SEA01FA017

NTSB accident investigation · Cessna 425 · Idaho Falls, ID · November 10, 2000

Accident · FatalField investigationFinal report
Date
November 10, 2000, 12:15 local (19:15 UTC)
Place
Idaho Falls, ID
Injuries
2 fatal
Damage
Substantial damage
Phase of flight
Unknown
Aircraft
N41054Cessna 425
Weather
Visual (VMC) · Day
Status
Completed · report January 16, 2003
Report
Approved by Office Director
Parties
Cessna Aircraft Co., Aerospace Control Products, Inc., Pratt & Whitney Canada Corp., FAA - Salt Lake City FSDO, McCauley Propeller Systems
FAA report
20001110038869A
Case key
50631

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-in-command's failure to maintain adequate airspeed with an asymmetric thrust condition, resulting in a loss of aircraft control. A factor was an asymmetric engine thrust condition, which was present for undetermined reasons.

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.

Loss of control - in flightUnknown
Miscellaneous,engine - asymmetricalFactor
Airspeed - not maintainedPilot in commandCause
Propeller system/accessories,auto-feather system - out of calibration
In flight collision with terrain/waterDescent - uncontrolled

Analysis

The accident aircraft had recently had maintenance work performed on its autofeather system pressure sensing switches, due to reports of the left engine not autofeathering properly in flight. The purpose of the accident flight was to verify proper inflight operation of the autofeather system following the maintenance work on the autofeather pressure sensing switches and a successful ground check of the autofeather system. Air traffic control (ATC) communications recordings disclosed that the pilot called ready for takeoff from runway 2 approximately 1207, and requested to orbit above the airport at 8,000 feet (note: the airport elevation is 4,740 feet.) The pilot subsequently reported established in a hold above the airport at 8,000 feet approximately 1213, and was instructed by ATC to report leaving the hold. Approximately 1215, an abbreviated radio transmission, "zero five four," was recorded. The Idaho Falls tower controller responded to this call but never got a response in return from the accident aircraft, despite repeated efforts to contact the aircraft. Witnesses reported that the aircraft banked to the left, or to the west, and that it entered a spiral from this bank and crashed (one witness reported the aircraft was flying at 200 to 300 feet above ground level when it entered this bank, and that it performed a "skidding" or "sliding" motion part way through the bank, about 1 second before entering the spiral.) The aircraft crashed about 2 miles north of the airport. On-site examination disclosed wreckage and impact signatures consistent with an uncontrolled, relatively low-speed, moderate to steep (i.e. greater than 22 degrees) angle, left-wing-low impact on an easterly flight path. No evidence of flight control system malfunction was found, and a large quantity of jet fuel was noted to be aboard the aircraft. Post-accident examination of the aircraft's engines indicated that the left engine was most likely operating in a low power range and the right engine was most likely operating in a mid to high power range at impact, but no indications of any anomalies or distress that would have precluded normal operation of the engines prior to impact was found. Post-accident examination of the aircraft's propellers disclosed indications that 1) both propellers were rotating at impact, 2) neither propeller was at or near the feather position at impact, 3) both propellers were being operated with power at impact (exact amount unknown), 4) both propellers were operating at approximately 14º to 20º blade angle at impact, and 5) there were no propeller failures prior to impact. Post-accident examination of the autofeather pressure-sensing switches disclosed evidence of alterations, tampering, or modifications made in the field on all but one switch (a replacement switch, which had been installed just before the accident flight during maintenance) installed on the aircraft at the time of the accident. All switches except for the replacement switch operated outside their design pressure specifications; the replacement switch operated within design pressure specifications. Examination of the switches indicated that all switches were installed in the correct positions relative to high- or low-pressure switch installations. Engineering analyses of expected autofeather system performance with the switches operating at their "as-found" pressure settings (vice at design pressure specifications) did not indicate a likelihood of any anomalous or abnormal autofeather system operation with the autofeather switches at their "as-found" pressure settings. Also, cockpit light and switch evidence indicated that the autofeather system was not activated at the time of impact. The combination of probable engine power and propeller pitch on the left engine (as per the post-accident engine and propeller teardown results) was noted to be generally consistent with the "zero-thrust" engine torque and propeller RPM settings specified for simulated single-engine practice in the aircraft Information Manual.

Factual narrative

History of flight

On November 10, 2000, approximately 1215 mountain standard time, a privately owned Cessna 425, N41054, was substantially damaged in a collision with terrain approximately 2 miles north of Fanning Field, Idaho Falls, Idaho. The airline transport pilot-in-command and a second airline transport pilot aboard for the flight were fatally injured in the accident. The local flight, which was a maintenance test flight, departed from Fanning Field approximately 1208, and was conducted under the provisions of 14 CFR 91. Visual meteorological conditions prevailed in the area at the time of the accident, and no flight plan had been filed for the flight.

The accident aircraft had recently had maintenance work performed on its autofeather system pressure sensing switches, due to reports of the left engine not autofeathering properly in flight. The maintenance work was performed by Aerohawk Aviation, a maintenance firm based at Fanning Field. According to Aerohawk's owner, the purpose of the accident flight was to verify proper inflight operation of the autofeather system following the maintenance work on the autofeather pressure sensing switches and a successful ground check of the autofeather system. Air traffic control (ATC) communications recordings from the Idaho Falls air traffic control tower disclosed that the pilot called ready for takeoff approximately 1207, and requested to orbit above the airport at 8,000 feet (note: the airport elevation is 4,740 feet.) He was cleared for takeoff on runway 2 at 1208, and his departure was approved by ATC as requested. The pilot subsequently reported established in a hold at the Idaho Falls VOR (collocated with the airport) at 8,000 feet approximately 1213. The Idaho Falls tower controller instructed the pilot to report leaving the hold. Approximately 1215, an abbreviated radio transmission, "zero five four," was recorded. The Idaho Falls tower controller responded to this call but never got a response in return from the accident aircraft, despite repeated efforts to contact the aircraft. At 1227, the Idaho Falls tower controller informed the Boise, Idaho, Automated Flight Service Station (AFSS) that she was receiving reports of an aircraft down about 2 miles north of the airport.

A witness to the accident reported that he first observed the aircraft flying south along Interstate Highway 15 (I-15) at an altitude of 200 to 300 feet above ground level. He stated that the aircraft then started banking left, and that part way throught the bank the aircraft then began a "skidding" or "sliding" motion. This witness reported that the aircraft entered a spiral about 1 second later and crashed. This witness reported he did not observe anything wrong with the aircraft at that time, but could not tell whether or not both of the aircraft's propellers were turning. The second witness reported that the airplane was banking west, and that it then "spiraled straight down and hit the ground." A third witness reported that the airplane was northbound, "banking to the west on its wingtip." This witness reported that the aircraft then went out of sight, and that he then saw a smoke cloud.

The accident occurred during the hours of daylight at approximately 43 degrees 32.2 minutes North latitude and 112 degrees 3.8 minutes West longitude.

Personnel information

Both pilots were employed as corporate pilots for local companies in Idaho Falls at the time of the accident. The pilot-in-command, who according to the aircraft's owner was highly experienced in the Cessna 425, was retained by Aerohawk Aviation to conduct maintenance test flights on an ad-hoc basis. He held an airline transport pilot certificate with airplane single-engine land, airplane multiengine land, and airplane single-engine sea ratings, and a Cessna 500 type rating (note: according to the provisions of 14 CFR 61.31(a), a type rating is not required for the Cessna 425). He also held a flight instructor certificate with airplane single-engine, airplane multiengine, and instrument airplane ratings, with a date of issue of October 28, 2000. The pilot held an FAA second-class medical certificate dated November 23, 1999, with a limitation requiring the pilot to possess glasses that corrected for intermediate and near vision. No pilot logbooks for the pilot-in-command were located by, or provided to, the NTSB. However, NTSB investigators recovered documentation of the pilot-in-command's completion of a pilot-in-command proficiency check in the Cessna 500 at SimuFlite, Inc. on March 11, 2000. The pilot indicated on his last FAA medical certificate application that he had 8,000 hours total pilot time, with 250 hours in the last 6 months.

According to the owner of Aerohawk, the pilot-in-command had invited the second pilot to fly on the accident flight because the company that employed the second pilot was purchasing a Cessna 425. The second pilot held an airline transport pilot certificate with an airplane single-engine land rating, with commercial privileges for airplane multiengine land. He held an FAA first-class medical certificate dated July 27, 2000, with no limitations. No pilot logbooks for the second pilot were located by, or provided to, the NTSB. The second pilot indicated on his last FAA medical certificate application that he had 2,500 hours total pilot time, with 200 hours in the last 6 months.

Aircraft information

The aircraft, a Cessna 425, serial number 425-0172, was manufactured in 1982, and was registered to the then-current owner (who was not aboard the aircraft at the time of the accident) on May 28, 1997. The Hobbs meter reading noted at the accident site was 4,027.1 hours, which according to the aircraft logs also corresponded to the airframe total time. The aircraft was on a manufacturer's approved aircraft inspection program. The last documented inspections were phase 2 and 3 inspections signed off by the owner of Aerohawk Aviation on February 10, 2000, at 3,963.5 airframe hours.

The aircraft was equipped with two McCauley 4HFR34C762-H four-bladed propellers, which according to the propeller logs were installed new on the aircraft on March 15, 1996, at 3,216.5 airframe hours. At the time of this new propeller installation, the aircraft was equipped with two Pratt & Whitney Canada PT6A-112 turboprop engines. The aircraft records indicated that the propellers were installed per FAA Supplemental Type Certificate (STC) SA1491GL (held by McCauley Propeller Systems), which authorizes installation of the McCauley 4-bladed propellers on PT6A-112 engines. Two new Pratt & Whitney Canada PT6A-135A engines, serial numbers PCE-PZ0025 (left) and PCE-PZ0026 (right), were subsequently installed on the accident aircraft by Aerohawk Aviation on September 24, 1999, at 3,937.7 airframe hours. The PT6A-135A installation was accomplished per STC SA622CH, held by Duncan Aviation (formerly Kal-Aero) of Battle Creek, Michigan. The McCauley 4-bladed propellers were removed from the aircraft and reinstalled on the new engines at the time of this engine change. A March 1996 amendment to STC SA1491GL added PT6A-135A engines to the eligibility for installation of the McCauley 4-bladed propellers (the original STC, issued in 1990, listed only PT6A-112 engines as eligible for installation of these propellers.)

The aircraft was equipped with a propeller autofeathering system that provided for automatic feathering of a propeller in the event of loss of the engine. This system was controlled by an arming switch in the cockpit with ARM, OFF, and TEST positions. In the OFF position, the system was deactivated. During nominal system operation with the switch in ARM, the propeller would automatically feather if engine torque dropped below approximately 185 foot-pounds (ft-lb) at power lever positions of 80% gas generator RPM (Ng) or greater. In nominal system operation, autofeathering of one propell

Aircraft

Registration
N41054
Reported as
Cessna 425
Category
Airplane
Serial number
425-0172
Airframe hours
4,027.1
Engines
Pratt & Whitney Canada PT6A-135A, 750 horsepower, turbo propPratt & Whitney Canada PT6A-135A, 750 horsepower, turbo prop
Damage
Substantial damage
Flight
Business · Part 91
Operator
Aerohawk Aviation
Registered owner
Fred H. Hibberd Jr.
Airworthiness certificate
Standard, Normal
Last inspection
AAIP · February 10, 2000 · 63.6 hours before
Departed
IDA · ID
Airport
IDA · Fanning Field

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
54
Injuries
Fatal
Certificates
Flight instructor, Airline transport
Airplane ratings
Single-engine land, Multi-engine land, Single-engine sea
Instrument ratings
Airplane
Medical
Class 2, Valid Medical--w/ waivers/lim
Last flight review
March 11, 2000
Seat
Left
Toxicology
Performed
Flight hours
8,000 total
Role
Other flight crew
Age
30
Injuries
Fatal
Certificates
Commercial, Airline transport
Airplane ratings
Single-engine land, Multi-engine land
Instrument ratings
Airplane
Medical
Class 1, Valid Medical--no waivers/lim.
Seat
Right
Toxicology
Performed
Flight hours
2,500 total

Weather

Conditions
Visual (VMC) · Day
Wind
25° at 8 knots
Visibility
10 statute miles
Lowest ceiling
None
Temperature
21 °F, dew point 9 °F
Altimeter
29.79 inHg
Observed at
IDA, 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.