CHI95LA048

NTSB accident investigation · Piper PA-28R-201T · La Porte City, IA · November 29, 1994

Accident · Minor injuriesLimited investigationFinal report
Date
November 29, 1994, 11:30 local (17:30 UTC)
Place
La Porte City, IA
Injuries
1 minor, 2 uninjured
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N1194HPiper PA-28R-201T
Weather
Visual (VMC) · Day
Status
Completed · report October 27, 1995
Report
Approved by Office Director
FAA report
19941129039839A
Case key
9805

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

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Probable cause

a material defect which resulted in the fatigue failure of the crankshaft and the aircraft owner's failure to comply with a Mandatory Service Bulletin addressing the defect. A factor related to the accident was the rough terrain on which the forced landing was made.

Sequence of events

NTSB’s coding before 2008: each occurrence and phase of flight, and the causes and factors under it. The codes are defined in NTSB’s coding manual.

Loss of engine power(total) - mech failure/malfCruise
Engine assembly,crankshaft - fatigueCause
Material defectManufacturerCause
Maintenance,service bulletin/letter - issuedManufacturer
Maintenance,service bulletin/letter - not complied withCompany/operator managementCause
Forced landingEmergency descent/landing
In flight collision with terrain/waterLanding
Terrain condition - rough/unevenFactor

Analysis

While en route the pilot heard a loud pop followed by engine vibrations and a partial loss of engine power. The pilot declared an emergency and was vectored toward a grass airstrip which he could not locate. En route to the grass strip a total loss of engine power was experienced. The airplane was landed in a plowed corn field. Post accident inspection revealed the crankshaft had separated between the no. 3 main bearing journal and the no. 5 cylinder crankpin due to fatigue cracking. Tcm service bulletin 92-16 addressing crankshafts made from non-vacuum arc remelted steel had not been complied with.

Factual narrative

On November 29, 1994, about 1130 central standard time, a Piper PA-28R-201T, N1194H, sustained substantial damage in a forced landing near La Porte City, Iowa, following a total loss of engine power. The private pilot and one passenger aboard the airplane were not injured. A second passenger received minor injuries. The personal flight originated at the St. Paul Downtown Airport, St. Paul, Missouri, at 1000, with an intended destination of Walnut Ridge, Arkansas. A VFR flight plan was filed, and visual meteorological conditions prevailed at the time.

While at 7,500 feet above mean sea level, 18.7 miles south of Waterloo, Iowa, the pilot reported he heard a "pop" from the engine and it started vibrating violently. He stated that at this time he still had partial engine power. The pilot was given vectors to a grass strip near LaPorte City. En route to the airport a complete loss of engine power was experienced. The airplane was landed one mile short of the airport in a field.

The wreckage was inspected by a Federal Aviation Administration Inspector from the Des Moines, Iowa, Flight Standards District Office. This inspector determined that there was no engine continuity between the front of the engine and the accessory drive. There was no movement of the #5 and #6 cylinder pistons when the crankshaft was rotated. No other anomalies were found which would have resulted in the loss of engine power.

The crankshaft, s/n F940, was removed from the engine and was shipped to the NTSB Materials Laboratory, in Washington D.C. for further examination. Inspection of the crankshaft showed a separation between the No. 3 main bearing journal and the No. 5 cylinder crankpin. The fracture contained, "crack arrest features and a smooth fracture surface, typical of high cycle fatigue cracking." See attached Metallurgists Factual Report for more details.

On September 29, 1992, Teledyne Continental Motors issued Mandatory Service Bulletin 92-16 addressing the replacement of Non-VAR crankshafts. This crankshaft was not manufactured from vacuum arc remelted steel. The service bulletin states, "Sufficient field service data has now been accumulated to lead us to believe that it is prudent to require replacement of all non-VAR crankshafts in service with VAR crankshafts." This service bulletin had not been complied with on the accident engine.

Aircraft

Registration
N1194H
Reported as
Piper PA-28R-201T (PA-28R-201)
Category
Airplane
Serial number
28R-7703016
Airframe hours
1,670
Engine
Continental TSIO-360-F, 200 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Registered owner
Eric S. Burka
Airworthiness certificate
Standard, Normal
Last inspection
Annual · August 4, 1994 · 40 hours before
Departed
STP · St. Paul, MN
Destination
ARG · Walnut Ridge, AR
Flight plan
VFR

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
44
Certificate
Private
Airplane ratings
Single-engine land
Medical
Class 3, Valid Medical--w/ waivers/lim
Seat
Left
Flight hours
208 total · 64 in this make and model · 97 as pilot in command · 40 in the last 90 days · 33 in the last 30 days · 2 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
310° at 7 knots
Visibility
7 statute miles
Lowest ceiling
2,000 ft overcast
Temperature
28 °F, dew point 19 °F
Altimeter
30.00 inHg
Observed at
ALO, 17 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.