What happened
On July 10, 1997, a PA-31T Cheyenne, operated by ATR Travessia Táxi Aéreo, was performing a visual flight rules (VFR) flight from Recife to Garanhuns, Pernambuco. The flight, carrying two pilots and one passenger, proceeded normally through the cruise phase at 10,500 feet.
Upon arrival at Garanhuns (SNGN), the aircraft attempted a landing on a wet runway. During the landing roll, the nose gear strut failed, causing the aircraft to strike the ground with its propellers. The aircraft traveled approximately 400 meters from the initial touchdown point until it came to a complete stop. The impact caused severe damage to both engines and rendered the propellers unserviceable, though the airframe sustained only minor damage. There were no injuries to the crew or the passenger.
The investigation
CENIPA investigators examined the wreckage and the nose gear actuator cylinder. Laboratory analysis conducted by the Institute of Aeronautics and Space (IAE) utilized scanning electron microscopy and metallographic exams, which ruled out fatigue or pre-existing cracks. The investigation concluded that the fracture in the nose gear actuator rod occurred due to overload.
Investigators also analyzed the flight dynamics, noting that the aircraft touched down between the first and second third of the runway. Evidence suggested a high, unstabilized approach characterized by excessive speed. The investigation also considered the meteorological conditions, which included low ceilings and rain, and the state of the runway, which was wet and contained small potholes.
Findings
- The nose gear actuator rod failed due to an overload caused by the aircraft's nose hitting the ground before the main gear.
- The approach was likely unstabilized, with the pilot performing a high and fast approach, potentially to maintain visual contact with the runway under low cloud ceilings.
- A possible tailwind component during landing contributed to the increased landing roll distance.
- There were indications of poor Crew Resource Management (CRM), as the co-pilot reportedly acted as a spectator rather than an active participant in decision-making.
- The pilot's high level of experience and self-confidence may have led to a loss of situational awareness and a failure to execute a go-around despite the unstable approach.
Safety action
- The Department of Civil Aviation (DAC) was tasked with evaluating the implementation of psychometric testing for pilots aged 55 and older during medical inspections.
- SERAC 2 was directed to conduct a flight safety inspection of the Garanhuns aerodrome to address runway surface issues, such as potholes and faded markings.
- The operator was advised to implement an accident prevention program focusing on flight planning and Crew Resource Management (CRM) training.