Investigation Summary
The flight was a repositioning ferry from Bridgeport, Connecticut, to Lebanon, New Hampshire. During the initial ILS approach to Runway 18, the crew reported they were unable to receive the localizer. In reality, the aircraft was approximately 5 nautical miles to the left of the course, likely due to strong 40-knot crosswinds at altitude that the crew had not accounted for. After executing a missed approach, the captain requested the VOR Runway 25 approach. The crew's briefing for this second approach was rushed and incomplete. While outbound for the procedure turn, the captain directed the first officer to descend to 2,900 feet, despite the minimum safe altitude being 4,300 feet. As they turned inbound, the captain misidentified a step-down fix (the outer marker) and authorized a further descent to 2,300 feet. The first officer noted that the VOR indications were fluctuating and 'all over the place,' but continued the descent. The aircraft impacted trees and terrain at the 2,300-foot level, approximately 10.3 nautical miles before the point where such a descent was authorized. Because the aircraft was exempt from ELT requirements under FAR Part 135 at the time, no signal was transmitted, and the wreckage remained undiscovered in dense forest until November 1999.
Final Conclusions
The NTSB concluded the probable cause was the captain's failure to maintain situational awareness and the crew's misinterpretation of a step-down fix passage, resulting in an early descent into terrain. Contributing factors included a rushed approach briefing, failure to use available DME or other navigational aids, and failure to account for high-velocity winds at altitude.
Video Analysis
No video analysis linked for this case file yet.
Airframe & Maintenance
Systems & Failure Modes
Emergency Locator Transmitter (ELT)
The absence of an ELT prevented searchers from narrowing the 2,800 square mile search area, leading to a three-year delay in recovery.
VOR/DME
The crew failed to utilize available Distance Measuring Equipment (DME) which would have provided their exact distance from the airport and prevented the premature descent.
Interesting Facts
- 01The search for the aircraft lasted nearly three years, the longest in New Hampshire history.
- 02The aircraft was not equipped with an Emergency Locator Transmitter (ELT) as it was exempt under then-current FAR Part 135 regulations.
- 03The crash site was located 10.3 nautical miles prior to the authorized descent point for 2,300 feet.
- 04Winds at 6,000 feet were exceeding 40 knots, significantly affecting the aircraft's track.
- 05The wreckage was spread over a 150-yard area in a densely forested region.
Safety Actions & Advisories
ELT Mandate for Business Jets
Following the crash and the prolonged search, Congress directed the FAA to require the installation of 406MHz ELTs in all U.S. registered business jets, removing previous exemptions.