, and high wind. Radar data indicated that the pilot turned into the intense weather cells instead of away from them as he had requested. The pilot declared a "mayday" and reported that he had lost visual reference and was in a spin. Damage to the airplane and witness marks on the ground were consistent with the airplane impacting in a level attitude and a flat spin. No mechanical anomalies were noted that would have precluded normal operation before the loss of control and impact with the ground. The investigation could not determine if there was an anomaly with the autopilot or if the rapidly developing thunderstorms and associated weather created a perception of an autopilot problem. The autopsy identified coronary artery disease. Although the coronary artery disease could have led to an acute coronary syndrome with symptoms such as chest pain, shortness of breath, palpitations, or fainting, it was unlikely to have impaired the pilot's judgment following a preflight weather briefing or while decision-making en route. Thus, there is no evidence that a medical condition contributed to the accident. The toxicology testing of the pilot identified zolpidem in the pilot's blood and tetrahydrocannabinol and its metabolite in the pilot's cavity blood, which indicated that he was using two potentially impairing substances in the days to hours before the accident. It is unlikely that the pilot's use of zolpidem contributed to the accident; however, the investigation could not determine whether the pilot's use of marijuana contributed to the cause of the accident.
Probable cause:
The pilot's improper decision to enter an area of known adverse weather, which resulted in the loss of airplane control. Contributing to the accident was the air traffic controller's failure to provide critical weather information to the pilot to help him avoid the storm, as required by Federal Aviation Administration directives.
Final Report:

Crash of a Grumman G-21A Goose in Sula: 1 killed

Date & Time: Jun 17, 2014 at 1700 LT
Type of aircraft:
Operator:
Registration:
N888GG
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Salmon - Hamilton
MSN:
B-70
YOM:
1944
Location:
Crew on board:
1
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
1
Captain / Total flying hours:
9800
Captain / Total hours on type:
50.00
Aircraft flight hours:
6394
Circumstances:
The airline transport pilot was repositioning the airplane to an airport near the owner's summer home. The airplane was not maintained for instrument flight, and the pilot had diverted the day before the accident due to weather. On the day of the accident, the pilot departed for the destination, but returned shortly after due to weather. After waiting for the weather conditions to improve, the pilot departed again that afternoon, and refueled the airplane at an intermediate airport before continuing toward the destination. The route of flight followed a highway that traversed a mountain pass. A witness located along the highway stated that he saw the accident airplane traveling northbound toward the mountain pass, below the overcast cloud layer. He also stated that the mountain pass was obscured, and he could see a thunderstorm developing toward the west, which was moving east toward the pass. A second witness, located near the accident site, saw the airplane descend vertically from the base of the clouds while spinning in a level attitude and impact the ground. The second witness reported that it was snowing and that the visibility was about ¼ mile at the time of the accident. The airplane impacted terrain in a level attitude, and was consumed by a postcrash fire. Examination of the flight controls, airframe, and engine revealed no mechanical malfunctions or anomalies that would have precluded normal operation. It is likely that the pilot experienced spatial disorientation and a subsequent loss of aircraft control upon encountering instrument meteorological conditions. The airplane exceeded its critical angle of attack and entered a flat spin at low altitude, resulting in an uncontrolled descent and impact with terrain.
Probable cause:
The pilot's decision to continue flight into deteriorating weather conditions in an airplane not maintained for instrument flight, which resulted in a loss of control due to spatial
disorientation.
Final Report:

Crash of a Cessna 208 Caravan I Near Lydenburg: 3 killed

Date & Time: Jun 17, 2014 at 1030 LT
Type of aircraft:
Operator:
Registration:
3006
Flight Phase:
Flight Type:
Survivors:
Yes
Site:
Schedule:
Sabi Sabi - Lydenburg
MSN:
208-00136
YOM:
1988
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
3
Pax fatalities:
Other fatalities:
Total fatalities:
3
Circumstances:
The single engine aircraft was completing a training flight from Sabi Sabi to Lydenburg on behalf of the 41st Squadron. While descending to Lydenburg, the aircraft crashed in a mountainous area near the Long Tom Pass. Two passengers were seriously injured while three other occupants were killed.

Crash of a Piper PA-46-310P Malibu near Narrabri

Date & Time: Jun 12, 2014 at 1630 LT
Operator:
Registration:
VH-TSV
Flight Phase:
Survivors:
Yes
Schedule:
Dubbo – Sunshine Coast
MSN:
46-8408022
YOM:
1984
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
On 12 June 2014, at about 1530 Eastern Standard Time (EST), a Piper PA-46 aircraft, registered VH-TSV, departed Dubbo, New South Wales for a private flight to the Sunshine Coast, Queensland with a pilot and one passenger on board. The planned route was to track via Moree and Toowoomba at 13,500 ft above mean sea level (AMSL). The pilot had operated the aircraft from Sunshine Coast to Lightning Ridge, Brewarrina and Dubbo earlier that day and reported that all engine indications were normal on those flights. About 1 hour after departing Dubbo, when about 26 NM south of Narrabri, at about 13,500 ft AMSL, the pilot observed the engine manifold pressure gauge indicating 25 inches Hg, when the throttle position selected would normally have produced about 28 inches Hg. The pilot selected the alternate air1 which did not result in any increase in power. He then elected to descend to 10,000 ft, and at that power setting when normally the engine would have produced about 29 inches Hg, the gauge still indicated only about 25 inches Hg. He turned the aircraft towards Narrabri in an attempt to fly clear of the Pilliga State Forest. The pilot assessed that the aircraft had a partial engine failure and performed troubleshooting checks. As the aircraft descended through about 8,000 ft, he observed the oil pressure gauge indicating decreasing pressure. When passing about 6,500 ft, the oil pressure gauge indicated zero and the pilot heard two loud bangs and observed the cowling lift momentarily from above the engine. The passenger observed a puff of smoke emanating from the engine and momentarily a small amount of smoke in the cockpit. The pilot established the aircraft in a glide at about 90 kt, secured the engine and completed the emergency checklist. He broadcast a ‘Mayday’ 2 call on Brisbane Centre radio frequency advising of an engine failure and forced landing. The pilot looked for a clear area below in which to conduct a forced landing and also requested the passenger to assist in identifying any cleared areas suitable to land. Both only identified heavily treed areas. The pilot extended the landing gear and selected 10º of flap and, when at about 1,000 ft, the pilot shut the fuel off, deployed the emergency beacon then switched off the electrical system. As the aircraft entered the tree tops, he flared to stall3 the aircraft. On impact, the pilot was seriously injured and lost consciousness. The passenger reported the wings impacted with trees and the aircraft slid about 10 m before coming to rest. The passenger checked for any evidence of fuel leak or fire and administered basic first aid to the pilot. The aircraft sustained substantial damage.
Final Report:

Crash of an Antonov AN-30B in Drobyshevo: 5 killed

Date & Time: Jun 6, 2014
Type of aircraft:
Operator:
Registration:
80 yellow
Flight Phase:
Flight Type:
Survivors:
Yes
MSN:
06 08
YOM:
1975
Country:
Region:
Crew on board:
8
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
5
Circumstances:
The crew was on his way to east Ukraine on a reconnaissance mission for pro-federalist militants positions. While overflying the region of Slavyansk, the aircraft was hit by a surface-to-air missile SAM that struck the right engine that caught fire. Three crew members were able to bail out and later found alive but injured. Out of control, the aircraft entered a dive and crashed in an open field located in Drobyshevo, between the villages of Krasny Liman and Nikolayevka. It was totally destroyed by impact forces and post crash fire and all five occupants were killed.
Probable cause:
Shot down.

Crash of a Fokker 100 in Ganla

Date & Time: May 10, 2014 at 2000 LT
Type of aircraft:
Operator:
Registration:
5N-SIK
Flight Phase:
Flight Type:
Survivors:
Yes
Site:
Schedule:
Bratislava – Ghardaïa – Kano
MSN:
11286
YOM:
1989
Location:
Country:
Region:
Crew on board:
2
Crew fatalities:
Pax on board:
0
Pax fatalities:
Other fatalities:
Total fatalities:
0
Circumstances:
Following a C-Check at Bratislava Airport, the aircraft was returning to its base in Kano, Nigeria, with an intermediate stop in Ghardaïa. While flying over the Niger airspace, the crew was in contact with Niamey ATC when he apparently encountered poor weather conditions (sand storm) and lost all communications. The exact circumstances of the accident are unclear, but it is believed that the crew was forced to attempt an emergency landing due to fuel shortage. The aircraft landed in a desert area located in the region of the Ganla beacon, south of Niger. Upon landing, the aircraft lost its undercarriage and slid for few dozen metres before coming to rest. Both pilots evacuated safely and the aircraft was damaged beyond repair. The wreckage was found about 190 km north of Kano.

Crash of a Douglas DC-3C near San Vincente del Caguán: 5 killed

Date & Time: May 8, 2014 at 1202 LT
Type of aircraft:
Operator:
Registration:
HK-4700
Flight Phase:
Flight Type:
Survivors:
No
Site:
Schedule:
Villavicencio – Florencia
MSN:
9700
YOM:
1943
Country:
Crew on board:
2
Crew fatalities:
Pax on board:
3
Pax fatalities:
Other fatalities:
Total fatalities:
5
Captain / Total flying hours:
10233
Captain / Total hours on type:
9950.00
Copilot / Total flying hours:
4417
Copilot / Total hours on type:
3812
Aircraft flight hours:
27771
Circumstances:
The aircraft departed Villavicencio on a cargo flight to Florencia, carrying three passengers, two pilots and a load consisting of 2,540 kg of various goods. While cruising under VFR mode at an altitude of 6,500 feet, weather conditions worsened and the crew attempted to modify his route when the aircraft impacted ground and crashed in a wooded and mountainous area located some 45 km north of San Vincente del Caguán, near Uribe. The aircraft was destroyed by impact forces and all five occupants were killed.
Probable cause:
It was determined that the accident was the consequence of a controlled flight into terrain. The crew failed to evaluate properly the risks and the danger of poor weather conditions and decided to perform the flight in VFR mode. While cruising in IMC and failing to check the minimum prescribed altitude, the crew suffered a loss of situational awareness, causing the aircraft to hit he mountainous terrain.
Final Report:

Crash of a Piper PA-31-310 Navajo near Coromoro: 2 killed

Date & Time: May 3, 2014 at 1023 LT
Type of aircraft:
Operator:
Registration:
C-GSVM
Flight Phase:
Survivors:
No
Site:
Schedule:
Bucaramanga - Bucaramanga
MSN:
31-109
YOM:
1968
Country:
Crew on board:
1
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
2
Captain / Total flying hours:
4000
Captain / Total hours on type:
1400.00
Aircraft flight hours:
11000
Circumstances:
The twin engine aircraft departed Bucaramanga-Palonegro Airport at 0804LT on a geophysical mission over the Coromoro Region, Santander. At 1000LT, the last radio contact was recorded with the pilot. While flying in marginal weather conditions (low clouds), the aircraft impacted the slope of a mountain located near Coromoro. The wreckage was found two days later at an altitude of 4,500 metres, some 98 km south of Bucaramanga. The aircraft disintegrated on impact and both occupants were killed, among them Peter Moore, co-founder of Oracle Geoscience International and Neville Ribeiro, the pilot.
Probable cause:
Controlled flight into terrain after the pilot was flying under VFR mode in IMC conditions. It was determined that the accident occurred after the pilot suffered a loss of situational awareness while flying under VFR mode in low clouds conditions.
Final Report:

Crash of a Piper PA-46-310P Malibu near Niekerkshoop: 2 killed

Date & Time: Apr 22, 2014 at 1121 LT
Operator:
Registration:
ZS-LLD
Flight Phase:
Flight Type:
Survivors:
No
Schedule:
Cape Town – Swartwater
MSN:
46-8408063
YOM:
1984
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
1
Pax fatalities:
Other fatalities:
Total fatalities:
2
Captain / Total flying hours:
1569
Captain / Total hours on type:
163.00
Aircraft flight hours:
2029
Circumstances:
On 22 April 2014 at approximately 0716Z the Commercial pilot accompanied by a passenger departed Cape Town International Airport (FACT) on an IFR flight to Swartwater in the Limpopo Province. Approximately 16 minutes after take-off with the aircraft climbing through an altitude of 13500 feet to 17000 feet, the Air Traffic Controller advised the pilot that the aircraft’s Mode C transponder started transmitting erroneous altitude data and indicating that the aircraft was descending whereas the pilot thought he was ascending. The pilot notified the ATC that the aircraft was not descending and attempted to rectify the problem by recycling the Mode C transponder that however didn’t resolve the problem. As the transponder information was intermittent during the IFR flight to Swartwater, the ATC requested the pilot to descent to the VFR flight level FL 135. The pilot then requested Area West for approval to ascent to flight level (FL 195) which was approved. It appears that the pilot was unaware that the pitot static tube system that supplies both pitot and static air pressure for the airspeed indicator, altimeter and triple indicator was most probably blocked by dust or sand. The aircraft exceeded the Maximum Structural Air Speed (VNO) of the aircraft and the VNE air speed of 1 hour 44 minutes and 9 minutes respectively. The VNO of 173 airspeed and VNE of 203 airspeed exceedance resulted in the catastrophic inflight breakup of the aircraft. The wreckage was found scattered in a 1.58km path in mountainous terrain. Both occupants on board the aircraft sustained fatal injuries.
Probable cause:
The aircraft exceeded the Maximum Structural Cruising Speed (VNO) and Calibrated Never Exceed Speed VNE airspeed due to the fact that erroneous airspeed and altitude data information indicated on the cockpit instruments as a result of blockage of the pitot tube by dust and sand. The fact that the pilot switched off the transponder was considered as a contributory factor.
Final Report:

Crash of a Comp Air CA-8 in Jämijärvi: 8 killed

Date & Time: Apr 20, 2014 at 1540 LT
Type of aircraft:
Registration:
OH-XDZ
Flight Phase:
Survivors:
Yes
Schedule:
Jämijärvi - Jämijärvi
MSN:
01
YOM:
2008
Country:
Region:
Crew on board:
1
Crew fatalities:
Pax on board:
10
Pax fatalities:
Other fatalities:
Total fatalities:
8
Captain / Total flying hours:
1029
Captain / Total hours on type:
43.00
Aircraft flight hours:
809
Aircraft flight cycles:
3015
Circumstances:
The Tampere Skydiving Club (TamLK) organized the skydiving event “Easter Boogie” at Jämijärvi aerodrome, in the Satakunta region, on Sunday 20 Apr 2014. The event started on Maundy Thursday, 17 Apr 2014 and was planned to end on Easter Monday, 21 Apr 2014. The aircraft reserved for the event were Finland’s Sport Aviators’ Comp Air 8 airplane (CA8, OH-XDZ), which was intended to be used to take skydivers up to 4 000 m, and the Tampere Skydiving Club’s own Cessna U206F (OH-CMT), to be used for jumps from lower altitudes. On Sunday morning the cloud base hampered skydiving operations, which is why the activity started with student jumps from the Cessna. The pilot of the accident flight flew two flights on the Cessna. Once the weather improved he began to fly on the OH-XDZ. He flew two flights on it before he took a lunch break. Another pilot flew four flights on the airplane, following which it was topped up with 240 l of fuel. After refuelling the pilots changed duties again and the pilot of the accident flight flew yet another skydiving flight, landing at 15:25. Ten skydivers boarded the airplane for the accident flight. Takeoff occurred at 15:28 from northern runway 27 of Jämijärvi aerodrome. The airplane climbed to 4 230 m AGL by making a wide, left turn. The pilot steered the aircraft to the jump run, which was over the southern runway. Some of the skydivers sitting at the rear rose to their knees, and two of them cracked the jump door open so as to check the jump run. The skydivers then gave instructions to the pilot as regards correcting the jump run. The pilot adjusted the heading following which he reduced engine power to idle, reducing airspeed to approximately 70-75 kt. Nonetheless, the skydivers noted that they had overshot the jump line and requested that the pilot take them to a new run. The skydivers closed the door. The pilot increased engine power and, according to his account, simultaneously began to turn to the left at a 20-30 degree bank angle. He did not order the skydivers to return to their seats as he was homing in on the new jump run. At the end of the turn the occupants of the aircraft felt a downward acceleration which the skydivers experienced as a force pushing them towards the cabin ceiling. Approximately three seconds later the situation returned to normal. According to the pilot the airspeed was approximately 100 kt when they encountered the vertical acceleration. A moment later the pilot noticed that the airplane was in a descent and that the airspeed had suddenly risen to over 180 kt IAS. According to the pilot the airspeed peaked at 185 kt. He attempted to end the descent by pulling on the control stick. The aircraft levelled out or went into a shallow climb. He reduced engine power to idle to decrease the airspeed. The pilot said that the pitch control stick forces were relatively high. The aircraft returned to level flight, or to a gentle climb. The longitudinal control force suddenly decreased and the airplane suddenly flipped forward past the vertical axis. One of the surviving skydivers said that he heard a crushing sound roughly at the same time; how-ever, he was unsure of the precise point in time of the sound. The aircraft became uncontrollable and began to rotate around its vertical axis, akin to an inverted spin. According to eyewitness videos the aircraft was turning to the left. The videos show that the right wing was buckled against the fuselage and that a vapour trail of fuel was streaming from the damaged wing. While the aircraft was spinning its left wing, which was intact, was pointing upwards and the airplane was falling with its right side forward. Shouts of “open the jump door, bail out immediately” were heard inside the airplane. The pilot concluded that the aircraft was so badly damaged that it was no longer possible to recover from the dive. He unbuckled his seat belts and opened the pilot’s door on his left at approximately 2 000 m. The pilot jumped out at approximately 1 800 m and opened his emergency parachute. Even though twists had developed in the parachute’s lines, the pilot managed to untangle them. The skydiver sitting at the rear of the seat positioned next to the pilot (skydiver 3) noted that it would be impossible for him to make it to the jump door. Therefore, he chose the pilot’s door as a point of exit. It was extremely difficult to get to the door because the airplane was spinning. The skydiver sitting at the front of the seat positioned next to the pilot (skydiver 2) followed skydiver 3 on his way to the cockpit door and pushed skydiver 3 out of the door. Following egress, skydiver 3 immediately hit his head on airplane structures. The blow momentarily blurred his field of vision but he remained conscious. The Automatic Activation Device (AAD) opened the reserve parachute almost immediately after egress, at approximately 250 m. While skydiver 2 was still behind skydiver 3 he grabbed the control stick, intending to reduce the g-forces caused by the spinning and make it easier to bail out of the airplane. He soon realized that the airplane did not respond to stick movements and exited through the pilot’s door immediately behind skydiver 3. The skydiver who had occupied the furthest forward position (skydiver 1) assisted skydiver 2 in exiting through the door. The AAD of skydiver 2 opened his reserve parachute at approximately 200 m. After skydiver 2 had bailed out neither skydiver 1, situated closest to the pilot’s door, nor the remaining seven skydivers in the rear of the cabin managed to bail out. The airplane collided with the ground at 15:40 and caught fire immediately. The pilot landed approximately 300 m downwind from the wreckage. Skydiver 3 landed on a dirt road, some 60 m from the wreckage and skydiver 2 in the woods, approximately 40 m from the wreckage.
Probable cause:
The cause of the accident was that the stress resistance of the right wing’s wing strut was exceeded as a result of the force which was generated by a negative g-force. The force which resulted in the buckling of the wing strut was the direct result of a negative (nose-down) change in pitching moment, in conjunction with an engine power reduction intended to decrease the high airspeed. The buckling was followed by the right wing folding against the fuselage and the jump door. The aircraft entered into a flight condition resembling an inverted spin, which was unrecoverable. It was impossible to exit through the jump door.
The contributing factors were the following:
1. There was a fatigue crack on the wing strut. Because of the damage to the aircraft it was not possible to investigate the mechanism of the fatigue crack formation. It is possible that, in addition to the stress caused to the aircraft by short flights and high takeoff weights, the temperature changes caused by the exhaust gas stream as well as vibration contributed to the fatigue cracking.
2. The nature of skydiving operations generated many takeoffs and landings in relation to flight hours. A significant part of the operations was flown close to the maximum takeoff weight. These factors increased the structural stress.
3. The pilot’s limited flight experience on a powerful turboprop aircraft, his inadequate training as regards aircraft loading and its effects on the centre of gravity and airplane behavior, the high weight of the aircraft and the aft position of the CG in the beginning of a new jump line and, possibly, the pilot’s incorrect observation of the actual visual horizon contributed to the onset of the occurrence. During the turn to a new jump run the aircraft began to descend and very rapidly accelerated close to its maximum permissible airspeed. The pilot did not immediately realize this.
4. The structural modifications on the wing increased the loads on the aircraft and the wing struts. Their effects had not been established beforehand. The kit manufacturer was aware of the modifications. No changes to the Permit to build were applied for in writing regarding the modifications. Neither the build supervisor nor the aircraft inspectors were aware of the origin or the effects of the modifications.
Final Report: