# NTSB ERA12LA332: Stinson SR-7B, N16122, West Ossipee, NH, May 13, 2012 - Type: NTSB accident investigation - Classification: Accident · Serious injuries · Limited investigation · Final report - Date: May 13, 2012, 13:54 local (17:54 UTC) - Place: West Ossipee, NH - Coordinates: 43.830554, -71.186943 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=43.8306&lon=-71.1869&mi=10 - Phase of flight: [Enroute](https://openairdocs.org/ntsb-phases/400) (OpenAirDocs' grouping) - Defining event: [Enroute-cruise: Loss of engine power (partial)](https://openairdocs.org/ntsb-events/342) - Highest injury: Serious injuries - Injuries: 1 serious - Status: Completed, report October 9, 2012 - Report: Approved by Office Director - NTSB office: Eastern Region Aviation - Parties: FAA Portland FSDO - NTSB case key (mKey): 83617 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=ERA12LA332 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/83617/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=83617 - Page: https://openairdocs.org/ntsb/ERA12LA332 ## Probable cause The pilot's inadequate application of carburetor heat which resulted in the formation of carburetor ice and a partial loss of engine power. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Use of equip/info: use of equip/system](https://openairdocs.org/ntsb-findings/02063015): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Stinson SR-7B, 1 case](https://openairdocs.org/ntsb-findings/02063015/cases.md?model=8631304), [All aircraft, 1,391 cases](https://openairdocs.org/ntsb-findings/02063015/cases.md) - [Temp/humidity/pressure: conducive to carburetor icing](https://openairdocs.org/ntsb-findings/03031030): Environmental issues › Conditions/weather/phenomena · Effect on equipment; cases with it: [Stinson SR-7B, 1 case](https://openairdocs.org/ntsb-findings/03031030/cases.md?model=8631304), [All aircraft, 435 cases](https://openairdocs.org/ntsb-findings/03031030/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Enroute-cruise: Loss of engine power (partial)](https://openairdocs.org/ntsb-events/342) (defining event); cases with it: [Stinson SR-7B, 1 case](https://openairdocs.org/ntsb-events/342/sequence.md?model=8631304), [All aircraft, 1,858 cases](https://openairdocs.org/ntsb-events/342/sequence.md) - [Emergency descent: Off-field or emergency landing](https://openairdocs.org/ntsb-events/440); cases with it: [Stinson SR-7B, 1 case](https://openairdocs.org/ntsb-events/440/sequence.md?model=8631304), [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: [Stinson SR-7B, 1 case](https://openairdocs.org/ntsb-events/470/sequence.md?model=8631304), [All aircraft, 10,189 cases](https://openairdocs.org/ntsb-events/470/sequence.md) ## Analysis According to the pilot, the airplane was in cruise flight at 1,500 feet above ground level when he noticed a decline in engine manifold pressure. The pilot pushed the carburetor heat in and pulled it back out after a short time with no power improvement. Unable to reach the airport, the pilot elected to perform a forced landing to a logging road. During the landing, the landing gear contacted stacked logs; the airplane flipped and impacted the ground inverted. Review of the carburetor icing chart for the reported temperature and dewpoint revealed the probability of icing at glide and cruise power. Examination of the airframe, flight controls, engine assembly, and accessories revealed no preaccident mechanical malfunctions or failures that would have precluded normal operation. ## Factual narrative On May 13, 2012, at 1354 eastern daylight time, a Stinson SR-7B, N16122, experienced a decrease in engine manifold pressure while returning to the departure airport. The pilot realized he could not make the airport and attempted to make a forced landing on a road next to a log yard. The landing gear collided with the top of a log pile and the airplane nosed over inverted, sustaining substantial damage.The private pilot sustained serious injuries. The airplane was registered to Starfire Aviation LLC and was operating as a Title 14 Code of Federal Regulations Part 91 personal flight. Visual meteorological conditions prevailed and no flight plan was filed. The flight originated from Windsock Village Airport (NH69), West Ossipee, New Hampshire, at 1338. The pilot stated he was at 1,500 feet above ground level (agl) when the manifold pressure started to decline. Attempts to trouble shoot the problem resulted in negative results. He checked the throttle to see if it was full forward. The pilot pushed the carburetor heat in and pulled it back out after a short time with negative results. The airplane continued to descend to 200 feet agl and he attempted to land to a road and collided with a log pile. Two witnesses observed the airplane in the vicinity of NH69. The airplane was about 60 feet just above the trees,in a rapid descent in the vicinity of Freedom Wood Yard. The witnesses stated the engine was not running and they knew the airplane was going to crash. They immediately pulled their car into the wood yard and got out to look for the airplane. There was no smoke or noise. They ran over a berm and observed the airplane upside down. They immediately called the emergency 911 operator and reported the accident. Law enforcement personnel arrived and they directed them to the crash site. The last annual inspection was conducted on August 12, 2011, and the airplane had flown 1 hour since the annual inspection. The total time on the airframe at the time of the inspection was 2, 293 hours. The airplane was recovered to local storage facility and examined. Examination of the airframe and flight controls revealed no preaccident mechanical malfunctions or failures that would have precluded normal operations. The fuel selector valve was in the on position. The main fuel caps were vented and there was evidence of fuel staining on the ground. The fuel tanks were not ruptured and 13 gallons of fuel was recovered. Fuel was present in the carburetor bowl and no contaminants were noted. The propeller was rotated by hand. Drive train continuity was confirmed. Both magnetos were checked and no anomalies were noted. No preaccident mechanical malfunctions or failures were noted that would have precluded normal operation of the engine assembly or accessories. The temperature at the time of the accident was 81 degrees Fahrenheit and the dewpoint temperature was 45 degrees Fahrenheit. According the carburetor icing chart the airplane would encounter icing at glide andcruise power. Review of Advisory Circular 91-51A EFFECT OF ICING ON AIRCRAFT CONTROL AND AIRPLANE DEICE AND ANTI-ICE SYSTEMS states in paragraph 5 DISCUSSION b. " There are two kinds of icing that are significant to aviation: structural icing and induction icing....c. Small aircraft engines commonly employ a carburetor fuel system or a pressure fuel injection system to supply fuel for combustion. Both types of induction systems hold the potential for icing which can cause engine failure. (1) The pilot should be aware that carburetor icing can occur at temperature between 13 degrees Celsius (C) (20 degrees Fahrenheit (F) and +21C (70F) when there is visible moisture or high humidity. This can occur in the carburetor because vaporization of fuel, combined with the expansion of air as it flows through the carburetor, causes sudden cooling, sometimes by a significant amount within a fraction of a second. Carburetor ice can be detected by a drop in rpm in fixed pitch propeller airplanes and a drop in manifold pressure in constant speed propeller airplanes. In both types, usually there will be a roughness in engine operation. Some engines are equipped with carburetor heat for use in both prevention and removal of ice." ## Aircraft - Registration: [N16122](https://openairdocs.org/aircraft/N16122), registered now, S/N 9684 (OpenAirDocs) - Reported make and model: STINSON SR-7B - Registry model: [Stinson SR-7B](https://openairdocs.org/model/stinson-sr-7b) (registry code 8631304) (OpenAirDocs) - Registry engine: [Lycoming R680E series](https://openairdocs.org/engine/lycoming-r680e-series) (registry code 41545, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 9684 - Airframe hours: 2293 - Engines: LYCOMING R680E 3B 300 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Operator: Starfire Aviation LLC - Registered owner: Starfire Aviation LLC - Airworthiness certificate: Standard, Normal - Last inspection: Annual, August 12, 2011, 1 hours before - Departed: NH69, West Ossipee, NH - Destination: NH69, West Ossipee, NH - Airport: NH69, Windsock Village ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 71; injuries: serious; private; airplane ratings: multi-engine land, single-engine land; instrument ratings: airplane; medical: class 3, without waivers/limitations; last flight review January 6, 2012; seat: left; flight hours: 2,950 total, 75 in this make and model, 2,950 as pilot in command, 20 in the last 90 days, 4 in the last 30 days ## Weather - Conditions: Visual (VMC), Day - Wind: 210° at 10 knots, gusting 14 - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 81 °F, dew point 45 °F - Altimeter: 30.04 inHg - Observed at: IZG, 14 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 20120513007429A](https://openairdocs.org/incident/20120513007429A), May 13, 2012: Stinson SR-7B, West Ossipee, NH, Substantial damage. Pilot departed Ossipee lake, NH (home) he was in flight and returning home when engine quit. Pilot determined he would be unable to land aircraft at (wsv)… ## Docket (12 files) The files NTSB released with the investigation on August 1, 2012, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=83617. 11.8 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 1.7 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40371643&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Redacted.PDF - Wife Initial Statement With Husband Concerning Accident (item 2, .PDF, 37 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40371644&FileExtension=.PDF&FileName=Wife%20Initial%20Statement%20With%20Husband%20Concerning%20Accident-Master.PDF - FAA Inspector Statements and Fuel receipt (item 3, .PDF, 942 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40371649&FileExtension=.PDF&FileName=FAA%20Inspector%20Statements%20and%20Fuel%20receipt-Redacted.PDF - Record of Conversation Bernard (item 4, .PDF, 195 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40371645&FileExtension=.PDF&FileName=Record%20of%20Conversation%20Bernard-Redacted.PDF - Freedom Police Report (item 5, .PDF, 2.3 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40371646&FileExtension=.PDF&FileName=Freedom%20Police%20Report-Redacted.PDF - Extract Airplane Logbook (item 6, .PDF, 142 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40371650&FileExtension=.PDF&FileName=Extract%20Airplane%20Logbook-Redacted.PDF - Carburetor Icing Chart (item 7, .PDF, 85 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40371651&FileExtension=.PDF&FileName=Carburetor%20Icing%20Chart-Master.PDF - Extract FAA Advisory Circular Circular 91 51A (item 8, .PDF, 213 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40371912&FileExtension=.PDF&FileName=Extract%20FAA%20Advisory%20Circular%20Circular%2091%2051A-Master.PDF - Photo 1 Front view of airplane inverted. Photo FAA (item 9, .PDF, 1.4 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40368413&FileExtension=.PDF&FileName=Photo%201%20Front%20view%20of%20airplane%20inverted.%20Photo%20FAA-Master.PDF - Photo 2 Right side view of airplane inverted. Photo FAA (item 10, .PDF, 1.6 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40368414&FileExtension=.PDF&FileName=Photo%202%20Right%20side%20view%20of%20airplane%20inverted.%20Photo%20FAA-Master.PDF - Photo 3 Left front view of airplane inverted. Photo FAA (item 11, .PDF, 1.5 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40368415&FileExtension=.PDF&FileName=Photo%203%20Left%20front%20view%20of%20airplane%20inverted.%20Photo%20FAA-Master.PDF - Photo 4 Left rear side view of airplane inverted. Photo FAA (item 12, .PDF, 1.8 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40368416&FileExtension=.PDF&FileName=Photo%204%20Left%20rear%20side%20view%20of%20airplane%20inverted.%20Photo%20FAA-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.