N814GV

Substantial
Minor

CESSNA 208BS/N: 208B0958

Accident Details

Date
Wednesday, April 11, 2018
NTSB Number
ANC18LA031
Location
Atqasuk, AK
Event ID
20180411X94535
Coordinates
70.489723, -157.504714
Aircraft Damage
Substantial
Highest Injury
Minor
Fatalities
0
Serious Injuries
0
Minor Injuries
1
Uninjured
0
Total Aboard
1

Probable Cause and Findings

The pilot's decision to continue a visual flight rules flight into an area of instrument meteorological conditions and his subsequent failure to level the airplane after the autopilot disconnected, which resulted in a collision with terrain.

Aircraft Information

Registration
Make
CESSNA
Serial Number
208B0958
Engine Type
Turbo-prop
Year Built
2002
Model / ICAO
208BC208
Aircraft Type
Fixed Wing Single Engine
No. of Engines
1
Seats
12
FAA Model
208B

Registered Owner (Current)

Name
ISR AVIATION LLC
Address
2801 CENTERVILLE RD PMB 8229
City
WILMINGTON
State / Zip Code
DE 19808
Country
United States

Analysis

HISTORY OF FLIGHT

On April 11, 2018, about 0818 Alaska daylight time, a single-engine, turbine-powered Cessna 208B airplane, N814GV, impacted snow-covered terrain about 2 miles north of the Atqasuk Airport (PATQ), Atqasuk, Alaska. The airline transport pilot sustained minor injuries, and the airplane sustained substantial damage. The airplane was being operated by Hageland Aviation Services, Inc., dba Ravn Connect, Anchorage, Alaska, as a visual flight rules (VFR) commuter flight under 14 Code of Federal Regulations Part 135. Visual meteorological conditions (VMC) existed at the flight's point of departure, and company flight-following procedures were in effect. The flight departed about 0759 from the Utqiagvik (formerly Barrow) Airport (PABR), Utqiagvik Alaska, and it was destined for PATQ.

Utqiagvik and Atqasuk are about 58 miles apart, and the area between the towns is remote, flat, featureless, tundra-covered terrain, which is snow-covered in April.

The director of safety for the company stated that the purpose of the flight was to transport a load of U.S. Postal Service mail to Atqasuk. The accident pilot said that he departed from Utqiagvik with about 1,500 pounds of mail on board. He noted that weather conditions at the time of departure were clear skies, 9 miles visibility, and a light wind. After takeoff, the airplane climbed to 2,500 feet mean sea level (msl) and proceeded southbound toward Atqasuk.

The pilot said that as the airplane neared Atqasuk, he descended to about 1,500 feet msl with the autopilot engaged and then noticed an area of low fog around Atqasuk. He said that when the airplane was about 2 miles from the airport, he heard the audible autopilot disengagement annunciator tone sound, which was immediately followed by the pilot's control column pitching forward. The pilot said that he was unable to pull the control column back, and the airplane subsequently descended into instrument meteorological conditions. He said that the airplane continued to descend into the fog, before impacting the snow-covered tundra and nosing over. The pilot stated that he recalled "having the yoke back, the plane recovering, but impacting the ground before fully recovered."

During a later interview, the pilot stated that after descending from 2,500 ft to 1,500 ft, he lost sight of Atqasuk and decided to turn toward the initial approach fix for the RNAV runway 6 approach into PATQ "not to initiate the approach, but to set myself up for the approach in a way that I was going to get a pop-up clearance for the approach, either from center or from Barrow Flight Service…as a relay through them." He remembered hearing an audible tone indicating the autopilot had disconnected. He said that shortly thereafter, the airplane began an uncommanded descent. He said he felt resistance on the control wheel while trying to recover. He did not recall the control wheel pitching forward at all during the descent. He further stated that he could not recall if he heard a Terrain Awareness and Warning System (TAWS) alert at any point.

When asked about the decision to get a clearance, he stated that he knew he would have to climb back up as the initial approach fix requires the airplane be at 2,000 ft. However, he added that in order to get a clearance, the minimum altitude for radio communication would be about 3,000 ft.

In a follow-up interview, the pilot stated that after being level at 1,500 ft he remembered hearing what he believed was the autopilot disconnect tone, followed by the airplane entering a "strong descent." He said "[t]he control wheel definitely went forward." He said that he remembered pulling on the control wheel and thought he had leveled off, but then the airplane impacted the terrain.

PERSONNEL INFORMATION

The pilot, age 60, held an airline transport pilot certificate with a multi-engine land rating and commercial pilot privileges for single-engine land airplanes. His most recent first-class Federal Aviation Administration medical certificate was issued on May 23, 2017 and was not valid for any class after May 31, 2018.

The pilot's personal logbooks were not obtained; however, the operator provided the following hours of flight experience for the pilot: 7,713 total hours, including 7,193 hours in single-engine airplanes; 230 hours in the Cessna 208 in the previous 90 days; 90 hours in the previous 30 days; and 5 hours in the previous 24 hours. His most recent pilot competency check conducted in accordance with 14 CFR 135.293 was completed on November 12, 2017.

AIRCRAFT INFORMATION

The accident airplane was manufactured in 2002. At the time of the most recent approved aircraft inspection program (AAIP) inspection on February 25, 2018, the airplane had a total time in service of 9,778.2 flight hours. At the time of the accident, the airplane had accrued 168 flight hours since the AAIP inspection.

The airplane was equipped with a Pratt and Whitney PT6A-114 turboprop engine rated at 675 horsepower. The engine had a total time in service of 3,950 hours.

The airplane was equipped with a Bendix/King (now Honeywell) KFC 225 automatic flight control system (AFCS). The system provided pitch, roll, and yaw damper control using gyros, servos, and an autopilot computer. The KC 225 flight computer provided pitch and roll guidance output commands to the pitch, roll, yaw, and trim servos. A total of 17 flight control components were removed from the airplane for testing postaccident.

The airplane was also equipped with a Honeywell KGP 560 general aviation enhanced ground proximity warning system (EGPWS) and automatic surveillance dependent-broadcast (ADS-B) "in and out" equipment.

METEOROLOGICAL INFORMATION

At 0753, PABR reported wind from 030° at 9 knots, visibility 9 statute miles (sm), sky clear under 12,000 ft, temperature -14°C, dew point -16°C, and an altimeter setting of 29.66 inches of mercury.

When the accident airplane departed PABR at 0759, an available METAR at PATQ was reporting wind from 340° at 5 knots, visibility 1 ¾ sm, in light snow and mist, temperature -19°C, dew point -21°C, and an altimeter setting of 29.65 inches of mercury. At 0818, PATQ reported wind from 340° at 4 knots, 3/4 mile visibility, light snow, mist, temperature -19° C, dew point -21°C, and an altimeter setting of 29.64 inches of mercury. Between 0730 and 0759, the visibility decreased from 7 sm to 1 ¾ sm at PATQ.

A North Slope Borough Search and Rescue helicopter pilot reported that, while en route from Utqiagvik to the accident site, he encountered ice fog, reduced visibility, and flat light conditions that made it difficult to discern topographical features on the snow-covered tundra. He noted that as the flight continued, both pilots noticed ice beginning to accumulate on the helicopter's windscreen, so the decision was made to abort the search and rescue flight, and the helicopter returned to Utqiagvik.

Beginning on March 19, 2018, the FAA noted that the local Atqasuk "Service A" (the telecommunications service (circuit) via which weather observations are disseminated from the PATQ AWOS) was inoperative during the days leading up to and including the accident day, which affected long-line dissemination of the PATQ AWOS observations and the Atqasuk FAA weather camera imagery. The FAA indicated that both VHF and telephone transmissions from the PATQ AWOS had been "serviceable." Review of historical PATQ weather observations revealed that the last observation disseminated longline to the public prior to the accident occurred at 1040 AKDT on March 18, 2018. A Notice to Airmen (NOTAM) that advised of the PATQ AWOS ceilometer being out of service was active between April 3, 2018, and April 21, 2018. This issue was first noted by the FAA on December 26, 2017. According to the FAA, there were no requirements to issue NOTAMs for Service A or FAA weather camera outages. Review of historical PATQ weather observations revealed that the last sky condition observation disseminated longline to the public before the accident occurred at 2145 on December 25, 2017. For additional weather information, see the weather study in the public docket for this accident.

The pilot stated that he checked the AWOS for updated weather as he was about 15 minutes from PATQ and the weather was reporting 7 miles visibility. In the 18 minutes before the accident, from 0800 until 0818, the visibility reported by the AWOS was never greater than 1 ¾ sm.

WRECKAGE AND IMPACT INFORMATION

The airplane impacted the snow-covered tundra in a nose-low attitude before flipping and coming to rest inverted. The airplane sustained substantial damage to the fuselage, vertical stabilizer and rudder. The cockpit area was intact with the floorboards buckled upward and the glass broken. The instrument panel was slightly buckled outward. The right control column was missing, and the left control column was fractured at the base and the switch cap separated into two pieces. The top half of the vertical stabilizer was bent to the left and the rudder was completely buckled. The horizontal stabilizers sustained minor damage. The elevators could not be moved due to impact damage.

Flight control continuity was established from the cockpit to the ailerons, elevators, and the rudder rear bell crank. The autopilot bridle cables were attached and secure around the capstans. All bridle cables were in place and secured to their associated bell cranks. The pitch, roll, yaw, and pitch trim servos and capstans were removed and all had freedom of rotation. The flaps were secure in the full-up position. The elevator trim actuators each measured about 1.95 inches, which correlates to a 0° deflection (neutral position).

MEDICAL AND PATHOLOGICAL INFORMATION

Postaccident Department of Transportation urine drug testing was negative for urinary metabolites of drugs of abuse.

The pilot stated in an interview that he received a "very slight bump" on the left top back of...

Data Source

Data provided by the National Transportation Safety Board (NTSB). For more information on this event, visit the NTSB Records Search website. NTSB# ANC18LA031