ANC13CA069

NTSB accident investigation · Cessna A185E · Kotzebue, AK · July 29, 2013

Accident · No injuriesData collectionFinal report
Date
July 28, 2013, 18:17 local (Jul 29, 2013, 02:17 UTC)
Place
Kotzebue, AK
Injuries
2 uninjured
Damage
Substantial damage
Phase of flight
Takeoff
Aircraft
N4557FCessna A185E
Defining event
Takeoff: Nose over/nose down
Weather
Visual (VMC) · Day
Status
Completed · report September 5, 2013
Report
Approved by Office Director
NTSB office
Alaska Regional Office
Parties
Federal Aviation Administration
FAA report
20130728015449A
Case key
87618

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

On this page

Probable cause

The pilot's lack of situational awareness and failure to maintain adequate clearance from terrain during takeoff. Factors contributing to the accident was the check airmen’s inadequate supervision.

Findings · 3

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.

Info processing/decision: decision making/judgmentPersonnel issues › Action/decision · Instructor/check pilotCessna A185E: 6 casesAll aircraft: 3,098 casesProbable cause
Runway/land/takeoff/taxi surfaceEnvironmental issues › Physical environment · Decision related to conditionCessna A185E: 3 casesAll aircraft: 253 cases

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 pilot was demonstrating a confined area takeoff for a part 135 Visual Flight Rules (VFR) competency check from a remote lake in a float equipped airplane. The check airman, seated in the right seat, instructed the pilot to begin his takeoff run 90 degrees from the prevailing wind, and turn into the wind as the airplane accelerated for departure. During the takeoff water run the pilot failed to turn away from the shoreline. The airplane was almost on the step when the shoreline jutted out perpendicular to the takeoff run. He attempted to force the airplane into the air by applying flaps, and pulling aft on the control yoke, but the airplane impacted the shore, bounced into the air, and slid across the ground for approximately 100 yards before nosing down. The airplane sustained substantial damage to the left wing. The pilot reported no preaccident mechanical malfunctions or failures with the airplane that would have precluded normal operation. In the recommendation section of the NTSB Accident/Incident Reporting Form 6120.1, the check airman stated that the accident may have been prevented if he had ensured the pilot understood his instructions, or if he would have discontinued the maneuver before an unsafe condition developed.

Factual narrative

The pilot was demonstrating a confined area takeoff for a part 135 Visual Flight Rules (VFR) competency check from a remote lake in a float equipped airplane. The check airman, seated in the right seat, instructed the pilot to begin his takeoff run 90 degrees from the prevailing wind, and turn into the wind as the airplane accelerated for departure. During the takeoff water run the pilot failed to turn away from the shoreline. The airplane was almost on the step when the shoreline jutted out perpendicular to the takeoff run. He attempted to force the airplane into the air by applying flaps, and pulling aft on the control yoke, but the airplane impacted the shore, bounced into the air, and slid across the ground for approximately 100 yards before nosing down. The airplane sustained substantial damage to the left wing. The pilot reported no preaccident mechanical malfunctions or failures with the airplane that would have precluded normal operation. In the recommendation section of the NTSB Accident/Incident Reporting Form 6120.1, the check airman stated that the accident may have been prevented if he had ensured the pilot understood his instructions, or if he would have discontinued the maneuver before an unsafe condition developed.

Aircraft

Registration
N4557F
Reported as
Cessna A185E
Category
Airplane
Serial number
185-1061
Airframe hours
5,630
Engine
Cont Motor IO 520 SERIES, 300 horsepower, reciprocating
Damage
Substantial damage
Flight
Instructional · Part 91
Operator
Northwestern Aviation Services Inc
Registered owner
Northwestern Aviation Services Inc
Airworthiness certificate
Standard, Normal
Last inspection
Annual · February 1, 2013
Departed
Kotzebue, AK
Destination
Kotzebue, AK
Flight plan
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 · 2

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
62
Injuries
None
Certificate
Commercial
Airplane ratings
Single-engine land, Single-engine sea
Instrument ratings
Airplane
Medical
Class 2, With waivers/limitations
Last flight review
July 28, 2013
Seat
Left
Flight hours
8,671 total · 600 in this make and model · 8,500 as pilot in command · 63 in the last 90 days · 20 in the last 30 days
Role
Check pilot
Age
63
Injuries
None
Certificates
Flight instructor, Airline transport
Airplane ratings
Single-engine sea, Single-engine land, Multi-engine land
Instrument ratings
Airplane
Medical
Class 2, With waivers/limitations
Last flight review
April 17, 2013
Seat
Right
Flight hours
11,992 total · 3,359 in this make and model · 11,940 as pilot in command · 202 in the last 90 days · 100 in the last 30 days · 5 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
200° at 9 knots
Visibility
10 statute miles
Lowest ceiling
2,400 ft overcast
Temperature
57 °F, dew point 126 °F
Altimeter
30.09 inHg
Observed at
PAOT, 8 nm away

Docket · 1

The files NTSB released with the investigation on August 23, 2013, on NTSB’s docket system: statements, records, photos and specialists’ reports. 3.3 MB in all.

FAA reports on this event · 1

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

Other investigations on N4557F · 3

Matched to the same aircraft by N-number and date.