# NTSB CEN14LA350: Piper PA 28R-200, N9469N, Mt. Vernon, TX, July 10, 2014 - Type: NTSB accident investigation - Classification: Accident · Serious injuries · Limited investigation · Final report - Date: July 10, 2014, 07:50 local (12:50 UTC) - Place: Mt. Vernon, TX - Coordinates: 33.089168, -95.260833 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=33.0892&lon=-95.2608&mi=10 - Phase of flight: [Enroute](https://openairdocs.org/ntsb-phases/400) (OpenAirDocs' grouping) - Defining event: [Enroute: Fuel exhaustion](https://openairdocs.org/ntsb-events/192) - Highest injury: Serious injuries - Injuries: 1 serious - Status: Completed, report January 14, 2015 - Report: Approved by Office Director - NTSB office: Central Region - Parties: FAA - NTSB case key (mKey): 89635 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=CEN14LA350 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/89635/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=89635 - Page: https://openairdocs.org/ntsb/CEN14LA350 ## Probable cause The pilot’s inadequate preflight inspection, which resulted in a loss of engine power due to fuel exhaustion. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Fluids: fuel](https://openairdocs.org/ntsb-findings/01071010): Aircraft › Fluids/misc hardware · Fluid level (probable cause); cases with it: [Piper PA-28R-200, 3 cases](https://openairdocs.org/ntsb-findings/01071010/cases.md?model=7102811), [All aircraft, 1,695 cases](https://openairdocs.org/ntsb-findings/01071010/cases.md) - [Inspection: preflight inspection](https://openairdocs.org/ntsb-findings/02061510): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Piper PA-28R-200, 2 cases](https://openairdocs.org/ntsb-findings/02061510/cases.md?model=7102811), [All aircraft, 551 cases](https://openairdocs.org/ntsb-findings/02061510/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Enroute-cruise: Loss of engine power (total)](https://openairdocs.org/ntsb-events/341); cases with it: [Piper PA-28R-200, 32 cases](https://openairdocs.org/ntsb-events/341/sequence.md?model=7102811), [All aircraft, 3,820 cases](https://openairdocs.org/ntsb-events/341/sequence.md) - [Emergency descent: Collision with terr/obj (non-CFIT) ](https://openairdocs.org/ntsb-events/470); cases with it: [Piper PA-28R-200, 45 cases](https://openairdocs.org/ntsb-events/470/sequence.md?model=7102811), [All aircraft, 10,189 cases](https://openairdocs.org/ntsb-events/470/sequence.md) - [Enroute: Fuel exhaustion](https://openairdocs.org/ntsb-events/192) (defining event); cases with it: [Piper PA-28R-200, 4 cases](https://openairdocs.org/ntsb-events/192/sequence.md?model=7102811), [All aircraft, 804 cases](https://openairdocs.org/ntsb-events/192/sequence.md) ## Analysis A witness reported that the engine was "backfiring" and that it "shut off" as the airplane flew over treetops low to the ground. The pilot made a forced landing, and, during the descent, the airplane collided with trees, continued into a field, and came to rest upright. Postaccident examination revealed no evidence of fuel in the fuel tanks or on the ground near the airplane, and no fuel was found in the fuel lines or the engine-driven fuel pump. The gascolator was half full of fuel; however, if adequate fuel had been available, it is likely that the gascolator would have been full of fuel. Based on the evidence, it is likely that the pilot did not conduct an adequate preflight inspection, which resulted in the airplane departing with insufficient fuel and resulted in a loss of engine power. ## Factual narrative The Piper PA 28R-200, was a low-wing, single engine, four place, retractable gear airplane and was manufactured in 1969. The airplane was powered by a 200-horsepower Lycoming IO 360-C engine which drove a three bladed McCauley propeller. On May 7, 2013 at total time of 3,881 hours, an annual inspection was completed with no anomalies noted. The airplane was due for an annual inspection on May 7, 2014. On July 10, 2014, about 0750 central daylight time, a Piper PA28R-200 airplane, N9469N, made a forced landing into a field following a loss of engine power near Mt. Vernon, Texas. The pilot, who was the sole occupant, sustained serious injuries. The airplane sustained substantial damage. The airplane was registered to East Texas Pilots Association Flying Club Inc., and was operated by a private individual under the provisions of 14 Code of Federal Regulations Part 91 as a personal flight. Visual meteorological conditions prevailed and no flight plan was filed. The flight originated from the Franklin County Airport (F53), Mt. Vernon, Texas, about 0740 and was en route to the Winnsboro Municipal Airport (F51), Winnsboro, Texas. The airplane's engine experienced a loss of power and the pilot made a forced landing into a field which contained several tall trees. Witness statements revealed that the engine was "backfiring" and "shut off" as the airplane was flying over tree tops and low to the ground. A pilot statement was never submitted. At 0755, an automated weather report for the Mount Pleasant Regional Airport (KOSA), Mount Pleasant, Texas, which was located 15 miles east of the accident site, reported: calm wind, visibility 7 miles, clear sky, temperature 73 degrees Fahrenheit (F), dew point 72 degrees F, altimeter setting 30.06 inches of mercury. The pilot, age 79, held a commercial pilot certificate with ratings for airplane single engine and multi-engine land and instrument airplane. He was a certified flight instructor for single engine land and instrument airplane. On October 14, 2013 the pilot was denied an FAA medical certificate. The airplane impacted the trees and the left wing separated from the fuselage. The right wing remained partially attached and was twisted aft. The airplane continued into the field and came to rest upright. The responding Federal Aviation Administration inspector stated that the fuel tanks were damaged during impact and there was no evidence of fuel in the fuel tanks or near the airplane. On October 1, 2014, the National Transportation Safety Board investigator-in-charge examined the wreckage at a storage facility; the examination revealed that the gascolator was about half full of fuel 100 low lead aviation fuel and no contaminants were present. The engine driven fuel pump did not contain fuel. The fuel line from the engine driven fuel pump to the fuel flow distributor was dry with no evidence of fuel. The left fuel tank was breached and the right tank quick drain port was broken off. ## Aircraft - Registration: [N9469N](https://openairdocs.org/deregistered/N9469N-2018-03-15), registration cancelled 2018-03-15, S/N 28R-35186, built 1969 (OpenAirDocs) - Reported make and model: PIPER PA 28R-200 - Registry model: [Piper PA-28R-200](https://openairdocs.org/model/piper-pa-28r-200) (registry code 7102811) (OpenAirDocs) - Registry engine: [Lycoming I0360 series](https://openairdocs.org/engine/lycoming-i0360-series) (registry code 41515, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 28R-35186 - Year built: 1969 - Airframe hours: 3881 - Engines: LYCOMING IO-360 200 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Airworthiness certificate: Standard, Normal - Last inspection: Annual, May 7, 2013 - Departed: Mt. Vernon, TX - Destination: F51, WINNSBORO, TX ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 79; injuries: serious; flight instructor, commercial; airplane ratings: single-engine land, multi-engine land; instrument ratings: airplane ## Weather - Conditions: Visual (VMC), Day - Wind: calm - Visibility: 7 statute miles - Lowest ceiling: none - Temperature: 73 °F, dew point 72 °F - Altimeter: 30.05 inHg - Observed at: KOSA, 15 nm away ## Docket (6 files) The files NTSB released with the investigation on October 30, 2014, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=89635. 5.7 MB in all. - Record of Conversation - FAA (item 1, .PDF, 108 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40418340&FileExtension=.PDF&FileName=Record%20of%20Conversation%20-%20FAA-Master.PDF - Witness Statements (item 2, .PDF, 102 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40418341&FileExtension=.PDF&FileName=Witness%20Statements-Redacted.PDF - Airplane Logbook Entry – Annual Inspection (item 3, .PDF, 217 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40418342&FileExtension=.PDF&FileName=Airplane%20Logbook%20Entry%20%E2%80%93%20Annual%20Inspection-Redacted.PDF - Statement of Party Representatives to NTSB Investigation (item 4, .PDF, 1.1 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40418345&FileExtension=.PDF&FileName=Statement%20of%20Party%20Representatives%20to%20NTSB%20Investigation-Redacted.PDF - Photo 1 - Main Wreckage (Photo Courtesy of FAA) (item 5, .PDF, 78 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40418343&FileExtension=.PDF&FileName=Photo%201%20-%20Main%20Wreckage%20(Photo%20Courtesy%20of%20FAA)-Master.PDF - Photo 2 - Gascolator (item 6, .PDF, 4.1 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40418344&FileExtension=.PDF&FileName=Photo%202%20-%20Gascolator-Master.PDF From the NTSB's public API. Aircraft are matched to registry aircraft by N-number and event date, checked against the reported serial number, make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model. --- OpenAirDocs.org is an independent research project of [Contrail Labs](https://contraillabs.com/). It is not affiliated with the FAA or the NTSB. Source documents are U.S. government works in the public domain.