# NTSB CEN24LA269: Piper PA-36-375, N2386X, Avoca, NE, July 16, 2024

- Type: NTSB accident investigation
- Classification: Accident · No injuries · Class 3 · Limited · Final report
- Date: July 16, 2024, 14:30 local (19:30 UTC)
- Place: Avoca, NE
- Coordinates: 40.815538, -96.085319 (estimated)
- Nearby events: https://openairdocs.org/map.md?lat=40.8155&lon=-96.0853&mi=10
- Phase of flight: [Maneuvering](https://openairdocs.org/ntsb-phases/450) (OpenAirDocs' grouping)
- Defining event: [Maneuvering-low-alt flying: Powerplant sys/comp malf/fail](https://openairdocs.org/ntsb-events/340)
- Highest injury: No injuries
- Injuries: 1 uninjured
- Status: Completed
- Report: Approved by Office Director
- Investigation class: Class 3
- NTSB office: Central Region
- Parties: Lycoming Engines, FAA FSDO
- NTSB case key (mKey): 194710
- NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=CEN24LA269
- NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/194710/pdf
- Page: https://openairdocs.org/ntsb/CEN24LA269

## Probable cause

A partial loss of engine power due to the loose left magneto which resulted in erratic engine timing.

## Findings

NTSB's coded findings; those marked are part of the probable cause.

- [Ignition system: magneto/distributor](https://openairdocs.org/ntsb-findings/01057414): Aircraft › Aircraft power plant · Malfunction (probable cause); cases with it: [Piper PA-36-375, 1 case](https://openairdocs.org/ntsb-findings/01057414/cases.md?model=7103620), [All aircraft, 101 cases](https://openairdocs.org/ntsb-findings/01057414/cases.md)

## Sequence of events

The events NTSB coded, in order, by phase of flight. The defining event best describes what happened.

- [Maneuvering-low-alt flying: Powerplant sys/comp malf/fail](https://openairdocs.org/ntsb-events/340) (defining event); cases with it: [Piper PA-36-375, 1 case](https://openairdocs.org/ntsb-events/340/sequence.md?model=7103620), [All aircraft, 820 cases](https://openairdocs.org/ntsb-events/340/sequence.md)
- [Maneuvering-low-alt flying: Loss of engine power (partial)](https://openairdocs.org/ntsb-events/342); cases with it: [Piper PA-36-375, 2 cases](https://openairdocs.org/ntsb-events/342/sequence.md?model=7103620), [All aircraft, 1,858 cases](https://openairdocs.org/ntsb-events/342/sequence.md)
- [Landing-flare/touchdown: Collision with terr/obj (non-CFIT) ](https://openairdocs.org/ntsb-events/470); cases with it: [Piper PA-36-375, 3 cases](https://openairdocs.org/ntsb-events/470/sequence.md?model=7103620), [All aircraft, 10,189 cases](https://openairdocs.org/ntsb-events/470/sequence.md)

## Analysis

The pilot reported that, during an aerial application flight, the engine lost power and the airplane began to descend. He added full power and pushed the propeller control full forward, but did not feel the engine respond and the airplane continued to descend. After he dumped the hopper tank, he still was not able to stop the airplane’s descent, and the airplane touched down in the field and continued through a cattle fence, resulting in substantial damage to the fuselage and left wing. The airplane was recovered to a secure facility for further examination. There was a crack observed between the Nos. 1, 2, and 3 cylinders that was most likely the result of impact damage. Examination of the magnetos revealed that, while still attached to the engine, the left magneto could be rotated at its flange. Both magnetos were removed and spun by hand and both magnetos produced spark at their terminal leads. The right magneto made a “clunking” sound when rotated and rattled when shaken. Further examination revealed that the right magneto coil wedges were loose in the housing. The coil wedges appeared to have been initially wedged in place, but only exhibited minimal marring, and may not have been secured sufficiently. That the left magneto was found loose and could be rotated at its flange, it’s likely it was out of time. Although the right magneto coil wedges were loose in the housing, it is more likely the left magneto firing at the wrong time would have had the most significant impact on the engine only being able to produce partial power.

## Factual narrative

On July 16, 2024, about 1430 central daylight time, a Piper PA-36-375 airplane, N2386X, was substantially damaged when it was involved in an accident near Avoca, Nebraska. The pilot was not injured. The airplane was operated as a Title 14 Code of Federal Regulations Part 137 aerial application flight. The pilot reported that he maneuvered the airplane for his fourth spray pass and had rolled the airplane level at an altitude of about 300 ft above ground level when the airplane “lost all power” and began to descend. He added full power and pushed the propeller control full forward, but did not feel the engine respond and the airplane continued to descend. After he dumped the hopper tank load, he still was not able to stop the airplane’s descent. The airplane touched down in the field and continued through a cattle fence before coming to rest, resulting in substantial damage to the fuselage and left wing. The airplane was recovered to a secure facility for further examination. There was a crack observed between the Nos. 1, 2, and 3 cylinders; however, no thermal distress was found within the engine. Internal continuity was confirmed throughout the engine and borescope examination of the cylinders revealed no anomalies. Examination of the fuel divider, injectors, servo, and pump revealed no anomalies. The oil filter was removed and contained no contamination. The air inlet and filter were free of debris. While still attached to the engine, the left magneto flange could be rotated slightly. Both magnetos were removed and rotated by hand. The right magneto made a “clunking” sound when rotated and rattled when shaken. Both magnetos produced spark at their terminal leads. Further examination of the magnetos found the right magneto distributor gear was timed correctly. Both coil wedges were loose in the housing. The coil wedges appeared to have been initially wedged in place, but only had minimal marring, which may not have provided enough tension to retain the wedges properly. A review of maintenance records found that the magneto was overhauled on November 27, 2023, and was installed on the airplane on April 12, 2024. The airplane had flown about 40 hours since the magneto installation. The left magneto was in good condition and subsequently bench tested. The magneto operated as expected.

## Aircraft

- Registration: [N2386X](https://openairdocs.org/deregistered/N2386X-2026-02-14), registration cancelled 2026-02-14, S/N 36-8202018, built 1982 (OpenAirDocs)
- Reported make and model: PIPER PA-36-375
- Registry model: [Piper PA-36-375](https://openairdocs.org/model/piper-pa-36-375) (registry code 7103620) (OpenAirDocs)
- Registry engine: [Lycoming IO-720 series](https://openairdocs.org/engine/lycoming-io-720-series) (registry code 41546, reciprocating) (OpenAirDocs)
- Category: Airplane
- Serial number: 36-8202018
- Year built: 1982
- Airframe hours: 5252.9
- Engines: Lycoming IO-720-D1C 400 horsepower reciprocating
- Damage: Substantial damage
- Flight: Aerial application, Part 137
- Registered owner: Stove Creek Air LLC
- Airworthiness certificate: Special, Restricted (Special)
- Last inspection: Annual, April 12, 2024, 40 hours before
- Departed: Elmwood, NE
- Equipment: Stall warning system, Satellite tracking device

## Flight crew

As NTSB recorded them. NTSB leaves out names.

- Pilot; age 41; injuries: none; commercial, private; airplane ratings: single-engine sea, single-engine land; instrument ratings: airplane; medical: class 1, with waivers/limitations; last flight review January 11, 2024; seat: single; restraint: 4-point; flight hours: 2,577 total, 64 in this make and model, 1,912 as pilot in command, 124 in the last 90 days, 66 in the last 30 days, 7 in the last 24 hours

## Weather

- Conditions: Visual (VMC), Day
- Wind: 30° at 6 knots
- Visibility: 10 statute miles
- Lowest ceiling: 11,000 ft broken
- Temperature: 77 °F, dew point 61 °F
- Altimeter: 29.97 inHg
- Observed at: KPMV, 11 nm away
- METAR: KPMV 161935Z AUTO 03006KT 10SM BKN110 25/16 A2997 RMK AO2 T02490163

## 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 20240716009599A](https://openairdocs.org/incident/20240716009599A), Jul 16, 2024: Piper PA-36-375, Avoca, NE, Substantial damage. On 07/16/2024, the pilot of [privacy data omitted] was performing aerial application for a part 137 operation and was on the 8th load of the day. The aircraft…

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.

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