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Thursday
Nov142013

Safe Landings - November 2013

General Aviation Fuel Management Issues

 While the ASRS receives an average of 35 General Aviation fuel starvation and fuel exhaustion incident reports per year, the NTSB investigates a significantly higher number of accidents related to fuel management. The voluntary nature of ASRS reports accounts for some of the difference in the number of reports, but the higher NTSB numbers also highlight another point — the fact that fuel management errors often lead to significant aircraft damage and/or personal injury. By taking heed of the lessons in the following ASRS reports, Pilots can help reduce fuel management errors and avoid the often costly results.

“I Aimed for a Thicket of Trees”

After a Student Pilot in a PA-44 set the fuel tank selector in the wrong position, only the quick action of the Instructor changed the event from a certain accident to an ASRS incident.

Lesson 1: Know how to operate the aircraft’s fuel tank selection panel.

The student…preflighted before the start of the lesson. While running the Start checklist, I observed some mishandling of switches such as engaging the starter when he meant to press the prime button and forgetting to turn the magnetos on prior to cranking the engine. During the run up, he demonstrated satisfactory procedures while checking the systems and briefing the takeoff and emergency procedures…. We taxied to the runway for the start of pattern work and were cleared for takeoff. While the student taxied onto the runway, I performed my own personal checks by visually confirming that all mags were on and both fuel selectors were in the ON position. 

After takeoff, the Student turned a left crosswind then downwind and started his Pre-Landing checks after the gear had been extended…. Abeam the runway, I requested a touch-and-go and read back the landing clearance…. The student reduced the throttles to 15 inches MAP (Manifold Absolute Pressure), added the first notch of flaps, and pitched for a 100 knot descent…. It was at that point that I noticed irregular left engine noise. Since we were flying on a fairly humid day, I promptly turned on the carb heat of the left engine and then the right. The left engine quit immediately following the application of the carb heat. I announced, “My controls,” took control of the aircraft and proceeded to adjust mixtures, props, and throttles full forward. At that point the right engine quit as well. I pitched for 88 knots and looked right and left in search of a place to land while declaring an emergency on Tower frequency. 

At this point we were approximately 1,000 feet AGL and somewhere just north of the…highway merger. I checked the mag switches to verify that they were on. Tower asked if we required equipment and I replied, “Yes, we can’t make the airport.” After ruling out any surrounding roads due to the amount of bank required to get to them, I aimed for a thicket of trees straight ahead. Reaching between the seats to verify that the fuel selectors were in the ON position, I found them both resting at the midpoint in the OFF position. I quickly pushed both fuel selectors full forward to ON and continued the glide. In the midst of preparing for a nose-high flare into the trees, both engines fired and started developing full power, pulling the aircraft up and away from the terrain. 

After reaching a safe altitude, I updated the Tower to let them know that we had regained power and would be landing on the runway. On final approach to land, the Student started reaching for the fuel selectors and yoke to which I responded, “Don’t touch anything. I am flying and will be taking this landing.” 

After parking and shutting down the aircraft, I questioned the Student on his actions. He stated, “I looked at the fuel selectors while on downwind; they looked wrong, so I moved them.”

 “I Flared and Landed in Rows of Soybeans”

A Pilot conducting skydiving operations in a light twin aircraft learned that a questionable visual inspection of the fuel tanks may not be the best way to confirm fuel gauge readings and could result in an unplanned arrival in the produce aisles. 

 

Lesson 2: Err on the side of caution. When it comes to fuel management, err much further on the side of caution.

This incident occurred while supporting skydiving operations. The flight was conducted in VFR conditions within a four-mile radius of the airport. The flight to altitude was uneventful and I released all the jumpers at an altitude of 13,000 feet. On the way down, I noticed a fluctuation in engine power from the right engine. Moments later, the power returned. I contacted [my base] and requested the Mechanic to meet me when I got down. I turned onto a four mile final with the landing gear down and locked, but flaps still up. At that point I saw the right engine fuel pump annunciator light come on. Moments later I felt the plane surge heavily and begin to slow. I powered up both throttle levers to arrest the loss of airspeed. The airplane immediately began to bank right and continued to do so despite counter control input. I determined the right engine was not producing power. At that point I was well short of the runway at about 500 feet AGL (or less), with the airspeed decreasing to around 80 knots. I immediately brought both throttles back to idle. This stopped the uncommanded turn and I was able to nose over a bit and select an open field east of the runway. I pushed the nose down to maintain my airspeed (still at 80 knots) and seconds later was able to clear some trees and head for a soybean field. As I cleared the trees, I selected the flap lever down, flared, and landed in the rows of soybeans. The roll out was short and surprisingly smooth. While still rolling, I feathered both engines and moved the condition levers to cut off…. 

I shut everything off, got out, and determined that the airplane had suffered no damage. I also determined that there were only trace amounts of fuel in each tank.

On pre-flight I was told by the pilot operating the plane the day before, that 40 gallons were flown off of the full nacelle tanks which contain 120 gallons total usable fuel. I visually confirmed that the tanks were approximately half-full, although this is very difficult to judge accurately. The fuel gauges in the cockpit also indicated ¾-full tanks on each side. After the off-field landing, I went back into the cockpit to check the fuel gauges again and they both still indicated ¼-full. 

In retrospect I can see my efforts to determine the fuel on board before the flight were inadequate, which lead to a fuel starvation event which nearly produced a low altitude VMC roll which would undoubtedly have ended me. I am still uncertain as to the exact discrepancy between perceived fuel and actual fuel onboard and I may never reconcile this. What is certain is that in the future I will err much further on the side of caution, especially when it comes to fuel management.

“All Was Normal Until Five Minutes After Takeoff”

The Pilot of an Experimental Homebuilt aircraft miscalculated the amount of fuel onboard and didn’t believe the tank that looked empty was actually empty. Unfortunately, he ran out of fuel while enroute to another airport… to get fuel. Fortunately, he shared a lesson in common (fuel) sense. 

Lesson 3: When a fuel tank shows no visible fuel, put fuel in, regardless of what you think is in the tank.

When I flew to the airport four days previously, I noted that I had about one hour of fuel remaining, i.e., a quarter of a tank. On the morning of the incident, I went to the airport to fly 20 miles south for fuel. In this airplane, no fuel will show up on inspection when there is less than a quarter tank. The tank gauges showed enough fuel and the previous trip should have allowed enough fuel. All was normal until five minutes after takeoff when the engine quit. [I] switched to the other tank and turned back to the airport. The engine restarted and ran for a minute and then quit. I attempted to return to the airport, but was unable. I elected to land alongside the highway…. 

Now I know that I should have added enough fuel to be sure there was no possibility of running out. I am not sure why my previous experience led me to believe that there was enough fuel…. When a fuel tank shows no visible fuel, put fuel in regardless of what previous experience tells one about how much should still be in the tank. No fuel visible means no fuel and not the four gallons that I “think” is still there.

 

Friday
Oct112013

Safe Landings - October 2013

Automation Issues

As autoflight system managers, Flight Crews are responsible for entering correct information into the flight management system, selecting the appropriate flight mode and monitoring the aircraft’s compliance with the desired flight path. As pilots, Flight Crews must maintain situational awareness, stay ahead of the aircraft, use good judgment, make sound decisions based upon training and experience, and do whatever is necessary (within the constraints of good airmanship) to put the airplane where it is supposed to be. These responsibilities apply not only to air carrier and corporate crews, but with the growing use of automation, to general aviation pilots as well.

This CALLBACK presents a few recent reports in which Air Carrier Flight Crews and a General Aviation Pilot share some lessons learned regarding automation issues

A Case of Complacency

Proper use of the autoflight system requires that pilots stay “in the loop” and maintain a proactive stance in regard to “flying” the aircraft. When the automation is consistently working as advertised, monitoring becomes more of a challenge. It becomes easier for pilots to enter a reactive state of mind and unconsciously disengage from anticipating the desired flightpath. In this case of autoflight complacency, the autoflight system went off track, but the A319 Flight Crew assumed everything was okay.

Approach cleared us for the visual approach to Runway 22L via direct to the Final Approach Fix. We inserted “Direct” to the fix in the box and verified NAV mode. Autopilot #1 and “APPR” modes were selected to intercept the localizer and glideslope at the Final Approach Fix. We were at 7,000 feet, the glideslope intercept altitude, three to four miles outside of the fix and east of the centerline for 22L. As we proceeded, still in NAV mode, the airplane remained left of a direct path to the Final Approach Fix. Both pilots were watching outside the aircraft. We were still tracking towards 22L, but not tracking to the fix anymore. Tower asked us to verify that we were landing on 22L. We acknowledged that we were. It was at this point that we saw we were going to intercept the 22L centerline inside of the final approach fix rather than at the fix. We landed without incident on 22L. 

We intercepted the LOC inside of the final approach fix instead of at the fix as we were cleared. We as a crew assumed the automation was doing what it was supposed to be doing. Being that we were cleared direct and the aircraft was confirmed to do this, we did not think the track was drifting off course (15 miles away). I have never seen this happen, but I will be more aware even in visual conditions.

Distracted and Dependent

Historically, distraction has been an element in many aviation incidents and accidents. Now, with the prevalence of automation, pilots are less actively engaged in flying the aircraft and it may well be that they are even more susceptible to distractions. 

An Air Carrier First Officer reported how a cockpit conversation, when combined with autoflight dependency, was enough to adversely affect their flight.

ATC cleared us to cross [a fix] on the arrival…at the expected, planned, and standard FL230. Our altitude was FL270. The Captain and I were talking. The fix started flashing indicating station passage. I recorded the fuel on the dispatch release and then realized that I had not begun descending. I told the Captain I had forgotten to descend and reduced power to idle, full spoilers, and adjusted vertical speed to 3,500 feet per minute. As I began descending, ATC told us to change to Center. We were 4,000 feet above our crossing altitude and leveled at FL230 five to six miles after the fix. 

It was a quiet morning with conversation on the flight deck to keep our minds active. My error as the flying pilot was not initiating the descent when assigned by ATC, not perceiving the [glideslope] guidance in my scan, and the Captain not catching my error in his monitoring cross check. I should, as I usually do, begin descending immediately when assigned crossing fixes. I should, if planning a three-degree descent, ask the Captain to remind me if he sees me not acting at the descent point. I should be aware that conversation, though good in keeping the mind active, also leads to distraction from flying responsibilities especially during low levels of activity and when the automation is “flying.”

“I Was Depending on My Autopilot…”

A BE35 Pilot interrupted monitoring the autopilot to deal with a radio problem. Fortunately, an Approach Controller wasn’t distracted from the responsibility to monitor the aircraft’s flight path.

Approach Control descended me to 3,000 feet. My heading was 160 degrees. I was told to maintain 3,000 feet and turn left to 060. I was depending on my autopilot to maintain my altitude and make the turn. The radio transmission from Approach was weak and barely audible. As I tried to ascertain the problem with the radio by turning the volume up and down and tapping on the radio, Approach Control said, “What are you doing? Where are you going? What altitude are you supposed to be at?” I then noticed that my altitude was approximately 2,000 feet. I stopped the descent and asked Approach, “What do you want me to do?” Approach gave me a left turn to 040 degrees, a right turn to base leg, and then a turn to final…. 

In a telephone conversation with ATC after landing, I was told that I had busted the assigned altitude and had come within 100 feet of another aircraft.

 

Monday
Jul152013

Safe Landings - July 2013

It has been said that the only voluntary act in aviation is the decision to take-off. Every action after take-off involves the skillful management of risk, the enjoyment of flight and a continuous stream of decisions that result in a safe landing.

In 1974, NASA created the Aviation Safety Reporting System (ASRS) to allow aviation professionals to share experiences in a frank, non-punitive manner. The ASRS structure allows pilots and other aviation professionals to file an anonymous report of an incident, error or occurrence that the contributor feels might be of value to others. These reports are gathered, analyzed and data based by NASA experts and made available to all interested parties as a tool for creating pro-active aviation safety programs. Additionally, NASA distributes an electronic publication, CALLBACK, which contains selected, de-identified, reports on a free subscription basis. In Flight USA is proud to reprint selected reports, exerted from CALLBACK, for our readers to read, study, occasionally laugh at, and always learn from. Visit http://asrs.arc.nasa.gov/ to learn how you can participate in the ASRS program.

RNAV Standard Terminal Arrival Route (STAR) Issues

According to the Aeronautical Information Manual (AIM) Chapter 5, Section 4 (Arrival Procedures), a STAR is an ATC coded IFR arrival route established for application to arriving IFR aircraft destined for certain airports. RNAV STAR/Flight Management System Procedures (FMSP) for arrivals serve the same purpose but are only used by aircraft equipped with FMS or GPS. The purpose of both is to simplify clearance delivery procedures and facilitate transition between en route and instrument approach procedures. A link to the full text of AIM Section 4 can be found at the end of this CALLBACK. ASRS receives a significant number of reports every month related to difficulties with RNAV arrival procedures. Examples of reported issues include:
•    Complexity of RNAV Optimized Profile Descents (OPDs)
•    Flight crew workload
•    Aircraft system compatibility or capability
•    ATC familiarity with aircraft performance and requirements
•    Procedure interruption and phraseology

The following ASRS report excerpts provide insight into some of the complexities surrounding RNAV arrival procedures and in particular, the problems associated with the “descend via” clearance.

IAD GIBBS1 RNAV Arrival


After having been cleared to “descend via” the GIBBS1 Arrival, the flight crew of an ERJ-170 was vectored off the arrival and uncertain as to their cleared altitude. Difficulty communicating with the busy controller to clarify the altitude forced a level off at an intermediate altitude until a new clearance could be provided.

• We were descending on the GIBBS1 RNAV into IAD between BBONE and KILMR when ATC assigned us a 020 heading for traffic. Our descent clearance was “descend via the GIBBS arrival” with no specific altitude given. I told my first officer to ask ATC what altitude he wanted us at and we got no reply. After two more unsuccessful tries to get an answer (the controller was busy), I leveled the aircraft at 11,000 feet, which was the altitude for the next fix. We finally got a reply to our questions and were told to continue to descend to 6,000 feet. ??As we had been cleared to “descend via” the STAR and, when vectored off of it, were no longer on the arrival, we had no guidance as to our cleared altitude. I’ve had this happen a couple times, with different altitudes given each time; some the same as the bottom altitude [on the STAR], some different. Anytime an aircraft has been given a “descend via” clearance and is later turned off the arrival, ATC needs to assign an altitude.

DCA TRUPS1

The Flight Crew of a CRJ-200, cleared to “descend via” the TRUPS1 Arrival, was understandably confused when given a heading change and then told to “continue” the arrival. The First Officer was the Pilot Flying and provides the first report on the incident.

• We were cleared to “descend via” the TRUPS1 Arrival and a second controller had cleared us to continue the arrival via the Runway 19 transition. Prior to reaching FRDMM waypoint, the controller told us to depart FRDMM heading 120, which seemed excessive. The [crossing] restriction at FRDMM is 8,000 feet. The pilot not flying queried the controller regarding the heading, but due to congestion he couldn’t get a word in edgewise. Finally, the controller issued new instructions to continue on the arrival. We were now at 8,000 feet and were past FRDMM [and were descending to comply with] the next crossing restriction of 6,000 feet [at STAND]. Shortly thereafter, the controller issued another heading change and took us off the arrival. Seconds prior, when [we were] on the arrival, we had continued our descent. I asked the captain to ask for clarification the controller replied that we were told to “continue on” the arrival and not to “descend via” the arrival. We quickly returned to 8,000 feet and were cleared for the River Visual shortly thereafter. The instructions were confusing at best. We were given a heading and, when we asked to confirm the heading, the response was changed to “stay on the arrival.” If the controller had said, “Stay on the arrival; maintain 8,000” the confusion would not have occurred.

From the captain’s report on the same incident:

• After crossing FRDMM, we started to descend to 6,000 feet per the STAR and at the same time the controller issued a heading change. I asked the First Officer if we should continue the descent since ATC just took us off the arrival and shortly after ATC asked us if we were still at 8,000 feet. I told him we were returning to 8,000 feet but thought we were still cleared to descend [as previously cleared] “via” the arrival. He explained that our new instructions were to “continue,” not to “descend via” the arrival.

PHX GEELA4


A controller report highlights the confusion that can occur when runway “transition” clearances are given in conjunction with RNAV arrivals.

• It was a busy arrival push into PHX this morning. With the GEELA4 RNAV arrival there are quite a few more transmissions that need to be made to ensure the pilot will do what we need him to do. If the pilot is to “descend via” the arrival, well that’s a straight-forward clearance. When we have to vector the aircraft for sequencing, the phraseology to put the aircraft back on the arrival is very confusing. An A320 was issued a clearance to cross GEELA at and maintain 12,000 feet and 250 knots. The pilot read this back correctly. The pilot was then issued, “Cleared for the GEELA4 Arrival, Runway 7R transition.” At no point was a “descend via” clearance given or read back. The aircraft then called PHX Approach and said he was descending “via” the arrival. ??We need to come up with some type of phraseology that will allow us to clear the aircraft for the arrival and transition without the pilot thinking he is cleared to “descend via” the arrival. It seems the pilots are associating the runway transition with a “descend via” clearance. Maybe we should give the runway transition on initial check in, if that is legal.

The complete AIM Section 4 Arrival Procedures can be found at: http:// www.faa.gov/air_traffic/publications/ atpubs/aim/aim0504.html

Thursday
Jun062013

Safe Landings - June 2013

It has been said that the only voluntary act in aviation is the decision to take-off. Every action after take-off involves the skillful management of risk, the enjoyment of flight and a continuous stream of decisions that result in a safe landing.

In 1974, NASA created the Aviation Safety Reporting System (ASRS) to allow aviation professionals to share experiences in a frank, non-punitive manner. The ASRS structure allows pilots and other aviation professionals to file an anonymous report of an incident, error or occurrence that the contributor feels might be of value to others. These reports are gathered, analyzed and data based by NASA experts and made available to all interested parties as a tool for creating pro-active aviation safety programs. Additionally, NASA distributes an electronic publication, CALLBACK, which contains selected, de-identified, reports on a free subscription basis. In Flight USA is proud to reprint selected reports, exerted from CALLBACK, for our readers to read, study, occasionally laugh at, and always learn from. Visit http://asrs.arc.nasa.gov/ to learn how you can participate in the ASRS program.

Weather and Aeronautical Information Services and Data Link Issues

In cooperation with the Federal Aviation Administration (FAA), the Aviation Safety Reporting System (ASRS) initiated a study of meteorological (MET) and aeronautical information services (AIS) received via data link. The purpose of the study was to analyze information from users of data link technologies as reported in ASRS incident reports. Qualitative assessments of available records provided valuable insight on data link user interface and actual cockpit experiences related to data link weather or AIS information. The preliminary findings in the Study included:

The incident reports within the study group were almost equally divided between air carrier operations and general aviation

The majority of reporters’ comments regarding MET data link usage were positive and indicated that the technology was a valued tool in the mitigation of adverse weather encounters
The problems most often cited in regard to MET data link information were related to the timeliness of the data

The following ASRS report excerpts were taken from the data set that was used for the Meteorological and Aeronautical Information Services Data Link Study.

A Dangerous Dilemma

A PA-32 Pilot experienced hazardous weather conditions after relying upon data link weather for a “real time” picture of enroute conditions.

• While in cruise flight, it became necessary to deviate due to existing and building thunderstorms. ATC had advised me of the largest storm which I had visually… The storm was to the north. I was also using XM downloaded weather for information. When the XM indicated it was safe to turn more northerly, I advised ATC that I was starting my turn and he agreed that the turn looked “good to him.” I went IMC momentarily and when I broke out there was a large buildup at my twelve o’clock position. The main storm was still off to my right. I could see several breaks around the buildup. I requested and was approved for a climb to 10,000 feet in an attempt to remain visual on the buildup. I was unable to do so and encountered IMC. While IMC, I flew into an area of fast building weather that was joining up with the known cell to my right. I advised ATC of my dilemma and he was very surprised to see how quickly the cell was developing. He vectored me through the safest part of it. I was forced to use every method from my training by turning the autopilot off, slowing, and keeping the wings level. At one time with [climb power] I was descending at 1,500 feet per minute. I eventually exited the weather…. ATC advised that the area had completely closed up. Only then did the XM weather update to reflect the actual conditions that existed. The great guy at ATC was almost as nervous as I was. The delay of the update with the speed of the buildup of these air mass thunderstorms resulted in an inaccurate pictorial that I was using to determine my route of flight.

“I Thought I Would Have an Uneventful Arrival”

When fast moving convective activity is present, more than a good preflight briefing and onboard NEXRAD information may be needed to keep up with current conditions. After enduring an unexpected “flight” on the ramp, this M-20 Pilot recognized that a false sense of security was a factor in his not getting real time data from Flight Watch.

• Just prior to departure I received a full VFR weather briefing which contained no SIGMETs. The forecast was VMC for the entire route. Mention was made of some convective activity, but it was not expected to affect my route of flight. Enroute, I had access to XM weather and SkyRadar. One hour prior to my ETA, I noticed a large cell with Level 6 activity within… I made some preliminary plans for an alternate, but as I approached within 20 minutes of my destination, I thought I would have an uneventful arrival. ATIS was reporting winds 280 degrees at 10 knots gusting to 14 knots with a broken ceiling at 5,500 feet. Approach Control and Tower casually mentioned the weather, but there was no sense of urgency concerning the developing situation. On a two mile final, lightning struck the field. As I flared to land, a large microburst was observed on the airport and wind gusted to 40 knots. By this point I landed and started to taxi to the ramp. Rain and wind became torrential and the aircraft started to weather vane on the taxiway. I maintained appropriate control inputs and made it to the ramp where I turned the aircraft into the wind, kept the engine running and maintained full forward yoke and full nose down trim. At times the wind gusted to 55 knots. The NEXRAD display was displaying Level 6 returns over the field. The rainwater on the ramp had whitecaps. Tower did a great job of keeping me informed of wind direction and speed. I “flew” on the ramp for 20 minutes before the winds let up…. I have always considered myself cautious and not a risk taker. I have not hesitated to deviate in the past when weather was dangerous. I am ashamed of my judgment during the conclusion of this flight. There were several factors that led to my decision… I had a false sense of security about the weather that led me to make an inappropriate decision. I could not believe a convective cell could move that fast… I should have been talking to Flight Watch to get real time data about the direction and velocity of the cell.

TFR Troubles

The ASRS Data Link Study noted that a number of incident reports cited missing, inadequate or late AIS data. This PA-28 Pilot’s experience was an example of how delayed TFR information can “pop up,” after it is too late.

• I departed…and flew direct…on a VFR flight. I thought I was departing just prior to the Presidential TFR, which I believed to be starting in 15 minutes… Unfortunately I was mistaken on the TFR start time either due to a change or an error on my part, but the TFR went into effect two minutes before I departed. I was asked upon landing to call the FAA, which I did…. The AWOS that I checked via phone prior to departure did not have any special NOTAMs for the TFR… In addition, my Garmin 496 must have been delayed with the data feed because I only saw the TFR pop up on my display as I was leaving the TFR.

Monday
Apr292013

Safe Landings - May 2013

Gear Up Landings – Getting a Handle on the Problem

Over the past five years, ASRS has received an average of 60 gear up landing reports per year. Gear up landings rarely meet the damage or injury requirements for a National Transportation Safety Board (NTSB) report or investigation and they are seldom reflected in general aviation safety statistics. Nevertheless, no pilot wants to experience a gear up landing. There is always the potential for a serious outcome and the repair costs associated with any gear up landing can be substantial. 

To avoid the risks and costs associated with gear up landings, pilots can get a handle on the lessons offered in these ASRS reports.

Scrape and Go Landing

A malfunctioning gauge, failure to use a checklist and the absence of a gear warning horn were all factors in this blade-bending low approach.

• A Student Pilot and I were performing practice landings in a C172RG. On the upwind of a touch and go we noticed that the manifold pressure gauge was reading atmospheric pressure no matter what the throttle position. The engine was still performing normally, but we decided to make the next landing a full stop. I took the controls momentarily on the start of the downwind so that the student could tap the gauge. We exchanged controls again and requested a full stop. We were performing short approaches and got clearance for another short approach. The Student reduced throttle (the manifold gauge still read atmospheric pressure) and selected flaps to 20 degrees. We touched down gear up, the Student added power and I took the controls and put the gear down. 

As I climbed out, an aircraft in the run-up area notified Tower about what had just occurred. Tower asked if we needed any assistance. The plane was flying normally so we declined, obtained a clearance to land and flew the pattern. I flew the aircraft, performed a soft field landing and taxied back. Upon shut down it was found that the prop did strike the ground. 

There were several human factors involved…. I failed to verify that the gear was down with my own checklist. I also relied on the aircraft too much to warn us that the gear was not down, but due to the fact that the manifold pressure was at an atmospheric level and the flaps were only at 20 the horn did not go off. 

The cause of the prop strike was lack of checklist usage, lack of communication during the exchange of controls, fixation on the inoperative instrument, complacency, and failure to verify that the gear was down…. Also, we should have notified Tower of the manifold pressure situation. It might have slowed us down in the cockpit as well as drawn attention to us by the Tower who may have notified us that our gear was still up. 

A Hull of a Mess

Switching from wheels up for water landings to wheels down for hard surface landings requires an extra measure of attention for pilots of amphibian aircraft. A series of water landings followed by distractions on final contributed to this Amphibian Pilot’s off-lake, gear up landing.

• I was supposed to have a Biennial Flight Review (BFR) and insurance re-currency flight in an aircraft that was right out of annual inspection…. I had not flown in 12 months so I was rusty and my Instructor was aware of this. We got in the air and did some pattern work. After about six landings we departed the airport to do some water landings and taxi work…. I proceeded back to our departure airport and was given a straight in approach for the runway. I was distracted with a logbook issue along with the fact that I would not be able to get my plane back to its base because I was not night current. We got into a conversation on how to proceed while I was on short final. We were both distracted and not going through the checklist and landed on the hull, gear up. 

I know that I share some blame on this because I know better than to be distracted in the cockpit.

If at First You Do Succeed…

It is never a good idea to second guess a landing gear warning indication. You might get away with it once or twice, but as this Bonanza 36 Pilot learned, there are times when it is not prudent to try, try again.

 

• The aircraft had been sitting in the owner’s hangar for several months without activity and I had been asked to fly it. The records available and the preflight all seemed excellent and all went well until I was to land. I did not get the gear down indication. I asked the Tower to visually check my gear and they suggested a low pass…. As I turned crosswind I could see my shadow on the ground and I could see that the gear was indeed down. As I passed the Tower I did not get a transmission from them. I proceeded to land as previously instructed and noticed that the radios were failing which explained why I had not heard from the Tower. I landed without incident and followed an operations vehicle to the main ramp and my hangar.

I discovered that the problem was loss of battery power and alternator output…. The electrical problem was corrected during the evening by re-charging the battery. I felt this had explained the gear indication problem and the radio failures.

On the following day… the Before Start and Taxi Checklists were completed and it was noted that all systems were functioning and three green lights with gear down were noted. Subsequently the flight proceeded to a nearby airport. I planned to use this uncontrolled field to do several takeoffs and landings to become familiar and current in the aircraft.

On the first landing I did not see three green gear lights, but there was no gear warning horn. Based on having had this same scenario the day prior, I continued and landed without incident. Because of a change in winds I decided to switch runways for the next takeoff and landing. This was accomplished with the same experience of no green gear down lights, but also no gear up horn.

Becoming uncomfortable with this condition, I decided to return to my final destination for resolution of the discrepancy. 

I was cleared to enter a visual right base…. When I put the gear down I heard no gear horn, but I did not see three green lights. The aircraft settled to the runway level and slid straight ahead. The gear were actually partially extended, but apparently not locked. I immediately exited the aircraft having shut the fuel off, closed the mixture and turned off the battery, alternator, and ignition. There was no fire or smoke, and I stood on the runway awaiting assistance.

Before flying an aircraft that had been so long in storage, maintenance personnel should have been consulted and an inspection and survey of the aircraft for proper airworthiness should have been made. My unfamiliarity with the aircraft was certainly a factor also.

 

What Goes Up, Doesn’t 
Always Come Down

Troubleshooting an electrical problem, a C210 Pilot, accompanied by a Maintenance Technician, cycled the landing gear a few times and then lowered and verified the gear down for a final landing. In an effort to make one last check, the gear was cycled again. Unfortunately, only half of the cycle was completed.

 

• The aircraft had just come out of repair for a failed alternator. Upon starting the engine the alternator again failed, but after shut down and restart, it worked until just after takeoff then failed again. So I landed uneventfully and returned to the FBO. During taxi the alternator restarted then briefly failed again. The Mechanic offered to come with me for a test flight to see if an over-voltage transient could be triggering the problem. At his suggestion, we stayed in the traffic pattern, cycling the gear up and down a few times, but could not duplicate the problem. After the first touch and go we still hadn’t seen a problem. On downwind, I lowered the gear as usual and did a GUMPS* check. The Mechanic then suggested cycling the gear once more. I raised it, but failed to lower it. Just before touchdown, the Tower noticed the lack of gear and called for a go-around, but it was too late and we landed gear up with full power.

Lessons: 1) Do maintenance work at altitude away from the airport 2) Maintain a sterile cockpit in the pattern and, 3) Do a GUMPS check on final.

 

*GUMPS is a commonly used acronym that is used as a final check to ensure that an aircraft is properly set up for landing. It should not be used as a substitute for the specific aircraft’s descent, approach, and landing checklists.

Gas (fullest tank)

Undercarriage (gear down and locked)

Mixture (full rich)

Propeller (high RPM)

Switches (fuel pumps, magneto check, landing lights, etc.)

C-GUMPS can be used when flying a plane with a carbureted engine; “C” standing for Carburetor (heat on).

 

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