30 Sep 2016: DEHAVILLAND BEAVER DHC 2 MK.1 MARKI — KENMORE AIR HARBOR INC

30 Sep 2016: DEHAVILLAND BEAVER DHC 2 MK.1 MARKI (N6781L) — KENMORE AIR HARBOR INC

No fatalities • Lopez Island, WA, United States

Probable cause

The pilot's decision to land in an area of low visibility and ground fog, which resulted in collision with water.

— NTSB Determination

Accident narrative

On September 30, 2016, at 0837 Pacific daylight time (PDT), a Dehavilland, Beaver DHC-2 MK1, N6781L, unintentionally impacted the water near Lopez Island, Washington, while descending through a break in a cloud layer. The airplane was registered to and operated by Kenmore Air Seaplanes under the provisions of 14 Code of Federal Regulations Part 135. The commercial pilot, and one passenger sustained minor injuries, two passengers sustained serious injuries. The airplane sustained substantial damage during the accident sequence, and subsequently sunk. The scheduled commuter flight departed Kenmore Air Harbor Seaplane Base (W55), Seattle, Washington, about 0800, with a planned destination of Fisherman Bay (81W), Washington. Visual and instrument meteorological conditions prevailed along the route of flight, and a company visual flight rules (VFR) flight plan had been filed.

In a statement submitted to the NTSB investigator-in-charge, the pilot reported that he departed W55 with three passengers, and that his first planned stop was 81W. As he initiated his descent just south of Cattle Pass at 2,000 ft, he observed breaks in the undercast north of the pass. The pilot stated that he could see the water at all times during the descent, and that he could see the destination "all the way down." The pilot further stated that he then completed the landing checklist, except for flaps, and at a certain point, before turning final to land north at 81W, he lost sight of the water. The pilot reported that when he realized the approach was no longer practical, he added go-around power, raised the nose, and initiated a go-around. Shortly thereafter, the airplane impacted the water, bounced, then impacted the water again. The pilot stated that after the airplane came to rest in an upright position, water began to enter the [cabin/cockpit areas]. The pilot mentioned that after he and his three passengers had successfully egressed the airplane and been in the water from between 35 to 45 minutes, they were rescued by a motor trawler and a local Sheriff's boat. The airplane sank and was not recovered.

The pilot reported no preaccident mechanical malfunctions or failures with the airplane that would have precluded normal operation.

Air Airmen's Meteorological Information (AIRMET) SIERRA advisory for instrument flight rules (IFR) conditions, which was applicable for the accident site, was issued at 0745 PDT. It advised of ceilings below 1,000 ft above ground level (agl), visibility below 3 statute miles, mist and fog.

At 0753, the Automated Surface Observing System (ASOS) located at Friday Harbor Airport (FHR), Friday Harbor Washington, about 3.5 nm northwest of the accident location, reported wind calm, visibility 6 miles, mist, ceiling overcast at 300 ft agl, temperature 10° C, dew point 8° C, and an altimeter setting of 30.03 inches of mercury.

At 0853, the FHR weather reporting facility indicated wind 080° at 3 knots, visibility 9 miles, ceiling overcast 400 ft agl, temperature 10° C, dew point 8° C, and an altimeter setting of 30.06 inches of mercury. (Refer to the NTSB's Meteorological Specialist's report, which is appended to the docket for this accident.)

In the RECOMMENDATION section of the NTSB 6120.1 report, the operator opined that the accident occurred because of the pilot's decision to operate in an area in which there was at least some ground fog present in some areas, including at the accident site itself. According to other [company] pilots flying that morning, this area was easily avoidable with a slight flight path deviation to the west, where ceiling and visibility remained unrestricted. The operator further stated that any recommendations for prevention, therefore, must address the pilot's decision to operate where he did. Additionally, the operator referenced the Federal Aviation Administration's Risk Management Handbook (FAA-H-8083-2), stating, "...this addresses this need well, and would be the template followed for training."

Contributing factors

  • cause Pilot
  • cause Pilot
  • cause Altitude — Not attained/maintained
  • cause Effect on operation

Conditions

Weather
IMC, wind 080/03kt, vis 7sm

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