DEN02GA074

NTSB accident investigation · Consolidated-Vultee P4Y-2 · Estes Park, CO · July 19, 2002

Accident · FatalFinal report
Date
July 18, 2002, 18:40 local (Jul 19, 2002, 00:40 UTC)
Place
Estes Park, CO
Injuries
2 fatal
Damage
Destroyed
Phase of flight
Maneuvering
Aircraft
N7620CConsolidated-Vultee P4Y-2
Weather
Visual (VMC) · Day
Status
Completed · report July 23, 2003
Report
Approved by Office Director
Parties
Hawkins & Powers Aviation, Inc., USDA Forest Service, Federal Aviation Administration
FAA report
20020718021919A
Case key
55256

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 inflight failure of the left wing due to fatigue cracking in the left wing's forward spar and wing skin. A factor contributing to the accident was inadequate maintenance procedures to detect fatigue cracking.

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/malfunctionManeuvering - aerial application
Wing - failure,total
Wing,spar - fatigueCause
Wing,skin - fatigueCause
Maintenance,inspection - inadequateCompany/operator managementFactor
Loss of control - in flightDescent - uncontrolled
Aircraft control - not possible
In flight collision with terrain/waterDescent - uncontrolled
Terrain condition - mountainous/hilly

Analysis

The airplane was maneuvering to deliver fire retardant when its left wing separated. Aircraft control was lost and the airplane crashed into mountainous terrain. A witness on the ground took a series of photographs that showed the airtanker's left wing separating at the wing root and the remaining airplane entering a 45-degree dive to the ground in a counterclockwise roll. An examination of the airplane wreckage revealed extensive areas of preexisting fatigue in the left wing's forward spar lower spar cap, the adjacent spar web, and the adjacent area of the lower wing skin. The portion of the wing containing the fatigue crack was obscured by the retardant tanks and would not have been detectable by an exterior visual inspection. An examination of two other airtankers of the same make and model revealed the area where the failure occurred on the accident airplane was in a location masked by the airplane's fuselage construction. The airplane was manufactured in 1945 and was in military service until 1956. It was not designed with the intention of operating as a firefighting airplane. In 1958, the airplane was converted to civilian use as an airtanker and served in that capacity until the time of the accident. The investigation revealed that the owner developed service and inspection procedures for the airtanker; however, the information contained in the procedures did not adequately describe where and how to inspect for critical fatigue cracks. The procedures were based on U.S Navy PB4Y-2 airplane structural repair manuals that had not been revised since 1948.

Factual narrative

History of flight

On July 18, 2002, at 1840 mountain daylight time, a Consolidated-Vultee P4Y-2, N7620C, under contract to the U. S. Department of Agriculture Forest Service and piloted by a commercial pilot, was destroyed when it impacted into mountainous terrain 6 miles southwest of Estes Park, Colorado. A post-crash explosion and fire ensued. Prior to the impact, the airplane's left wing separated and aircraft control was lost while maneuvering to deliver fire retardant on the Big Elk wildfire, burning in an area northwest of Lyons, Colorado. Visual meteorological conditions prevailed at the time of the accident. The aerial attack flight was being conducted under the provisions of Title 14 CFR Part 91, public use. A company visual flight rules flight plan was on file. The pilot and second pilot on board the airplane were fatally injured. The flight originated at Broomfield, Colorado, at 1814.

According to the Airtanker Base Manager at Jeffco Airport, Broomfield, Colorado, the airplane, Tanker 123, was dispatched to join other airtankers, Tanker 161 and Tanker 22, a helitanker, number T-16, and a U. S. Forest Service lead airplane, Lead Bravo 8, to drop fire retardant on the Big Elk Fire. The airplane had flown seven previous air attack missions on the fire that day. Prior to the accident mission, the airplane was loaded with approximately 2,000 gallons of fire retardant, and 550 gallons of fuel.

The captain of T-161 said, "Tanker 22 had just completed his drop and Tanker 123 had observed the drop and was preparing to drop. All communication between 123 and Lead Bravo 8 was normal. I fell behind T-123 on downwind and base. I looked away momentarily and I again focused on T-123. I noticed his left wing was falling. The aircraft was in a 15 to 20 degree bank. I next saw fire near the fuselage as the wing failed inboard of the number 2 engine. The aircraft pitched nose down in a huge fireball and plunged into the ground vertically starting an immediate large fire."

The copilot of T-161 said Tanker 123 was in his base turn for the drop and in a "smooth 15 to 20 degree bank turn", when the left wing separated from the airplane. "The aircraft then went into a rotation and impacted the ground." The copilot said that operations were normal and the weather in the area consisted of "the smoothest, least turbulent conditions of the day."

The pilot in the Forest Service leadplane said, "The conditions were perfect for a tanker drop. No turbulence and no smoke in that area." The pilot said, "I had just made two runs with Tanker 22 on the same drop area. He had departed and I allowed helicopter 72D to make a water drop on the area. Tanker 123 was on scene when Tanker 22 made his split load drop, two different runs. I instructed Tanker 123 that we would be extending Tanker 22's first drop. Tanker 123 responded with something like, 'We can do that' or 'We see that," and that he was on downwind for the drop. I told him I was at his 8 o'clock and [he] said that he had me in sight. I then told him I would come up on his left side and continue downwind with him until he was ready to turn back. He then responded with 'I think I'm going to use this nice big valley to turn around in.' I told him that sounded like a good idea to me. We flew approximately 15 seconds before he began a gentle turn to final. We continued in the turn from downwind to final without squaring off for a base, which is normal on tanker runs." The pilot said that after he turned on final, he told the captain on Tanker 123 that his attack run would require a pitch over which was approximately 1/2 mile ahead. The pilot said after he finished that transmission, the captain of Tanker 161 called him and said that the left wing had just come off of Tanker 123 and the airplane had gone in.

A witness on the ground, approximately 6 miles east of the accident location, using a digital camera with a telephoto lens and automatic shutter, took a series of eight still photographs of the airplane at the time of the accident. The photo series shows the airplane's left wing separate at the wing root and fuselage, a fire ensues at the separation, and the airplane enters an approximately 45-degree dive to the ground. The photos also show the airplane in a counter-clockwise roll during its dive toward the ground. The witness said when he saw what was happening, he depressed the shutter button and held it until the airplane went behind a treed ridge. Copies of the eight photographs are provided as an attachment to this report.

Several witnesses on the ground in the vicinity of the accident location said they saw the airplane in a left banking turn. Some of the witnesses described the turn as "steep" or "tight." One witness said the airplane had rolled out of the turn after making a "hard banking turn." At this time, none of the witnesses indicated that there were any apparent problems with the airplane. The witnesses then said the left wing "folded upward" and severed at the "left wing-fuselage point." They all described "slurry" coming out and "fire erupting" from the area where the wing separated. The witnesses said the airplane rapidly descended and impacted into the hillside.

Radar information provided by the Denver Air Route Traffic Control Center showed the airplane come out of the Broomfield area and proceeding northwest to the Lyons-Estes Park area where the Big Elk fire was burning. The airplane is shown entering a series of counter-clockwise 3.5 to 4 nautical mile diameter orbits at an altitude averaging 8,900 feet mean sea level (msl), over Lion's Gulch, and in the vicinity of Moose Mountain. Terrain in this area is mountainous averaging from 7,300 feet msl to 8,500 feet msl. The radar information showed the airplane make five orbits over this area. On the last half of the fifth orbit, the radar information shows the airplane at an altitude of 8,500 feet msl and heading approximately 315 degrees. The airplane is shown on a 315-degree heading for 1.3 nautical miles. The airplane is then shown making a left turn to 260 degrees. The airplane is shown on a 260-degree heading for 1.1 nautical miles and at an altitude of 8,400 feet msl. The airplane is then shown making a left turn and rolling out on a 195-degree heading. The airplane remains on this heading for 0.6 nautical miles, when radar contact is lost. The accident site was approximately 0.1 nautical miles southwest of the last radar plot.

Personnel information

The pilot-in-command held a commercial pilot license with single and multiengine land, instrument airplane ratings, dated January 17, 1996. The pilot was type-rated in CV-P4Y airplanes. The pilot also held a flight instructor certificate with endorsements for instruction in single-engine land airplanes. The pilot-in-command held a second-class medical certificate dated January 18, 2002. The certificate contained no restrictions or limitations. The pilot-in-command met contract qualifications for the U. S. Department of Agriculture (USDA) and U. S. Department of the Interior (DOI) as a pilot-in-command for special mission, low level, airtanker initial attack in PB4Y-2 airplanes. The pilot-in-command completed a company pilot proficiency check in the P4Y-2 on January 31, 2002. At the time of his proficiency check, the pilot had 3,416 total flying hours and 1,094 hours in P4Y-2 airplanes. Information provided by the Forest Service indicated that at the time of the accident, the pilot-in-command had 3,658 total flying hours, and 1,328 hours in P4Y-2 airplanes.

The second pilot held a commercial pilot license with single-engine land and sea, multiengine land and sea, instrument airplane ratings, dated October 15, 1997. The second pilot was type-rated in CV-P4Y, DC-3, DC-B26, M-202, M-404, and N-B25 airplanes. The second pilot held a second-class medical certificate dated January 22, 2002. The c

Aircraft

Registration
N7620C
Reported as
Consolidated-Vultee P4Y-2
Category
Airplane
Serial number
66260
Airframe hours
8,346.3
Engines
Wright R2600-35, 1,350 horsepower, reciprocatingWright R2600-35, 1,350 horsepower, reciprocatingWright R2600-35, 1,350 horsepower, reciprocatingWright R2600-35, 1,350 horsepower, reciprocating
Damage
Destroyed
Fire
Both
Flight
Aerial application · Public use
Registered owner
Hawkins & Powers Aviation, Inc.
Airworthiness certificate
Special, Restricted (Special)
Last inspection
Continuous airworthiness · June 14, 2002 · 87.29 hours before
Departed
BJC · Broomfield, CO
Flight plan
Company 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
39
Injuries
Fatal
Certificates
Commercial, Flight instructor
Airplane ratings
Single-engine land, Multi-engine land
Instrument ratings
Airplane
Medical
Class 2, Valid Medical--no waivers/lim.
Last flight review
January 31, 2002
Seat
Left
Toxicology
Performed
Flight hours
3,658 total · 1,328 in this make and model · 3,081 as pilot in command · 217 in the last 90 days · 93 in the last 30 days · 5 in the last 24 hours
Role
Co-pilot
Age
56
Injuries
Fatal
Certificate
Commercial
Airplane ratings
Single-engine land, Multi-engine land, Multi-engine sea
Instrument ratings
Airplane
Medical
Class 2, Valid Medical--w/ waivers/lim
Last flight review
January 23, 2002
Seat
Right
Toxicology
Performed
Flight hours
6,689 total · 913 in this make and model · 5,707 as pilot in command · 210 in the last 90 days · 93 in the last 30 days · 5 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
40° at 8 knots
Visibility
30 statute miles
Lowest ceiling
12,000 ft broken
Temperature
93 °F, dew point 52 °F
Altimeter
30.04 inHg
Observed at
BJC, 27 nm away

Docket · 48

The files NTSB released with the investigation on February 25, 2003, on NTSB’s docket system: statements, records, photos and specialists’ reports. 41.0 MB in all.

Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1Item 1 · .PDF · 332 KBMaterials Laboratory 15 - Factual Report 02-089Item 2 · .PDF · 2.8 MBStructures 7 - Factual Report of Group ChairmanItem 3 · .PDF · 531 KBWitness StatementsItem 4 · .PDF · 1.4 MBWreckage DiagramsItem 5 · .PDF · 698 KBReports from Local AgenciesItem 6 · .PDF · 384 KBStatement of Party Representatives to NTSB InvestigationItem 7 · .PDF · 85 KBRelease of Aircraft Wreckage, NTSB Form 6120.15Item 8 · .PDF · 45 KBToxicological ReportsItem 9 · .PDF · 97 KBMiscellaneous - Radar DataItem 10 · .PDF · 430 KBMiscellaneous - Mission Resource LogItem 11 · .PDF · 76 KBMiscellaneous - Fuel RecordsItem 12 · .PDF · 51 KBMiscellaneous - Tanker 123 Missions LogItem 13 · .PDF · 64 KBMiscellaneous - Airplane DiagramsItem 14 · .PDF · 850 KBMiscellaneous - Type Certificate Number AR-29Item 15 · .PDF · 33 KBMiscellaneous - Operating LimitationsItem 16 · .PDF · 83 KBMiscellaneous - Extracts from Erection and Maintenance HandbookItem 17 · .PDF · 801 KBMiscellaneous - Extracts from Handbook of Instructions for Structural Repair PB4Y-2Item 18 · .PDF · 1.9 MBMiscellaneous - Extracts from H&P Service and Inspection GuideItem 19 · .PDF · 425 KBMiscellaneous - Extracts from Airframe Maintenance LogbookItem 20 · .PDF · 129 KBMiscellaneous - Summary of Repairs and Inspections performed between 6-10-02 and 6-15-02Item 21 · .PDF · 22 KBMiscellaneous - C Check Inspection RecordsItem 22 · .PDF · 14.0 MBMiscellaneous - Other Inspection and Repairs performed between 6-10-02 and 6-15-02Item 23 · .PDF · 10.1 MBMiscellaneous - Extractions from the National AirTanker Service ContractItem 24 · .PDF · 1.5 MBPhoto 1 - Left Wing PieceItem 25 · .PDF · 277 KBPhoto 2 - Left Outboard Wing SectionItem 26 · .PDF · 191 KBPhoto 3 - Left Outboard Wing SectionItem 27 · .PDF · 245 KBPhoto 4 - Number 2 (Left Inboard) Engine & PropellerItem 28 · .PDF · 258 KBPhoto 5 - Number 1 (Left Outboard) Engine, Aft ViewItem 29 · .PDF · 277 KBPhoto 6 - Airplane Main Wreckage, Right Wing, Center Fuselage, Left Main Gear, Number 4 EngineItem 30 · .PDF · 271 KBPhoto 7 - Number 1 Engine & Propeller, Side ViewItem 31 · .PDF · 253 KBPhoto 8 - Airplane Main Wreckage, Number 4 Engine, Right Wing, Forward Fuselage and Cockpit Debris, Burned Area (South-Facing)Item 32 · .PDF · 274 KBPhoto 9 - Empennage, Tail Cone, Foward and Aft Fuselage Pieces, Cockpit Instruments (Southeast-Facing)Item 33 · .PDF · 268 KBPhoto 10 - Airplane Main Wreckage, Center Fuselage Area, Retardant Tanks & Doors, Fire Retardant on Ground & Trees (Southwest-Facing)Item 34 · .PDF · 268 KBPhoto 11 - Broken Trees (North-Facing)Item 35 · .PDF · 181 KBPhoto 12 - Impact Crater, Downed Trees, Fuselage & right Wing PiecesItem 36 · .PDF · 280 KBPhoto 13 - Fuel tank Baffle (North Debris Field)Item 37 · .PDF · 274 KBPhoto 14 - Wing Rib (North Debris Field)Item 38 · .PDF · 272 KBPhoto 15 - Engine Cowling Door (North Debris Field)Item 39 · .PDF · 265 KBPhoto 16 - Engine Cowling Parts (North Debris Field)Item 40 · .PDF · 244 KBPhoto 17 - Accident Sequence 1Item 41 · .PDF · 11 KBPhoto 18 - Accident Sequence 2Item 42 · .PDF · 13 KBPhoto 19 - Accident Sequence 3Item 43 · .PDF · 16 KBPhoto 20 - Accident Sequence 4Item 44 · .PDF · 13 KBPhoto 21 - Accident Sequence 5Item 45 · .PDF · 15 KBPhoto 22 - Accident Sequence 6Item 46 · .PDF · 16 KBPhoto 23 - Accident Sequence 7Item 47 · .PDF · 14 KBPhoto 24 - Accident Sequence 8Item 48 · .PDF · 13 KB

FAA reports on this event · 1

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