- Date
- August 13, 2016, 10:01 local (15:01 UTC)
- Place
- Des Moines, IA
- Injuries
- 3 minor, 1 uninjured
- Damage
- Destroyed
- Phase of flight
- Initial climb
- Aircraft
- N314BFCirrus Design SR20
- Defining event
- Initial climb: Loss of engine power (partial)
- Weather
- Visual (VMC) · Day
- Status
- Completed · report June 8, 2020
- Report
- Approved by Office Director
- NTSB office
- Central Region
- Parties
- Continental Motors Group, Federal Aviation Administration, Des Moines FSDO, Cirrus Aircraft
- FAA report
- 20160813014419A
- Case key
- 93827
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
The two separations in the induction system due to improper installation and/or maintenance, which resulted in a partial loss of engine power during initial climb.
Findings · 3
NTSB’s coded findings. Those marked are part of the probable cause; the rest are factors or other findings. Under each, the cases with the same finding.
Sequence of events
The events NTSB coded, in order, by phase of flight. The defining event is the one that best describes the accident. Under each, the cases with the same event anywhere in their sequence.
Analysis
The pilot and three passengers departed on a personal cross-country flight when the pilot heard and felt a sudden reduction in engine power during initial climb. He told the tower controller that he had engine trouble and requested an immediate landing. The pilot was unable to maintain altitude and, as a result, deployed the airplane's emergency parachute system. After a successful parachute deployment, the airplane contacted power lines shortly before it impacted the ground in a nose-level attitude. After the airplane landed, the occupants egressed, and a fire erupted that destroyed the airframe. A postaccident engine examination revealed that the induction tube coupler closest to the No. 1 cylinder was partially disconnected from its associated induction tube. Although both coupler clamps were tight, the clamp closest to the No. 1 cylinder did not overlap its associated induction tube. Additionally, the cylinder No. 3 induction tube was fractured at the cylinder mounting flange. A laboratory examination of the cylinder No. 3 induction tube revealed multiple areas of fatigue; however, the cause of the fatigue could not be conclusively determined due to postfracture damage. The material properties of the induction tube were consistent with the manufacturer's specification for an annealed aluminum alloy. A review of the engine logbook was inconclusive as to whether the induction system tubes had been removed for maintenance in the 7.4 years since the engine had been rebuilt. The two separations in the induction system likely caused an imbalance of the intake pressures and the partial loss of engine power during initial climb.
Factual narrative
On August 13, 2016, about 1001 central daylight time, a Cirrus Design Corporation SR20 airplane, N314BF, had a partial loss of engine power shortly after takeoff from Des Moines International Airport (DSM), Des Moines, Iowa. The pilot deployed the Cirrus Airframe Parachute System (CAPS) and descended into power lines and terrain. The airplane was subsequently destroyed by a postimpact fire. The pilot and 2 passengers sustained minor injuries. An additional passenger was not injured. The airplane was operated as a Title 14 Code of Federal Regulations Part 91 personal flight. The pilot reported that he did not observe any airframe or engine anomalies during his preflight inspection. He also noted that the fuel tanks were completely full, and that he did not observe any contamination in the fuel samples that he obtained during his preflight inspection. The pilot reported that the engine started without hesitation and idled normally before taxi, and that he did not observe any anomalies during his before takeoff engine run-up. A normal takeoff was made on runway 31 from the taxiway Romeo intersection with the wing flaps set at 50%, the electric fuel pump selected to boost, and the mixture-control set to full rich. The pilot reported that the engine instrumentation indicated normal readings during the takeoff run and that liftoff was achieved at 70 knots indicated airspeed (KIAS). After liftoff, the pilot reduced airplane pitch and accelerated to 90-95 KIAS before he retracted the wing flaps. The pilot reported that during the initial climb, about 500 ft above ground level (agl), he heard and felt a sudden reduction in engine power. He told the tower controller that he had engine trouble and requested an immediate landing. The tower controller cleared the pilot to enter a right downwind for landing on runway 31. The pilot reported that he was unable to maintain altitude and, as a result, he deployed the CAPS. After a successful parachute deployment, the airplane contacted power lines shortly before it impacted the ground at the intersection of Park Avenue and SW 56th Street. The pilot remarked that the airplane had landed "remarkably soft" in a nose level attitude. After landing, a fire erupted from under the left wing and the pilot told his passengers to evacuate from the right cabin door. The airplane was subsequently destroyed by the postimpact fire. The airplane was a four-place single engine low-wing airplane of primarily composite construction. The airplane was powered by a 6-cylinder, 200 horsepower, Continental Motors IO-360-ES16B engine, serial number 1000059, which drove a two-blade Hartzell model BHC-J2YF-1BF/F7694 constant speed propeller. According to airplane logbook entries, the most recent annual inspection was completed on May 19, 2016, at 1,565.6 hours total airframe time. As of the annual inspection, the engine had accumulated 555.1 hours since it was rebuilt at the factory on March 20, 2009. A review the engine logbook onlyrevealed one maintenance entry, dated February 10, 2012, at 181.5 hours total engine time, in which the induction system was specifically mentioned as having been inspected. However, further review the engine logbook was inconclusive if the induction system tubes had been removed for maintenance in the 7.4 years since the engine had been rebuilt. According to the pilot, the airplane had accumulated about 66.5 flight hours since the last annual inspection. The engine and propeller were not damaged by the postimpact fire. The engine remained attached to the firewall and the propeller remained attached to the crankshaft flange. The propeller exhibited torsional twisting, S-shaped spanwise bends, leading edge damage, and burnishing of the blade face and back. Internal engine and valve train continuity was confirmed as the engine crankshaft was rotated. Compression and suction were observed on all cylinders in conjunction with crankshaft rotation, and both magnetos provided spark at all leads. The sparkplugs for cylinder Nos. 4 and 5 exhibited excessive black soot, consistent with an over-rich fuel/air mixture. The remaining sparkplugs exhibited features consistent with normal engine operation. A borescope inspection of each cylinder did not reveal any anomalies. Additionally, no anomalies were observed with the fuel servo, mechanical fuel pump, fuel flow divider, or fuel injectors. A disassembly of the oil filter did not reveal any metal debris. The induction tube coupler closest to the No. 1 cylinder, part number (p/n) 654439-16, was observed partially disconnected from its associated induction tube. Although both coupler clamps were tight, the clamp, p/n AN737TW74, closest to the No. 1 cylinder did not overlap its associated induction tube. Additionally, the cylinder No. 3 induction tube, p/n 655224-1, was fractured at the cylinder mounting flange. The fractured No. 3 induction tube, p/n 655224-1, was submitted to the National Transportation Safety Board (NTSB) Materials Laboratory for additional examination. A visual examination confirmed that the mounting flange of the induction tube had fractured from the main body of the tube. An additional attachment flange that had been installed between the induction tube flange and the engine cylinder did not exhibit any discernible damage. Several measurements of the induction tube revealed it was deformed in multiple directions such that the measurements at various locations produced inconsistent data. The tube inner diameter measured 1.624 inches, and the outer diameter measured between 1.742 and 1.767 inches. The tube thickness ranged between 0.705 and 0.735 inches. The manufacturer drawing dimension AB measured 2.822 inches, and the AC line measured about 2.6 inches. The fracture between the flange and the remaining tube was circumferential in orientation and perpendicular to the tube direction. The flange had also fractured in two additional locations longitudinally, creating two flange fragments. Ingeneral, the mating fracture surfaces exhibited a flat orientation, with some other areas exhibiting a 45° fracture orientation. The fracture surfaces exhibited smearing and rub marks, consistent with post-fracture damage. Examination of the flange-side fracture surface with a scanning electron microscope revealed fatigue striations, consistent with fatigue crack propagation. The character and spacing of the striations were consistent with high-cycle fatigue. The likely initiation sites of the fatigue had been destroyed by the post-fracture smearing. The chemical composition of the fractured induction tube flange was determined by energy dispersive x-ray spectroscopy (EDS) and was consistent with an AA 6061-series aluminum alloy. The results of material electrical conductivity and hardness testing were consistent with those typical of the 6061-O aluminum alloy in the annealed condition. The chemical composition, electrical conductivity, and hardness values were consistent with the engine manufacturer's part specification.
Aircraft
- Registration
- N314BF
- Reported as
- Cirrus Design SR20 (NO SERIES)
- Category
- Airplane
- Serial number
- 1055
- Built
- 2000
- Airframe hours
- 1,632
- Engine
- Continental IO-360-ES16B, 200 horsepower, reciprocating
- Damage
- Destroyed
- Fire
- On-Ground
- Flight
- Personal · Part 91
- Operator
- Alidade Partners, LLC
- Registered owner
- Alidade Partners, LLC
- Airworthiness certificate
- Standard, Normal
- Last inspection
- Annual · May 19, 2016 · 66 hours before
- Departed
- DSM · Des Moines, IA
- Destination
- I68 · Lebanon, OH
- Flight plan
- IFR
- Airport
- DSM · Des Moines International Arpt, runway 31, 9,002 × 150 ft, concrete
- Equipment
- Onboard weather, Satellite tracking device, Stall warning system, Airframe parachute, Auto-pilot, Electronic flight bag or handheld device, Electronic multifunction display
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
- 42
- Injuries
- Minor
- Certificate
- Private
- Airplane ratings
- Single-engine land
- Instrument ratings
- Airplane
- Medical
- Class 3, Without waivers/limitations
- Last flight review
- March 23, 2016
- Seat
- Left
- Restraint
- 4-point
- Flight hours
- 252 total · 66 in this make and model · 211 as pilot in command · 66 in the last 90 days · 37 in the last 30 days · 0 in the last 24 hours
Weather
- Conditions
- Visual (VMC) · Day
- Wind
- 350° at 8 knots
- Visibility
- 10 statute miles
- Lowest ceiling
- None
- Temperature
- 77 °F, dew point 64 °F
- Altimeter
- 29.96 inHg
- Observed at
- DSM, 2 nm away
Docket · 8
The files NTSB released with the investigation on April 24, 2020, on NTSB’s docket system: statements, records, photos and specialists’ reports. 14.9 MB in all.
FAA reports on this event · 1
The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.