ANC10MA068

NTSB accident investigation · Dehavilland DHC-3 · Aleknagik, AK · August 9, 2010

Accident · FatalClass 1 · MajorFinal report
Date
August 9, 2010, 14:45 local (22:45 UTC)
Place
Aleknagik, AK
Injuries
5 fatal, 4 serious
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N455ADehavilland DHC-3
Weather
Visual (VMC) · Day
Status
Completed · report June 2, 2011
Report
Board-adopted at Board Meeting
Investigation class
Class 1
NTSB office
Alaska Regional Office
Parties
Federal Aviation Administration, Viking Air Limited, Honeywell
Safety recommendations
Yes
FAA report
20100809045749A
Case key
76920

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

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Probable cause

The pilot's temporary unresponsiveness for reasons that could not be established from the available information. Contributing to the investigation's inability to determine exactly what occurred in the final minutes of the flight was the lack of a cockpit recorder system with the ability to capture audio, images, and parametric data.

Findings · 6

NTSB’s coded findings. Those marked are part of the probable cause; the rest are factors or other findings. Under each, the cases with the same finding.

Personnel issuesPersonnel issues › Physical · PilotDehavilland DHC-3: 1 caseAll aircraft: 15 casesProbable cause
Not determinedNot determined › Not determined · Unknown/Not determinedDehavilland DHC-3: 2 casesAll aircraft: 2,247 casesProbable cause

Sequence of events

The events NTSB coded, in order, by phase of flight. The defining event is the one that best describes the accident. Under each, the cases with the same event anywhere in their sequence.

Analysis

The Safety Board’s full report is available at http://www.ntsb.gov/publictn/A_Acc1.htm. The Aircraft Accident Report number is NTSB/AAR-11/03. On August 9, 2010, about 1442 Alaska daylight time, a single-engine, turbine powered, amphibious float-equipped de Havilland DHC-3T airplane, N455A, impacted mountainous, tree-covered terrain about 10 nautical miles (nm) northeast of Aleknagik, Alaska. The airline transport pilot and four passengers received fatal injuries, and four passengers received serious injuries. The airplane sustained substantial damage, including deformation and breaching of the fuselage. The flight was operated by GCI Communication Corp. (GCI), of Anchorage, Alaska, under the provisions of 14 Code of Federal Regulations Part 91. About the time of the accident, meteorological conditions that met the criteria for marginal visual flight rules were reported at Dillingham Airport, Dillingham, Alaska, about 18 nm south of the accident site. No flight plan was filed. The flight departed about 1427 from a GCI-owned private lodge on the shore of Lake Nerka and was en route to a remote sport fishing camp about 52 nm southeast on the Nushagak River.

Factual narrative

The Safety Board’s full report is available at http://www.ntsb.gov/publictn/A_Acc1.htm. The Aircraft Accident Report number is NTSB/AAR-11/03. On August 9, 2010, about 1442 Alaska daylight time, a single-engine, turbine powered, amphibious float-equipped de Havilland DHC-3T airplane, N455A, impacted mountainous, tree-covered terrain about 10 nautical miles (nm) northeast of Aleknagik, Alaska. The airline transport pilot and four passengers received fatal injuries, and four passengers received serious injuries. The airplane sustained substantial damage, including deformation and breaching of the fuselage. The flight was operated by GCI Communication Corp. (GCI), of Anchorage, Alaska, under the provisions of 14 Code of Federal Regulations Part 91. About the time of the accident, meteorological conditions that met the criteria for marginal visual flight rules were reported at Dillingham Airport, Dillingham, Alaska, about 18 nm south of the accident site. No flight plan was filed. The flight departed about 1427 from a GCI-owned private lodge on the shore of Lake Nerka and was en route to a remote sport fishing camp about 52 nm southeast on the Nushagak River.

Aircraft

Registration
N455A
Reported as
Dehavilland DHC-3
Category
Airplane
Serial number
206
Engine
Honeywell TPE 331, 900 horsepower, turbo prop
Damage
Substantial damage
Flight
Other work use · Part 91
Operator
General Communication Corporation (GCI)
Registered owner
Gci Communication Corp
Airworthiness certificate
Standard, Normal
Departed
Aleknagik, AK
Destination
Dillingham, AK
Flight plan
Company VFR

Matched to the registry by N-number and the event date; the registry’s history has gaps, so older matches can be wrong. Compare the reported make and model.

Flight crew

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
62
Injuries
Fatal
Certificate
Airline transport
Airplane ratings
Single-engine sea, Multi-engine land, Single-engine land, Multi-engine sea
Instrument ratings
Airplane
Medical
Class 1, With waivers/limitations
Seat
Left
Toxicology
Performed

Weather

Conditions
Visual (VMC) · Day
Wind
180° at 12 knots, gusting 23
Visibility
3 statute miles
Lowest ceiling
1,000 ft overcast
Temperature
52 °F, dew point 48 °F
Altimeter
29.57 inHg
Observed at
DLG, 18 nm away

Docket · 51

The files NTSB released with the investigation on April 21, 2011, on NTSB’s docket system: statements, records, photos and specialists’ reports. 77.6 MB in all.

Operations 2 - Factual Report of Group Chairman with 2 Embedded PhotosItem 1 · .PDF · 2 photos · 756 KBOperations 2 - Attachment 1 - Record of InterviewsItem 2 · .PDF · 718 KBOperations 2 - Attachment 2 - Record of StatementsItem 3 · .PDF · 2.3 MBOperations 2 - Attachment 3 - SkyConnect Flight Data (8-1 to 8-9 2010)Item 4 · .PDF · 296 KBOperations 2 - Attachment 4 - Pilot Employment/Training Records (ConocoPhillips)Item 5 · .PDF · 4.0 MBOperations 2 - Attachment 5 - Satellite Map with 1 Embedded PhotoItem 6 · .PDF · 1 photo · 180 KBOperations 2 - Attachment 6 - Flight Track Map of PIC (Terry Smith's Flight) 8/4 to 8/9/2010 with 6 Embedded ImagesItem 7 · .PDF · 6 photos · 801 KBOperations 2 - Attachment 7 - Weight and Balance DataItem 8 · .PDF · 55 KBOperations 2 - Attachment 8 - DLG Audio Highlights Aug 7 and 9Item 9 · .PDF · 67 KBOperations 2 - Addendum 1: Interview of the pilot's wifeItem 10 · .PDF · 126 KBOperations 2 - Addendum 2: Additional Interviews and Follow-up InformationItem 11 · .PDF · 86 KBOperations 2 - Addendum 3: Supplemental Interviews and InformationItem 12 · .PDF · 118 KBOperations 2 - Addendum 4: Attachment 2 - Record of Statement - Ron Duncan Supplemental StatementItem 13 · .PDF · 10.3 MBOperations 2 - Addendum 4: Interviews Related to HRM TripsItem 14 · .PDF · 39 KBMeteorology 5 - Factual Report of Group Chairman with 26 Embedded ImagesItem 15 · .PDF · 26 photos · 7.1 MBMeteorology 5 - Attachment 1 - PANW AWSS Record of PerformanceItem 16 · .PDF · 132 KBMeteorology 5 - Attachment 2 - Weather Camera Images with 52 Embedded PhotosItem 17 · .PDF · 52 photos · 3.0 MBMeteorology 5 - Attachment 3 - Witness StatementItem 18 · .PDF · 395 KBSurvival Factors Group Chairman's Factual Report (includes 2 photos)Item 19 · .PDF · 2 photos · 635 KBSurvival Factors Factual Report - Attachment 1 - Passenger Injury TableItem 20 · .PDF · 36 KBSurvival Factors Factual Report - Attachment 2 - AK DPS ChronologyItem 21 · .PDF · 3.1 MBSurvival Factors Factual Report - Attachment 3 - AK RCC Summary ReportItem 22 · .PDF · 1.6 MBSurvival Factors Factual Report - Attachment 4 - Statement from Sam EgliItem 23 · .PDF · 52 KBSurvival Factors Factual Report - Attachment 5 - Statement from Dr. Dani BowmanItem 24 · .PDF · 45 KBSurvival Factors Factual Report - Attachment 6 - Artex Analysis ReportItem 25 · .PDF · 1.6 MBSurvival Factors Factual Report - Addendum 1 - Satellite phone, survival kit, and passenger briefing card from N455AItem 26 · .PDF · 1.9 MBSurvival Factors Factual Report - Addendum 2 - Summary of additional comments - Passenger #3Item 27 · .PDF · 25 KBPowerplants 8 - Factual Report of Group Chairman with 47 PicturesItem 28 · .PDF · 47 photos · 4.1 MBAircraft Performance 13 - StudyItem 29 · .PDF · 10.7 MBMaterials Laboratory 15 - Factual Report 11-023 (with 25 photos embedded)Item 30 · .PDF · 25 photos · 3.0 MBMaterials Laboratory 15 - Factual Report 10-092 (with 6 Embedded Photos)Item 31 · .PDF · 6 photos · 665 KBMaterials Laboratory 15 - Factual Report 10-095 (with 12 Embedded Photos)Item 32 · .PDF · 12 photos · 1.5 MBAirworthiness Group Chairman's Factual Report With 80 Embedded PhotosItem 33 · .PDF · 80 photos · 9.3 MBAirworthiness submission of raw flight data from Sky ConnectItem 34 · .CSV · 142 KBAirworthiness Factual Report – Addendum 1: Examination of Instrument Gauges with 11 Embedded ImagesItem 35 · .PDF · 11 photos · 821 KBAirworthiness Group Chairman's Factual Addendum for Weight and Balance with 13 embedded photosItem 36 · .PDF · 13 photos · 1.1 MBAirworthiness Group Chairman's Factual Addendum for Maintenance Records With 5 Embedded PhotosItem 37 · .PDF · 5 photos · 920 KBGlobal Positioning System Data File - Specialist's Factual Report with 2 Embedded ImagesItem 38 · .PDF · 2 photos · 241 KBGlobal Positioning System Data File - Attachment 1 (CSV Data File)Item 39 · .CSV · 18 KBGlobal Positioning System Data File - Attachment 2 (CSV Data File)Item 40 · .CSV · 21 KBComputer Data - Factual Report with 1 Embedded ImageItem 41 · .PDF · 1 photo · 61 KBImpact Study and Altitude Alerter Operation with 10 Embedded ImagesItem 42 · .PDF · 10 photos · 1.4 MBMedical Records InformationItem 43 · .PDF · 103 KBRecord of Memorandum - Neurological EvaluationItem 44 · .PDF · 286 KBPilot/Operator Aircraft Accident Report, NTSB Form 6120.1Item 45 · .PDF · 868 KBRecord of Conversation (Willis Simmons) and e-mail from FAA Regional CounselItem 46 · .PDF · 71 KBTranscript of Radio CommunicationsItem 47 · .PDF · 1.8 MBGCI Communication Corporation SubmissionItem 48 · .PDF · 3 photos · 510 KBStatement of Party Representatives to NTSB InvestigationItem 49 · .PDF · 303 KBReturn of Parts ListItem 50 · .PDF · 29 KBToxicological ReportItem 51 · .PDF · 110 KB

FAA reports on this event · 1

The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.