ATL04LA187

NTSB accident investigation · Piper PA-22-108 · Inverness, FL · September 16, 2004

Accident · No injuriesLimited investigationFinal report
Date
September 16, 2004, 18:48 local (22:48 UTC)
Place
Inverness, FL
Injuries
1 uninjured
Damage
Substantial damage
Phase of flight
Initial climb
Aircraft
N4647ZPiper PA-22-108
Weather
Visual (VMC) · Day
Status
Completed · report July 7, 2005
Report
Approved by Office Director
Parties
Tampa FSDO - 35
FAA report
20040916031149A
Case key
60145

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

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Probable cause

The improper installation of the carburetor which resulted in a loss of engine power and subsequent collision with trees during an emergency landing.

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 powerTakeoff - initial climb
Maintenance,installation - improperUnknownCause
Fuel system,carburetor - loose part/bolt/nut/clamp/etcCause
Forced landingEmergency descent/landing
In flight collision with objectEmergency descent/landing
Terrain condition - none suitable
Object - tree(s)

Analysis

During climbout about 300 feet above the ground, the airplane's engine lost power down to 2000 rpm. The student pilot reported it audibly "lost a cylinder." He stated the EGT showed very hot on the No. 3 cylinder. He stated he verified the mixture was at full rich, and he reduced throttle a little, but the EGT did not improve. He stated he returned to full throttle and almost immediately the "engine stopped hard" within two seconds, and the airframe shook heavily. He glided the airplane toward a road, and the airplane collided with trees and the ground. Examination of the engine revealed compression developed on all four cylinders when the crankshaft was rotated at the propeller flange. Valve train continuity was observed, and both magnetos produced spark on all towers. The air intake box displayed crush damage. The lower engine cowling was removed, and the carburetor was found separated from the intake manifold. The manifold mount studs displayed chafing, one manifold mount stud was bent. One mounting nut and two flat washers were found in the cowling, and the other mounting nuts were not located.

Factual narrative

On September 16, 2004, about 1848 eastern daylight time, a Piper PA-22-108, N4647Z, registered to and operated by the student pilot, collided with trees and the ground following a loss of engine power shortly after takeoff from Inverness, Florida. The personal flight was operated under the provisions of Title 14 CFR Part 91 with no flight plan filed. Visual meteorological conditions prevailed. The student pilot reported no injuries, and the airplane sustained substantial damage. The local flight departed Inverness, Florida, about 1846 on September 16, 2004.

The student pilot stated he departed the airport to the south. He stated that, during climbout about 300 feet above the ground, the airplane's engine lost power down to 2000 rpm, and audibly "lost a cylinder." He stated the EGT showed very hot on the No. 3 cylinder. He stated he verified the mixture was at full rich, and he reduced throttle a little, but the EGT did not improve. He stated he returned to full throttle and "almost immediately, the engine stopped hard, 1800 rpm to 0 rpm in 1 - 2 seconds" and shook the airframe "heavily." He stated he glided the airplane toward a dirt road, and the airplane collided with trees about 50 feet short of the road and came to rest on the ground about 20 feet from the road.

Examination of the airplane revealed damage to the wings, wing struts, landing gear, and horizontal stabilizer. Fuel was observed leaking from the wing tanks. Examination of the engine revealed compression developed on all four cylinders when the crankshaft was rotated at the propeller flange. Valve train continuity was observed, and both magnetos produced spark on all towers. The air intake box displayed crush damage. The lower engine cowling was removed, and the carburetor was found separated from the intake manifold. The manifold mount studs displayed chafing, one manifold mount stud was bent. One mounting nut and two flat washers were found in the cowling, and the other mounting nuts were not located.

Examination of the maintenance records for the airplane revealed an annual inspection was completed on March 24, 2004. The engine had accumulated 46.4 hours since inspection, and the owner stated he did not know who last handled the carburetor. At the time of the accident, the engine had accumulated 655.9 hours since major overhaul; the engine overhaul was completed June 11, 1977. According to Lycoming Service Instruction 1009AR, the recommended time between overhaul periods (TBO) for the O-235-C1B engine is 2400 hours, or, "in the twelfth year," whichever occurs first.

Aircraft

Registration
N4647Z
Reported as
Piper PA-22-108
Category
Airplane
Serial number
22-8169
Airframe hours
2,376.3
Engine
Lycoming O-235-C1B, 108 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Registered owner
Albert James Verka
Airworthiness certificate
Standard, Normal
Last inspection
Annual · March 24, 2004 · 46.4 hours before
Departed
KX40 · Inverness, FL
Airport
KX40 · Inverness, runway 19, 3,762 × 60 ft, asphalt

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
54
Injuries
None
Certificate
Student
Medical
Class 3, With waivers/limitations
Seat
Left
Flight hours
81 total · 65 in this make and model · 38 as pilot in command · 23 in the last 90 days · 3 in the last 30 days · 0 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
220° at 9 knots
Visibility
10 statute miles
Lowest ceiling
None
Temperature
88 °F, dew point 70 °F
Altimeter
29.88 inHg
Observed at
KOCF, 22 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.