What happened
On the night of September 14, 1999, an EMB 110 C, registration PT-ODK, operated by Norte Jet Táxi Aéreo Ltda, was performing a cargo flight from Belém to Monte Dourado, Pará. The aircraft was transporting approximately 1,636 kg of abrasive grit, which was distributed in 36 paper bags across the cabin floor without any securing straps. Due to the cargo configuration, the aircraft seats had been removed.
During the approach to Monte Dourado, while executing the ECHO-1 procedure, the aircraft experienced a sudden loss of power in the left engine. Approximately three minutes after the crew reported the start of their descent, a transmission was received by the Monte Dourado radio station stating that the aircraft was "falling." The aircraft subsequently struck trees and impacted the ground at a 50-degree nose-down angle in a forested area. The impact and subsequent fire destroyed the aircraft, making it a total loss. Both pilots sustained fatal injuries.
The investigation
The CENIPA investigation focused on the mechanical failure of the left engine and the operational conditions of the flight. Investigators examined the left P&W PT6A-27 engine and discovered an aluminum chip within the Fuel Control Unit (FCU) metering section. This foreign object had caused the unit to jam at a power setting below the minimum required for the flight phase. It was hypothesized that this debris may have been introduced during a 1,200-hour inspection performed months prior.
Furthermore, the investigation scrutinized the aircraft's weight and balance. The aircraft had departed Belém with a weight of approximately 6,250 kg, significantly exceeding the maximum takeoff weight of 5,600 kg. At the time of the engine failure, the aircraft was still approximately 595 kg above the maximum landing weight of 5,300 kg. The investigation also noted that the aircraft was not configured for cargo operations according to required service bulletins and lacked sufficient fuel autonomy for the return leg.
Findings
- Foreign object debris: An aluminum chip in the left engine's FCU caused the power loss.
- Overweight operation: The aircraft was operating significantly above both maximum takeoff and maximum landing weight limits.
- Improper cargo securing: The cargo was not lashed or secured to the aircraft floor.
- Operational non-compliance: The crew and the operator demonstrated a pattern of complacency regarding flight safety regulations, including accepting flight plans with insufficient fuel autonomy and excessive weight.
- Maintenance uncertainty: While the exact source of the debris was unconfirmed, the investigation highlighted risks associated with the assembly of fuel lines during maintenance.