Aviation Accident Summaries

Aviation Accident Summary NYC08LA311

Hackettstown, NJ, USA

Aircraft #1

N301KC

MOONEY M20J

Analysis

On the day of the accident, the pilot completed two uneventful positioning flight legs before refueling. The pilot added fuel to the right wing tank only, since the left tank was still full. In his subsequent preflight inspection, he drained some fuel from the gascolator, and obtained and examined a fuel sample from the right tank drain, without noting any anomalies. The pilot did not capture a sample when he drained the gascolator, since the gascolator drain was activated from the cockpit. The pilot’s procedure was contrary to the instructions in the pilot’s operating handbook, which stated to sample the fuel from the gascolator drain. Engine start, taxi, and engine run-up, all of which were conducted using the right tank, were normal. The takeoff roll and initial climb were normal, but when the airplane was approximately 25 feet above the runway, the engine "quit dead." The pilot performed an emergency landing in the grass alongside the runway, and the airplane was stopped by trees beyond the runway end. Postaccident fuel samples yielded several ounces of water each from the right tank, gascolator, and engine fuel line. No other anomalies were noted with the airplane or engine. No water or other contaminants were found in the airport fuel storage tank or dispensing system, and no problems were reported by the operators of any aircraft that were fueled from the airport storage tank on the same day as the accident airplane.

Factual Information

HISTORY OF FLIGHT On September 8, 2008, about 1630 eastern daylight time, a Mooney M20J, N301KC, was substantially damaged during an emergency landing immediately after takeoff from runway 23 at Hackettstown Airport (N05), Hackettstown, New Jersey. The private pilot, who was the sole occupant, was uninjured. The positioning flight was operated under the provisions of 14 Code of Federal Regulations Part 91. Visual meteorological conditions prevailed, and no flight plan had been filed. According to the pilot, he was an aircraft broker, and he was repositioning the airplane for the owner from its base at Essex County Airport (CDW) Caldwell, New Jersey, to another airport, in conjunction with the possible sale of the airplane. The pilot stated that he did not add any fuel to the airplane at CDW, and that he activated all three fuel drains prior to the flight. He did not observe any water in the fuel samples that he captured from the two wing tanks. The pilot did not capture a sample when he drained the gascolator, since the gascolator drain was activated from the cockpit. Engine start and run-up were normal, and the airplane departed CDW for Sky Manor Airport (N40) Pottstown, New Jersey, where the pilot stopped to pick up an acquaintance. The pilot and his passenger then flew from N40 to N05. Both flights were uneventful. After they arrived at N05, the passenger left the pilot, in order to depart in a different airplane. The pilot then dispensed 21.6 gallons of fuel from the self-service facility at N05 into the right wing tank, but he did not add any to the left wing tank, since it was still full. At the time of the fueling, the airplane was parked in an area which resulted in an airplane-nose-down attitude. Subsequent to the fueling, the pilot sampled fuel from the right tank drain, and he did not observe any water. He also activated the cockpit control to drain the gascolator, but again he did not capture the gascolator sample. Engine start and taxi were normal. The pilot planned to depart using runway 23, so he taxied to the runway, turned the airplane to a heading of approximately north for the engine run-up, and stopped the airplane. At this point, the airplane was in a slightly left-wing-down attitude. The pilot stated that for the engine run-up and takeoff, fuel was supplied to the engine from the right wing tank, and that the run-up was normal. He also stated that he began the takeoff attempt about 45 minutes after the fueling was completed. According to the pilot, the takeoff roll and initial climb were normal, but when the airplane reached approximately 25 feet above ground level, the engine "quit dead." The pilot added that due to the short amount of pavement that remained ahead on runway 23, he initiated a turn to the left in an attempt to use a "crossing runway" for the emergency landing and rollout. However, the airplane did not have sufficient altitude or airspeed to complete the turn, so the pilot leveled the wings, touched down in the grass approximately 20 feet off the left side of runway 23, and applied "heavy braking." The airplane impacted trees and shrubs that bordered the airport, and came to a stop. After the accident, the pilot sampled the fuel from the gascolator and the two wing tank drains. He stated that he used a "16 ounce Coke bottle," and that he captured approximately "1 to 1 1/2" inches of water from the gascolator. He used a fuel drain cup that measured approximately 2 inches high by 1 1/2 inches in diameter, and obtained two cupfuls of water from the right tank. The pilot did not observe any water in the sample that he obtained from the left tank. PERSONNEL INFORMATION According to Federal Aviation Administration (FAA) and pilot-provided information, the pilot held a private pilot certificate with airplane single- and multiengine land ratings. He had approximately 4,000 total hours of flight experience. His most recent FAA third-class medical certificate was issued in March 2007. According to the owner of the airplane, the pilot was recommended to him by a large aircraft sales company which specialized in Mooney airplanes. Due to the recommendation, and the fact that the pilot told the owner that he had "substantial Mooney time," the owner did not ask the pilot for details of his experience. The owner stated that the pilot had possession of the airplane for about 2 to 3 months prior to the accident, that he (the owner) did not fly the airplane during this period, and that he (the owner) was not aware of the pilot's flight activity in the airplane during that period. The NTSB was unable to determine the pilot's experience in the accident airplane make and model. Despite verbal assurances from the pilot that he would comply with multiple NTSB requests for additional information regarding his experience, qualifications, and the events of the day, the pilot did not provide the requested information. AIRCRAFT INFORMATION The airplane was a low-wing monoplane of all-metal construction. It was equipped with a Lycoming IO-360 four-cylinder engine, a constant-speed propeller, and retractable tricycle-style landing gear. According to FAA information, the airplane was manufactured in 1978, and it was purchased by the current owner in 1998. The owner reported that the airplane had approximately 2,760 total hours in service, and that the most recent annual inspection was accomplished in December 2007. METEOROLOGICAL INFORMATION The 1554 surface weather observation at Aeroflex-Andover Airport (12N), Andover, New Jersey, located 13 miles northeast of N05, reported variable winds at 6 knots with gusts to 16 knots, temperature 27 degrees C, dew point 11 degrees C, and an altimeter setting of 30.12 inches of mercury. The 1654 observation reported similar conditions. AIRPORT INFORMATION According to FAA and commercially-available information, N05 was equipped with only a single runway. Runway 5/23 was asphalt, measured 2,200 feet by 50 feet, and was dry at the time of the accident. Examination of aerial photographs of the airport revealed that the grassy area that was bounded by the southern portion of the treeline along the southeast side of the airport had two rectangular extensions which were similar in appearance to defunct runways. One extension was oriented perpendicular to runway 23, along a heading of approximately 140 degrees. The other extension was oriented approximately 50 degrees to the southeast of runway 23, along a heading of approximately 180 degrees. Each of these extensions was approximately 800 feet long, and 200 feet wide. WRECKAGE AND IMPACT INFORMATION According to FAA information, the airplane was stopped by the treeline that was perpendicular to the runway centerline, and situated approximately 100 feet beyond the end of the paved runway surface. The airplane was offset approximately 100 feet southeast of the runway centerline. It remained upright, and all three landing gear were intact. The outboard 2 feet of the left wing were fracture-separated from the wing, and remained attached to the wing by the inboard hinge of the left aileron. The wing skin and underlying structure just inboard of the separation line was crushed aft and up. The right wing bore three crush damage sites that began at the leading edge and extended aft. The skin at the inboard site was crushed approximately 8 inches aft of the leading edge. The skin and underlying structure at the mid and outboard sites was crushed and torn for nearly the full chord of the wing. The right and upper sides of the aft fuselage sustained buckling damage, and the propeller spinner sustained crush damage in the aft direction. There was no fire. ADDITIONAL INFORMATION Airplane Fuel System Configuration According to the airplane manufacturer, each fuel tank consisted of an integral sealed bay in the inboard section of each wing. The total usable fuel capacity was 64 gallons, and each tank had an unusable fuel quantity of 1.25 gallons. The inboard and outboard walls of each tank were the wing ribs at wing station (WS) 24.5 and WS 74.0, respectively. The forward tank wall was formed by webs and baffles aft of the wing leading edge, and the aft tank wall was the main wing spar. Internal tank ribs at WS 43.5 and WS 59.25, which extended for the full chord of the tank, also functioned as anti-slosh baffles. A discontinuous stringer, located midway between the forward and aft tank walls on the tank floor, extended spanwise from the inboard tank wall to the outboard tank wall. The inboard stringer segment ran from the inboard tank wall, through a cutout in the WS 43.5 rib, to the WS 59.25 rib, and the outboard segment ran from the WS 59.25 rib to the outboard tank wall. Each tank's internal structure was designed to enable the fuel to reach the fuel pickup point, and to allow any water in the tank to reach the tank sump drain point. Each of the WS 43.5 and WS 59.25 ribs had four large, circular lightening holes in their webs. Each WS 43.5 rib had eight 1/4-inch diameter holes distributed chordwise just above its juncture with the tank floor; four were forward of the stringer, and four were aft. Each WS 59.25 rib had one 1/4 by 1/2-inch oval hole, and five 1/4-inch circular holes, distributed chordwise just above its juncture with the tank floor; three circular holes were forward of the stringer, and the other three holes were aft of the stringer. The standing leg of each stringer segment was approximately 3/4 inch high. Each inboard stringer segment had two holes located between the inboard tank wall and the WS 43.5 rib, and two more located between the WS 43.5 rib and the WS 59.25 rib. The outboard stringer segments did not have any similar drain holes. Each fuel tank was equipped with a flush-fitting fuel cap, and each cap utilized an O-ring to preclude water intrusion through the cap-tank juncture. A fuel selector valve in the cockpit enabled a pilot to select one of three possible settings; LEFT tank, RIGHT tank, or OFF. A fuel line connected each tank to the fuel selector valve. Five more separate lines routed fuel to the system components in the following sequence: selector valve to gascolator, gascolator to boost pump, boost pump to engine-driven pump, engine-driven pump to fuel injector ("fuel servo") and fuel injector to flow distributor. Four additional lines, one to each cylinder, connected the flow distributor to the cylinders. The manufacturer's Pilot Operating Handbook (POH) stated that the airplane was equipped with two sump drains, one each "at the lowest point in each tank for taking fuel samples to check for sediment contamination and condensed water accumulation." Examination of the airplane manufacturer's design drawings showed that a sump drain was located near the aft inboard corner of each fuel tank, approximately 2 inches outboard and forward of the tank corner. The POH stated that the gascolator was "for draining condensed water and sediment from the lowest point in the fuel lines before the first flight of the day and after each refueling." Examination of the design drawings showed that the fuel pickup point (to route fuel to the gascolator) in each tank was located above, and approximately 2 inches forward of, the respective tank sump drain. The gascolator drain activation control was located in the cockpit, and was activated (drain valve opened) by pulling a ring up, and de-activated (drain valve closed) by releasing the ring. The POH preflight inspection procedures contained the following text: "Fuel Selector Drain - - Selector handle on R; pull gascolator ring and hold for five seconds. Repeat procedure with selector handle on L." Two additional POH preflight inspection entries, one each for the left and right side of the airplane, stated "Fuel Tank Sump Drain --SAMPLE." Airworthiness Directives and Service Bulletins On January 6, 1985, FAA Airworthiness Directive (AD) 85-24-03 became effective. According to the FAA, the AD was issued "to preclude fuel contamination and water entrapment" in Mooney airplanes. The AD applied to the accident airplane, and compliance was required within 100 hours time-in-service after the effective date of the AD, or at the next annual inspection, whichever occurred first. For the accident airplane, the AD stated "visually inspect all fuel tank bays and rib stations in accordance with the instructions contained in Mooney [Service Bulletin] S/B M20-230, dated April 10, 1985" and "Repair all discrepancies found prior to further flight." S/B M20-230 was entitled "Inspection of Fuel Tank Sealant Application," and it provided instructions and information to ensure that all fuel tank internal passages were open and free from obstructions, in order to permit any water in the tank to reach the fuel sump drain. The AD also stated "visually inspect the fuel tank filler cap assemblies in accordance with the instructions contained in Mooney S/B M20-229, dated April 10, 1985" and "Repair all discrepancies found prior to further flight." S/B M20-229 was entitled "Fuel Filler Caps (Shaw Aero) Inspection and Adjustment," and it provided instructions and information to ensure that the O-ring gaskets on the fuel caps were in good condition and that the cap locking mechanisms were properly adjusted, in order to prevent water intrusion into the tanks. The AD specified a one-time compliance with the two referenced Mooney S/Bs. However, S/B M20-229 specified repetitive compliance, and S/B M20-230 specified one-time compliance. Airplane Fuel Tank Repairs According to the airplane owner, some fuel tank leaks were sealed during the airplane's most recent annual inspection. The technician who performed the tank repairs stated that fuel staining (indicative of a fuel leak) was observed on each wing at the point where the upper wing skin attached to the rear spar. He stated that leaks at this location were "not uncommon" for the airplane model, and that the repair method involved removing an access panel from each tank, "scuffing" the area on the inside of the tank where the leak was believed to be, and applying a poly-sulfide fuel tank sealant (specified by the airplane manufacturer for such repairs) to the affected area. Several months after the accident, the technician removed the inspection panels in the right wing, in order to re-examine the fuel tank passages. He reported that all passages were open and free from obstructions, and that the airplane was still in compliance with the requirements of S/B M20-230. Information Provided By FAA Inspector An FAA inspector responded to the accident site the morning of the day after the accident. The inspector noted that the emergency locator transmitter (ELT) did not activate during the impact sequence, and that the ELT battery had an expiration date of March 2008. However, the airplane owner reported that the ELT battery expiration date was December 2008. The FAA inspector also noted that the vacuum pump shaft was sheared, that the owner told him that the shaft had been sheared prior to the accident, and that the pilot was aware of that condition prior to the flight. The inspector stated that the pilot told him that after the pilot fueled the airplane, but prior to the accident, the pilot obtained a fuel sample from the right fuel tank drain, but he did not activate the gascolator drain. This information differed from the account that the pilot provided directly to the NTSB investigator several days later, when the pilot told the NTSB that he did activate the gascolator drain. The inspector stated that the pilot informed him of the pilot's postaccident observation of water in the fuel samples that he obtained from the right wing tank and the gascolator. Subsequent to the pilot's postaccident fuel samplings, the inspector also conducted his own fuel sampling. The inspector stated that with the fuel selector valve set to the right tank, he activated the gascolator drain and captured the outflow; the sample was primarily fuel, but it did contain "a trace of water." The inspector also noted that the fuel line from the gascolator to the fuel servo contained only water, and no fuel. The inspector's visual examination of the engine did not reveal any mechanical anomalies or defi

Probable Cause and Findings

The pilot's failure to adhere to the airplane manufacturer's published preflight inspection procedures, enabling water to remain undetected in the fuel system, which resulted in a complete loss of engine power immediately after takeoff.

 

Source: NTSB Aviation Accident Database

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