Status: | Accident investigation report completed and information captured |
Date: | Sunday 2 August 2009 |
Time: | 11:00 |
Type: | de Havilland Canada DHC-6 Twin Otter 300 |
Operator: | Merpati Nusantara Airlines |
Registration: | PK-NVC |
MSN: | 626 |
First flight: | 1979-05-30 (30 years 2 months) |
Total airframe hrs: | 27336 |
Engines: | 2 Pratt & Whitney Canada PT6A-27 |
Crew: | Fatalities: 3 / Occupants: 3 |
Passengers: | Fatalities: 12 / Occupants: 12 |
Total: | Fatalities: 15 / Occupants: 15 |
Aircraft damage: | Destroyed |
Aircraft fate: | Written off (damaged beyond repair) |
Location: | 42 km (26.3 mls) N of Oksibil Airport (OKL) ( Indonesia)
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Crash site elevation: | 2834 m (9298 feet) amsl |
Phase: | En route (ENR) |
Nature: | Domestic Scheduled Passenger |
Departure airport: | Jayapura-Sentani Airport (DJJ/WAJJ), Indonesia |
Destination airport: | Oksibil Airport (OKL/WAJO), Indonesia |
Flightnumber: | MZ9760D |
Narrative:A Merpati Nusantara Airlines DHC-6 Twin Otter passenger plane was destroyed when it flew into the side of a mountain during a domestic flight from Jayapura (DJJ) to Oksibil Airport (OKL). Merpati Flight MZ9760D took off at 10:15 with an estimated time of arrival at Oksibil of 11:05. The pilots were operating under visual flight rules (VFR) procedures. This required them to remain clear of cloud. Ten minutes before impact the pilot in command mentioned climbing to 10,000 feet, and stated "if we cannot go visual I will turn left". The cockpit conversations did not exhibit any signs of stress or concern until two minutes before the impact, when the copilot mentioned haze and asked the captain if he could see. Fifty seconds before impact, the copilot expressed further concern and asked about the captain's intentions, and the captain said "climb, to the left". Forty-two seconds before impact the copilot asked if it was safe on the left.
The copilot became increasingly uncertain about the safety of the flight, specifically mentioning visibility and speed. From the recorded sounds, it is apparent that 13 seconds before impact, engine power was increased symmetrically to a high power setting. The Twin Otter struck the side of a mountain at an elevation of 9300 feet.
The wreckage was located August 4 with some difficulty because the ELT was unserviceable.
Probable Cause:
CAUSES: "The pilots did not maintain visual flight procedures when flying below lowest safe altitude, and the aircraft was flown into cloud in the vicinity of gap north west of Oksibil. The accident was consistent with controlled flight into terrain."
Accident investigation:
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Investigating agency: | NTSC Indonesia |
Status: | Investigation completed |
Duration: | 262 days (9 months) | Accident number: | KNKT.09.08.21.04 | Download report: | Final report
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Classification:
Controlled Flight Into Terrain (CFIT) - Mountain
Sources:
»
SKYbrary » Departemen Perhubungan news releases
» Inilah Nama Penumpang dan Awak Merpati yang Hilang di Papua (Kompas, 2-8-2009)
» All 15 On Crashed Papua Plane Are Dead: Airline Director (Jakarta Globe, 5-8-2009)
Follow-up / safety actions
NTSC issued 4 Safety Recommendations
Issued: -- | To: Merpati Nusantara | 04.O.2011.15.1 |
The National Transportation Safety Committee recommends that PT. Merpati Nusantara Airline review its maintenance procedures and maintenance inspection programs, to ensure that Emergency Locator Transmitters are serviceable. (CLOSED) |
Issued: -- | To: DGCA Indonesia | 04.R.2011.15.1 |
The National Transportation Safety Committee recommends that the Directorate General of Civil Aviation review the training and checking requirements for pilots operating in remote and mountainous regions such as Papua.
- Particular attention should be given to visual flight operations in mountainous and unpredictable weather conditions. This should include intensive route and aerodrome familiarization in locations, and over routes, where aids such as EGPWS, TAWS, GPS, and Radio Altimeter are not effective, are not practical, or are not available. |
Issued: -- | To: DGCA Indonesia | 04.R.2011.15.2 |
The National Transportation Safety Committee recommends that the Directorate General of Civil Aviation issue an urgent notice to airmen (NOTAM) to remind pilots that flight below lowest safe altitude, in particular in mountainous regions, must be conducted in accordance with the visual flight rules (VFR). |
Issued: -- | To: DGCA Indonesia | 04.R.2011.15.3 |
The National Transportation Safety Committee recommends that the Directorate General of Civil Aviation liaise with the Meteorologi Klimatologi dan Geoficika (BMKG) to establish an aviation weather information service for all areas covered by civilian aircraft operators. |
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Photos
accident date:
02-08-2009type: de Havilland Canada DHC-6 Twin Otter 300
registration: PK-NVC
accident date:
02-08-2009type: de Havilland Canada DHC-6 Twin Otter 300
registration: PK-NVC
Aircraft history
30 MAY 1979 |
PH-SAY |
de Havilland Canada |
first flight
|
21 JUN 1979 |
PH-SAY |
Schreiner Airways |
delivered
|
21 AUG 1984 |
N5467X |
Crown Air |
|
23 OCT 1986 |
PH-SAY |
Schreiner Airways |
registered
|
19 DEC 1986 |
9M-PEG |
Pelangi Air |
|
APR 1990 |
9M-BMM |
Boskym Udara |
|
10 NOV 2006 |
PK-NVC |
Merpati Nusantara Airlines |
registered
|
Map
This map shows the airport of departure and the intended destination of the flight. The line between the airports does
not display the exact flight path.
Distance from Jayapura-Sentani Airport to Oksibil Airport as the crow flies is 258 km (161 miles).
Accident location: Exact; as reported in the official accident report.
This information is not presented as the Flight Safety Foundation or the Aviation Safety Network’s opinion as to the cause of the accident. It is preliminary and is based on the facts as they are known at this time.