# NTSB CHI02IA083: Canadair CL-600-2B19, N991CA, Appleton, WI, February 27, 2002 - Type: NTSB incident investigation - Classification: Incident · No injuries · Incident investigation · Final report - Date: February 27, 2002, 06:01 local (12:01 UTC) - Place: Appleton, WI - Coordinates: 44.25962, -88.389884 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=44.2596&lon=-88.3899&mi=10 - Phase of flight: [Enroute](https://openairdocs.org/ntsb-phases/400) (OpenAirDocs' grouping) - Highest injury: No injuries - Injuries: 38 uninjured - Status: Completed, report March 2, 2004 - Report: Approved by Office Director - Parties: Comair, Inc., General Electric, Bombardier Aerospace, Federal Aviation Administration - ADs cited in the narratives: [AD 2001-19-02](https://openairdocs.org/ad/2001-19-02) (OpenAirDocs) - NTSB case key (mKey): 54280 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=CHI02IA083 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/54280/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=54280 - Page: https://openairdocs.org/ntsb/CHI02IA083 ## Probable cause The separation of the low pressure turbine module due to coke resulting in the blockage of the oil system. ## Sequence of events In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf). - Airframe/component/system failure/malfunction, climb - lubricating system - blocked(partial) (cause) - compressor assembly - separation (cause) ## Analysis The scheduled commercial passenger flight returned to the departure airport after the number two engine's low pressure turbine module separated from the engine and departed the airplane while climbing through 3,000 mean sea level and 4 nautical miles from the airport. Examination of the B-sump forward scavenge screen revealed that the entire screen area was blocked with coke including several metallic flakes, the largest of which was 1/3 inch by 1/3 inch. The screen was also partially collapsed. An oil sample from the B-sump forward scavenge line was black and contained black particles. The B-sump aft scavenge screen was estimated to have been approximately 90 percent blocked and contained some metallic flakes. An oil sample from the B-sump aft scavenge line was black and contained black particles. The C-sump forward scavenge screen contained a block of about 75 percent with coke. The center portion of the screen was clear. The C-sump aft screen was 5 percent blocked. The oil filter contained black particles and black oil. The impending bypass button on the oil filter was popped. ## Factual narrative On February 27, 2002, at 0601 central standard time, a Canadair CL-600-2B19, N991CA, operated by Comair, Inc. (d.b.a. Comair Airlines) as flight 5266, received minor damage during a failure of the number two engine during climbout from runway 29 (6,501 feet by 150 feet, concrete) at the Outagamie County Regional Airport (ATW), Appleton, Wisconsin. Visual meteorological conditions prevailed at the time of the accident. The 14 CFR Part 121 passenger flight was operating on an instrument rules flight plan. No injuries were reported. The flight was en route to the Cincinnati/Northern Kentucky International Airport, Covington, Kentucky. The flight crew reported that there was a vibration while in a climbing turn through 3,000 feet msl and 4 nm from the departure end of runway 29. The flight crew shut down the number two engine and returned to land without further incident at ATW five minutes later. On-site investigation of the airplane in Appleton, Wisconsin, revealed that the low pressure turbine (LPT) module had separated from the engine and departed the airplane. The LPT module was later recovered in a farm field about 4 miles from the airport. Airframe damage was limited to some scratches on the vertical stabilizer and a small puncture in the right hand stabilizer leading edge. The engine was removed from the airplane and shipped along with the LPT module to the Comair maintenance facility in Cincinnati, Ohio. The airplane was powered by two General Electric CF34-3A1 dual spool, high-bypass turbofan engines incorporating a single-stage fan and fourteen-stage high-pressure compressor (HPC), which are driven by a 4-stage LPT and 2-stage high-pressure turbine (HPT), respectively. The engines have a normal takeoff thrust rating of 8,729 lbs and a maximum takeoff thrust of 9,220 lbs. According to company maintenance records, the engine was received new in May 1997 and had not been overhauled. The engine accumulated 9,121.6 hours since new (TSN) and 9,317 cycles since new (CSN). The last shop visit occurred on December 27, 2001, at Comair's Cincinnati facility. General Electric has issued two Service Bulletins (SBs), CF34-AL SB 79-A0014 revision 1 dated August 23, 2001, and CF34-BJ SB 79-0015 revision 1, dated August 23, 2001, which introduced an initial and repetitive inspection program to prevent potential B-sump oil events due to B-sump scavenge screen blockage. The Federal Aviation Administration (FAA) issued Airworthiness Directive 2001-19-02, dated September 10, 2001, that mandated the B-sump scavenge screen inspection and cleaning procedures. According to Comair records, the inspection required by the AD was last complied with on December 27, 2001, during a 500-hour inspection at a TSN of 8,714 hours and a CSN 8,885 cycles. Examination of the B-sump forward scavenge screen revealed that the entire screen area was blocked with coke including several metallic flakes, the largest of which was 1/3 inch by 1/3 inch. The screen was also partially collapsed. An oil sample from the B-sump forward scavenge line was black and contained black particles. The B-sump aft scavenge screen was estimated to have been approximately 90 percent blocked and contained some metallic flakes. An oil sample from the B-sump aft scavenge line was black and contained black particles. The C-sump forward scavenge screen contained a block of about 75 percent with coke. The center portion of the screen was clear. The C-sump aft screen was 5 percent blocked. The oil filter contained black particles and black oil. The impending bypass button on the oil filter was popped. Since the incident, General Electric Aircraft Engines has issued two additional Alert SBs, CF34-AL SB 79-A0016 and CF34-AL SB 79-A0017. These SBs provide instructions to either replace or rework the B-sump scavenge screen fittings located at the forward and aft end of the lube and scavenge pump assembly. The rework will remove the screens to prevent B-sump oil release events that result from coke blockage of the screens. The new replacement fittings do not have screens. These new SBs are being mandated by the FAA and will provide a terminating action to the repetitive inspection requirements of AD 2001-19-02. Documentation of the engine was performed by the Powerplant Group Chairman's report which is included in the docket of this report. The FAA, Bombardier, Comair, and General Electric were parties to the investigation. The Canadian Transportation Safety Board was the designated representative to the investigation. ## Aircraft - Registration: [N991CA](https://openairdocs.org/deregistered/N991CA-2009-08-26), registration cancelled 2009-08-26, S/N 7216, built 1998 (OpenAirDocs) - Reported make and model: Canadair CL-600-2B19 - Registry model: [Canadair CL-600-2B19](https://openairdocs.org/model/canadair-cl-600-2b19) (registry code 1900309) (OpenAirDocs) - Registry engine: [GE CF34 series](https://openairdocs.org/engine/ge-cf34-series) (registry code 30015, turbo-fan) (OpenAirDocs) - Category: Airplane - Serial number: 7216 - Airframe hours: 9018.4 - Engines: General Electric CF34-3A1 9220 lbs thrust turbo fan - Damage: Minor damage - Flight: Part 121 - Operator: Comair, Inc., doing business as Comair Airlines - Registered owner: Wachovia Bank NA Trustee - Airworthiness certificate: Standard, Transport - Last inspection: Continuous airworthiness, February 13, 2002, 103.4 hours before - Departed: ATW, Appleton, WI - Destination: CVG, Covington, KY - Flight plan: IFR - Airport: ATW, Outagamie County Regional, runway 29, 6,501 × 150 ft, asphalt ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 35; injuries: none; airline transport; airplane ratings: multi-engine land, single-engine land; instrument ratings: airplane; medical: class 1, valid medical--no waivers/lim.; last flight review August 20, 2001; seat: left; flight hours: 8,810 total, 901 in this make and model, 5,034 as pilot in command, 52 in the last 90 days, 18 in the last 30 days, 2 in the last 24 hours - Co-pilot; age 28; injuries: none; commercial; airplane ratings: single-engine land, multi-engine land; instrument ratings: airplane; medical: class 1, valid medical--w/ waivers/lim; last flight review January 22, 2002; seat: right; flight hours: 1,721 total, 423 in this make and model, 1,045 as pilot in command, 161 in the last 90 days, 59 in the last 30 days, 2 in the last 24 hours ## Weather - Conditions: Visual (VMC), Dawn - Wind: 320° at 10 knots - Visibility: 10 statute miles - Lowest ceiling: 13,000 ft broken - Temperature: 18 °F, dew point 9 °F - Altimeter: 29.86 inHg - Observed at: ATW, 2 nm away ## FAA reports on this event (1) The FAA's own accident and incident reports, matched to the aircraft by N-number and date (OpenAirDocs). - [Incident 20020227007019I](https://openairdocs.org/incident/20020227007019I), Feb 27, 2002: Cndair CL6002B19, Appleton, WI, Minor damage. (-23) On 02/27/2002, a comair CL-600-2B19, N991CA, departed the Outagamie County Airport (atw) in Appleton, WI. While climbing through 3000 feet, the crew… ## Docket (12 files) The files NTSB released with the investigation on December 16, 2003, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=54280. 4.0 MB in all. - Flight Data Recorder 10 - Factual Report of Group Chairman (item 1, .PDF, 12 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40166457&FileExtension=.PDF&FileName=Flight%20Data%20Recorder%2010%20-%20Factual%20Report%20of%20Group%20Chairman-Master.PDF - Flight Data Recorder 10 - Attachment 1: Plots (item 2, .PDF, 344 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40166458&FileExtension=.PDF&FileName=Flight%20Data%20Recorder%2010%20-%20Attachment%201%3A%20Plots-Master.PDF - Flight Data Recorder 10 - Attachment 2: Data (item 3, .CSV, 166 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40166460&FileExtension=.csv&FileName=Flight%20Data%20Recorder%2010%20-%20Attachment%202%3A%20Data-Master.csv - Powerplants 8 - Factual Report of Group Chairman (item 4, .PDF, 117 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40183088&FileExtension=.PDF&FileName=Powerplants%208%20-%20Factual%20Report%20of%20Group%20Chairman-Master.PDF - Powerplants 8 - Attachment 2 (item 5, .PDF, 417 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40183105&FileExtension=.PDF&FileName=Powerplants%208%20-%20Attachment%202-Master.PDF - Powerplants 8 - Attachment 3 (item 6, .PDF, 476 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40183107&FileExtension=.PDF&FileName=Powerplants%208%20-%20Attachment%203-Master.PDF - Powerplants 8 - Attachment 4 (item 7, .PDF, 467 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40183108&FileExtension=.PDF&FileName=Powerplants%208%20-%20Attachment%204-Master.PDF - Powerplants 8 - Attachment 5 (item 8, .PDF, 549 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40183109&FileExtension=.PDF&FileName=Powerplants%208%20-%20Attachment%205-Master.PDF - Powerplants 8 - Attachment 6 (item 9, .PDF, 510 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40183110&FileExtension=.PDF&FileName=Powerplants%208%20-%20Attachment%206-Master.PDF - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 10, .PDF, 563 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40390631&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Redacted.PDF - Weather Information (item 11, .PDF, 45 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40201898&FileExtension=.PDF&FileName=Weather%20Information-Master.PDF - Statement of Party Representatives to NTSB Investigation (item 12, .PDF, 361 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40390632&FileExtension=.PDF&FileName=Statement%20of%20Party%20Representatives%20to%20NTSB%20Investigation-Redacted.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.