What happened
On February 7, 1998, an EMB 201 Ipanema, registration PT-GQC, departed from an uncertified airstrip in Campo Novo dos Parecis, Mato Grosso, for a local flight. The aircraft was operated by Aviação Agrícola Gaivota Ltda and was carrying the pilot and one passenger seated in the baggage compartment behind the pilot's seat.
Following takeoff, the pilot performed intentional low-altitude passes over the center of the city at approximately 30 meters. During the return to the airfield, the pilot attempted to enter the final approach for runway 36 via a right-hand turn. During this maneuver, the aircraft entered a stall and collided with the ground. The impact resulted in the death of the pilot and serious injuries to the passenger. The aircraft sustained severe damage to its structure, engine, and propeller.
The investigation
CENIPA investigators established that the aircraft was being operated outside of its approved envelope. The aircraft's Certificate of Airworthiness had been canceled, and its annual maintenance inspection (IAM) was 12 years overdue. Furthermore, the pilot was flying with an expired medical certificate.
Technical analysis of the wreckage revealed that the aircraft's center of gravity (CG) was at 29.3% of the Mean Aerodynamic Chord (MAC), exceeding the maximum allowable limit of 27% due to the presence of the passenger in the rear compartment. This aft CG shift made the aircraft's pitch control highly sensitive. Physical evidence from the engine and propeller indicated the engine was at low power at the moment of impact. Investigators also noted that the pilot had consumed a large quantity of alcohol several hours before the flight, having gone to sleep only after 5:00 AM on the day of the accident.
Findings
- Aft Center of Gravity: The presence of a passenger in the baggage area shifted the CG beyond limits, increasing pitch sensitivity.
- Loss of Control: The combination of a tight right-hand turn, low airspeed, and low altitude led to an aerodynamic stall.
- Pilot Impairment: The pilot's physiological state was compromised by recent heavy alcohol consumption, likely affecting judgment and reflexes.
- Operational Deviations: The pilot intentionally disregarded safety regulations, including performing low-altitude maneuvers over populated areas and operating an aircraft with expired maintenance and airworthiness documentation.