ANC16CA069

NTSB accident investigation · Piper PA18 · Willow, AK · September 25, 2016

Accident · Minor injuriesData collectionFinal report
Date
September 24, 2016, 16:03 local (Sep 25, 2016, 00:03 UTC)
Place
Willow, AK
Injuries
1 minor
Damage
Substantial damage
Phase of flight
Landing
Aircraft
N743RPiper PA18
Defining event
Landing-landing roll: Miscellaneous/other
Weather
Visual (VMC) · Day
Status
Completed · report January 18, 2017
Report
Approved by Office Director
NTSB office
Alaska Regional Office
Parties
FAA Anchorage FSDO
FAA report
20160924024249A
Case key
94082

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 failure to maintain airplane control during the landing roll, which resulted in a nose-over.

Findings · 2

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.

Use of equip/info: aircraft controlPersonnel issues › Task performance · PilotPiper PA-18-150: 160 casesAll aircraft: 9,295 casesProbable cause
Performance/control parametersAircraft › Aircraft oper/perf/capability · Not attained/maintainedPiper PA-18-150: 14 casesAll aircraft: 1,269 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 pilot reported he was conducting stop-and-go-landings in a tailwheel-equipped airplane to a dry, gravel runway. During the third landing, he reported all three wheels from the landing gear were in contact with the runway and he slowed with normal braking application. He reported that he abruptly felt the tail of the airplane lift, the propeller impacted terrain, and the airplane nosed over. The airplane sustained substantial damage to the fuselage, the right wing struts, and the rudder. During a telephone conversation with the National Transportation Safety Board investigator-in-charge, the pilot stated that he was unsure if a tail wind or his braking application caused the airplane to nose over. The pilot reported there were no preimpact mechanical failures or malfunctions with the airframe or engine that would have precluded normal operation. The pilot wore a surplus U.S. Navy Flight Deck Crewman's helmet for the flight in addition to utilizing a four-point restraint system. He reported that if he was not wearing a helmet, the injuries sustained to his face, head, and brain would have been serious or fatal. The closest weather reporting facility was the Wasilla Airport, Wasilla, Alaska, about 20 miles southeast of the accident site. At 1556, an Aviation Routine Weather Report (METAR) was reporting in part: wind, calm. In the weather section of the National Transportation Safety Board Accident/Incident Reporting Form 6120.1, the pilot reported the wind direction was variable and the wind speed was light and variable at the accident site. The Federal Aviation Administration (FAA) has published the Airplane Flying Handbook FAA-H-8083-3A (2004). This handbook discusses braking application procedures for tailwheel-equipped airplanes and states in part: Some models of tailwheel airplanes are equipped with heel brakes rather than toe brakes. In either configuration the brakes are used primarily to stop the airplane at a desired point, to slow the airplane, or as an aid in making a sharp controlled turn. Whenever used, they must be applied smoothly, evenly, and cautiously at all times. The FAA and the Medallion Foundation has published the Alaska Flight Review Guide (2014). This guide discusses aviation life support equipment and states in part: Considering the type of aircraft and mission, a helmet may help survive an accident. The U.S. military and European community has established standards for flying helmets. Emphasize the importance of choosing a helmet which meets an appropriate standard for the type of operation, and which is kept in good repair. Fatal and serious injury data suggests that helmets are most useful in tandem seat aircraft. A three-point harness is the minimum installation recommended for both front and back seats. The four and five point harnesses are a great improvement to the security of the user due to the geometry of the belts installation. Any properly installed and worn shoulder harness is an improvement over noshoulder harness at all.

Factual narrative

The pilot reported he was conducting stop-and-go-landings in a tailwheel-equipped airplane to a dry, gravel runway. During the third landing, he reported all three wheels from the landing gear were in contact with the runway and he slowed with normal braking application. He reported that he abruptly felt the tail of the airplane lift, the propeller impacted terrain, and the airplane nosed over. The airplane sustained substantial damage to the fuselage, the right wing struts, and the rudder. During a telephone conversation with the National Transportation Safety Board investigator-in-charge, the pilot stated that he was unsure if a tail wind or his braking application caused the airplane to nose over. The pilot reported there were no preimpact mechanical failures or malfunctions with the airframe or engine that would have precluded normal operation. The pilot wore a surplus U.S. Navy Flight Deck Crewman's helmet for the flight in addition to utilizing a four-point restraint system. He reported that if he was not wearing a helmet, the injuries sustained to his face, head, and brain would have been serious or fatal. The closest weather reporting facility was the Wasilla Airport, Wasilla, Alaska, about 20 miles southeast of the accident site. At 1556, an Aviation Routine Weather Report (METAR) was reporting in part: wind, calm. In the weather section of the National Transportation Safety Board Accident/Incident Reporting Form 6120.1, the pilot reported the wind direction was variable and the wind speed was light and variable at the accident site. The Federal Aviation Administration (FAA) has published the Airplane Flying Handbook FAA-H-8083-3A (2004). This handbook discusses braking application procedures for tailwheel-equipped airplanes and states in part: Some models of tailwheel airplanes are equipped with heel brakes rather than toe brakes. In either configuration the brakes are used primarily to stop the airplane at a desired point, to slow the airplane, or as an aid in making a sharp controlled turn. Whenever used, they must be applied smoothly, evenly, and cautiously at all times. The FAA and the Medallion Foundation has published the Alaska Flight Review Guide (2014). This guide discusses aviation life support equipment and states in part: Considering the type of aircraft and mission, a helmet may help survive an accident. The U.S. military and European community has established standards for flying helmets. Emphasize the importance of choosing a helmet which meets an appropriate standard for the type of operation, and which is kept in good repair. Fatal and serious injury data suggests that helmets are most useful in tandem seat aircraft. A three-point harness is the minimum installation recommended for both front and back seats. The four and five point harnesses are a great improvement to the security of the user due to the geometry of the belts installation. Any properly installed and worn shoulder harness is an improvement over noshoulder harness at all.

Aircraft

Registration
N743R
Reported as
Piper PA18 (150)
Category
Airplane
Serial number
18-8109055
Built
1981
Airframe hours
4,426
Engine
Lycoming O-320-B2B, 160 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Airworthiness certificate
Standard, Utility
Last inspection
Condition · August 12, 2016
Departed
AA06 · Anchorage, AK
Destination
AA06 · Anchorage, AK
Airport
UUO · Willow, runway 31, 4,400 × 75 ft, gravel
Equipment
Satellite tracking device, Electronic flight bag or handheld device, Electronic multifunction display

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
61
Injuries
Minor
Certificate
Commercial
Airplane ratings
Single-engine sea, Single-engine land
Instrument ratings
Airplane
Medical
Class 2, With waivers/limitations
Last flight review
April 16, 2016
Seat
Front
Restraint
4-point
Flight hours
904 total · 53 in this make and model · 877 as pilot in command · 18 in the last 90 days · 7 in the last 30 days

Weather

Conditions
Visual (VMC) · Day
Wind
Calm
Visibility
10 statute miles
Lowest ceiling
7,500 ft overcast
Temperature
55 °F, dew point 36 °F
Altimeter
29.70 inHg
Observed at
PAWS, 18 nm away

Docket · 3

The files NTSB released with the investigation on November 21, 2016, on NTSB’s docket system: statements, records, photos and specialists’ reports. 3.4 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.