Aviation Accident Summaries

Aviation Accident Summary NYC93FA133

VESTAL, NY, USA

Aircraft #1

N5932L

American General Aircraft AA-1

Analysis

THE FLIGHT INSTRUCTOR AND STUDENT PILOT DEPARTED ON A LOCAL TRAINING FLIGHT. TEN MINUTES AFTER DEPARTURE, THE AIRPLANE WAS OBSERVED IN A DESCENDING SPIRAL, WITH THE ENGINE RUNNING, OVER AN AREA WHERE FORCED LANDINGS WERE PRACTICED. A WITNESS OBSERVED THE AIRPLANE LEVELING OFF AS IT WENT BEHIND A HILL TOP, THEN HEARD THE AIRPLANE IMPACT THE GROUND. ANOTHER WITNESS HEARD THE ENGINE BACKFIRING, FOLLOWED BY THE SOUND OF IMPACT. POST ACCIDENT INVESTIGATION REVEALED THE STUDENT PILOT/OWNER OF THE AIRPLANE WAS PERFORMING HIS OWN MAINTENANCE. THIS INCLUDED CHANGING ENGINE PISTONS AND RINGS. NUMEROUS FUEL STAINS WERE OBSERVED OVER SEVERAL COMPONENTS OF THE ENGINE. THE CARBURETOR MIXTURE SCREW WAS SET TO THE MAXIMUM LEAN CONDITION. DUCT TAPE AND ELECTRICAL TAPE HAD BEEN USED EXTENSIVELY FOR REPAIRS ON THE AIR INDUCTION SYSTEM.

Factual Information

HISTORY OF FLIGHT On Tuesday, June 29, 1993, at about 1525 eastern daylight time, an American General AA1, N5932L, piloted by David R. Jones, was destroyed when it impacted the ground in a field, approximately 3 miles south of the Tri-Cities Airport, Endicott, New York. The Certified Flight Instructor, and the student pilot, were fatally injured. Visual meteorological conditions prevailed. A flight plan had not been filed for the flight operating under 14 CFR 91. The student pilot, David W. Ford, and the Certified Flight Instructor, David R. Jones, departed the Tri-Cities Airport for a local training flight at approximately 1515. Michael Ackley, a pilot at the Tri-Cities Airport, spoke to David Ford prior to the accident flight: "...I...spoke with Dave Ford quite often and he told me that he was having engine problems and...they were there when he brought the airplane. He said that he had tried everything...Dave Ford told me that he wanted Dave Jones to fly with him so Jones could tell for himself whether or not it would be exceptable [sic] for a check ride airplane." In an interview with Robert Parry, the owner of a Flight School at the Tri-Cities Airport, he stated: "...A practice area for the airport is the vicinity of the crash site. That area would have been an entry point for the airport traffic pattern and is a place where forced landings are practiced." A witness, Mr. Charles R. Buchanan, was interviewed by the Vestal Police. In summary he stated, when he first saw the airplane, it was over the south side of Baker Hill Road, and it did not appear the pilot was having any difficulty controlling it. When asked what the airplane was doing when he first observed it, he stated, "It was spiraling toward the ground." Mr. Buchanan indicated the airplane's engine was running during the spiraling descent. He also stated that it appeared the nose of the airplane did start to pull up, when he lost sight of it behind trees. Approximately 2 seconds later he heard a crash. Mr. Cady, a resident near the accident site stated: "...I was at my residence in the house when I heard what appeared to be an engine shutting on and off which is common, due to the fact that we are in some type of flight pattern with Tri-Cities. This particular sound was a little different, it appeared to have some type of backfiring. I looked out back...I heard some type of thud..." The accident occurred during the hours of daylight at approximately 42 degrees, 2 minutes north latitude, and 76 degrees, 5 minutes west longitude. PERSONNEL INFORMATION The flight instructor, David R. Jones, held an Airline Transport Pilot Certificate with ratings for airplane multi- engine land, and Commercial Pilot Privileges for airplane single engine land, single and multi-engine sea, rotorcraft-helicopter and glider. He also held a Flight Instructor Certificate for airplane single and multiengine land, instrument airplane and glider. His most recent Federal Aviation Administration (FAA) First Class Medical Certificate was issued on April 1, 1993. Mr. Jones's pilot log book was not located. According to FAA, and Company records, Mr. Jones's total flying time exceeded 19,000 flight hours, of which he had accumulated over 1500 hours as a flight instructor. Mr. David W. Ford was the owner of N5932L. He held a Student Pilot Certificate with a solo endorsement for this airplane. His most recent FAA Third Class Medical was issued on August 20, 1992. Mr. Ford's pilot log book indicated he had accumulated approximately 141 flight hours as of June 21, 1993. WRECKAGE AND IMPACT INFORMATION The airplane wreckage was examined at the accident site on June 30, 1993. The examination revealed that all major components of the airplane were accounted for at the scene. Landing gear ground scars, 25 feet south of the main wreckage, indicated an impact heading of approximately 300 degrees, 10 feet from a tree line. The airplane came to rest inverted, on an approximate heading of 010 degrees, in a tree line corner, at the edge of a sloping field. The terrain elevation at the impact site was approximately 1500 feet, above mean sea level. The landing gear impact scars, 25 feet south of the main wreckage, measured about 11 feet apart. Three feet in front of, and centered on, the landing gear impact scars, was an impact hole approximately 18 inches deep at the center, 40 inches wide and 30 inches long. The recognition light from the left wing was found imbedded in the ground approximately 8 feet left of the initial landing gear scars. Pieces of the right wing tip navigation lens were found about 18 feet to the right of the initial gear scars. The left wing was separated from the main fuselage. The right wing was folded over the bottom of the airplane fuselage. Due to the separation of the left wing and twisting of the main fuselage, control continuity was not possible; however, continuity was established with the available cables and control tubes. Fuel was found in both wing tanks. The fuel was tested with water finding paste. No presence of water was found. The engine was attached to the fuselage. Several bolts attaching the propeller hub to the engine crank shaft were broken loose. The hub was bent downward from the engine crank shaft. The propeller spinner was crushed inward from left to right. Both propeller blades were curved rearward. Nicks were found on the leading and trailing edges of both blades. There was no evidence of cord wise twisting of the blades. Examination of the engine, and engine compartment, revealed red fuel stains on the inside and outside of the air inlet of the carburetor, the air induction duct, air filter and carburetor heat box. Fuel stains were also found around the sides and bottom of the carburetor, on the primer shaft housing where it connects to the primer body, and on the lower engine compartment sheet metal. The carburetor air inlet duct was found to be brittle and deteriorated. The outside of the inlet duct was wrapped with gray "duct tape." Pieces of black electrical tape, partially fuel soaked, were wrapped around the front of the carburetor heat box inlet. There was also a piece of electrical tape between the carburetor heat valve, and the carburetor heat box. Engine drive train, and accessory drive continuity, was confirmed. Compression was obtained on all cylinders by use of the "thumb method." Valve clearances were measured and found to be according to the specifications of 6/1000 to 12/1000 of an inch on all valves, except on the #3 intake valve. This was measured at 1/1000 of an inch. When the engine was rotated by hand, oil was observed pumping from the disconnected oil line. The fuel pump was actuated by hand and fuel was observed flowing from the pump outlet. Both magnetos were removed from the engine. The left magneto was installed 180 degrees out of phase. Both magnetos were rotated by hand and spark was produced from all distributor block towers. The carburetor was disassembled. The fuel inlet screen was clean. The floats were of the composite type and not fuel soaked. The fuel nozzle, venturies and throttle plate were in place. The top of the idle mixture screw on the carburetor was marked with 2 arrows. One arrow was marked with an "L" and the other with an "R". The screw was found to be set to the limit of the "L" direction. The fuel inlet line to the carburetor was loosened by the weight of the wrench, without additional pressure. Pieces of the exhaust system, including the muffler tail pipe were broken. These components were crushed and twisted. Duct tape, from the carburetor air inlet duct, was found melted onto the muffler. MEDICAL AND PATHOLOGICAL INFORMATION Autopsies were performed on Mr. David W. Ford and Mr. David R. Jones, on June 30, 1993, by Dr. Timothy Jones, of the Broom County Coroners Office, Binghamton, New York. The results indicated that both pilots died of, "multiple blunt traumatic injuries." The toxicological testing was conducted by the FAA Toxicology Accident Research Laboratory, Oklahoma City, Oklahoma. It revealed negative for drugs, volatiles, cyanide and carbon monoxide, for both pilots except, Mr. David R. Jones, who tested positive for gemfibrozil (gemfibrozil: used to lower blood cholesterol) in the blood and urine. ADDITIONAL INFORMATION In a review of the airplane airframe and engine maintenance log books, no documented maintenance was performed on N5932L, after the annual inspection in October, 1992. The log books further revealed no replacement of pistons or rings, since engine installation in 1969. Mr. Thomas Gazda, a friend and business associate of Mr. Ford, stated: "...Dave told me aprox [approximately] 3 weeks prior to crash, they were having difficulty with engine running at lower flight RPMS [revolution per minute]. He said he thought it was a vacuum leak. Possibly manifold. In prior inspections for the problem they found broken piston rings and they were replaced, but did not solve problem." Several witnesses reported observing Mr. Ford performing maintenance on this airplane. One witness, an airplane mechanic, stated: "...Mr. Ford occasionally asked my opinion about troubleshooting and how he could make various repairs to his aircraft. The areas included removing and reinstalling cylinders, magneto repairs, finding an intermittent engine miss, and radio repairs..." In the hanger where Mr. Ford kept his airplane, a paper bag containing pistons and rings was found next to Mr. Ford's tool box. The bag also contained a letter written by Mr. Ford which stated: "...Well looks like excessive wear on the two compression rings. The top one was broke when I pulled off the cylinder. (I helped Sherm do it so I was very careful). Looks like some rust pitting in bore, but no real scoring. I just wonder if the comp [compression] ring groves are worn beyond limits. Oh well it doesn't look too bad..." Mr. Ford was not an FAA Certified Airframe and Powerplant (A&P) mechanic.

Probable Cause and Findings

THE LOSS OF ENGINE POWER DUE TO FUEL STARVATION FROM A FUEL LEAK CAUSED BY INADEQUATE MAINTENANCE BY UNQUALIFIED PERSONNEL, THE PILOT'S FAILURE TO MAINTAIN ADEQUATE AIRSPEED, WHICH RESULTED IN AN INADVERTENT STALL AND COLLISION WITH THE GROUND.

 

Source: NTSB Aviation Accident Database

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