# NTSB ERA09LA470: Cessna A188B, N4842R, McRae, GA, August 20, 2009 - Type: NTSB accident investigation - Classification: Accident · No injuries · Limited investigation · Final report - Date: August 20, 2009, 16:00 local (20:00 UTC) - Place: McRae, GA - Coordinates: 32.095554, -82.879997 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=32.0956&lon=-82.8800&mi=10 - Phase of flight: [Maneuvering](https://openairdocs.org/ntsb-phases/450) (OpenAirDocs' grouping) - Defining event: [Maneuvering: Loss of engine power (total)](https://openairdocs.org/ntsb-events/341) - Highest injury: No injuries - Injuries: 1 uninjured - Status: Completed, report October 6, 2011 - Report: Approved by Office Director - NTSB office: Eastern Region Aviation - Parties: FAA/FSDO, Teledyne Continental Motors - NTSB case key (mKey): 74562 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=ERA09LA470 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/74562/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=74562 - Page: https://openairdocs.org/ntsb/ERA09LA470 ## Probable cause A total loss of engine power due to pre-ignition/detonation as a result of a fuel control malfunction. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Engine (reciprocating): recip eng cyl section](https://openairdocs.org/ntsb-findings/01058530): Aircraft › Aircraft power plant · Damaged/degraded (probable cause); cases with it: [Cessna A188B, 2 cases](https://openairdocs.org/ntsb-findings/01058530/cases.md?model=2073005), [All aircraft, 373 cases](https://openairdocs.org/ntsb-findings/01058530/cases.md) - [Aircraft](https://openairdocs.org/ntsb-findings/01050000): Aircraft › Aircraft power plant · Malfunction (probable cause); cases with it: [Cessna A188B, 2 cases](https://openairdocs.org/ntsb-findings/01050000/cases.md?model=2073005), [All aircraft, 151 cases](https://openairdocs.org/ntsb-findings/01050000/cases.md) - [Engine fuel and control](https://openairdocs.org/ntsb-findings/01057300): Aircraft › Aircraft power plant · Malfunction (probable cause); cases with it: [Cessna A188B, 1 case](https://openairdocs.org/ntsb-findings/01057300/cases.md?model=2073005), [All aircraft, 49 cases](https://openairdocs.org/ntsb-findings/01057300/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Maneuvering: Loss of engine power (total)](https://openairdocs.org/ntsb-events/341) (defining event); cases with it: [Cessna A188B, 8 cases](https://openairdocs.org/ntsb-events/341/sequence.md?model=2073005), [All aircraft, 3,820 cases](https://openairdocs.org/ntsb-events/341/sequence.md) - [Emergency descent: Off-field or emergency landing](https://openairdocs.org/ntsb-events/440); cases with it: [Cessna A188B, 14 cases](https://openairdocs.org/ntsb-events/440/sequence.md?model=2073005), [All aircraft, 3,365 cases](https://openairdocs.org/ntsb-events/440/sequence.md) - [Landing-flare/touchdown: Collision with terr/obj (non-CFIT) ](https://openairdocs.org/ntsb-events/470); cases with it: [Cessna A188B, 24 cases](https://openairdocs.org/ntsb-events/470/sequence.md?model=2073005), [All aircraft, 10,189 cases](https://openairdocs.org/ntsb-events/470/sequence.md) ## Analysis During an aerial application flight, the pilot noticed the engine oil temperature rise and the oil pressure decrease. The oil pressure went to zero and the engine lost all power. The pilot initiated a forced landing into a soybean field. Examination of the engine found an abnormal fuel flow through the return fitting at full rich mixture setting and a leak at the mixture shaft. Additionally, the Nos. 1 and 4 piston heads exhibited thermal erosion consistent with a pre-ignition/detonation event. This type of piston damage would elevate crankcase pressure and allow oil loss through the crankcase breather system, decreasing oil pressure and increasing oil temperature. ## Factual narrative On August 20, 2009, about 1600 eastern daylight time, a Cessna A188B, N4842R, sustained substantial damage when it impacted a field during a forced landing in McRae, Georgia. The certificated commercial pilot was not injured. Visual meteorological conditions prevailed and no flight plan was filed for the local aerial application flight. The flight was operated under the provisions of 14 Code of Federal Regulations Part 137. The flight originated at Telfair-Wheeler Airport (MQW) McRae, Georgia, at 1545. According to the pilot, while spraying chemicals on a field, the engine oil temperature started rising while the oil pressure was dropping. He exited the field and noticed the engine was losing power rapidly. The oil pressure went to zero and the engine then lost all power. The pilot initiated an emergency dump of the spray solution and attempted to climb, but was unable to do so because of low airspeed. He initiated a forced landing into a soybean field. The nose and engine compartment came to rest in the dirt and the landing gear collapsed. The pilot stated that fuel leaked from the right fuel tank. Examination of the airplane by a Federal Aviation Administration (FAA) inspector found the airplane on its belly with substantial damage to the firewall, engine mounts, fuselage attachments, and the left wing. The airplane was recovered for further examination. Examination of the engine revealed that the engine remained attached to the airframe, and had light impact damage on the front of the oil sump. Some heat damage was observed on the crankcase vent tube. The top spark plugs were removed and the crankshaft was rotated using the propeller. Compression was confirmed on all of the cylinders, and continuity was confirmed to the rear of the engine and the magneto drives. Both magnetos were in place and not damaged. The magnetos were rotated at high speed and no spark was observed on any of the magneto terminals on either magneto. They were both disassembled and the points on both magnetos had severe wear and burning damage. The points would not separate when the drive shafts were rotated. Evidence of arcing was observed in the interiors of both magnetos. The top spark plugs had normal wear when compared to the Champion Check A Plug comparison chart. They all had dark deposits in the electrode areas. The oil filter had light impact damage. It was opened and metallic particulates were observed in the filter element. The engine was prepared for an attempted engine run. Both magnetos were replaced with operational Slick-6310 magnetos. Both sets of ignition harnesses were replaced and the spark plugs were replaced on the right side with Champion RHB-32E spark plugs. The oil filter was replaced with a champion oil filter, and after several start attempts the starter was replaced. The airplane battery was replaced for the run attempts. Numerous attempts were made to start the engine using two different starters and several different batteries. All of theattempts failed, and the engine was sent to the manufacturer for further examination. The examination found the throttle body and mixture control assembly was tested and found to have abnormal flow through the return fitting at full rich with a leak at the mixture shaft. The unit was disassembled and scoring was found on the interface surfaces of the mixture control shaft and fuel metering plug. Disassembly of the engine showed the numbers 1 and 4 piston heads exhibited thermal erosion consistent with a pre-ignition/detonation event. A review of the engine logbooks found that the engine was overhauled on May 3, 2006. The last 100 hour inspection was completed on October 3, 2008.The airplane flew 105 flight hours since this inspection. ## Aircraft - Registration: [N4842R](https://openairdocs.org/deregistered/N4842R-2017-03-21), registration cancelled 2017-03-21, S/N 18802361T, built 1976 (OpenAirDocs) - Reported make and model: CESSNA A188B - Registry model: [Cessna A188B](https://openairdocs.org/model/cessna-a188b) (registry code 2073005) (OpenAirDocs) - Registry engine: [Continental IO-520 series](https://openairdocs.org/engine/continental-io-520-series) (registry code 17032, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 18802361T - Airframe hours: 4100 - Engines: CONT MOTOR IO 520 SERIES 285 horsepower reciprocating - Damage: Substantial damage - Flight: Aerial application, Part 137 - Operator: Gilder Flying Service Inc. - Registered owner: Gilder Flying Service Inc. - Airworthiness certificate: Special, Restricted (Special); Standard, Utility - Last inspection: Annual, October 3, 2008, 105 hours before - Departed: MQW, McRae, GA - Destination: MQW, McRae, GA ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 28; injuries: none; commercial; airplane ratings: multi-engine land, single-engine land; instrument ratings: airplane; medical: class 2, without waivers/limitations; last flight review January 3, 2009; seat: center; flight hours: 3,994 total, 1,790 in this make and model, 36 as pilot in command, 112 in the last 90 days, 48 in the last 30 days, 0 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: 200° at 5 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 93 °F, dew point 72 °F - Altimeter: 29.97 inHg - Observed at: VDI, 27 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). - [Accident 20090820048389A](https://openairdocs.org/incident/20090820048389A), Aug 20, 2009: Cessna A188B, Alamo, GA, Substantial damage. The accident site is located on[privacy data omitted] property located at n 32.06.122- w 082.48.147 the aircraft was resting in a soy bean field on its nose… ## Other investigations on N4842R (2) 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. - [NTSB DFW05CA176](https://openairdocs.org/ntsb/DFW05CA176), Jun 10, 2005: Cessna A188B (N4842R), Truman, AR, substantial damage. Probable cause: The pilot's failure to maintain clearance with the power lines while maneuvering during an aerial application flight. A contributing factor was the sunglare. - [NTSB OAK77DVG44](https://openairdocs.org/ntsb/OAK77DVG44), Jun 22, 1977: Cessna 188B (N4842R), Tulelake, CA, substantial damage ## Docket (9 files) The files NTSB released with the investigation on August 31, 2011, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=74562. 1.8 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 345 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40341856&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Redacted.PDF - Reports from Federal Agencies, FAA Inspectors Statement (item 2, .PDF, 62 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40341857&FileExtension=.PDF&FileName=Reports%20from%20Federal%20Agencies,%20FAA%20Inspectors%20Statement-Redacted.PDF - Statement of Party Representatives to NTSB Investigation (item 3, .PDF, 48 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40341859&FileExtension=.PDF&FileName=Statement%20of%20Party%20Representatives%20to%20NTSB%20Investigation-Redacted.PDF - Pilot Statement (item 4, .PDF, 39 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40341862&FileExtension=.PDF&FileName=Pilot%20Statement-Redacted.PDF - Release of Aircraft Wreckage, NTSB Form 6120.15 (item 5, .PDF, 196 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40341866&FileExtension=.PDF&FileName=Release%20of%20Aircraft%20Wreckage,%20NTSB%20Form%206120.15-Redacted.PDF - Photo 1; Left side of engine. (item 6, .PDF, 290 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40341897&FileExtension=.PDF&FileName=Photo%201;%20Left%20side%20of%20engine.-Master.PDF - Photo 2; right side of engine. (item 7, .PDF, 289 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40341898&FileExtension=.PDF&FileName=Photo%202;%20right%20side%20of%20engine.-Master.PDF - Photo 3; Engine run. (item 8, .PDF, 251 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40341899&FileExtension=.PDF&FileName=Photo%203;%20Engine%20run.-Master.PDF - Photo 4; contamination in oil filter. (item 9, .PDF, 248 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40341900&FileExtension=.PDF&FileName=Photo%204;%20contamination%20in%20oil%20filter.-Master.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.