ANC96FA078

NTSB accident investigation · Piper PA-31-350 · Point Hope, AK · May 24, 1996

Accident · Serious injuriesField investigationFinal report
Date
May 24, 1996, 14:38 local (22:38 UTC)
Place
Point Hope, AK
Injuries
2 serious, 2 minor, 2 uninjured
Damage
Substantial damage
Phase of flight
Initial climb
Aircraft
N4109EPiper PA-31-350
Weather
Visual (VMC) · Day
Status
Completed · report January 8, 1997
Report
Approved by Office Director
NTSB office
Alaska Regional Office
FAA report
19960524045629A
Case key
2754

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 inadequate preflight to ensure the nose baggage door was properly latched, and the subsequent opening of the baggage compartment door, which allowed items to collide with the left propeller, resulting in propeller damage and loss of thrust from the left engine.

Sequence of events

NTSB’s coding before 2008: each occurrence and phase of flight, and the causes and factors under it. The codes are defined in NTSB’s coding manual.

Airframe/component/system failure/malfunctionTakeoff - initial climb
Door,cargo/baggage - not securedCause
Aircraft preflight - inadequatePilot in commandCause
Door,cargo/baggage - openCause
Propeller system/accessories - overload
Propeller feathering - not performedPilot in command
Forced landingEmergency landing after takeoff
In flight collision with terrain/waterEmergency landing

Analysis

The scheduled air taxi flight was to depart Point Hope, Alaska, with a destination of Wainwright, Alaska. While the airplane was on the ground at Point Hope, the station agent loaded the nose baggage compartment and closed the nose baggage door. The pilot visually checked the nose baggage door while standing on the wing next to the cockpit door. During the takeoff, at rotation, the nose baggage door came fully open. Baggage and boxes exited the nose baggage compartment and fell through the left engine's propeller. The pilot elected to land on sea ice. Just prior to touching down, the airplane started a slow, uncontrolled roll to the left. The passenger reported that when baggage exited the baggage compartment, a duffel bag hit the propeller; he described the propeller as being destroyed by the encounter. According to the pilot, the company training program included instructions concerning baggage door operation. The pilot was under the impression from informal discussions that the PA-31 airplane would not fly with the nose baggage door in the open position. The company training program did not discuss operations with an open nose baggage door.

Factual narrative

History of flight

On May 24, 1996, at 1438 Alaska daylight time, a retractable gear, wheel equipped Piper PA-31-350 Navajo airplane, N4109E, registered to and operated by Cape Smythe Air Service of Barrow, Alaska, sustained substantial damage during an off airport emergency landing near Point Hope, Alaska. The scheduled air taxi flight, operating under 14 CFR Part 135, had just departed the Point Hope airport, and the destination was Wainwright, Alaska. A visual flight rules flight plan was in effect and visual meteorological conditions prevailed. The certificated airline transport pilot and one passenger were seriously injured, two passengers received minor injuries, and two passengers were not injured.

During a telephone conversation with the pilot on May 28, 1996, she stated that the station agent at Point Hope had loaded some boxes into the airplane's nose baggage compartment, and closed the baggage door. She said that she visually checked the latch handle while she was standing on the wing, prior to entering the cockpit. The takeoff run was normal until she raised the nose of the airplane for liftoff. The nose baggage door opened and boxes and baggage began departing the compartment and falling through the left engine's propeller. The pilot attempted to return to Point Hope. She stated she was not able to maintain altitude or airspeed and she elected to land on the sea ice. The airplane began to roll to the left just prior to touchdown on the sea ice, and landed "hard" on the ice.

Aircraft information

The nose baggage door was recovered and examined. The latches and hinge mechanisms were found to be fully functional. The latch assembly was equipped with two safety devices. One device was a bar that slid over the latch handle. The other safety device was a black knob which took the place of the key lock. The black knob is supposed to point horizontally when it locks the latch handle in place.

Wreckage and impact information

The airplane came to rest on the sea ice, approximately .4 miles off the coast of Point Hope on a magnetic bearing from Point Hope of 300 degrees. The wreckage could not be examined because the sea ice broke apart and the airplane sank into the ocean. The wreckage has not been recovered.

The pilot stated she felt the left engine stopped producing power after the baggage from the nose compartment traveled through the left engine's propeller. She did not feather the engine prior to landing. Just prior to landing the airplane began an uncontrolled slow roll to the left.

Additional information

During an interview with the pilot, she stated that she was trained on how to operate the nose baggage door. She also stated that idle conversation in the hallway among the pilots during training indicated that most pilots believed the Navajo PA-31 airplane would not fly with the nose baggage door open. She stated this information was not covered in training.

According to a passenger, Mr. John Tidwell of Barrow, Alaska, the nose baggage door came open and boxes started falling out. The pilot banked the airplane to the left and a large duffel bag fell out and hit the propeller. Mr. Tidwell described the propeller as destroyed after the duffel bag struck the propeller. The airplane continued in a left turn and crashed onto the sea ice. Mr. Tidwell stated that prior to takeoff, the pilot was loading the airplane while the station agent loaded the nose baggage compartment. He heard the pilot ask the station agent if he had closed the "left front hatch." The station agent replied in the affirmative. Mr. Tidwell said the pilot never went up to the "left front hatch" to check its security.

According to the pilot, the company procedure does not state how the pilot should check to ensure the nose baggage door is secure. She stated she stood on the wing and viewed the latch handle and black knob and they both appeared to be in their correct position.

Aircraft

Registration
N4109E
Reported as
Piper PA-31-350
Category
Airplane
Serial number
31-8353003
Airframe hours
11,070
Engine
Lycoming IO-540, 350 horsepower, reciprocating
Damage
Substantial damage
Flight
Part 135
Registered owner
Cape Smythe Air Service
Airworthiness certificate
Standard, Normal
Last inspection
100 hour · May 1, 1996 · 87 hours before
Departed
PHO
Destination
AK03 · Wainwright, AK
Flight plan
VFR
Airport
PHO · Point Hope, runway 1, 4,000 × 75 ft, asphalt

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
36
Certificates
Airline transport, Flight instructor, Commercial
Airplane ratings
Single-engine land, Single-engine sea, Multi-engine land
Instrument ratings
Airplane
Medical
Class 1, Valid Medical--no waivers/lim.
Seat
Left
Toxicology
Performed
Flight hours
2,854 total · 85 in this make and model · 2,000 as pilot in command

Weather

Conditions
Visual (VMC) · Day
Wind
330° at 10 knots
Visibility
10 statute miles
Lowest ceiling
None
Temperature
36 °F

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 N4109E · 2

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