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Cases › ANC23FA045 · Part 135 fatal · Class 3

PIPER PA-32-300Vertigo Air Taxi

Old Harbor, AK, USA · 2023-07-02·N1132Q

2
fatal
3
serious
Fatal
highest injury
Substantial
damage

What happened

NTSB summary, verbatim

The pilot departed with four passengers and cargo on the air taxi flight up a valley toward an area of rising terrain. The pilot reported that, during the six-minute flight, the airplane's rate of climb was 500 feet per minute and the engine power setting was 2,500 rpm with 25 inches of manifold pressure. Upon realizing that the airplane would not clear the terrain ahead, the pilot maneuvered the airplane to the right side of the confined valley in order to make a 180° left turn; however, the airplane subsequently stopped climbing and impacted terrain. The departure airport elevation was 55 ft mean sea level (msl) and the elevation of the accident site was 750 ft msl. Postaccident examination of the airframe and engine revealed no evidence of mechanical malfunctions or failures that would have precluded normal operation; the pilot reported there were no mechanical anomalies with the airplane. The pilot reported that the airplane’s gross weight at takeoff was about 50 lbs under its maximum gross weight and the investigation independently estimated that it was about 110 pounds below the maximum gross takeoff weight. A pilot in another airplane loaded similarly to the accident airplane departed about two minutes before the accident airplane on the same route of flight and reported that the weather was “great” and that he had no performance issues climbing through the mountain pass. Based on the available information, the pilot failed to maintain clearance from rising terrain. It is likely that his delayed decision to turn away from the rising terrain when he realized that the airplane’s climb performance was insufficient contributed to the impact with terrain.

Photographs

6the aircraft, and what the investigators found
Wreckage and site documentation · 6 photographs from the docket

Photographs are NTSB docket attachments — works of the US government, in the public domain. Captions are the Board’s own.

Probable cause

the Board's determination
The pilot’s failure to maintain clearance from rising terrain. Contributing to the accident was the pilot’s delayed decision to turn away from the terrain.

Occurrence sequence

1 stepsNTSB coding · CICTT taxonomy
  1. 1 · Maneuvering
    Controlled flight into terr/obj (CFIT)
    defining event

Findings

5 causal · 0 contributing
  • CAUSE
    Personnel issues › Action/decision › Info processing/decision › Decision making/judgment — Pilot
  • CAUSE
    Personnel issues › Action/decision › Info processing/decision › Understanding/comprehension — Pilot
  • CAUSE
    Personnel issues › Action/decision › Info processing/decision › Identification/recognition — Pilot
  • CAUSE
    Personnel issues › Task performance › Use of equip/info › Use of policy/procedure — Pilot
  • CAUSE
    Aircraft › Aircraft oper/perf/capability › Aircraft capability › Climb capability — Capability exceeded

NTSB analysis

from the final report

The pilot departed with four passengers and cargo on the air taxi flight up a valley toward an area of rising terrain. The pilot reported that, during the six-minute flight, the airplane's rate of climb was 500 feet per minute and the engine power setting was 2,500 rpm with 25 inches of manifold pressure. Upon realizing that the airplane would not clear the terrain ahead, the pilot maneuvered the airplane to the right side of the confined valley in order to make a 180° left turn; however, the airplane subsequently stopped climbing and impacted terrain. The departure airport elevation was 55 ft mean sea level (msl) and the elevation of the accident site was 750 ft msl. Postaccident examination of the airframe and engine revealed no evidence of mechanical malfunctions or failures that would have precluded normal operation; the pilot reported there were no mechanical anomalies with the airplane. The pilot reported that the airplane’s gross weight at takeoff was about 50 lbs under its maximum gross weight and the investigation independently estimated that it was about 110 pounds below the maximum gross takeoff weight. A pilot in another airplane loaded similarly to the accident airplane departed about two minutes before the accident airplane on the same route of flight and reported that the weather was “great” and that he had no performance issues climbing through the mountain pass. Based on the available information, the pilot failed to maintain clearance from rising terrain. It is likely that his delayed decision to turn away from the rising terrain when he realized that the airplane’s climb performance was insufficient contributed to the impact with terrain.