CEN16LA387

NTSB accident investigation · Pahnke Vernon A Vans RV 9A · Newark, IL · September 22, 2016

Accident · Minor injuriesLimited investigationFinal report
Date
September 22, 2016, 14:00 local (19:00 UTC)
Place
Newark, IL
Injuries
1 minor, 1 uninjured
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N699RVPahnke Vernon A Vans RV 9A
Defining event
Enroute: Loss of engine power (partial)
Weather
Visual (VMC) · Day
Status
Completed · report June 3, 2020
Report
Approved by Office Director
NTSB office
Central Region
Parties
FAA
Case key
94118

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 pilot's failure to properly assemble the fuel pump, which resulted in the loss of fuel pressure and the subsequent partial loss of engine power.

Findings · 4

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.

Maintenance: installationPersonnel issues › Task performance · PilotLyons Nathan F VANS RV-6A: 1 caseAll aircraft: 371 casesProbable cause
Fuel system: fuel pumpsAircraft › Aircraft systems · Incorrect service/maintenanceLyons Nathan F VANS RV-6A: 1 caseAll aircraft: 71 casesProbable cause
Engine fuel and control: fuel pumpAircraft › Aircraft power plant · Incorrect service/maintenanceLyons Nathan F VANS RV-6A: 1 caseAll aircraft: 34 casesProbable cause
Performance/control parameters: altitudeAircraft › Aircraft oper/perf/capability · Attain/maintain not possibleLyons Nathan F VANS RV-6A: 1 caseAll aircraft: 1,310 cases

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 was conducting a cross-country flight in an experimental airplane when he observed the fuel pressure fluctuating, and the engine began to surge. The pilot turned on the backup fuel pump but the engine continued to surge, so he diverted to a nearby airport. The pilot stated that he had difficulty visually acquiring the airport and was losing altitude while circling over the airport. He performed an "S" turn but was still too high. He was running out of runway below him, so he performed a "hard slip" to lose altitude. The airplane stalled 10-15 ft above the runway, hit the ground, and slid about 30 ft before stopping. The primary fuel pump had failed 4 days before the accident. The pilot replaced the fuel pump with a new unit that required partial assembly. He noted during assembly that there was not an O-ring where the lower fitting attached but that the mating surfaces were different between the two pumps and he had believed one was not required. The instructions with the new pump did not address the installation of an O-ring at the fitting. After the accident, the pilot reexamined the box the new fuel pump came in and found an O-ring for the lower fitting. Without the O-ring installed, the fuel system was not able to maintain the fuel pressure necessary to ensure smooth engine operation and resulted in the partial loss of engine power. The pilot stated the accident resulted from this maintenance issue.

Factual narrative

On September 22, 2016, about 1400 central daylight time (CDT), a Vans RV9A experimental airplane, N699RV, was substantially damaged during a forced landing near Cushing Field Ltd Airport (0C8), Newark, Illinois. The private pilot was not injured and the passenger suffered minor injuries. The airplane was privately registered and operated under the provisions of Title 14 Code of Federal Regulations Part 91 as a personal flight. Visual meteorological conditions prevailed for the flight, and no flight plan was filed. The pilot and passenger were conducting a cross-country flight when the pilot observed the fuel pressure fluctuating, and the engine began sto surge. The pilot turned on the backup fuel pump; the engine continued to surge so he diverted to 0C8. The pilot stated he had difficulty maintaining visual reference to the airport and the airplane was losing altitude as he circled over the airport. The pilot performed an "S" turn and found he was still too high. He was running out of runway below him, so he performed a "hard slip" to lose altitude. The airplane stalled 10-15 ft above the runway, hit the ground, and slid about 30 ft before stopping. The pilot reported he conducted a flight four days before the accident, on September 18, and he felt a "couple small pauses in the powerplant." The engine quit after landing and did not restart until the auxiliary fuel pump was turned on. He subsequently tested the primary fuel pump, which did not work, and ordered a new fuel pump. When the new pump arrived it did not have the bottom fitting attached, whereas the previous replacement was fully assembled. The pilot took the fitting off the old pump and there was an O-ring present; however, he did not see an O-ring with the new pump "kit." He said the mating surfaces were different between the two pumps and the new pump did not appear to require an O-ring. Additionally, the instructions that came with the new pump did not mention an O-ring. The pilot installed the new fuel pump without an O-ring and conducted a successful test of the new pump. Following the accident flight, the pilot questioned whether there could have been an O-ring accompanying the new fuel pump that he had not seen. He examined the area where he performed the maintenance and subsequently located a 5/8" O-ring inside another component that came from the box containing the new pump. The pilot stated the accident was caused by this maintenance issue.

Aircraft

Registration
N699RV
Reported as
Pahnke Vernon A Vans RV 9A (NO SERIES)
Category
Airplane, amateur-built
Serial number
90537
Built
2006
Airframe hours
515
Engine
Subaru EJ25, 160 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Airworthiness certificate
Standard, Normal
Last inspection
Condition · June 11, 2016
Departed
1C5 · Bolingbrook, IL
Destination
K34 · Gardner, KS
Airport
0C8 · Cushing Field Ltd, runway 18, 2,831 × 180 ft, grass/turf
Equipment
Electronic multifunction display, Electronic primary flight display, Onboard weather, ADS-B, Angle of attack indicator, Auto-pilot

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
68
Injuries
None
Certificate
Private
Airplane ratings
Single-engine land
Medical
Class 3, Waiver time limited special
Last flight review
September 16, 2014
Seat
Left
Restraint
5-point
Flight hours
1,573 total · 515 in this make and model · 1,573 as pilot in command · 19 in the last 90 days · 8 in the last 30 days · 1 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
Calm
Visibility
10 statute miles
Lowest ceiling
2,300 ft broken
Temperature
79 °F, dew point 68 °F
Altimeter
30.06 inHg
Observed at
KC09, 10 nm away

Docket · 3

The files NTSB released with the investigation on February 28, 2020, on NTSB’s docket system: statements, records, photos and specialists’ reports. 2.5 MB in all.