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N1229C accident description

Alaska map... Alaska list
Crash location 60.779723°N, 161.838055°W
Nearest city Bethel, AK
60.792222°N, 161.755833°W
2.9 miles away
Tail number N1229C
Accident date 07 Oct 2008
Aircraft type Cessna 208B
Additional details: None

NTSB Factual Report

On October 7, 2008, about 1706 Alaska daylight time, a Cessna 208B airplane, N1229C, was taxiing from runway 36 at Taxiway B (Bravo) at the Bethel Airport, Bethel, Alaska, when it collided with a second Cessna 208B, N411GV, which was taxiing to the runway on Taxiway C (Charlie). Both airplanes sustained substantial damage to their respective left wings. Each airplane was being operated as visual flight rules (VFR) scheduled domestic commuter flights under Title 14, CFR Part 135, when the accident occurred. N1229C was operated as Flight 165 by Grant Aviation Inc., Anchorage, Alaska. The airline transport certificated pilot seated in the left seat, and a company check airman seated in the right seat, and the 7 passengers, were not injured. N411GV was operated as Flight 413 by Hageland Aviation Inc., Anchorage. The commercial certificated pilot and seven of the eight passengers were not injured. One passenger received minor injuries. Visual meteorological conditions prevailed, and VFR company flight following procedures were in effect for each airplane.

During a telephone conversation with the National Transportation Safety Board (NTSB) investigator-in-charge (IIC), on October 7, the director of operations for Grant Aviation reported that N1229C was exiting runway 36 toward the west, near the north end of the runway on Taxiway B, and was headed for the north air taxi apron, west of Taxiway C. Taxiway B intersects Taxiway C, which parallels the west side of runway 36. The operator also indicated that since the pilot had recently been hired from Hageland Aviation, the check airman, seated in the right seat, was monitoring the flight to observe the pilot's understanding of company procedures.

The director of operations for Hageland Aviation reported the N411GV was leaving the north air taxi apron via Taxiway C, and was headed toward the south for the departure end of runway 36. The left wingtips of each airplane collided at the intersection of Taxiways B and C. The collision pivoted each airplane to the left about 45 degrees. Each airplane received structural damage to their respective wingtips, and damage to each airplane's fuselage at the inboard end of their left wings.

In the Pilot/Operator Aircraft Accident Report (NTSB Form 6120.1) submitted by Grant Aviation, the operator noted, in part, that N1229C's ability to move to the right at Taxiway B was constrained by the taxiway, and N411GV could have altered course to the right to use the ramp surface while taxiing on Taxiway C. In addition, chief pilot for the operator indicated that during telephone conversations with Bethel ATCT personnel after the collision, he was told that they did not want to file any accident paperwork, the director of operations should retract his statements to the FAA and NTSB regarding the ground collision, and if pursued, "it could create an unwanted situation for all parties involved."

In the NTSB Form 6120.1 submitted by Hageland Aviation, the operator noted, in part, that the pilot of N411GV was not instructed by the ATCT to taxi on the right side of Taxiway C, or to hold short of any intersection or runway.

Taxiway Configuration

Taxiway B is oriented east/west. It is about 75 feet wide, and its width is defined by taxiway light fixtures, and the edges of its asphalt surface, which terminate into grass areas between the runway and Taxiway C. There is a taxiway centerline stripe which transitions north and south to join the centerline stripe of Taxiway C. Taxiway C is oriented north/south. It is also about 75 feet wide, and its width is defined along the east edge by taxiway lights and its asphalt surface, which terminates into grass areas between the runway and Taxiway C. The west edge of Taxiway C, at the intersection of Taxiway B and C, is defined by a painted edge stripe that separates the taxiway from the paved non-movement area of the north air taxi apron.

The intersection of Taxiway B and Taxiway C is not large enough to accommodate two aircraft at the same time.

Communications

The Bethel Air Traffic Control Tower (ATCT) is a Federal Contract Tower (FCT), managed by Serco Management Service Inc. A review of recorded radio transmissions at the Bethel FCT revealed that at 1705:14, the ground controller (GC) issued taxi instructions to N411GV, stating, "Hageland 1GV, taxi to runway 36 at Golf."

At 1706:24, N1229C contacted ground control and stated, "Ground, 29C is off Bravo, would like to park," and the controller replied, "Caravan 29C, taxi to park on the right, use caution for company traffic." The ground controller mistakenly thought the two airplanes were from the same company. The pilot of 1229C replied, "Use caution, back to park, 29C."

At 1707:32, the pilot of N1229C contacted the ground controller and stated, "Ground, 29C, looks like we bumped wings here at Bravo." As a result of the collision, which pivoted N411GV to the left, the nose of that airplane was facing intersection Bravo.

At 1712:04, the ground controller contacted the pilot of N411GV and stated, "And 1GV, just out of curiosity, I told you to taxi to 36 and you turned there at Bravo, did you ask me for Bravo or did you go there and contact tower." The pilot of N411GV replied, "Going straight down on the right side, then 29C came out on the middle center line and then swinging out to the right, then he (unintelligible) we hit our wingtips."

The ground controller and the pilots of both airplanes had several radio transmissions that discussed whether the collision was an accident or not, and the controller was initially going to notify the Alaska Department of Transportation of an accident. Further radio transmissions occurred with the two aircraft, and at 1717:03, the pilot of N1229C stated, "No, it is not an accident, but we bumped wings. I was just trying to tell you that we hit wings. I don't know if you know that."

1717:09, the ground controller stated to N1229C, "OK roger that, well let me call the State guy and just tell him to go back to the, if we can avoid not like filling out paperwork, that would be the best thing." The ground controller directed both pilots to call him once the airplanes returned to parking. Ultimately, it was determined that both airplanes sustained substantial damage, and the NTSB was notified.

Air Traffic Control Procedures

Chapter 3, Section 7, Taxi and Ground Movement Procedures, of the FAA's Air Traffic Controllers Handbook contains instructions and phraseology for use by air traffic controllers to approve or disapprove the movement of aircraft, vehicles, equipment, or personnel on the airport's movement area. Section 3-7-2 states, in part: "Issue, as required or requested, the route for the aircraft to follow on the movement area in concise and easy to understand terms. If it is the intent to hold the aircraft short of any given point along the taxi route, issue the route, if necessary, then state the holding instructions."

Phraseology to be used by the controller for holding instructions are listed, in part, in the controller's handbook as, "HOLD POSITION; HOLD FOR (reason); CROSS (runway/taxiway); or TAXI/CONTINUE TAXIING/PROCEED/VIA (route); or ON (runway numbers or taxiways, etc,); or TO (location) or (direction); or ACROSS RUNWAY (number); or VIA (route), HOLD SHORT OF (location); or FOLLOW (traffic) (restrictions as necessary); or BEHIND (traffic)."

Following the accident, the Bethel FCT manager issued corrective actions for ATCT ground operations, which included notifying airport operators of a change in taxiing procedures, training all controllers of new taxiing procedures, and additional phraseology training of the controller involved in the accident.

The memo sent to airport operators by the Bethel FCT manager stated, in part, "Effective immediately, aircraft are no longer allowed to pass each other on any taxiway or intersection until a safety review has been completed. This includes arriving aircraft and aircraft holding short for departure."

Pilot-In-Command Responsibilities

Federal Aviation Regulation (FAR) Part 91.3, Responsibility and Authority of the Pilot-In-Command, states, in part: "(a) The pilot-in-command of an aircraft is directly responsible for, and is the final authority as to the operation of that aircraft."

Chapter 4, Air Traffic Control, Paragraph 4-3-18, Taxiing, of the Aeronautical Information Manual (AIM), states, in part: " b. ATC clearances or instructions pertaining to taxiing are predicated on known traffic and known physical airport conditions. Therefore, it is important that pilots clearly understand the clearance or instruction. Although an ATC clearance is issued for taxiing purposes, when operating in accordance with the CFR's, it is the responsibility of the pilot to avoid collision with other aircraft."

NTSB Probable Cause

The failure of both pilots to maintain adequate clearance/distance from each other at the taxiway intersection to avoid a collision. Contributing to the accident was a lack of clear and concise instruction to either airplane by the ground controller to preclude them from entering the taxiway intersection at the same time.

© 2009-2020 Lee C. Baker / Crosswind Software, LLC. For informational purposes only.