ANC03LA091

NTSB accident investigation · Cessna 207A · Bethel, AK · August 8, 2003

Accident · No injuriesLimited investigationFinal report
Date
August 8, 2003, 12:53 local (20:53 UTC)
Place
Bethel, AK
Injuries
2 uninjured
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N6439HCessna 207A
Weather
Visual (VMC) · Day
Status
Completed · report April 28, 2004
Report
Approved by Office Director
NTSB office
Alaska Regional Office
Parties
FAA-AL-ANC FSDO 03
FAA report
20030808025499A
Case key
57672

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

On this page

Probable cause

A complete loss of engine power during cruise flight due to the shifting of a main crankshaft bearing that produced a fatigue failure of the crankshaft. A factor contributing to the accident was unsuitable terrain for a forced landing, which resulted in a nose over .

Sequence of events

NTSB’s coding before 2008: each occurrence and phase of flight, and the causes and factors under it. The codes are defined in NTSB’s coding manual.

Loss of engine power(total) - mech failure/malfCruise
Engine assembly,bearing - shiftedCause
Engine assembly,crankshaft - fatigueCause
Forced landingEmergency descent/landing
On ground/water encounter with terrain/waterEmergency descent/landing
Terrain condition - none suitableFactor
Terrain condition - tundra
Terrain condition - soft
Nose overEmergency landing

Analysis

The commercial certificated pilot was conducting a non-scheduled domestic cargo flight carrying mail, and the airplane was in cruise flight about 1,000 feet agl when the engine lost all power. The pilot performed a forced landing in rough, tundra covered terrain. During the landing, the airplane nosed over. The engine was overhauled 1090.9 hours before the accident. During the overhaul process, the engine case was sent to a vendor to be welded and rebored to match original engine case specifications. A postaccident examination of the engine revealed that the number 1 main bearing was deformed in its bearing saddle, and portions of the number 2 main bearing were flattened, fractured and fragmented, and were found in the engine case. The number 2 bearing saddle was extensively distorted and gouged. The engine crankshaft was fractured at the radius of the number 2 main bearing and the number 3 crankshaft cheek, adjacent to the main bearing surface. The fracture surface had discoloration consistent with high heat, and beach marks consistent with fatigue. The area of the number 2 engine bearing saddle, under the bearing insert, had several areas of cracking and exfoliation of the case material along the edges of the oil supply channel. No evidence of engine case fretting was observed during the examination. The engine case was examined by the manufacturer's metallurgical personnel. The report of examination stated that the case contained no signs of lubrication distress on the journals. The manufacturer's metallurgist stated that a determination of a weld repair at the number 2 main bearing support could not be made with a high degree of certainty, although there were several work order stamps on the crankcase indicating that it had been reworked.

Factual narrative

On August 8, 2003, about 1253 Alaska daylight time, a wheel-equipped Cessna 207A airplane, N6439H, sustained substantial damage when it nosed over during a forced landing following a loss of engine power about 8 miles northwest of Bethel, Alaska. The airplane was being operated as a visual flight rules (VFR) non-scheduled domestic cargo flight under Title 14, CFR Part 135, when the accident occurred. The airplane was operated as Flight 10-1 by Hageland Aviation Inc., Anchorage, Alaska. The commercial certificated pilot, and the sole passenger, who is the director of training for the operator, were not injured. Visual meteorological conditions prevailed, and VFR company flight following procedures were in effect. The flight originated at the Tuluksak Airport, Tuluksak, Alaska, about 1245, with a planned destination of Atmautluak, Alaska.

During a telephone conversation with the National Transportation Safety Board (NTSB) investigator-in-charge (IIC), on August 8, the director of operations for the operator reported the airplane was carrying mail, and was in cruise flight about 1,000 feet agl. He said the pilot reported a complete loss of engine power, and made a forced landing in rough, tundra-covered terrain. During the landing, the airplane nosed over.

At 1253, an Aviation Routine Weather Report (METAR) at Bethel was reporting, in part: Wind, light and variable; visibility, 10 statute miles; clouds and sky condition, few at 6,000 feet, 20,000 feet scattered; temperature, 70 degrees F; dew point, 59 degrees F; altimeter, 30.27 inHg.

Examination of the engine maintenance records revealed that the engine was overhauled on July 18, 2002, by Aero Recip, Anchorage, Alaska. During the overhaul process, the engine case was reportedly welded by Divco Inc., Tulsa, Oklahoma, on March 28, 2002. The engine case was rebored to match original engine case specifications, and released as serviceable. The engine was then installed by the operator in the accident airplane.

At the time of the accident, the engine had accrued 4557.3 total service hours, 1090.9 hours since the overhaul, and 1 hour since its most recent approved airworthiness inspection program (AAIP) inspection. The engine also received a top overhaul in May, 2003, during which all 6 engine cylinders were replaced. The engine then accrued 279.9 hours before the accident.

On September 9, a postaccident examination of the engine revealed that the engine case was fractured under the left magneto. A portion of the number 2 piston connecting rod was visible, protruding through the case. Removal of the engine cylinders and separation of the engine case halves revealed that the lower half of the number 2 connecting rod cap and bearing had separated from the upper half. The connecting rod cap bolts were stretched and broken. The number 1 main bearing was deformed in its bearing saddle. Portions of the number 2 main bearing were deformed, flattened, fractured and fragmented, and were found in the engine case. The number 2 bearing saddle was extensively distorted and gouged. The engine crankshaft had a transverse shear fracture at the aft fillet radius of the number 2 main bearing, and the number 3 crankshaft cheek, adjacent to the main bearing surface. The fracture surface had areas of deep blue discoloration, and beach marks radiating inward from the outer edge of the crankshaft surface. The area of the number 2 engine bearing saddle, under the bearing insert, had several areas of cracking and exfoliation of the case material along the edges of the oil supply channel. No evidence of engine case fretting was observed during the examination. The oil filter contained numerous metal fragments.

On December 8, 2003, the engine case was examined by the manufacturer's metallurgical personnel at Teledyne Continental Motors, Mobile, Alabama. The report of examination stated that the case contained no signs of lubrication distress on the journals. The metallurgist stated that a determination of a weld repair at the number 2 main bearing support could not be made with a high degree of certainty, although there were several work order stamps on the crankcase indicating that it had been reworked.

Following the examination at Teledyne Continental Motors, the engine case was released to the owner's representatives on January 22, 2004.

Aircraft

Registration
N6439H
Reported as
Cessna 207A
Category
Airplane
Serial number
20700525
Airframe hours
14,408
Engine
Continental IO-520F, 300 horsepower, reciprocating
Damage
Substantial damage
Flight
Part 135
Operator
Hageland Aviation Inc.
Registered owner
Gussic Ventures
Airworthiness certificate
Standard, Normal
Last inspection
AAIP · August 8, 2003 · 1 hours before
Departed
TLT · Tuluksak, AK
Destination
4A2 · Atmautluak, AK
Flight plan
Company VFR

Matched to the registry by N-number and the event date; the registry’s history has gaps, so older matches can be wrong. Compare the reported make and model.

Flight crew

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
26
Injuries
None
Certificates
Commercial, Flight instructor
Airplane ratings
Multi-engine land, Single-engine land
Instrument ratings
Airplane
Medical
Class 1, Valid Medical--no waivers/lim.
Last flight review
March 15, 2003
Seat
Left
Flight hours
2,070 total · 395 in this make and model · 2,020 as pilot in command · 272 in the last 90 days · 130 in the last 30 days · 2 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Visibility
10 statute miles
Lowest ceiling
None
Temperature
70 °F, dew point 59 °F
Altimeter
30.27 inHg
Observed at
PABE, 8 nm away

FAA reports on this event · 1

The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.