# NTSB ATL06CA016: Cessna 177, N821KF, New Bern, NC, November 16, 2005 - Type: NTSB accident investigation - Classification: Accident · Minor injuries · Data collection · Final report - Date: November 16, 2005, 13:45 local (18:45 UTC) - Place: New Bern, NC - Coordinates: 35.073055, -77.043052 - Nearby events: https://openairdocs.org/map.md?lat=35.0731&lon=-77.0431&mi=10 - Phase of flight: [Approach](https://openairdocs.org/ntsb-phases/500) (OpenAirDocs' grouping) - Highest injury: Minor injuries - Injuries: 1 minor - Status: Completed, report February 28, 2006 - Report: Approved by Office Director - Parties: Greensboro FSDO-05, Cessna Aircraft Company - NTSB case key (mKey): 62893 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=ATL06CA016 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/62893/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=62893 - Page: https://openairdocs.org/ntsb/ATL06CA016 ## Probable cause The pilot's failure to activate the carburetor heat during approach resulting in a total loss of engine power due to carburetor ice. ## Sequence of events In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf). - Loss of engine power(total) - nonmechanical, approach - faf/outer marker to threshold (ifr) - weather condition - carburetor icing conditions - carburetor heat - not used, pilot in command (cause) - fuel system,carburetor - ice - Forced landing, descent - emergency - Ditching, descent - emergency ## Analysis The pilot was on an instrument flight rules flight. The controller cleared the pilot for a VOR runway 22 approach at the destination airport. The pilot initiated a descent and did not apply carburetor heat. The Let-Down procedures in the checklist states, "Carburetor Heat-AS REQUIRED to prevent carburetor icing." Upon reaching the minimum descent altitude for the approach, the pilot increased the throttle and did not get an engine response. The pilot realized he could not make the runway and made a forced landing into a river. The surface weather observation at the destination airport revealed the temperature was 75-degrees Fahrenheit and the dew point temperature was 61-degrees Fahrenheit. Review of the Department of Transportation Icing Probability Chart indicates the airplane will encounter serious icing conditions at glide power. The engine was mounted in a test stand and an alternate fuel, and battery source was attached. Engine controls, and magneto grounding wires were installed. The mixture control was safetied wired in the full rich position. The engine was started and ran at idle power. After engine warm up the throttle was advanced to full power and the engine stabilized at takeoff rpm of 2,000. The throttle was returned back to the idle position, the safety wire on the mixture was cut, and the engine was shut down with the mixture control. ## Factual narrative The pilot was on an instrument flight rules flight. The controller cleared the pilot for a VOR runway 22 approach at the destination airport. The pilot initiated a descent and did not apply carburetor heat. The Let-Down procedures in the checklist states, "Carburetor Heat-AS REQUIRED to prevent carburetor icing." Upon reaching the minimum descent altitude for the approach, the pilot increased the throttle and did not get an engine response. The pilot realized he could not make the runway and made a forced landing into a river. The surface weather observation at the destination airport revealed the temperature was 75-degrees Fahrenheit and the dew point temperature was 61-degrees Fahrenheit. Review of the Department of Transportation Icing Probability Chart indicates the airplane will encounter serious icing conditions at glide power. The engine was mounted in a test stand and an alternate fuel, and battery source was attached. Engine controls, and magneto grounding wires were installed. The mixture control was safetied wired in the full rich position. The engine was started and ran at idle power. After engine warm up the throttle was advanced to full power and the engine stabilized at takeoff rpm of 2,000. The throttle was returned back to the idle position, the safety wire on the mixture was cut, and the engine was shut down with the mixture control. ## Aircraft - Registration: [N821KF](https://openairdocs.org/deregistered/N821KF-2007-07-14), registration cancelled 2007-07-14, S/N 17702351, built 1975 (OpenAirDocs) - Reported make and model: Cessna 177 - Registry model: [Cessna 177B](https://openairdocs.org/model/cessna-177b) (registry code 2073708) (OpenAirDocs) - Registry engine: [Lycoming O&VO-360 series](https://openairdocs.org/engine/lycoming-o-vo-360-series) (registry code 41514, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 17702351 - Airframe hours: 2500 - Engines: Lycoming O-360-A1F6D 180 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Registered owner: Kent P. Larsen Sr. - Airworthiness certificate: Standard, Normal - Last inspection: Annual, April 1, 2005, 225 hours before - Departed: W40, Mount Olive, NC - Destination: EWN, New Bern, CA - Flight plan: IFR ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 68; injuries: minor; airline transport; airplane ratings: multi-engine land, single-engine land; instrument ratings: airplane; medical: class 2, with waivers/limitations; last flight review June 1, 2004; seat: left; flight hours: 6,000 total, 400 in this make and model, 5,990 as pilot in command, 150 in the last 90 days, 20 in the last 30 days ## Weather - Conditions: Visual (VMC), Day - Wind: 200° at 14 knots, gusting 18 - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 75 °F, dew point 61 °F - Altimeter: 30.06 inHg - Observed at: EWN, 1 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 20051116029469A](https://openairdocs.org/incident/20051116029469A), Nov 16, 2005: Cessna 177B, New Bern, NC, Substantial damage. (-23) Pilot was on approach to the New Bern airport ewn when the aircraft lost power on a 2 mile final to runway 22. The pilot stated that he had approximately… ## Docket (6 files) The files NTSB released with the investigation on December 9, 2005, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=62893. 526 KB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 310 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40423892&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Redacted.PDF - Carburetor Icing Probability Chart (item 2, .PDF, 34 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40242261&FileExtension=.PDF&FileName=Carburetor%20Icing%20Probability%20Chart-Master.PDF - Checklist (item 3, .PDF, 46 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40242263&FileExtension=.PDF&FileName=Checklist-Master.PDF - Statement of Party Representatives to NTSB Investigation (item 4, .PDF, 53 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40423893&FileExtension=.PDF&FileName=Statement%20of%20Party%20Representatives%20to%20NTSB%20Investigation-Redacted.PDF - Statement (item 5, .PDF, 50 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40423895&FileExtension=.PDF&FileName=Statement-Redacted.PDF - VOR or GPS RWY 22 Approach (item 6, .PDF, 32 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40242267&FileExtension=.PDF&FileName=VOR%20or%20GPS%20RWY%2022%20Approach-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.