N388LS

Destroyed
Fatal

Learjet 35A S/N: 388

Accident Details

Date
Tuesday, December 24, 1996
NTSB Number
NYC97FA194
Location
DORCHESTER, NH
Event ID
20001208X07226
Aircraft Damage
Destroyed
Highest Injury
Fatal
Fatalities
2
Serious Injuries
0
Minor Injuries
0
Uninjured
0
Total Aboard
2

Probable Cause and Findings

The captain's failure to maintain situational awareness, which resulted in the airplane being outside the confines of the instrument approach; and the crew's misinterpretation of a step-down fix passage, which resulted in an early descent into rising terrain. Factors included the captain's misreading of the instrument approach procedure, the crew's rushed and incomplete instrument approach briefing, their failure to use additional, available navigational aids, and their failure to account for the winds at altitude.

Aircraft Information

Registration
N388LS
Make
LEARJET
Serial Number
388
Engine Type
Turbo-jet
Model / ICAO
35A LJ35
Aircraft Type
Fixed Wing Multi Engine
No. of Engines
2

Registered Owner (Historical)

Name
AIRLAND L L C
Address
C/O CORP TRUST 1209 ORANGE ST
Status
Deregistered
City
WILMINGTON
State / Zip Code
DE 19801
Country
United States

Analysis

HISTORY OF FLIGHT

On December 24, 1996, at 1005 Eastern Standard Time, a Learjet 35A, N388LS, operated by Aircraft Charter Group Inc., was destroyed when it impacted terrain near Dorchester, New Hampshire. At the time of the accident, the airplane was in instrument meteorological conditions, conducting an instrument approach to the Lebanon Municipal Airport (LEB), Lebanon, New Hampshire. The captain and the first officer, both of whom were certificated airline transport pilots, were fatally injured. An instrument flight rules flight plan had been filed for the flight, from Igor I. Sikorsky Memorial Airport (BDR), Bridgeport, Connecticut, to Lebanon. The positioning flight was conducted under 14 CFR Part 91.

A sequence of events was derived from Boston Air Route Traffic Control Center (ARTCC) communications transcripts, Lebanon Tower communications transcripts, the airplane's cockpit voice recorder (CVR), and radar/transponder beacon information, which was incorporated into a Safety Board Recorded Radar Study. Timelines provided in the tower transcripts lagged those of the center by 22 to 27 seconds. In addition, there were occasional, slight discrepancies between center and CVR timelines (1 second), due to transcription differences.

The flight departed Bridgeport at 0919. The captain was in the right seat, and the first officer was in the left seat, flying the airplane. The airplane climbed to flight level 190 per instructions, and then was gradually "stepped down" to 7,000 feet as it neared Lebanon.

At 0927:04, the center controller cleared the flight to proceed direct, to Lebanon. About 10 minutes later, the captain copied the ATIS information, then read part of it back to the first officer, and said, "doing the i-l-s approach." At 0937:53, the captain stated to the first officer, "you wanna review this and i'll take the airplane if you like." The first officer responded with, "yeah i will. you can have the airplane." Exactly when control of the airplane was passed back to the first officer, was not determined. At 0938:44, there was an unintelligible conversation, followed, shortly thereafter, by one of the pilots, which one, being unknown, stating, "yeah, we're set up on eleven nine."

According to the instrument approach procedure, the ILS RWY 18 approach frequency at Lebanon was 111.9 mhz.

At 0939:40, the first officer called for the approach checklist, and the captain responded with the approach items, followed by, "okay, approach set up is complete." At 0941:28, the captain confirmed with the center controller that the crew had weather "information hotel" for Lebanon. At 0945:10, the crew was instructed to maintain a heading of 050 degrees magnetic, and at 0946:06, they were issued a descent from 7,000 feet to 4,700 feet. At 0946:14, the controller stated, "lear eight lima sierra...once you leave five thousand proceed direct burgr for the i-l-s approach," which was acknowledged by the captain.

According to the radar data, the airplane was about 1 nautical mile southwest of the Lebanon VOR, heading northeast, at that time.

The Lebanon VOR was located 066 degrees magnetic, 4.4 nautical miles from the approach end of Runway 25 at Lebanon Airport. According to the ILS RWY 18 approach procedure, BURGR intersection was identified as an outer marker on the localizer, and was also 6 nautical miles from the Lebanon VOR, on its 317-degree radial.

At 0947:21, the airplane was about 3 nautical miles northeast of the Lebanon VOR, descending through 5,500 feet. About that time, the center controller radioed: "and eight eight lima sierra, maintain four thousand seven hundred until established on a portion of the approach, cleared i-l-s approach lebanon." The captain acknowledged both the altitude and the approach clearance, and shortly thereafter, the crew configured the airplane to "flaps eight."

According to the radar data, the airplane continued to the northeast, until the last outbound radar contact, at 0947:45. At the time, the airplane was at 4,900 feet.

At 0948:35, the controller told the crew that radar service was terminated, and to contact Lebanon Tower.

At 0948:52, the captain contacted the Lebanon Tower controller, and reported, "...with you i-l-s one eight inbound, seven out outside of burgr." The tower controller then reported that, "weather remains basically the same. winds are one niner zero at seven now. altimeter two niner eight three." The captain acknowledged the call, then asked if the airplane was cleared to land. The tower controller told him to report BURGR inbound.

At 0948:57, radar contact was regained, northwest of the last contact, consistent with the airplane having made a left, teardrop turn. Subsequent radar returns indicated that the airplane then headed southwest. At 0949:57, the airplane was at 4,700 feet, and about 11 nautical miles northeast of Lebanon Airport.

At 0949:58, the captain stated to the first officer, "well, i was looking at the ah airport thinking that it was eight miles." The first officer then discussed the amount of flaps deployed, and the captain asked, "you want 'em up?" The first officer said that he did, and right after, at 0950:17, the captain said, "four thousand seven hundred...." Shortly thereafter, he said, "let's get some speed up here."

At 0950:41, the first officer stated, "okay, localizer's coming alive," then, "localizer's alive."

At 0950:55, the captain stated to the first officer, "what's up with this...," and the first officer then asked, at 0951:16, "tuned and identified, right?" The captain did not answer the question, but at 0951:20, said, "we're not getting a localizer here." At 0951:21, the captain reported to the tower, "...we're burgr inbound we're not getting a localizer."

Radar data revealed that the airplane was not at BURGR at that time, but was about 5 nautical miles to the southeast of it, heading southwest.

At 0951:29, the tower controller asked if the crew was going to continue the approach or execute a missed approach from that position, and reported that the localizer was "in the green." The captain answered back, "roger." The captain then told the first officer to descend to 3,500 feet. The first officer asked for flaps eight, and the captain answered, "going to eight." At 0952:07, the captain stated, "all right, we've missed, execute missed approach," to which the first officer responded, "okay."

At 0952:09, the tower controller asked for the crew's intentions. The captain responded that they were going to execute the missed approach, and, "we're not receiving the localizer." Six seconds later, at 0952:18, the controller said, "roger."

The published missed approach for the ILS RWY 18 approach was: "Climb to 2000', then climbing RIGHT turn to 4800' direct IVV NDB and hold." The IVV NDB was the White River NDB, which was located about 8 nautical miles southwest of the Lebanon Airport, with a frequency of 379 khz.

At 0952:20, the captain said to the first officer, "missed approach," then told him to "climb to two thousand turn forty eight hundred, direct to the n-d-b." The first officer responded, "all right", and the captain then said, "set three seventy nine, i'll put that in there." At 0952:28, the tower controller told the crew to execute the "...published missed approach, contact boston center...."

According to the radar data, at that time, the airplane was about 2 nautical miles southeast of the VOR, proceeding southeast, at approximately 4,500 feet.

At 0952:36, the first officer called for "flaps up," and the captain responded with, "flaps up." The first officer then asked, "what's the altitude you want me to go to," to which, the captain first answered, "just climb," then said right after that, "forty seven hundred." At 0952:50, the captain reported to Boston Center that the airplane was "on the missed." The center controller asked for the crew's intentions, and the captain responded with a request for a confirmation that the localizer frequency was 111.9 mhz. The center controller told the captain that he'd check on it, but to fly the "published missed procedure," and maintain 5,000 feet. At 0953:24, the captain acknowledged the instructions to fly the published missed approach procedure at 5,000 feet.

According to the radar data, the airplane climbed to 5,000 feet shortly after being cleared to that altitude. However, it did not make a turn to the right, to proceed to the White River NDB, per the published missed approach instructions. Instead, it continued heading to the southeast.

At 0953:27, the first officer stated, "this ah this ah i'm not even getting an a-d-f." Seven seconds later, the captain responded with, "here you go."

At 0953:35, the center controller confirmed that the localizer frequency had been 111.9 mhz, and the captain reiterated that the crew was unable to receive it. At 0953:50, the captain requested the VOR RWY 25 approach with "circle to land." The controller approved the request, and then, at 0954:19, cleared the airplane to proceed directly to the VOR.

According to the radar data, at that time, the airplane was about 9 nautical miles southeast of the Lebanon VOR. The airplane made a right turn from that position, and headed back toward the northwest.

According to the VOR or GPS RWY 25 approach procedure in effect at the time, the outbound course from the VOR was 066 degrees magnetic, with a descent down to a minimum of 4,300 feet above mean sea level. The procedure turn was to be completed within 10 nautical miles of the VOR. The published course reversal for the procedure turn included an initial left turn to a heading of 021 degrees magnetic, followed by a right turn to a heading of 201 degrees magnetic, until joining an inbound course to the VOR of 246 degrees magnetic. After joining the inbound course, the approach called for a descent to a minimum of 2,900 feet, until the Hanov...

Data Source

Data provided by the National Transportation Safety Board (NTSB). For more information on this event, visit the NTSB Records Search website. NTSB# NYC97FA194