N88833

Substantial
Serious

CESSNA 402CS/N: 402C0265

Accident Details

Date
Thursday, September 9, 2021
NTSB Number
ERA21FA354
Location
Provincetown, MA
Event ID
20210909103831
Coordinates
42.075993, -70.211744
Aircraft Damage
Substantial
Highest Injury
Serious
Fatalities
0
Serious Injuries
7
Minor Injuries
0
Uninjured
0
Total Aboard
7

Probable Cause and Findings

The pilot’s delayed decision to perform an aborted landing late in the landing roll with insufficient runway remaining. Contributing to the accident was the pilot’s failure to execute a go-around once the approach became unstabilized, per the operator’s procedures.

Aircraft Information

Registration
N88833
Make
CESSNA
Serial Number
402C0265
Engine Type
Reciprocating
Year Built
1980
Model / ICAO
402CC402
Aircraft Type
Fixed Wing Multi Engine
No. of Engines
2

Registered Owner (Historical)

Name
HYANNIS AIR SERVICE INC
Address
660 BARNSTABLE RD
Status
Deregistered
City
HYANNIS
State / Zip Code
MA 02601-1927
Country
United States

Analysis

HISTORY OF FLIGHT

On September 9, 2021, about 1527 eastern daylight time, a Cessna 402C, N88833, was substantially damaged when it was involved in an accident near Provincetown, Massachusetts. The pilot and the six passengers were seriously injured. The airplane was operated as a Title 14 Code of Federal Regulations (CFR) Part 135 flight.

The flight was being operated by Hyannis Air Service, Inc. d.b.a. Cape Air on an instrument flight rules flight plan from Boston-Logan International Airport (BOS), Boston, Massachusetts, to Provincetown Municipal Airport (PVC), Provincetown, Massachusetts.

In a postaccident interview, the pilot said he obtained weather information before the flight via a computer in the pilot crew room at BOS just before the passengers were boarded. The weather information included the graphic forecast for aviation; weather advisories including AIRMETs and SIGMETs, weather radar, METARs, and NOTAMs. The pilot reported that the radar was showing green bands of rain only between BOS and PVC. The pilot said that based on the weather conditions, he planned for the ILS RWY 7 approach into PVC. He then filed an IFR flight plan and began the boarding process.

According to Federal Aviation Administration (FAA) air traffic control (ATC) communications, the flight departed BOS about 1504. The pilot said it was a very quick flight and the AWOS frequency for PVC was already dialed into the No. 2 radio. He said he checked the AWOS “at least twice” during the flight but did not recall exactly when. He was required by the operator to check the AWOS before he started the approach and before he crossed the final approach fix (FAF) on the approach.

He recalled the weather being 200 ft overcast, visibility 3 to 4 miles in moderate rain, and the wind was 5 knots or below from the southwest. The pilot knew he would be landing with a quartering tailwind on runway 7 (a 3,502 ft-long runway) and that the wind conditions favored runway 25, but the ILS to runway 7 allowed for a lower ceiling minima than the RNAV approach to runway 25. So, runway 7 was preferable based on the existing weather conditions. The pilot also calculated that the tailwind component was within the performance limits for the airplane and the company requirements since Cape Air prohibited instrument approaches to short runways (4,000 ft or less) when the tailwind component was 5 knots or more.

At 1511, the pilot advised ATC that he had the weather at PVC and could accept the ILS RWY 7 approach. A controller instructed the pilot to proceed direct to WOMECK intersection, an intermediate fix for the approach. At 1513, a controller cleared him for the ILS RWY 7 approach, and the pilot acknowledged.

At 1521, a controller advised the pilot to cancel his flight plan once on the ground, and the pilot acknowledged. This was the last communication received by the pilot before the accident.

Review of FAA radar surveillance data revealed that the airplane crossed over the FAF at 1524, at an altitude of about 2,000 ft msl, and landed about 3 minutes later, at 1527.

According to the pilot, he said he flew the approach using the autopilot and extended the flaps to 15° a few miles outside the final-approach-fix (FAF). He stated that when the airplane crossed the FAF, the airplane’s indicated airspeed was 120 knots, and he extended the landing gear. Once inside the FAF, he turned off the autopilot at 1,000 ft and extended the flaps to 20°-25° to compensate for the tailwind and wet runway. The pilot said the airplane slowed to about 90 knots and they broke out of the clouds at 500 ft, which gave him extra time to set up for the landing. The airport’s runway landing lights were on, and it was raining.

The pilot stated that he extended the flaps to 45° when the airplane was about 300 ft above the ground. He said that when the airplane was about 50 to 100 ft above the ground, the airplane encountered “an aggressive sinking tendency” and “very heavy rain.” The pilot believed he had encountered a downdraft and associated wind gust (which he estimated to be about 20 knots), which pushed the airplane down and to the left. The pilot added that the approach became unstable and that he immediately initiated a go-around before the airplane touched down. He brought both throttles full forward and retracted the flaps to 15°.

The airplane continued to descend and touched down on the runway for about 2 seconds before it became airborne again. The pilot said that he never applied the brakes because he was fully committed to going around. The pilot did not remember where on the runway the airplane touched down, but said it was beyond his intended landing point due to him initiating the go-around. The pilot said he was unable to establish a positive rate of climb and that he could feel the wings buffeting. The airplane impacted the trees off the end of the runway, then the ground, and caught on fire.

Another Cape Air pilot was holding short of runway 25 waiting to depart and witnessed the accident. He said that he first saw the accident airplane after it landed and was about halfway down the runway. As the accident airplane got closer to his position, he could tell that it was traveling “a little faster than it should be” and would not have room to stop on the remaining runway. The accident airplane then took off and entered a slow climb. The accident airplane cleared the localizer antennas at the far end of the runway, then the perimeter fence, before it collided with trees. The accident airplane disappeared into the trees and a ball of flames erupted shortly afterwards. The pilot told ATC that the accident airplane had gone off the runway and that he was returning to the terminal to contact his company about the accident.

The accident was recorded on three airport surveillance cameras, which showed a different series of events versus what the pilot recalled. The videos revealed the airplane actually made a normal landing and touched down about 500 ft from the end of the runway’s threshold. It was raining heavily at the time and a splash of water was observed when the main landing gear contacted the ground. The airplane rolled down the runway before it became airborne near the end of the runway. The airplane entered a shallow climb, collided with trees, and caught on fire. The airport’s windsock was observed in the video and was consistent with the airplane landing with a tailwind.

The passengers reported that they perceived the airplane was moving too fast to land and stop safely on the runway. One passenger said that after the airplane landed, the pilot tried to stop, and she felt the sensation of decelerating in her seat as the brakes were applied. But the airplane did not slow down. The pilot brought power up on both engines as they neared the end of the runway and attempted to take off. The passengers could see the trees located off the end of the runway and did not believe the airplane would get high enough to clear them.

PERSONNEL INFORMATION

The pilot held an airline transport pilot certificate with a rating for airplane multiengine land. He also held a commercial pilot certificate with ratings for single and multiengine land airplanes, and instrument airplane. In addition, the pilot was a certified flight instructor with ratings for single and multiengine airplanes, and instrument airplane. His last FAA first-class medical certificate was issued on April 2, 2021. The pilot had been employed by Cape Air for about 9 years and reported a total of 17,617 flight hours, of which, 10,000 hours were in the Cessna 402C. He was also type rated in Boeing 727 and Beech 1900 airplanes.

AIRCRAFT INFORMATION

The Cessna 402C is a light twin, piston engine aircraft and certificated for single-pilot operations. The airplane is powered by two 325 hp turbocharged Continental engines with three-bladed, constant-speed, fully feathering propellers. The airplane was maintained via an FAA-approved inspection program (AAIP). The last inspection was completed on August 26, 2021. At the time of the accident, the airplane had accrued a total of 36,722 hours.

The airplane was not equipped, and was not required to be equipped, with a flight data recorder (FDR) or cockpit voice recorder (CVR). There were no other sources of nonvolatile memory devices installed onboard the airplane.

METEOROLOGICAL INFORMATION

A review of the weather conditions at the time of the accident indicated a low-pressure system and associated cold front was moving across Massachusetts with moderate to heavy rain and thunderstorms across the region. A convective SIGMET was current during the period over the route of flight and destination airport. IFR conditions were reported approximately 40 minutes before departure with LIFR conditions at the time of the accident due to moderate to heavy rain and low ceilings at 200 ft above ground level.

Figure 1 – Boston WSR-88D Composite reflectivity image and flight track at 1527 EDT

The High Resolution Rapid-Refresh (HRRR) sounding indicated an unstable atmosphere favorable for convection, with a low potential for any non-convective low-level wind shear at the time of the accident. The sounding (and satellite imagery) did not indicate any microburst potential over the accident site at the time of the accident. Furthermore, WSR-88D weather radar imagery did not detect any outflow boundaries or microburst at the time of the accident.

PVC was equipped with an AWOS. The AWOS disseminated weather in two formats: hourly and continuous. The hourly reports (which also included any special observations) were in the form of an official meteorological aerodrome report (METAR). At the time of the accident, the hourly issued METAR observations at PVC were:

At 1456, wind was 200° at 5 knots, visibility 4 miles, moderate rain, mist, ceiling broken clouds at 200 ft, overcast clouds at 600 ft, temperature 21° C, dewpoint 21° C, and an altimeter setting of 29.79 in Hg. The hourly precipitation...

Data Source

Data provided by the National Transportation Safety Board (NTSB). For more information on this event, visit the NTSB Records Search website. NTSB# ERA21FA354