GENERAL INFORMATION FOR NTSB REPORT: ANC00LA008
Data Source NTSB AVIATION ACCIDENT/INCIDENT DATABASE
NTSB Report Nbr ANC00LA008
Event Id 20001212X19899
Local Date 10/27/1999
Local Time 1342
State AK
Airport Name BETHEL
Event Type ACCIDENT
Injury Severity NONE
Record Status
Mid Air Collision NO
Event Location OFF AIRPORT/AIRSTRIP

WEATHER INFORMATION
Weather Briefing Complete UNKNOWN
Basic Weather Conditions INSTRUMENT METEOROLOGICAL COND
Light Condition DAY
Cloud Condition SCATTERED
Cloud Height above Ground Level (ft) 100
Ceiling Height above Ground Level (ft) 400
Cloud Type OVERCAST
Visibility RVR (ft) 0
Visibility RVV (sm) 0
Visibility (sm) 4
Wind Direction (deg) 0
Wind Condition Flag U
Wind Speed (knots) 0
Wind Condition Indicated Calm

AIRCRAFT INFORMATION
Aircraft 1
Type of Operation PART 135: AIR TAXI & COMMUTER
Registration Number N207SE
Aircraft Make CESSNA
Aircraft Model 207
Aircraft Series UNDESIGNATED SERIES
Aircraft Damage SUBSTANTIAL
Aircraft Fire NONE
Aircraft Explosion NONE
Aircraft Type AIRPLANE
Aircraft Homebuilt UNKNOWN
Phase of Flight CRUISE
Aircraft Use UNKNOWN
Category of Operation SCHEDULED
Flight Plan Filed COMPANY VFR
Domestic/International DOMESTIC
Passenger/Cargo PASSENGER ONLY
Operator Name HAGELAND AVIATION SERVICES INC
Operator Doing Business As
Owner Name GUSSIC VENTURES
Number of Seats 7
Number of Engines 1
ELT Installed YES
ELT Operated YES
Departure Airport Id PABE
Departure City
Last Departure Point YES
Destination Airport Id AKI
Destination City AKIAK
Destination State ALASKA
Runway Id 0
Air Carrier Operating Certificates YES
Air Carrier Other Operating Certificates UNKNOWN
Rotocraft/Agriculture Operating Certificate UNKNOWN
Cert Max Gross Wgt 3800

ENGINE INFORMATION

Aircraft 1 - Engine : #1
Engine Manufactuer Continental
Engine Model IO-520-F27B
Engine Horsepower 300
Engine Thrust HP
Carb/Injection FUEL INJECTED

INJURY INFORMATION
Injury Summary for Aircraft 1
Fatal Serious Minor None
Crew 0 0 0 0
Pass 0 0 0 0
Total 0 0 0 2
Sequence of Events for Aircraft 1
Occurrence #1
IN FLIGHT ENCOUNTER WITH WEATHER
Phase of Operation: CRUISE

Events Sequence for Occurrence #1 of Aircraft 1
Event Seq # Event Group Code Subject Modifier Personnel Cause/Factor
1 1 WEATHER CONDITION LOW CEILING FACTOR
2 2 WEATHER EVALUATION INADEQUATE PILOT IN COMMAND CAUSE
3 2 SUPERVISION INADEQUATE COMPANY/OPERATOR MANAGEMENT FACTOR
4 1 WEATHER CONDITION ICING CONDITIONS FACTOR
5 2 FLIGHT INTO ADVERSE WEATHER INITIATED PILOT IN COMMAND CAUSE
6 1 AIRFRAME ICE FACTOR
7 2 ALTITUDE NOT OBTAINED/MAINTAINED NO PERSON SPECIFIED

Occurrence #2
IN FLIGHT COLLISION WITH TERRAIN/WATER
Phase of Operation: EMERGENCY LANDING

Events Sequence for Occurrence #2 of Aircraft 1
Event Seq # Event Group Code Subject Modifier Personnel Cause/Factor
8 1 TERRAIN CONDITION SNOW COVERED




AIRCRAFT 1 PRELIMINARY REPORT


On October 27, 1999, about 1342 Alaska daylight time, a wheel equipped Cessna 207 airplane, N207SE, sustained substantial damage after colliding with snow-covered terrain, about 2 miles west of Bethel, Alaska. The airplane was being operated as a visual flight rules (VFR) scheduled domestic passenger flight under Title 14, CFR Part 135, when the accident occurred. The airplane was operated by Hageland Aviation Services Inc., Anchorage, Alaska, as Flight 70 from Bethel, to Akiak, Alaska, to Tuluksak, Alaska, and return to Bethel. The commercial certificated pilot, and the sole passenger, were not injured. Instrument meteorological conditions prevailed in the area of the accident. VFR company flight following procedures were in effect. The flight originated at the Bethel Airport, at 1309. A terminal forecast for Bethel, issued on October 27, 1999, at 0716 and valid from 0700 to 0200 on October 28, stated, in part: Wind, 040 degrees at 5 knots; visibility, 5 statute miles in light snow; clouds and sky conditions, 1,200 feet scattered, 4,000 feet overcast. Temporary conditions from 0700 to 1000; visibility 1/2 statute mile in freezing fog; ceiling, 100 feet broken. From 1000, wind, 020 degrees at 9 knots; visibility greater than 6 statute miles; clouds and sky conditions, 2,500 feet scattered, 5,000 feet broken. Temporary conditions from 1000 to 1400; visibility, 3 statute miles in light snow and mist; ceiling, 2,500 feet broken. From 1400, wind, 350 degrees at 12 knots; visibility greater than 6 statute miles; clouds, 3,500 feet scattered, 8,000 feet broken. An amended terminal forecast for Bethel was issued on October 27, at 1227, and was valid from 1200 to 1000 on October 28, stated, in part: Wind, variable at 3 knots; visibility, 1 1/2 statute mile in mist; clouds and sky condition, 100 feet scattered, 1,500 feet scattered. Temporary conditions from 1200 to 1400; visibility, 3/4 statute mile in mist, ceiling, 1,200 feet broken. From 1400, wind, 360 degrees at 7 knots; visibility greater than 6 statute miles; clouds and sky condition, 2,500 feet scattered, 4,500 feet broken. Temporary conditions from 1400 to 1700; visibility, 1 statute mile in mist. From 1700, wind, 010 degrees at 8 knots; visibility greater than 6 statute miles; clouds and sky condition, 4,500 feet scattered, 8,000 feet broken. On October 27, from about 0600 to about 1200, Aviation Routine Weather Reports (METARs) from the Bethel Airport included visibilities between 1/2 to 3/4 mile in mist and freezing fog. The ceiling varied between 100 feet, to 1,100 feet. At 1253, a METAR report included a visibility of 2 miles in mist, few clouds at 100 feet, and broken clouds at 700 feet. At 1300, the visibility was 4 miles in patchy fog, few clouds at 100 feet, and broken clouds at 500 feet. At 1300, the Bethel Automated Terminal Information System (ATIS) was reporting, in part: Bethel tower information Sierra, 2053Z; wind, calm; visibility, four miles in mist; ceiling, 500 feet overcast; temperature, 8 degrees F; dew point temperature, 6 degrees F. Instrument meteorological conditions prevailed in the Bethel Class E airspace. At the time of the accident, airplanes were arriving and departing with Special VFR clearances. At 1309, the pilot was cleared for a Special VFR departure toward the east by the Bethel Air Traffic Control Tower (ATCT) local controller. At 1312, the pilot reported he was clear of the Bethel Class E airspace. At 1321, the pilot contacted the Bethel ATCT and inquired whether the airport was VFR or IFR. When told the airport was IFR, he requested a Special VFR clearance to return to the airport, and said he was 9.3 miles southeast of Bethel. The pilot was told to maintain VFR, and report one mile southeast of the Bethel Class E surface area. At 1330, the pilot reported he was holding just south of Napaskiak, Alaska, (5 miles southeast of Bethel), and at 1331, he was cleared into the Class E surface area to enter right traffic for runway 36. At 1333, the Bethel METAR was reporting in part: Wind, calm; visibility, 4 statute miles in light snow and patchy fog; sky condition, 100 feet scattered, 400 feet overcast; temperature, 10 degrees F; dew point, 8 degrees F; altimeter, 29.73 inHg; remarks, occasional localized lower visibility, ceiling varying between 300 to 600 feet. Snow began 27 minutes past the hour. At 1334, the pilot was cleared to land, but at 1335, he reported that he had flown over the runway and never saw it. He said he was entering a left downwind for runway 36. At 1336, the pilot said he was 1.6 miles northwest of Bethel. The Bethel ATCT controller turned the runway lights up to maximum. At 1340, the controller requested to know the pilot's intentions. He replied that he would head to the southeast and try to get into Napakiak (6 miles south of Bethel). At 1340, several pilots waiting to depart Bethel began to cancel their Special VFR clearances, and one pilot asked if the weather had changed. The Bethel ATCT controller replied that the weather conditions were rapidly decreasing, but he did not have a current report. At 1341, the Bethel local controller made a radio broadcast, stating: "Bethel tower broadcasting in the blind, due to rapidly decreasing conditions, the weather is posting a 100 foot ceiling, at this time 100 foot broken." At 1343, the pilot contacted the Bethel ATCT and advised he lost engine power, and was down on the tundra, 2.4 miles west of the airport. At 1343, the Bethel ATIS was reporting, in part: Bethel tower information Tango, 2142Z; wind, calm; visibility, four miles in patchy fog; ceiling, 100 feet overcast; temperature, 10 degrees F; dew point temperature, 8 degrees F. A Federal Aviation Administration (FAA) operations inspector, Anchorage Flight Standards District Office (FSDO), was at the Bethel Airport when the accident occurred. He reported the cloud condition at the airport was 100 feet overcast. He traveled to the accident scene, and interviewed the pilot. The inspector reported the pilot said he departed Bethel under VFR conditions, after waiting most of the day due to low visibility at the airport. The pilot encountered worsening weather conditions and decided to return to Bethel. The pilot had to hold out of the Bethel surface area for a Special VFR clearance. Once cleared into the surface area, the pilot said he could not see the runway because the windshield of the airplane was iced over. The pilot decided to proceed toward the southeast, but said the engine began to run rough and lose power. He said that application of full power was unable to prevent the airplane from losing altitude. He lowered the flaps and the airplane touched down on snow-covered terrain. During the landing, the nose gear was sheared off, and the right wing received rib damage to the outboard end. At the accident scene, the FAA inspector noted about 1/8 inch of ice on the airplane. In the Pilot/Operator report (NTSB Form 6120.1/2) submitted by the operator, the pilot included a written statement. In the statement, the pilot reported, in part, that he conducted a preflight inspection of the accident airplane at 0815. He said the airplane's left fuel tank was empty, and the right fuel tank was full. He sumped the right fuel tank, and indicted he had two hours of fuel for a 40 minute flight. The pilot said he was dispatched on Flight 70, and that two company representatives were in the dispatch office. During a telephone conversation with the National Transportation Safety Board (NTSB) investigator-in-charge (IIC), on October 28, 1999, the pilot reported he was about 4 miles northeast of Bethel when the weather conditions worsened. When he contacted the Bethel tower to inquire about the weather, he was told the airport was IFR. He returned to the airport area, and held on the 135 degree radial of the Bethel VOR, one mile outside the surface area, near the village of Napaskiak, Alaska. He made four or five turns, waiting for a special VFR clearance. Once he was cleared into the Bethel Class E airspace, he proceeded toward the airport. The airplane was accumulating ice, and the forward windshield was icing over. He said he could see the ground out the left and right windows, and the engine was running fine. When he arrived at the airport, he did not see the runway, but he could see several hangars out the side window. He then decided to return to the area of Napaskiak and began a left turn toward the south. The engine began to run rough and lose power, and he climbed to 500 feet. The airplane could not maintain altitude, and it began to descend. He said he made a "MAYDAY" call on the radio, and lowered the flaps in preparation for an emergency landing. About 15 seconds later, the airplane touched down on the snow. In the pilot's statement, he said the engine began to run rough, and was not producing enough power to remain airborne. He did not say the engine quit. He said that after the airplane came to a stop, he turned the fuel selector from the right tank to OFF. After the airplane was recovered to Bethel, it was examined by a FAA inspector on October 29, 1999. The inspector reported the left fuel tank was nearly empty. The right fuel tank was near full. The fuel strainer was about 1/3 full. The strainer screen, and the fuel in the strainer were free of contaminants. The fuel control inlet screen was free of contaminants. Hand rotation of the engine produce sounds of compression, and spark at each cylinder. The alternate air mechanism was free to open without binding. The engine was removed and shipped to Alaskan Aircraft Engines, Anchorage. On November 17, 1999, the engine was placed on a test stand where it operated at 2,750 rpm.

AIRCRAFT 1 FINAL REPORT


The commercial certificated pilot arrived at his company offices and conducted a preflight inspection of the accident airplane at 0815 in preparation for a VFR scheduled domestic passenger flight to a remote village. The flight was delayed due to poor weather conditions that included visibilities between 1/2 to 3/4 mile in mist and freezing fog. The ceiling varied between 100 feet, to 1,100 feet. During the delay, two company representatives were in the dispatch office. When the weather conditions improved to 500 feet broken, and a visibility of 4 miles in patchy fog, the pilot departed at 1309 with a Special VFR clearance. The pilot encountered worsening weather about 4 miles from the airport, and decided to return. Instrument meteorological conditions prevailed in the Class E airspace around the airport, and the pilot had to hold, out of the surface area awaiting a Special VFR clearance. Once cleared into the surface area, the pilot said he could not see the runway because the windshield of the airplane was iced over. He could see hangars out the side window. The pilot decided to proceed toward the southeast and began a left turn, but said the engine began to run rough and lose power. The pilot said that application of full power was unable to prevent the airplane from losing altitude. He lowered the flaps in preparation for an emergency landing, and the airplane touched down on snow-covered terrain. During the landing, the nose gear was sheared off, and the right wing received rib damage to the outboard end. At the accident scene, an FAA inspector noted about 1/8 inch of ice on the airplane. Three minutes before the accident, the weather conditions at the airport included a visibility of four miles in light snow and patchy fog; sky condition, 100 feet scattered, 400 feet overcast, with occasional localized lower visibility, and the ceiling varyied between 300 to 600 feet. Examination of the airplane after the accident did not reveal any preimpact mechanical malfunction. The engine produced 2,750 rpm on an engine test stand.

AIRCRAFT 1 CAUSE REPORT


The pilot's inadequate evaluation of the weather, and his decision to initiate flight into adverse weather conditions. Factors in the accident were adverse weather consisting of low ceilings and icing conditions, inadequate supervision by company management, and airframe icing.


END REPORT