CEN17LA372

NTSB accident investigation · Piper PA 25-235 · Westphalia, KS · September 28, 2017

Accident · No injuriesLimited investigationFinal report
Date
September 28, 2017, 17:16 local (22:16 UTC)
Place
Westphalia, KS
Injuries
1 uninjured
Damage
Substantial damage
Phase of flight
Maneuvering
Aircraft
N7336ZPiper PA 25-235
Defining event
Maneuvering-low-alt flying: Loss of engine power (total)
Weather
Visual (VMC) · Day
Status
Completed · report May 29, 2019
Report
Approved by Office Director
NTSB office
Central Region
Parties
Federal Aviation Administration
FAA report
20170928014209A
Case key
96129

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

A total loss of engine power due to a fatigue failure of the crankshaft that resulted from main bearing shift and lack of lubrication.

Findings · 2

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 engine power sectionAircraft › Aircraft power plant · Fatigue/wear/corrosionPiper PA-25-235: 1 caseAll aircraft: 233 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 he departed in the airplane with full fuel and chemical for the aerial application flight. After spraying a field for about 20 minutes, the engine experienced a total loss of power. The pilot jettisoned the chemical load and initiated a forced landing to a field. About 5 ft above the field, as the pilot tried to bleed off airspeed, the airplane stalled and impacted terrain. Disassembly and examination of the engine revealed that the crankshaft was fractured, and the main bearings displayed thermal damage and smearing. Material examination of the crankshaft showed features consistent with a subsurface crack initiation and fatigue crack propagation. The fatigue striations, particularly near the initiation site, were consistent with high-cycle fatigue. The forward main bearings exhibited spalling, displacement, and cracking consistent with bearing wear fatigue. All the bearing damage was typical of similar bearings that had been operated at elevated temperatures using inadequate lubrication. The main bearing damage was likely the result of main bearing shift and a blockage of the lubrication paths. The blockage resulted in a lack of lubrication, main bearing failure, and a fatigue failure of the crankshaft. The reason for the main bearing shift could not be determined based on the available information.

Factual narrative

On September 28, 2017, at 1716 central daylight time, a Piper PA-25-235 airplane, N7336Z, impacted terrain following a loss of engine power while maneuvering at low altitude near Westphalia, Kansas. The commercial pilot, who was the sole occupant, was not injured, and the airplane sustained substantial damage. The airplane was registered to and operated by a private individual under the provisions of 14 Code of Federal Regulations Part 137 as an aerial application flight. Visual meteorological conditions prevailed, and no flight plan had been filed for the flight. The local flight departed the Garnett Municipal Airport (K68), Garnett, Kansas, about 1630. According to the pilot, the airplane departed K68 with full fuel and chemical for the aerial application flight. After spraying a field for about 20 minutes, the engine lost power. The pilot jettisoned his chemical load and initiated a forced landing to a field. About 5 feet above the field as the pilot tried to bleed off airspeed, the airplane stalled and impacted terrain. The airplane sustained substantial damage to the left wing. The Lycoming O-540-B2B5 engine was removed from the airframe for further examination. A review of the maintenance records showed the engine underwent a field major overhaul on January 28, 2016, about 218 hours prior to the accident. On October 25, 2017, the engine was disassembled under the supervision of the Federal Aviation Administration inspectors. Disassembly of the engine revealed the crankshaft was fractured, and the main bearings displayed thermal damage and smearing. The crankshaft and main bearings were retained for further examination. The fractured crankshaft and forward main journal bearings were examined by the National Transportation Safety Board Materials Laboratory. Examination of the crankshaft showed a fracture across a web located between the second cylinder (C2) journal and the second main (M2) journal. Approximately 60% of the fracture surface exhibited a general flat portion with crack arrest marks. The crack arrest marks appeared to emanate out from near the corner of the web near the M2 journal. The crack arrest features were not consistent with having progressed from a surface or from an internal feature, but were consistent with a subsurface crack initiation, and fatigue crack propagation. The fatigue striations, particularly near the initiation site, were consistent with high-cycle fatigue. The forward main bearing (M1) journal displayed discoloration and dark circumferential wear marks on the aft most two inches. One aft bearing surface revealed spalling, displacement, and cracking consistent with bearing wear fatigue. The other aft bearing surface exhibited spalling, material displacement, and smearing. Much of the spalled and smeared material was found accumulated in the lubrication groove. All the bearing damage was typical of similar bearings that operated at elevated temperatures with inadequate lubrication.

Aircraft

Registration
N7336Z
Reported as
Piper PA 25-235 (UNDESIGNAT)
Category
Airplane
Serial number
25-3285
Built
1965
Engine
Lycoming O-540-B2B5, 260 horsepower, reciprocating
Damage
Substantial damage
Flight
Aerial application · Part 137
Airworthiness certificate
Special, Restricted (Special)
Last inspection
Annual · January 1, 2017 · 110 hours before
Departed
K68 · Garnett, KS
Destination
K68 · Garnett, KS
Equipment
Stall warning system

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
43
Injuries
None
Certificate
Commercial
Airplane ratings
Single-engine land
Medical
Class 2, Without waivers/limitations
Last flight review
January 5, 2017
Seat
Center
Restraint
4-point
Flight hours
463 total · 233 in this make and model · 408 as pilot in command · 96 in the last 90 days · 32 in the last 30 days · 5 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
360° at 6 knots
Visibility
10 statute miles
Lowest ceiling
None
Temperature
73 °F, dew point 54 °F
Altimeter
30.20 inHg
Observed at
KIXD, 36 nm away

Docket · 4

The files NTSB released with the investigation on June 19, 2018, on NTSB’s docket system: statements, records, photos and specialists’ reports. 7.0 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.

Other investigations on N7336Z · 2

Matched to the same aircraft by N-number and date.