# NTSB ERA13LA374: Mooney M20J, N3700H, Marco Island, FL, August 24, 2013 - Type: NTSB accident investigation - Classification: Accident · Minor injuries · Limited investigation · Final report - Date: August 24, 2013, 10:30 local (14:30 UTC) - Place: Marco Island, FL - Coordinates: 25.995, -81.6725 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=25.9950&lon=-81.6725&mi=10 - Phase of flight: [Takeoff](https://openairdocs.org/ntsb-phases/300) (OpenAirDocs' grouping) - Defining event: [Takeoff: Loss of control in flight](https://openairdocs.org/ntsb-events/240) - Highest injury: Minor injuries - Injuries: 1 minor - Status: Completed, report January 12, 2015 - Report: Approved by Office Director - NTSB office: Eastern Region Aviation - Parties: FAA/FSDO - NTSB case key (mKey): 87859 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=ERA13LA374 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/87859/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=87859 - Page: https://openairdocs.org/ntsb/ERA13LA374 ## Probable cause The pilot’s improper pitch trim setting before takeoff, which resulted in the airplane’s rapid, nose-high pitch at takeoff and the pilot’s subsequent loss of control. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Flight control system: stabilizer actuator](https://openairdocs.org/ntsb-findings/01022742): Aircraft › Aircraft systems · Incorrect use/operation; cases with it: [Mooney M20J, 1 case](https://openairdocs.org/ntsb-findings/01022742/cases.md?model=5870219), [All aircraft, 1 case](https://openairdocs.org/ntsb-findings/01022742/cases.md) - [Action: incorrect action performance](https://openairdocs.org/ntsb-findings/02041015): Personnel issues › Action/decision · Pilot (probable cause); cases with it: [Mooney M20J, 4 cases](https://openairdocs.org/ntsb-findings/02041015/cases.md?model=5870219), [All aircraft, 1,386 cases](https://openairdocs.org/ntsb-findings/02041015/cases.md) - [Use of equip/info: aircraft control](https://openairdocs.org/ntsb-findings/02063040): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Mooney M20J, 36 cases](https://openairdocs.org/ntsb-findings/02063040/cases.md?model=5870219), [All aircraft, 9,295 cases](https://openairdocs.org/ntsb-findings/02063040/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Prior to flight: Preflight or dispatch event](https://openairdocs.org/ntsb-events/030); cases with it: [Mooney M20J, 1 case](https://openairdocs.org/ntsb-events/030/sequence.md?model=5870219), [All aircraft, 355 cases](https://openairdocs.org/ntsb-events/030/sequence.md) - [Takeoff: Loss of control in flight](https://openairdocs.org/ntsb-events/240) (defining event); cases with it: [Mooney M20J, 21 cases](https://openairdocs.org/ntsb-events/240/sequence.md?model=5870219), [All aircraft, 5,002 cases](https://openairdocs.org/ntsb-events/240/sequence.md) - [Takeoff: Runway excursion](https://openairdocs.org/ntsb-events/300); cases with it: [Mooney M20J, 21 cases](https://openairdocs.org/ntsb-events/300/sequence.md?model=5870219), [All aircraft, 3,643 cases](https://openairdocs.org/ntsb-events/300/sequence.md) ## Analysis The pilot stated that he set the flaps at 15 degrees for takeoff and that the flap position indicator and the adjacent pitch trim position indicator appeared to "line up," which was normal. However, during the takeoff, the airplane pitched up more rapidly than normal, and the pitch trim did not seem to be working. The event occurred too quickly for the pilot to abort the takeoff, and, because of the relatively low airspeed and the high engine torque and P-factor, he was unable to counteract the airplane's left turning tendency. The airplane subsequently descended into a swamp left of the runway. At the accident scene, the airplane's flap and trim position annunciators indicated that the flaps were in the "takeoff" position but that the pitch trim was in the "up" position; the Pilot's Operating Handbook stated that the pitch trim was to be set to the "takeoff" position for takeoff. For pitch trim control, the airplane's entire empennage would have pivoted to increase or decrease the horizontal stabilizer angle. The system used a worm gear, which would have prevented the annunciated trim position from moving when the airplane impacted the ground. Pitch trim was subsequently tested electrically to the stops with no binding noted. The pilot did not report any runaway pitch anomalies. ## Factual narrative On August 24, 2013, about 1030 eastern daylight time, a Mooney M20J, N3700H, was substantially damaged when it impacted swampy terrain during a takeoff attempt from Marco Island Airport (MKY), Marco Island, Florida. The airline transport pilot sustained minor injuries. Visual meteorological conditions prevailed, and no flight plan was filed for the flight, to Wing South Airpark (FA37), Naples, Florida. The personal flight was operating under the provisions of 14 Code of Federal Regulations Part 91. According to the pilot, he set the flaps at 15 degrees for takeoff, and the flap indicator and trim indicator next to each other appeared to line up, which was normal. However, during the takeoff, at an approximate rotation speed of 63 knots indicated, the airplane pitched up more rapidly than normal and the stabilizer trim did not seem to be working. The event occurred so suddenly that the pilot did not have an opportunity to abort the takeoff with a power reduction. "It was an uncommanded pitch-up and the yoke would not respond to counteract the pitch and turn The rudder and ailerons were stuck in the neutral position and would not move in the direction to initiate a right counteracting turn. Although the left turning tendencies are well known on takeoff with high power and angle of attack ("P" factor, torque and slipstream affect all work together requiring lots of right rudder), something caused the stab trim to go forward and prevent the normal rudder and aileron coordination for a turn to the right to counteract the left turning tendencies." The airplane then descended into the swamp to the left of the runway. According to the pilot's operating handbook (POH), "Push-pull tubes with self-aligning rod end bearings actuate the primary flight control surfaces. A spring-loaded interconnect device indirectly joins the aileron and rudder control systems to assist in lateral stability during flight maneuvers." In addition, "For pitch control, the entire empennage pivots on the tail cone attachment points to increase or decrease the horizontal stabilizer angle. This design allows flight trim establishment with minimum control surface deflection. A trim indicator on the console indicates stabilizer trim position. In flight, forward rotation of the trim wheel lowers the nose; rearward rotation raises the nose." A photograph of the trim/flap annunciator taken at the accident site by a Federal Aviation Administration (FAA) inspector showed separate indicators for each, with positions noted as "Down", "Takeoff" and "Up." The flap indication was in the "Takeoff" position, while the trim indication was in the "Up" position. A corner of the photograph also showed the autopilot controller, which indicated the autopilot as being "Off." According to a representative of Mooney, and as verified in the M20J Illustrated Parts Catalog, trim position was established via a "trim screw assembly" (worm drive) which would not have been movable as a result of ground impact.The representative also noted that according to a company engineer, earlier models of the airplane "could jam if the trim was electrically or manually run hard up against the stops. The jack screw and jam nuts have since been re-designed to resolve the issue." After the airplane had been moved to a storage facility, the FAA inspector tested the trim electrically to the stops and noted no binding. According to the pilot, he was a partial owner of the airplane and the only one to fly it. He did not run the trim to the stops during the preflight checks, and he didn't know why the trim would have been in the "Up" position. Per the M20J Pilot Operating Handbook, Before Takeoff checklist, "Trim – Takeoff Setting." ## Aircraft - Registration: [N3700H](https://openairdocs.org/deregistered/N3700H-2014-12-18), registration cancelled 2014-12-18, S/N 24-1038, built 1980 (OpenAirDocs) - Reported make and model: MOONEY M20J - Registry model: [Mooney M20J](https://openairdocs.org/model/mooney-m20j) (registry code 5870219) (OpenAirDocs) - Registry engine: [Lycoming I0360 SER A&C](https://openairdocs.org/engine/lycoming-i0360-ser-a-c) (registry code 41511, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 24-1038 - Airframe hours: 4631 - Engines: LYCOMING I0-360-A3B6D 200 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Airworthiness certificate: Standard, Normal - Last inspection: Annual, March 1, 2013, 74 hours before - Departed: MKY, Marco Island, FL - Destination: FA37, NAPLES, FL - Airport: MKY, Marco Island, runway 17, 5,000 × 100 ft, asphalt - Equipment: Stall warning system ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 70; injuries: minor; airline transport; airplane ratings: single-engine land, single-engine sea; instrument ratings: airplane; medical: class 2, without waivers/limitations; last flight review October 15, 2012; seat: left; flight hours: 20,238 total, 2,250 in this make and model, 19,750 as pilot in command, 113 in the last 90 days, 40 in the last 30 days, 3 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: 120° at 4 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 84 °F, dew point 70 °F - Altimeter: 30.06 inHg - Observed at: MKY ## Docket (5 files) The files NTSB released with the investigation on November 25, 2014, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=87859. 5.9 MB in all. - Pilot Operator Report (item 1, .PDF, 3.7 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40419478&FileExtension=.PDF&FileName=Pilot%20Operator%20Report-Redacted.PDF - Memorandums of Record (item 2, .PDF, 61 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40419479&FileExtension=.PDF&FileName=Memorandums%20of%20Record-Master.PDF - Excerpts, Illustrated Parts Catalogue (item 3, .PDF, 719 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40419480&FileExtension=.PDF&FileName=Excerpts,%20Illustrated%20Parts%20Catalogue-Master.PDF - Photo 1- Wreckage Overview (Courtesy FAA) (item 4, .PDF, 818 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40419481&FileExtension=.PDF&FileName=Photo%201-%20Wreckage%20Overview%20(Courtesy%20FAA)-Master.PDF - Photo 2- Trim Position Indicator (Courtesy FAA) (item 5, .PDF, 620 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40419482&FileExtension=.PDF&FileName=Photo%202-%20Trim%20Position%20Indicator%20(Courtesy%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.