CEN19LA002

NTSB accident investigation · Cirrus SR22 · Midland, TX · October 12, 2018

Accident · Minor injuriesLimited investigationFinal report
Date
October 12, 2018, 10:45 local (15:45 UTC)
Place
Midland, TX
Injuries
2 minor
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N729TGCirrus SR22
Defining event
Enroute-climb to cruise: Loss of engine power (partial)
Weather
Visual (VMC) · Day
Status
Completed · report June 29, 2020
Report
Approved by Office Director
NTSB office
Central Region
Parties
Hartzell Engine Technologies, Inc, FAA FSDO, Cirrus Aircraft, Continental Aerospace Technology
FAA report
20181012019779A
Case key
98461

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 loss of engine power due to excessive fuel flow.

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.

Fuel systemAircraft › Aircraft systems · Not specifiedCirrus Design SR22T: 3 casesAll aircraft: 181 casesProbable cause
Object/animal/substance: ground vehicleEnvironmental issues › Physical environment · Contributed to outcomeCirrus Design SR22T: 1 caseAll aircraft: 132 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 and passenger departed on a cross-country flight in a single-engine airplane. Shortly after takeoff and about 500 ft above ground level, the engine "surged." The pilot turned the airplane back toward the airport; however, the engine lost power. The pilot recognized the airplane would not make it back to the airport, so he deployed the airplane's parachute. The airplane descended under the parachute into a parking lot and impacted a parked automobile, which resulted in substantial damage to the airplane. The engine examination and test run noted that the engine fuel flow was high and above specified engine and airframe manufacturers' limits. Data from the airplane's data monitor also indicated that the airplane engine's fuel flow was high on the accident flight and on previous flights, although the maximum fuel flow recorded varied. A review of maintenance records revealed that the engine manifold pressure and fuel flow were adjusted in accordance with the manufacturer's maintenance manual about 3 months before the accident.

Factual narrative

On October 12, 2018, about 1045 central daylight time, a Cirrus SR22 airplane, N729TG, impacted a parking lot shortly after departing the Midland Airpark (MDD), Midland, Texas. The pilot and passenger received minor injuries, and the airplane was substantially damaged. The airplane was registered to and operated by TJG Equipment, LLC under the provisions of Title 14 Code of Federal Regulations Part 91 as a cross-country flight. The pilot reported that after departure and about 500 ft above ground level, the engine "surged". He turned back toward the airport and the engine lost power. The pilot recognized the airplane would not make it back to the airport, so he deployed the Cirrus Airframe Parachute System (CAPS). The airplane descended under the parachute into a parking lot and impacted a parked automobile. The airplane was recovered to a salvage facility. An engine examination was then conducted by the NTSB Investigator in Charge (IIC), and technical representatives from the engine and airframe manufacturers. A visual inspection and borescope examination of the engine was conducted: a damaged propeller and minor damage to the exhaust system was noted. In order to facilitate an engine test run, a replacement propeller was installed, and a fuel can was plumbed into the airplane fuel system. An engine run was then conducted, and the engine started without hesitation. The engine was operated about 1,000 rpm to bring the engine up to operation temperatures. During the engine test run, full throttle was applied: manifold pressure stabilized at 39 inHg and fuel flow reached 49 gph. [The engine manufacturer specifications are 36.6 inHg and 37.5 gph, with Cirrus specified a 40.5gph limit]. After the engine run, the turbocharger controller and wastegate actuator were removed from the airplane and sent to the manufacturer for additional testing. It was also noted that during the wastegate actuator removal, the wastegate valve appeared "stuck". After moving the valve, it appeared to move normally. The airplane's parachute was also removed and sent to Cirrus for a performance and conformity inspections. The airplane's recoverable data module (RDM) was downloaded, and a review of the data noted that on the accident flight and previous flights, the engine's fuel flow was high, including near or above the maximum limit. A review of the airplane's maintenance records revealed a maintenance entry dated July 18, 2018, that annotated the manifold pressure was set to 36.5, and fuel flow to 41gph, and rpm to 2,500, per Cirrus aircraft maintenance manual 5-30. There were no additional entries that indicated the fuel flow was later changed. The wastegate actuator and turbocharger controller were bench tested at Hartzell's Engine Technologies (HET) facility, in Montgomery, Alabama, with representatives from the NTSB, FAA, and HET present. Both units operated normally, with no discrepancies noted that would have affected normal performance. The engine was removed andshipped to the manufacturer's facility where it was placed in an engine test cell. The NTSB IIC and technical representative from the airframe and engine manufacturers conducted the test. The engine was started and ran at various power settings. It was noted that fuel flows were high, enough so that the engine would run rough, but did not experience a total loss of power. A small amount of black smoke was also observed during portions of the engine test run. Later during the test run, adjustments were made that lowered fuel flow; the engine appeared to run normally, without black smoke nor roughness. A review of Cirrus support publications revealed two publications that address potential issues with engine high fuel flows: Service Advisory SA19-01, Subject: High Boost/Prime Altitude Lockout Software Condition, which advises that high boost/prime mode be avoided in-flight, below 10,000 ft. Service Bulletin SB2x-42-17, Subject: 42-20 INTEGRATED MODULAR AVIONICS - Perspective S/W Update, which provides a 10,000 ft altitude lockout feature; and a high fuel flow CAS message, at 42 gph.

Aircraft

Registration
N729TG
Reported as
Cirrus SR22 (T)
Category
Airplane
Serial number
1347
Built
2016
Airframe hours
582.5
Engine
Continental TIO-550, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Operator
TJG Equipment LLC
Registered owner
TJG Equipment LLC
Airworthiness certificate
Standard, Normal
Last inspection
Annual · June 26, 2018
Departed
Midland, TX
Destination
E11 · Andrews, TX
Flight plan
IFR
Equipment
Data recorder, Airframe parachute

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
33
Injuries
Minor
Certificate
Airline transport
Airplane ratings
Multi-engine land, Single-engine land
Instrument ratings
Airplane
Medical
Class 1, Without waivers/limitations
Seat
Left
Restraint
3-point
Flight hours
3,979 total · 1,468 in this make and model · 3,941 as pilot in command · 67 in the last 90 days · 16 in the last 30 days · 2 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
180° at 9 knots
Visibility
10 statute miles
Temperature
68 °F, dew point 66 °F
Altimeter
30.00 inHg
Observed at
KMDD

Docket · 4

The files NTSB released with the investigation on April 21, 2020, on NTSB’s docket system: statements, records, photos and specialists’ reports. 8.1 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.