Aviation Accident Summaries

Aviation Accident Summary ERA14LA227

Covington, TN, USA

Aircraft #1

N4506W

PIPER PA-28-181

Analysis

According to the instrument flight rules flight plan filed by the pilot, the airplane departed on an estimated 3.1-hour-long flight and had sufficient fuel on board for an estimated 4.8-hour-long flight. A direct 20- to 25-knot headwind existed at the airplane's cruise altitude. Based on the tachometer reading, about 4.2 hours into the flight, the pilot announced over the destination airport's common traffic advisory frequency that the airplane was "out of fuel." The airplane subsequently impacted swampy, wooded terrain 3 miles from the airport. The cockpit and cabin areas were destroyed by impact. There was no evidence of fuel in the wreckage or fuel spillage at the accident site. A detailed examination of the wreckage revealed no preimpact mechanical anomaly with the airframe, engine, or fuel system that would have precluded normal operation. According to the engine manufacturer, at the minimum allowable fuel flow, the engine had a fuel consumption rate of slightly less than 6 gallons per hour (gph) at 45 percent of rated power to slightly less than 15 gph at 100 percent power. Operators of similarly powered airplanes reported that the engine usually consumes 8.8 to 8.9 gph in a cruise configuration, which did not account for fuel used during taxi, takeoff, and climb. A review of flying club logs and aircraft fueling records revealed that the airplane consumed about 10 gph of fuel during the 12 flights in the month before the accident. According to the airplane manufacturer's Pilot's Operating Handbook, the performance charts are unfactored, and the effect of conditions not considered on the charts, including wind aloft on cruise and range performance, must be evaluated by the pilot. The handbook recommends that pilots conduct in-flight fuel flow and quantity checks.

Factual Information

HISTORY OF FLIGHTOn May 7, 2014, at 1107 central daylight time (CDT), a Piper PA-28-181, N4506W, operated by the Dayton Pilots Club, Inc., was destroyed when it collided with wooded terrain during a forced landing following a total loss of engine power on approach to Covington Municipal Airport (M04), Covington, Tennessee. The certificated private pilot was seriously injured. Visual meteorological conditions (VMC) prevailed, and an instrument flight rules (IFR) flight plan was filed for the flight that departed Dayton-Wright Brothers Airport (MGY), Dayton, Ohio, about 0710 CDT. The personal flight was conducted under the provisions of Title 14 Code of Federal Regulations Part 91. Air traffic control information from the Federal Aviation Administration (FAA) revealed that the airplane was at an altitude of 6,000 feet and 8 miles northeast of M04 when the pilot reported the destination airport in sight, and cancelled his IFR clearance. The controller then issued the airplane a frequency change to the M04 common traffic advisory frequency (CTAF). There were no further communications from the accident airplane. In a telephone interview, the airport manager stated he was monitoring the CTAF when the accident pilot announced he was 7.5 miles from the airport, and in-bound for landing. The manager recognized the pilot's voice, as they had spoken by telephone the previous day, and was aware of the pilot's plans upon arrival. He advised the pilot that parking, fueling of his airplane, and ground transportation had been arranged. Approximately 2 minutes later, the pilot announced over the radio that he was "out of fuel, and putting [the airplane] down short of the airport." The manager stated there were no further radio transmissions from the accident airplane. Due to his injuries, the pilot was not interviewed, but he provided an NTSB Form 6120.1 Pilot/Operator report through a personal friend; an airline transport pilot (ATP) and flight instructor. PERSONNEL INFORMATIONThe pilot held a private pilot certificate with ratings for airplane single engine land and instrument airplane. His most recent FAA second-class medical certificate was issued March 26, 2014. According to a friend who reviewed the pilot's records, the pilot had accrued approximately 272 hours of flight experience, of which 196 hours were in the accident airplane make and model. The pilot was issued his private pilot certificate on September 8, 2010. His instrument rating was added to his certificate on August 15, 2013. The pilot did not hold a flight engineer certificate or any other FAA certificates AIRCRAFT INFORMATIONAccording to FAA records, the airplane was manufactured in 1979. Its most recent annual inspection was completed December 9, 2013, at 7,945 aircraft hours. The airplane had a fuel capacity of 50 gallons, of which 48 gallons were usable. According to a line technician at MGY, he serviced the airplane with 13 gallons of aviation gasoline prior to the accident flight, which filled the tanks. Interpolation of flying club logs and aircraft fueling records revealed that the airplane consumed approximately 10 gallons of fuel per hour over the 12 flights in the month previous to the accident. The airplane tachometer reading was 321.1 hours at the completion of the flight previous to the accident flight, and the tachometer showed 325.3 hours when examined after the accident. METEOROLOGICAL INFORMATIONAt 1050, the weather conditions reported at Millington Regional Jetport (NQA), 20 miles southwest of M04, included few clouds at 2,500 feet, 10 miles of visibility, and winds from 180 degrees at 9 knots. The temperature was 25 degrees C, the dew point was 17 degrees C, and the altimeter setting was 29.98 inches of mercury. An NTSB meteorologist observed that the winds aloft at the airplane's cruising altitude of 6,000 were from about 225 degrees at 20 to 25 knots. Throughout the flight, the airplane maintained an approximate ground track of 225 degrees. AIRPORT INFORMATIONAccording to FAA records, the airplane was manufactured in 1979. Its most recent annual inspection was completed December 9, 2013, at 7,945 aircraft hours. The airplane had a fuel capacity of 50 gallons, of which 48 gallons were usable. According to a line technician at MGY, he serviced the airplane with 13 gallons of aviation gasoline prior to the accident flight, which filled the tanks. Interpolation of flying club logs and aircraft fueling records revealed that the airplane consumed approximately 10 gallons of fuel per hour over the 12 flights in the month previous to the accident. The airplane tachometer reading was 321.1 hours at the completion of the flight previous to the accident flight, and the tachometer showed 325.3 hours when examined after the accident. WRECKAGE AND IMPACT INFORMATION Examination of photographs revealed the airplane came to rest in standing water among wooded terrain. The cockpit and cabin areas were destroyed by impact, and had also been cut by first responders. The empennage appeared separated from the fuselage, but still attached by cables. The left wing separated before the airplane came to rest, and the left main fuel tank was breached. According to detectives of the Tipton County Sheriff's Office, there was no odor of fuel, no evidence of fuel in the airplane, and no evidence of fuel spillage at the scene. The Chief of Detectives stated she did not order any environmental remediation of the crash site due to fuel spillage because "there was nothing to remediate." On September 5, 2014, a detailed examination of the wreckage was completed at a recovery facility. Continuity of the fuel system was confirmed from the fuel tanks, through the fuel lines, the fuel selector, and to the fuel pump. Several breaks were noted due to impact damage, and cutting by rescue and recovery personnel. The fuel tank fuel caps were serviceable and properly vented. Both fuel tank intake finger strainers were intact, and absent of blockage or debris. The drain petcocks were intact, functioned properly, and displayed no evidence of leakage or fuel staining. Both left and right fuel quantity indicating sensors were secure and free to move through their full-travel range. The fuel selector valve was free to move, displayed a positive detent in all positions, and the spring-loaded lock-out function for the "off" position functioned as designed. The fuel lines from the left and right tanks were separated at the fuel valve, but the fuel line to the gascolator was intact. There was no evidence of blockage in the fuel selector or the fuel line to the gascolator. The line from the gascolator to the electric fuel pump was intact and secure. There was no evidence of blockage in the line. The line from the electric pump to the engine driven pump was secure at the electric pump, but impact-separated from the engine driven pump. The engine driven fuel pump was broken and separated by impact. The gascolator and filter element were separated by impact, and not recovered. No evidence of preimpact damage or deterioration of the fuel system was noted. No evidence or staining indicative of static or dynamic fuel leakage was noted anywhere in the fuel system or surrounding aircraft structure. The engine was rotated by hand at the propeller flange. Continuity was established through the powertrain and valvetrain to the accessory section. Creek water was ejected from the sparkplug holes during rotation. Compression was confirmed on all cylinders using the thumb method. Intake and exhaust valve operation was confirmed. The magnetos were removed, and rotated by electric drill. Neither magneto sparked due to water immersion and corrosion. The carburetor was disassembled, and no mechanical anomalies were noted. The carburetor bowl contained several ounces of creek water. The floats were intact and moved freely. The filter screen was clear and absent of debris or blockage. ADDITIONAL INFORMATIONAccording to the statement prepared by the pilot's friend, the airplane departed with 48 gallons of useable fuel on board. Prior to departure, the pilot told his wife that based on his planned flight time and taking winds "into consideration," he should arrive at his destination with 13 gallons of fuel remaining. The friend calculated that the airplane's engine produced 65 percent power at 6,000 feet while consuming approximately 8.5 gallons per hour. He then calculated the airplane should have landed with "14 gallons of fuel (1.4 hours of flight time)." At 0538, the pilot filed a flight plan through an online commercial vendor (CSC DUATS). The pilot filed an estimated fuel endurance of 4.8 hours and an estimated time en route of 3.1 hours. According to the engine manufacturer, at the minimum allowable fuel flow, an O-360 engine had a fuel consumption rate of slightly less than 6 gallons per hour at 45 percent of rated power to slightly less than 15 gallons per hour at 100 percent power. Operators of similar powered airplanes reported that the engine usually consumed 8.8 to 8.9 gallons per hour in a cruise configuration, which did not account for fuel used during taxi, takeoff, and climb. According to FAA Private Pilot Practical Test Standards, the examiner ensures the pilot applicant "Corrects for and records the differences between preflight groundspeed, fuel consumption, and heading calculations and those determined en route." According to the airplane manufacturer's Pilot's Operating Handbook, Section 5, Performance: The performance charts are unfactored and do not make any allowance for varying degrees of pilot proficiency or mechanical deterioration of the aircraft. This performance, however, can be duplicated by following the stated procedures in a properly maintained airplane. Effects of conditions not considered on the charts must be evaluated by the pilot, such as the effect of soft or grass runway surface on takeoff and landing performance, or the effect of winds aloft on cruise and range performance. Endurance can be grossly affected by improper leaning procedures, and inflight fuel flow and quantity checks are recommended. In a letter to the Chairman of the NTSB, the Ohio Attorney General stated that the pilot graduated from the United States Air Force Test Pilot School (TPS), was a 20-year Air Force veteran, and after retirement spent 11 years as a "professional flight engineer." He suggested that the NTSB had predetermined the probable cause of the accident, that the pilot's experience made an operational cause unlikely, and requested that the NTSB inspect the wreckage for problems that could not be detected through normal maintenance or preflight inspection. According to the United States Air Force Test Pilot School, the pilot attended Flight Test Engineer (FTE) Class 78B from July 31, 1978 to July 16, 1979, and an official history and curriculum from the class was examined. When asked to draw a distinction between an Air Force Test Pilot and a Flight Test Engineer, representatives of the school stated, "[The] role as an FTE encompasses data collection, safety of test, technical adequacy, and data analysis. FTEs are not trained to be navigators or fuel planners. They are provided with a basic intro to aviation, which includes performing fuel calculations using flight manuals, but not to the extent of planning fuel or [estimated time en route] calculations for cross-country sorties. Cross-country planning is neither taught nor evaluated at TPS. That type of training would be covered in Undergraduate Pilot/Nav training (UPT or UNT), but FTEs do not obtain any of this training at TPS since they are trained to be flight test engineers, not navigators. Additionally, unlike military pilots, FTEs cannot apply any military flying training/experience to get credit towards an FAA rating." According to the head of the FTE Airmanship Program, and a graduate of FTE Class 82A, the current airmanship program began in 2000. Prior to that year, students were not flown in light aircraft as an introduction to the course. Students were instructed on the use of Pilot Operating Handbooks to compute fuel consumption rates; "however, cross-country flight planning was neither taught nor evaluated."

Probable Cause and Findings

The pilot’s improper preflight and in-flight fuel planning, which resulted in fuel exhaustion and a subsequent total loss of engine power over unsuitable terrain.

 

Source: NTSB Aviation Accident Database

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