CEN17LA317

NTSB accident investigation · Piper PA22 · Beckville, TX · August 14, 2017

Accident · Minor injuriesLimited investigationFinal report
Date
August 14, 2017, 10:17 local (15:17 UTC)
Place
Beckville, TX
Injuries
1 minor
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N2591APiper PA22
Defining event
Enroute-cruise: Loss of engine power (partial)
Weather
Visual (VMC) · Day
Status
Completed · report July 8, 2019
Report
Approved by Office Director
NTSB office
Central Region
Parties
FAA Flight Standards, Lycoming Engines
Case key
95818

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

A stuck exhaust valve, which resulted in the failure of the valve and a loss of engine power. Contributing to the valve failure and loss of engine power was the extended time since the last overhaul.

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.

Engine (reciprocating): recip eng cyl sectionAircraft › Aircraft power plant · Fatigue/wear/corrosionPiper PA-22-135: 1 caseAll aircraft: 373 casesProbable cause
Engine (reciprocating)Aircraft › Aircraft power plant · Not serviced/maintainedPiper PA-22-135: 1 caseAll aircraft: 497 casesProbable cause

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 commercial pilot reported that, about 2 hours into the pipeline surveillance flight, the engine began running roughly. He initially established a course to a nearby airport; however, the engine was not producing enough power to maintain altitude. He subsequently executed a forced landing to a pasture, which resulted in substantial damage to the left wing. A postaccident engine examination revealed that the No. 3 cylinder exhaust valve fractured at the stem seat. Metallurgical examination revealed that the fracture features were consistent with torsional loading at fracture. The stem was tapered adjacent to the fracture, and interconnected voids and surface oxidation were observed at the fracture surface. The presence of voids, tapering of the stem, and oxidation are consistent with high-temperature deformation under stress. Further examination revealed grain structure and subsurface oxidation consistent with exposure to elevated temperatures over an extended period of time, consistent with a stuck valve condition. Factors leading to stuck exhaust valves include excessive engine temperature, dirty or contaminated engine oil, high lead content fuels, hot engine shut-downs, and poor engine baffling. Running engines past the recommended overhaul interval or at elevated temperatures risks creating an exhaust valve fatigue event. The investigation was unable to determine the exact combination of elements that led to the stuck valve. However, based on the available maintenance records, the most recent engine overhaul was completed in 1968, and it is likely that the extended 49-year interval contributed to the stuck valve. While this exceeded the engine manufacturer's 12-year or 1,500-hour time between overhaul interval, the operator was not required to comply under current regulations due to the type of operation.

Factual narrative

On August 14, 2017, about 1017 central daylight time, a Piper PA22-135 airplane, N2591A, was substantially damaged during a forced landing following a partial loss of engine power near Beckville, Texas. The pilot sustained minor injuries. The airplane was registered to and operated by private individuals as a Title 14 Code of Federal Regulations Part 91 flight. Day visual meteorological conditions prevailed. The flight was not operated on a flight plan. The pipeline surveillance flight originated from Cypress River Airport (24F), Jefferson, Texas, about 0800. The intended destination was the Gladewater Municipal Airport (07F), Gladewater, Texas.The pilot reported fueling the airplane at 24F before departing on his planned pipeline surveillance route. About 2 hours into the flight, en route to 07F, the engine began running rough. He initially established a course to Panola County Airport (4F2) about 8 miles away. However, the engine was not producing enough power to maintain altitude. He subsequently executed a forced landing to a pasture, which resulted in substantial damage to the left wing. A postaccident engine examination revealed that the no. 3 cylinder exhaust valve fractured at the stem seat. The intake valve appeared intact. The cylinder walls exhibited impact and scraping marks consistent with secondary damage from the separated exhaust valve head. The piston had fractured at several locations; the features appeared consistent with overstress fractures. The piston crown exhibited multiple impact marks similar to the cylinder walls. Metallurgical examination revealed that the fracture surface on the separated valve head was obliterated consistent with secondary mechanical damage after separation from the stem. The mating fracture surface on the stem was relatively undamaged. The fracture features were consistent with torsional loading at fracture. The stem was tapered adjacent to the fracture, and interconnected voids were observed at the fracture surface. Surface oxidation, sub-surface intergranular oxidation and deposits of lead-based compounds were also observed. The presence of the voids, the tapering of the stem, and the oxidation are consistent with high-temperature deformation under stress. Further examination revealed grain structure and sub-surface oxidation consistent with exposure to elevated temperatures over an extended period of time. The available airplane maintenance records included an entry, dated April 5, 1968, that noted: "major overhaul of engine this date;" the associated tachometer time was 1,153 hours. No subsequent entries regarding an engine overhaul were observed in the records. The most recent annual inspection was completed on April 22, 2017, at 1,770.4 hours tachometer time. The current owner purchased the airplane on April 23, 2017. The most recent engine maintenance consisted of an oil change on August 1, 2017. The tachometer indicated 1,986.5 hours at the accident site. The engine manufacturer recommendedtime between overhaul (TBO) was 1,500 hours operating time or 12 calendar years. Federal Aviation Administration regulations do not require Part 91 operators to comply with an engine manufacturer's TBO interval provided the engine meets annual inspection requirements.

Aircraft

Registration
N2591A
Reported as
Piper PA22 (135)
Category
Airplane
Serial number
22-876
Built
1952
Airframe hours
1,986
Engine
Lycoming O-290-D2, 135 horsepower, reciprocating
Damage
Substantial damage
Flight
Aerial observation · Part 91
Airworthiness certificate
Standard, Normal
Last inspection
Annual · April 22, 2018 · 216 hours before
Departed
24F · Jefferson, TX
Destination
07F · Gladewater, TX

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
60
Injuries
Minor
Certificate
Commercial
Airplane ratings
Single-engine land
Medical
Class 2, With waivers/limitations
Last flight review
June 26, 2016
Seat
Left
Restraint
Lap only
Flight hours
5,941 total · 203 in this make and model · 240 in the last 90 days · 70 in the last 30 days · 2 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
230° at 8 knots
Visibility
8 statute miles
Lowest ceiling
None
Temperature
81 °F, dew point 79 °F
Altimeter
29.90 inHg
Observed at
GGG, 20 nm away

Docket · 5

The files NTSB released with the investigation on May 1, 2019, on NTSB’s docket system: statements, records, photos and specialists’ reports. 19.1 MB in all.