# NTSB CEN19LA265: Piper PA28, N6754J, Fairhope, AL, July 30, 2019 - Type: NTSB accident investigation - Classification: Accident · No injuries · Class 3 · Limited · Final report - Date: July 30, 2019, 16:30 local (21:30 UTC) - Place: Fairhope, AL - Coordinates: 30.514722, -87.871948 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=30.5147&lon=-87.8719&mi=10 - Phase of flight: [Enroute](https://openairdocs.org/ntsb-phases/400) (OpenAirDocs' grouping) - Defining event: [Enroute: Loss of engine power (partial)](https://openairdocs.org/ntsb-events/342) - Highest injury: No injuries - Injuries: 2 uninjured - Status: Completed - Report: Approved by Office Director - Investigation class: Class 3 - NTSB office: Central Region - Parties: FAA FSDO - NTSB case key (mKey): 100043 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=CEN19LA265 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/100043/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=100043 - Page: https://openairdocs.org/ntsb/CEN19LA265 ## Probable cause Failure of the No. 3 exhaust valve and the subsequent loss of engine power due to engine operation with an excessively lean fuel mixture over a period of time. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Engine (reciprocating): recip engine power section](https://openairdocs.org/ntsb-findings/01058520): Aircraft › Aircraft power plant · Damaged/degraded (probable cause); cases with it: [Piper PA-28-140, 3 cases](https://openairdocs.org/ntsb-findings/01058520/cases.md?model=7102802), [All aircraft, 233 cases](https://openairdocs.org/ntsb-findings/01058520/cases.md) - [Action: incorrect action performance](https://openairdocs.org/ntsb-findings/02041015): Personnel issues › Action/decision · Pilot (probable cause); cases with it: [Piper PA-28-140, 15 cases](https://openairdocs.org/ntsb-findings/02041015/cases.md?model=7102802), [All aircraft, 1,386 cases](https://openairdocs.org/ntsb-findings/02041015/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Enroute: Loss of engine power (partial)](https://openairdocs.org/ntsb-events/342) (defining event); cases with it: [Piper PA-28-140, 47 cases](https://openairdocs.org/ntsb-events/342/sequence.md?model=7102802), [All aircraft, 1,858 cases](https://openairdocs.org/ntsb-events/342/sequence.md) - [Emergency descent: Off-field or emergency landing](https://openairdocs.org/ntsb-events/440); cases with it: [Piper PA-28-140, 56 cases](https://openairdocs.org/ntsb-events/440/sequence.md?model=7102802), [All aircraft, 3,365 cases](https://openairdocs.org/ntsb-events/440/sequence.md) ## Analysis The flight instructor and student pilot had performed several touch-and-go landings; after the final landing, they departed for another airport. Shortly after takeoff, the engine started to vibrate severely and then lost power. The instructor performed a forced landing in a field, which resulted in substantial damage to the airplane's left wing. Postaccident engine examination revealed a failed No. 3 cylinder exhaust valve and extensive erosion on the No. 4 cylinder exhaust valve. The engine had accumulated 2,600 hours since the last overhaul, which was 600 hours beyond the manufacturer's recommended time before overhaul. The flight instructor reported that the leaning technique used while the airplane was on the ground was to lean the mixture during taxi or engine idle. For the engine run-up, they would use a full rich mixture. He added that during flight maneuvers at or below 3,000 ft mean sea level, they would not lean the mixture. However, the exhaust valve erosion is consistent with the engine being operated with an excessively lean fuel mixture over an extended period. ## Factual narrative On July 30, 2019, about 1630 central daylight time, a Piper PA28-140 airplane, N6754J, conducted a forced landing after departing the H L Sonny Callahan Airport (CQF), Fairhope, Alabama. The flight instructor and student pilot were not injured, and the airplane sustained substantial damage. The airplane was registered to and operated by Lightning Aviation, LLC under the provisions of Title 14 Code of Federal Regulations Part 91 as an instructional flight. The flight instructor reported that he was preparing the student pilot for his private pilot check ride and they had finished several touch-and-go landings. After the final landing, they planned to return to the Foley Municipal Airport (5R4). Shortly after take-off, the engine started a severe vibration, and then lost power. The instructor then preformed a forced landing in a cornfield, about two miles from the airport. An examination of the airplane by a Federal Aviation Administration inspector, found damage to the airplane's left wing and engine mount. Further examination of the engine's No. 3 cylinder revealed a failed exhaust valve. The examination also found extensive erosion on the No. 4 cylinder exhaust valve. He also noted that the engine had 2,600 hours since the last overhaul, adding that the engine manufacturer's recommended overhaul is 2,000 hours, and the flight school consistently ran the engines past the recommended overhaul time. Figure 1: Failed Exhaust valve FAA photo The flight instructor reported that the leaning technique used while on the ground, was to lean during taxi or engine idle. For the engine runup, they would go to a full rich mixture. He added that during flight maneuvers at or below 3,000 ft msl, they would not lean the mixture. ## Aircraft - Registration: [N6754J](https://openairdocs.org/deregistered/N6754J-2022-07-02), registration cancelled 2022-07-02, S/N 28-24477, built 1968 (OpenAirDocs) - Reported make and model: Piper PA28 (140) - Registry model: [Piper PA-28-140](https://openairdocs.org/model/piper-pa-28-140) (registry code 7102802) (OpenAirDocs) - Registry engine: [Lycoming 0-320 series](https://openairdocs.org/engine/lycoming-0-320-series) (registry code 41508, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 28-24477 - Year built: 1968 - Engines: Lycoming O-320 SERIES reciprocating - Damage: Substantial damage - Flight: Instructional, Part 91 - Airworthiness certificate: Standard, Normal - Departed: CQF, Fairhope, AL - Destination: 5R4, Foley, AL ## Flight crew As NTSB recorded them. NTSB leaves out names. - Flight instructor; age 42; injuries: none; commercial, flight engineer; airplane ratings: multi-engine land, single-engine land; instrument ratings: airplane; medical: class 1, without waivers/limitations; seat: right; restraint: 3-point; flight hours: 1,004 total, 300 in this make and model, 930 as pilot in command - Student pilot; injuries: none; seat: left; restraint: 3-point ## Weather - Conditions: Visual (VMC), Day - Wind: 200° at 5 knots - Visibility: 10 statute miles - Temperature: 86 °F, dew point 72 °F - Altimeter: 30.02 inHg - Observed at: KCQF ## FAA reports on this event (1) The FAA's own accident and incident reports, matched to the aircraft by N-number and date (OpenAirDocs). - [Accident 20190730014909A](https://openairdocs.org/incident/20190730014909A), Jul 30, 2019: Piper PA-28-140, Fairhope, AL, Substantial damage. After approximately 1 hour of flying and 4th touch and go, the aircraft engine lost power on climb out at approximately 300 ft AGL. Loss of power and heavy… ## Docket (4 files) The files NTSB released with the investigation on March 30, 2020, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=100043. 3.5 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 2.3 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40481691&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Master.PDF - CFI Statement (item 2, .PDF, 51 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40481692&FileExtension=.PDF&FileName=CFI%20Statement-Master.PDF - Inspector's Statement (item 3, .PDF, 18 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40481693&FileExtension=.PDF&FileName=Inspector%27s%20%20Statement-Master.PDF - Photos (item 4, .PDF, 1.1 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40481694&FileExtension=.PDF&FileName=Photos-Master.PDF From the NTSB's public API. Aircraft are matched to registry aircraft by N-number and event date, checked against the reported serial number, make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model. --- OpenAirDocs.org is an independent research project of [Contrail Labs](https://contraillabs.com/). It is not affiliated with the FAA or the NTSB. Source documents are U.S. government works in the public domain.