CEN20LA329

NTSB accident investigation · Piper PA22 · Burlington, WI · August 9, 2020

Accident · Serious injuriesClass 3 · LimitedFinal report
Date
August 9, 2020, 14:30 local (19:30 UTC)
Place
Burlington, WI
Injuries
1 serious, 1 minor
Damage
Substantial damage
Phase of flight
Initial climb
Aircraft
N6849BPiper PA22
Defining event
Initial climb: Fuel related
Weather
Visual (VMC) · Day
Status
Completed
Report
Approved by Office Director
Investigation class
Class 3
NTSB office
Central Region
Parties
FAA
FAA report
20200809009879A
Case key
101762

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 partial loss of engine power due to the formation of carburetor ice while on the ground, which resulted in reduced climb capability and impact with trees during the initial climb.

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.

Temp/humidity/pressure: conducive to carburetor icingEnvironmental issues › Conditions/weather/phenomena · Effect on operationPiper PA-22-150: 3 casesAll aircraft: 435 casesProbable cause
Object/animal/substance: tree(s)Environmental issues › Physical environment · Effect on operationPiper PA-22-150: 4 casesAll aircraft: 933 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 pilot reported that the engine was not developing the expected rpm during the takeoff and initial climb. He noticed the airplane was not climbing well and could have trouble clearing small trees near the end of the runway. The pilot maneuvered the airplane through a low spot in the trees after he realized he did not have sufficient runway remaining to land. The pilot attempted to gain altitude and airspeed but only gained minimal altitude. The pilot considered applying carburetor heat but realized it would guarantee a loss of engine power with another line of trees ahead of the airplane. The pilot cleared the line of trees, but then impacted the next line of trees. The airplane nosed down, impacted the terrain, and came to rest inverted in a residential yard. The pilot speculated the reduced engine power was due to carburetor ice. Postaccident examination of the airframe and engine revealed no evidence of mechanical malfunctions or failures that would have precluded normal operations. Weather conditions reported at the time of the accident were conducive for carburetor icing at glide and cruise power. The pilot reported that during the takeoff and initial climb, the carburetor heat was off. Therefore, it is likely that carburetor ice accumulated during taxi and run-up before the takeoff, which resulted in a partial loss of engine power and reduced takeoff performance.

Factual narrative

On August 9, 2020, about 1430 central daylight time, a Piper PA-22-150 airplane, N6849B, was substantially damaged when it was involved in an accident near Burlington, Wisconsin. The pilot sustained minor injuries and the passenger was seriously injured. The airplane was operated as a Title 14 Code of Federal Regulations Part 91 personal flight. The pilot reported that the engine was not developing the expected engine RPMs during the takeoff and initial climb. He noticed the airplane was not climbing well and may have trouble clearing small trees near the end of the runway. The pilot maneuvered the airplane through a low spot in the trees after he realized he did not have sufficient runway remaining to land. The pilot performed a couple pitch maneuvers in an attempt to gain altitude and airspeed which resulted in a minimal gain in altitude. The pilot considered applying carburetor heat but realized it would guarantee a loss of engine power with another line of trees ahead of the airplane. The pilot cleared the line of trees, but then impacted the next line of trees. The airplane nosed down, impacted the terrain, and came to rest inverted in a residential yard. The pilot speculated the reduced engine power was due to carburetor ice. According to witnesses and a surveillance video at the Burlington Municipal Airport (BUU), Burlington, Wisconsin, the airplane departed the turf runway 19. The airplane appeared to have a gradual takeoff climb to about 30 to 35 ft above ground level. The airplane continued at that altitude before it disappeared from the witnesses and video view behind some trees south of BUU. The airplane sustained substantial damage to the fuselage, both wings, and empennage. Postaccident examination of the airframe and engine revealed no evidence of mechanical malfunctions or failures that would have precluded normal operations. According to a carburetor ice probability chart, the atmospheric conditions at the time of the accident were conducive to icing at glide and cruise power. Federal Aviation Administration Advisory Circular 20-113 explains, "To prevent accidents due to induction system icing, the pilot should regularly use [carburetor] heat under conditions known to be conducive to atmospheric icing and be alert at all times for indications of icing in the fuel system."

Aircraft

Registration
N6849B
Reported as
Piper PA22 (150)
Category
Airplane
Serial number
22-4148
Engine
Lycoming O-320 SERIES, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Airworthiness certificate
Standard, Normal
Last inspection
Annual · July 1, 2020
Departed
Burlington, WI
Destination
Burlington, WI
Equipment
Unknown

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
Minor
Certificate
Private
Airplane ratings
Single-engine land
Instrument ratings
Airplane
Medical
BasicMed, Unknown
Seat
Left
Flight hours
952 total · 371 in this make and model

Weather

Conditions
Visual (VMC) · Day
Wind
190° at 7 knots, gusting 16
Visibility
10 statute miles
Lowest ceiling
None
Temperature
86 °F, dew point 72 °F
Altimeter
29.97 inHg
Observed at
BUU, 1 nm away

Docket · 6

The files NTSB released with the investigation on October 9, 2020, on NTSB’s docket system: statements, records, photos and specialists’ reports. 6.5 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 N6849B · 1

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