Circumstances:

The pilot had flown from Archerfield to Surfers Gardens to pick up a passenger and made a normal landing on strip 12. About 20 minutes later he was taxiing for take-off on strip 12 when the nosewheel strut collapsed, and the propeller struck the ground. The ALA had only recently been reopened after having been closed for some time due to a soft wet surface. The nosewheel had entered a slight depression prior to the strut collapsing but the depression should not have been sufficient to overload the strut to the point of failure at normal taxiing speed. Examination of the nose gear showed that the metal to metal epoxy bonding which attaches the torque tube to the airframe end fittings had failed. This failure allowed the torque tube to rotate inside the end fittings, to the extent that all normal suspension action was lost. The nose gear strut assembly then folded upwards into the engine cowls, and the propeller struck the ground. The epoxy bonding had deteriorated to the extent that the load carrying capacity of the nose gear had been substantially reduced.

Significant Factors:

The following factors were considered relevant to the development of the accident:

1. The nosewheel entered a depression whilst the aircraft was being taxied.
2. The epoxy glue which bonds the nose landing gear torque tube to the attachment fittings failed.

Recommendations:

The engineer involved in the recovery of the aircraft had previously experienced a similar failure on this type of aircraft. As a result, he had sought assistance from the American distributor. The distributor confirmed that as a result of many USA operators experiencing similar defects, a Supplemental Type Certificate (STC) number SA3564SW, had been issued allowing modification of the torque tube and end fittings. This simple modification places taper pins through the torque tube and end fittings, effectively preventing movement even if the epoxy bonding deteriorates. The Civil Aviation Authority should examine the above aspects with a view to recommending incorporation of a similar modification to all high-houred aircraft of this type.

Circumstances:

The aircraft had taken off on runway 24 towards a range of hills. Wind at the time was reported as a steady 20 knots from the south-west, straight down the runway. After take-off, the pilot retracted the landing gear and reduced power for climb. He reported that soon after, the aircraft encountered a windshear, lost airspeed, and failed to climb. He did not reapply full power. There were no clear areas ahead, so he commenced a left turn; however, the airspeed decayed further, and the left wing dropped. The aircraft struck the top branches of a 15 m pine tree, rolling inverted before coming to rest approximately 15 m from a house. The occupants were trapped in the wreckage until emergency services arrived. The accident site was approximately 1 250 m south-west of the end of the runway. The terrain is below a five percent gradient, but beyond this area it rises quite steeply to a ridge line approximately 5 km from the runway. No fault was found with the aircraft. There was evidence from propeller strike marks on severed branches that the engine had been delivering substantial power at the time of impact. The area is well known for local wind effects due to the terrain. The prevailing wind direction would have been conducive to wind shear in the lee of the ridge where the accident occurred. This is the second of three similar accidents which have occurred within an area of 1.5 km during the last few years. In each case the aircraft failed to outclimb the terrain after taking off from runway 24.

Significant Factors:

The following factors were considered relevant to the development of the accident:

1. The aircraft may have encountered windshear soon after lift-off.

2. The pilot did not operate the aircraft for maximum performance.

3. The pilot was not able to maintain speed.

Recommendations:

Over the past ten years BASI records indicate at least 16 take-off accidents to fixed wing aircraft attributed in part or totally to the effects of wind over the local terrain and to high density altitude. The following recommendations are made:

1. The CAA consider preparing an educational article to be widely distributed detailing considerations for GA type aircraft operations in areas where flight may be affected by terrain, wind, and density altitude.

2. The CAA bring to the attention of training schools the need to accent these issues in both theoretical and practical training.

Spraying operations were being conducted in generally calm weather conditions. One load had been sprayed successfully, but the pilot later advised that, as he manoeuvred at the end of the second run with the next load, sink was encountered. Although he dumped the remainder of the load, he reported that he had insufficient time to increase power. The aircraft collided with a tree, then struck the edge of a road and groundlooped into an adjacent crop. Weather conditions at the time were unlikely to have produced any sink. It was probable that while turning towards rising ground the pilot misjudged the slope of the terrain. The aircraft had stalled, with insufficient height available in which to effect a recovery.

The pilot was accompanied by two friends on a local flight to view a property in the South West Rocks area. About twenty minutes after take off, the engine commenced to run roughly and lose power. The pilot carried out a trouble check which revealed the left magneto had failed. Whilst the pilot was attempting a forced landing the engine stopped, the aircraft collided with trees before coming to rest in a semi-inverted attitude. The pilot and passengers were able to vacate the aircraft without assistance. Post accident testing of the ignition system revealed that both magnetos were unserviceable because of age deterioration of the insulation around the transformer coils. The failure of both magnetos resulted in the loss of engine power. A service bulletin was issued by the magneto manufacturer in 1973 which recommended replacement of the transformer coils in the type of magneto fitted to VH-DLT. The aircaft maintenance records show the magnetos were repaired and tested in 1985 but the transformer coils were not replaced as recommended by the service bulletin.

The pilot was cleared to conduct a straight in approach at the destination aerodrome. At a position 15 kilometres from touchdown, he commenced the prelanding checks and selected gear down. The gear selector panel indication of three green lights and a visual inspection from the cockpit windows, which included the use of an engine cowl mounted mirror to view the nose landing gear, confirmed that the landing gear was fully extended. Shortly after touchdown, the right main gear collapsed causing the aircraft to veer from the runway. An inspection of the gear and its systems revealed two defects which are considered to have contributed to this accident. The throttle warning horn had been rendered unserviceable due to a blown fuse in the warning system electrical circuit. The down-lock pin had failed to locate in the lower dragstay due to a worn bearing, allowing the stay to be misaligned from the lock pin. The down-lock microswitch is attached to the lower dragstay and does not come into contact with the down-lock pin. It is therefore possible for the gear to be fully extended, the electrical circuit to be made and three greens indicating, but for the down-lock pin to be disengaged. It is considered that the gear extended fully prior to touchdown, providing the pilot with three green indications, but remained in an unlocked state due to the misalignment of the lock assembly. As the weight of the aircraft transferred onto the gear during the landing roll, the unlocked gear collapsed. The pilot was deprived of an aural warning, due to the failed aural warning electrical warning circuit. The investigation also revealed a potential problem with the main gear ground handling lock pin system, which is used to prevent the down-lock pin from dislocating. If the down-lock pin has not correctly located in the lower dragstay, the ground handling pin is ineffective. This accident was not the subject of an on-site investigation.

The pilot intended to transport two passengers and their equipment along the Katherine Gorge. The helipad used for take-off was on the side of the gorge, some 40 feet above the river level. The pilot initiated a running take-off on the skids, but the helicopter began to sink as it left the river bank. Full throttle was applied, but without effect. As the helicopter approached the opposite bank at tree-top level, the pilot raised the collective lever in an attempt to clear the trees. The aircraft did not respond and as it continued to sink, the pilot recalled seeing the engine and rotor rpm decay towards the lower limit of the operating range. The helicopter descended into the trees and came to rest on its left side about 400 metres from the take-off point. The pilot subsequently advised that the helicopter had not been performing as well as he had expected during previous flights. Investigation revealed that the engine had been unable to develop rated power output and that the helicopter was some 114 kilograms over the maximum permissible all-up weight. Detailed examination of the turbocharger revealed that various components had suffered severe deterioration. The unit had exceeded its authorised life by nearly 400 hours. It was also likely that pilot operating techniques had contributed to the faults in the turbocharger, in that insufficient engine idling time prior to shutdown had been allowed.

The aircraft was in normal cruise at 1500 feet above sea level when the pilot noted a mild shuddering, and almost immediately the oil pressure reading dropped to zero. Shortly afterwards, the engine began vibrating severely, and the pilot was committed to a forced landing. In the latter stages of the approach the pilot was forced to pull-up to clear powerlines, following which the aircraft descended and struck a tree and a steel mesh fence at the edge of an industrial area. Investigation revealed that the flexible oil line between the engine and oil cooler had failed due to deterioration, resulting in oil starvation and seizure of the engine. Examination of Bureau records revealed three other recent occurrences in New South Wales where the subject hoses have failed in flight. The hoses are currently required to be inspected and tested every six years. However, the manufacturer recommends that the hoses should be replaced every five years or at engine overhaul, whichever comes first. The particular hose which failed had been in service for more than six years.

Circumstances:

The aircraft had been flown twice that day prior to the accident flight. No problems or unserviceabilities had been reported. The purpose of this flight was to take a youth for a joy flight and the passenger emplaned while the engine was still running after the previous flight. After take-off, the aircraft was seen by several witnesses to fly low over the strip and adjoining areas before starting a manoeuvre at low level which resulted in the aircraft apparently stalling. The aircraft was then seen to rotate several times before crashing in a near vertical attitude through several branches of a large tree. Witnesses ran to the aircraft and found the pilot dead, but they were able to free the surviving passenger from the rear seat. It would appear that at the time of the accident, the pilot was carrying out some form of impromptu display at low level or "showing off". The investigation established that the pilot was want, at times, to show off or enjoy "pushing it" or taking an aircraft to its limits. Although it was not possible to determine the exact manoeuvre performed by the pilot which lead to his loss of control, there is no doubt that he carried out a manoeuvre at low level that resulted in the aircraft stalling at a height insufficient for recovery. Such a manoeuvre was apparently induced by the pilot rather than as a result of his experiencing a problem with the aircraft. No faults or anomalies were detected in the aircraft that could have contributed to the accident. All witness evidence is consistent in that the "spin" or spiral occurred after the aircraft entered the turn at low level. During his earlier flight in the aircraft that day, the pilot was reported to have performed aerobatic manoeuvres. The aircraft was not certified for aerobatic flight, and no record was found of the pilot holding an endorsement to perform aerobatic manoeuvres.

Significant Factors:

The following factors were considered relevant to the development of the accident:

1. The pilot was engaged in an unauthorised impromptu display at low level.

2. The pilot stalled the aircraft at a height insufficient for recovery.

3. The pilot attempted manoeuvres beyond his level of experience.

Recommendations:

It is recommended that the Civil Aviation Authority

1. Require evidence of logbook endorsements for aerobatic manoeuvres, Biennial Flight Reviews, and other logbook only entry qualifications to be recorded on the departmental pilot history file.

The rudder failed when the pilot initiated a climb at the end of a spray run. The rudder was bent over at the top by about 45 degrees, but the pilot was able to maintain control of the aircraft and carry out a safe landing at Dalby. The rudder spar had failed above the top hinge point near a weld which was associated with a modification to replace the single point hinge with a three point hinge. The failure of the spar was caused by the pressure of a crack which had not been detected prior to the welding of the upper hinge modification. This accident was not the subject of an on-site investigation.

The flight had been arranged to transport a critically injured patient to hospital in Brisbane. The pilot evidently experienced some difficulty in starting one of the engines. However, witnesses reported that the engines sounded normal as the aircraft commenced moving from the parking area. At 0310 hours the pilot contacted Brisbane Flight Service Unit and reported that the aircraft was taxying. He advised that he was in a hurry, and indicated that he would provide details of the flight after takeoff. Two minutes later he advised that takeoff was being commenced from Runway 14. No further transmissions were received from the aircraft. The aircraft was seen to become airborne and shortly afterwards enter a fog bank. Other witnesses subsequently reported hearing the sounds of an impact. The investigation revealed that the aircraft had collided with a tree 800 metres beyond the aerodrome boundary, while tracking about 10 degrees to the right of the extended centreline of the runway. It had then continued on the same heading until striking the ground 177 metres beyond the initial impact point. The wreckage was almost totally consumed by fire. The extensive fire damage hampered the investigation of the accident. The surviving passenger believed that the aircraft was on fire before the collision with the tree. No other evidence of an in-flight fire could be obtained, and it was considered possible that the survivor's recall of the accident sequence had been affected by the impact and the fire. Such discrepancies in recall are not uncommon among accident survivors. The elevator trim control jack was found to be in the full nose-down position, but it was not possible to establish whether the trim was in this position prior to impact. Such a pre-impact position could indicate either a runaway electric trim situation or that, in his hurry to depart, the pilot had not correctly set the trim for takeoff. The aircraft was known to have had an intermittent fault in the engine fire warning system. The fault apparently caused the fire warning light to illuminate, and the fire bell to sound, usually just after the aircraft became airborne. The pilot was aware of this fault. It was considered possible that, if the fault occurred on this occasion as the aircraft entered the fog shortly after liftoff, the pilot's attention may have been focussed temporarily on the task of cancelling the warnings. During this time he would not have been monitoring the primary flight attitude indicator, and would have had no external visual references. It was also possible that, if for some reason the pilot was not monitoring his flight instruments as the aircraft entered the fog, he suffered a form of spatial disorientation known as the somatogravic illusion. This illusion has been identified as a major factor in many similar accidents following night takeoffs. As an aircraft accelerates, the combination of the forces of acceleration and gravity induce a sensation that the aircraft is pitching nose-up. The typical reaction of the pilot is to counter this apparent pitch by gently applying forward elevator control, which can result in the aircraft descending into the ground. In this particular case, the pilot would probably have been more susceptible to disorientating effects, because he was suffering from a bronchial or influenzal infection. Although all of the above were possible explanations for the accident, there was insufficient evidence available to form a firm conclusion. The precise cause of the accident remains undetermined. POSSIBLE