# NTSB ANC15LA005: Piper PA 18-150, N9720P, Nikiski, AK, November 27, 2014 - Type: NTSB accident investigation - Classification: Accident · Serious injuries · Limited investigation · Final report - Date: November 27, 2014, 11:17 local (20:17 UTC) - Place: Nikiski, AK - Coordinates: 60.876388, -152.085281 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=60.8764&lon=-152.0853&mi=10 - Phase of flight: [Approach](https://openairdocs.org/ntsb-phases/500) (OpenAirDocs' grouping) - Defining event: [Approach-VFR pattern final: Fuel related](https://openairdocs.org/ntsb-events/190) - Highest injury: Serious injuries - Injuries: 1 serious, 1 minor - Status: Completed, report March 17, 2015 - Report: Approved by Office Director - NTSB office: Alaska Regional Office - Parties: FAA, Lycoming Engines - NTSB case key (mKey): 90471 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=ANC15LA005 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/90471/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=90471 - Page: https://openairdocs.org/ntsb/ANC15LA005 ## Probable cause The total loss of engine power due to carburetor icing, which resulted from the pilot’s failure to use carburetor heat while operating at low-power settings in an area conducive to carburetor icing. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Temp/humidity/pressure: conducive to carburetor icing](https://openairdocs.org/ntsb-findings/03031030): Environmental issues › Conditions/weather/phenomena · Effect on equipment (probable cause); cases with it: [Piper PA-18-150, 15 cases](https://openairdocs.org/ntsb-findings/03031030/cases.md?model=7101828), [All aircraft, 435 cases](https://openairdocs.org/ntsb-findings/03031030/cases.md) - [Ice/rain protection system: intake anti-ice, deice](https://openairdocs.org/ntsb-findings/01023020): Aircraft › Aircraft systems · Not used/operated (probable cause); cases with it: [Piper PA-18-150, 4 cases](https://openairdocs.org/ntsb-findings/01023020/cases.md?model=7101828), [All aircraft, 108 cases](https://openairdocs.org/ntsb-findings/01023020/cases.md) - [Action: lack of action](https://openairdocs.org/ntsb-findings/02041030): Personnel issues › Action/decision · Pilot (probable cause); cases with it: [Piper PA-18-150, 4 cases](https://openairdocs.org/ntsb-findings/02041030/cases.md?model=7101828), [All aircraft, 792 cases](https://openairdocs.org/ntsb-findings/02041030/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Approach-VFR pattern final: Fuel related](https://openairdocs.org/ntsb-events/190) (defining event); cases with it: [Piper PA-18-150, 6 cases](https://openairdocs.org/ntsb-events/190/sequence.md?model=7101828), [All aircraft, 361 cases](https://openairdocs.org/ntsb-events/190/sequence.md) - [Emergency descent: Collision with terr/obj (non-CFIT) ](https://openairdocs.org/ntsb-events/470); cases with it: [Piper PA-18-150, 115 cases](https://openairdocs.org/ntsb-events/470/sequence.md?model=7101828), [All aircraft, 10,189 cases](https://openairdocs.org/ntsb-events/470/sequence.md) ## Analysis The pilot reported that he had flown the airplane for about 20 to 30 minutes to survey the area for possible landing sites. After choosing a landing site, the pilot completed the prelanding checklist, cycled the carburetor heat on, and then placed it in the "off" position. When the airplane was established on short final for landing, the engine lost total power. The pilot attempted to restart the engine by switching fuel tanks and applying carburetor heat, but engine power was not restored. The airplane subsequently collided with rising terrain, which resulted in substantial damage to the fuselage and wings. A postaccident examination of the engine revealed no evidence of any preimpact mechanical problems that would have precluded normal operation. Another company pilot, who had landed his airplane at the same location only minutes before the accident airplane approached, stated that carburetor ice accumulated during the descent. Further, the atmospheric conditions at the time of the accident were conducive to the accumulation of carburetor icing at glide and cruise power settings. Therefore, it is likely that, as the pilot reduced engine power, carburetor ice formed, which caused the engine to lose power. ## Factual narrative On November 27, 2014, at 1117 Alaska standard time, a Piper PA-18-150 airplane, N9720P, collided with terrain after a total loss of engine power while maneuvering for an off-airport landing near Nikiski, Alaska. The certificated commercial pilot sustained serious injuries and the sole passenger sustained minor injuries. The aircraft was registered to Summit Leasing LLC and operated by Alaska West Air, Inc., under the provisions of 14 Code of Federal Regulations Part 135 as an on-demand commercial air taxi flight. Visual meteorological conditions prevailed for the entire flight, and a company flight plan was filed. The flight originated from Kenai, Alaska approximately 1030. In a statement provided to the National Transportation Safety Board (NTSB) investigator-in-charge (IIC), the pilot stated that prior to the accident he flew approximately 20 to 30 minutes surveying the area for possible landing sites. During this time, he applied carburetor heat three or four times to check for carburetor ice. After a landing site had been selected, the pre-landing checklist was completed, and the carburetor heat was placed in the off position. On short final the engine lost all power. The pilot then switched fuel tanks and turned the carburetor heat back on, but the engine would not restart. The airplane subsequently collided with an area of rising terrain just short of the intended landing site, sustaining substantial damage to the fuselage and wings. On December 1, 2014, the NTSB IIC, along with another NTSB investigator performed a post-accident examination of the airframe and engine. Control cable continuity was established from the cockpit control to the engine for the throttle, mixture, carburetor heat and cabin heat. On December 11, the NTSB IIC, along with another NTSB investigator, performed a follow-up examination of the engine and fuel system. No anomalies, contamination, or evidence of malfunction was found in any of the engine accessories. The cylinders, pistons, valve train, crankshaft, and other internal components were all without evidence of anomaly or malfunction that would have precluded normal operation. Both magnetos were removed from the engine and the coupling was rotated. When the coupling was rotated, a blue spark was produced from each terminal, in rotational order. The closest weather reporting facility was the Kenai Airport, Kenai, about 31 miles southeast of the accident site. At 1053, an aviation routine weather report (METAR) from the Kenai Airport was reporting in part: wind from 010 degrees at 3 knots; sky condition, clear; visibility, 10 statute miles; temperature 10 degrees F; dewpoint 9 degrees F; barometric pressure 30.23 inHG. According to a carburetor icing probability chart, an airplane operating in the ambient conditions at the accident site could expect light carburetor icing while at cruise of glide power. Another company pilot who landed at the same location only minutes before the accident aircraft approached,stated that during the descent, his aircraft had accumulated carburetor ice during the approach. A Lycoming Service Instruction states in part, "if icing conditions are suspected, apply 'Full Heat.' In the case that full power needs to be applied under these conditions, as for an aborted landing, return the carburetor heat to 'Full Cold' after full power application. ## Aircraft - Registration: [N9720P](https://openairdocs.org/aircraft/N9720P), registered now, S/N 18-7509137, built 1975 (OpenAirDocs) - Reported make and model: PIPER PA 18-150 - Registry model: [Piper PA-18-150](https://openairdocs.org/model/piper-pa-18-150) (registry code 7101828) (OpenAirDocs) - Registry engine: [Lycoming 0-320 series](https://openairdocs.org/engine/lycoming-0-320-series) (registry code 41508, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 18-7509137 - Year built: 1975 - Airframe hours: 7484 - Engines: LYCOMING O-360 SERIES 180 horsepower reciprocating - Damage: Substantial damage - Flight: Part 135 - Operator: Alaska West Air, INC - Registered owner: Summit Leasing LLC - Airworthiness certificate: Standard, Normal - Last inspection: Annual, September 4, 2014, 80 hours before - Departed: ENA, Kenai, AK - Destination: Nikiski, AK - Flight plan: Company VFR ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 55; injuries: serious; commercial; airplane ratings: multi-engine land, single-engine sea, single-engine land; instrument ratings: airplane; medical: class 2, with waivers/limitations; last flight review June 9, 2014; seat: front; flight hours: 6,600 total, 3,500 in this make and model, 100 in the last 90 days, 10 in the last 30 days ## Weather - Conditions: Visual (VMC), Day - Wind: 10° at 3 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 10 °F, dew point 9 °F - Altimeter: 30.22 inHg - Observed at: PAEN, 31 nm away ## FAA reports on this event (1) The FAA's own accident and incident reports, matched to the aircraft by N-number and date (OpenAirDocs). - [Accident 20141127022349A](https://openairdocs.org/incident/20141127022349A), Nov 27, 2014: Piper PA-18-150, Beluga, AK, Substantial damage. N9720P is a Piper PA18 that crashed approximately 30NM sw of Beluga point airport on 27 nov 2014. There were two on board an Alaska west air, 14CFR part 135… ## Other investigations on N9720P (1) From the NTSB's public API. Aircraft are matched to registry aircraft by N-number and event date, checked against the reported serial number, make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model. - [NTSB FTW78FPA33](https://openairdocs.org/ntsb/FTW78FPA33), Aug 13, 1978: Piper PA-18 (N9720P), Caddo Mills, TX, substantial damage ## Docket (8 files) The files NTSB released with the investigation on January 27, 2015, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=90471. 2.5 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 601 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40421739&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Master.PDF - Pilot's Statement (item 2, .PDF, 82 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40421741&FileExtension=.PDF&FileName=Pilot%27s%20Statement-Master.PDF - Carburetor Icing Probability Chart (item 3, .PDF, 49 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40421743&FileExtension=.PDF&FileName=Carburetor%20Icing%20Probability%20Chart-Master.PDF - Airframe and Engine Examination Report (item 4, .PDF, 5 photos, 1.4 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40421746&FileExtension=.PDF&FileName=Airframe%20and%20Engine%20Examination%20Report-Master.PDF - Lycoming Service Instruction No. 1148C (item 5, .PDF, 39 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40421749&FileExtension=.PDF&FileName=Lycoming%20Service%20Instruction%20No.%201148C-Master.PDF - 0000UTC Anchorage Sounding (item 6, .PDF, 146 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40421750&FileExtension=.PDF&FileName=0000UTC%20Anchorage%20Sounding-Master.PDF - 0000UTC Kodiak Sounding (item 7, .PDF, 147 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40421751&FileExtension=.PDF&FileName=0000UTC%20Kodiak%20Sounding-Master.PDF - Statement of Party Representatives to NTSB Investigation (item 8, .PDF, 91 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40421752&FileExtension=.PDF&FileName=Statement%20of%20Party%20Representatives%20to%20NTSB%20Investigation-Master.PDF From the NTSB's public API. Aircraft are matched to registry aircraft by N-number and event date, checked against the reported serial number, make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model. --- OpenAirDocs.org is an independent research project of [Contrail Labs](https://contraillabs.com/). It is not affiliated with the FAA or the NTSB. Source documents are U.S. government works in the public domain.