CHI95LA187

NTSB accident investigation · Bell 47J2A · Elkhorn, WI · June 19, 1995

Accident · No injuriesLimited investigationFinal report
Date
June 19, 1995, 14:40 local (19:40 UTC)
Place
Elkhorn, WI
Injuries
2 uninjured
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N470RABell 47J2A
Weather
Visual (VMC) · Day
Status
Completed · report March 6, 1996
Report
Approved by Office Director
FAA report
19950619022669A
Case key
9916

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

loss of power as a result of an intake valve failure due to improper maintenance performed during the major engine overhaul, and pilot misjudgment of the flare during autorotation.

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,valve,intake - failureCause
Maintenance,major repair - improperOther maintenance personnelCause
Forced landingEmergency descent/landing
Autorotation - performedPilot in command
Hard landingEmergency landing
Flare - misjudgedPilot in commandCause
Rotor drive system,tail rotor drive shaft - blade strike

Analysis

The pilot reported that he was cruising at about 1,000 feet when the engine lost power. An autorotation was initiated. During the landing phase (cyclic flare), the main rotor struck the tailrotor drive shaft. An examination of the engine revealed that the number two cylinder intake valve had failed in the top radius (neck area) of the valve keeper recess, causing damage to the cylinder combustion chamber and piston. An inspection of the engine logbooks indicated that an identical failure had occurred eight hours previously. Further inspection revealed that the major engine overhaul, which had been conducted 27 hours prior to the accident, had not been performed in accordance with the manufacturer's procedures and specifications.

Factual narrative

On June 19, 1995, at 1440 central daylight time, a Bell 47J2A helicopter, N470RA, sustained substantial damage as a result of an engine failure and subsequent autorotation. The accident took place near Elkhorn, Wisconsin. The airline transport pilot and the passenger reported no injury. The 14 CFR Part 91 flight departed East Troy Airport, East Troy, Wisconsin, on a local flight. Visual meteorological conditions prevailed and no flight plan was filed.

The pilot reported that he was cruising at about 1,000 feet above ground level when the engine failed. An autorotation was initiated. During the landing phase (cyclic flare), the main rotor struck the tailrotor drive shaft.

An examination of the engine revealed that the number two cylinder intake valve had failed in the top radius (necked area) of the valve keeper recess, causing damage to the cylinder combustion chamber and piston. An inspection of the engine logbooks indicated that an identical failure had occurred eight hours previously. The first failure occurred on a factory new cylinder assembly, and the second on a "used" cylinder of undetermined time in service. Further inspection revealed that the major engine overhaul, which had been conducted 27 hours prior to the accident, had not been performed in accordance with the manufacturer's procedures and specifications. (See attachments)

Aircraft

Registration
N470RA
Reported as
Bell 47J2A
Category
Helicopter
Serial number
3719
Airframe hours
6,100
Engine
Lycoming VO-540-B1B3, 305 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Registered owner
John M. Wilson
Airworthiness certificate
Standard, Normal
Last inspection
Annual · May 30, 1995 · 27 hours before
Departed
57C · East Troy, WI

Flight crew

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
40
Certificate
Airline transport
Airplane ratings
Multi-engine land, Single-engine land
Instrument ratings
Helicopter, Airplane
Medical
Class 1, Unknown
Seat
Right
Flight hours
9,600 total · 200 in this make and model · 7,200 as pilot in command · 90 in the last 90 days · 30 in the last 30 days · 6 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
300° at 10 knots
Visibility
8 statute miles
Lowest ceiling
None
Temperature
90 °F
Altimeter
30.00 inHg
Observed at
UES, 28 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.