# NTSB ERA15LA015: Piper PA-28-151, N57SH, Granville, MA, October 12, 2014 - Type: NTSB accident investigation - Classification: Accident · No injuries · Class 3 · Limited · Final report - Date: October 12, 2014, 13:50 local (17:50 UTC) - Place: Granville, MA - Coordinates: 42.099723, -72.923057 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=42.0997&lon=-72.9231&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: No injuries - Injuries: 1 uninjured - Status: Completed - Report: Approved by Office Director - Investigation class: Class 3 - NTSB office: Eastern Region Aviation - Parties: FAA/FSDO - NTSB case key (mKey): 90253 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=ERA15LA015 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/90253/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=90253 - Page: https://openairdocs.org/ntsb/ERA15LA015 ## Probable cause Deformation of the No. 1 cylinder's intake valve, which resulted in a partial loss of engine power and a subsequent off-airport precautionary landing. ## 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: [Piper PA-28-151, 3 cases](https://openairdocs.org/ntsb-findings/01058530/cases.md?model=7102805), [All aircraft, 373 cases](https://openairdocs.org/ntsb-findings/01058530/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: [Piper PA-28-151, 4 cases](https://openairdocs.org/ntsb-events/342/sequence.md?model=7102805), [All aircraft, 1,858 cases](https://openairdocs.org/ntsb-events/342/sequence.md) - [Landing: Hard landing](https://openairdocs.org/ntsb-events/092); cases with it: [Piper PA-28-151, 3 cases](https://openairdocs.org/ntsb-events/092/sequence.md?model=7102805), [All aircraft, 2,102 cases](https://openairdocs.org/ntsb-events/092/sequence.md) ## Analysis About 20 minutes into a visual flight rules cross-country flight, the airplane's engine began running roughly and shortly thereafter began losing power. The pilot initially attempted to divert to an airport about 20 miles away, but as the engine's power output continued to gradually decrease, the pilot instead decided to perform a precautionary landing to a farm field. During the landing, the airplane touched down hard resulting in substantial damage to the airframe. Postaccident examination of the engine revealed that the engine's No. 1 cylinder compression was intermittently low, that the head of the intake valve of that cylinder was deformed, and that the valve was not seating properly. The deformation of the intake valve may have been the result of high valve seating forces that occurred as the result of improperly adjusted valve spring tension. However, the airplane's maintenance records did not note any maintenance actions to the cylinder or its internal components between the last engine overhaul and the accident. While a maintenance log entry documenting the engine overhaul indicated that new cylinder assemblies were installed at that time, it did not indicate when the spring tension for the valve was last set. ## Factual narrative On October 12, 2014, about 1350 eastern daylight time, a Piper PA-28-151, N57SH, was substantially damaged during an off-airport landing near Granville, Massachusetts. The private pilot was not injured. Visual meteorological conditions prevailed, and no flight plan was filed for the flight, which departed from Floyd Bennett Memorial Airport (GFL), Glens Falls, New York and was destined for Norwood Memorial Airport (OWD), Norwood, Massachusetts. The personal flight was conducted under the provisions of Title 14 Code of Federal Regulations Part 91. According to the pilot, about 20 minutes into the cross-country flight, the engine began running roughly. He scanned the engine instruments and noticed that the tachometer was still showing a normal rpm reading, but that the No. 1 cylinder's digital temperature indication graph was blank. Shortly thereafter, the engine began losing power, and the pilot advised air traffic control that he intended to divert to Westfield-Barnes Regional Airport (BAF), Springfield, Massachusetts, located about 20 miles away. Shortly thereafter, the pilot observed the No. 1 cylinder temperature briefly change from no indication to a full red bar, then back to no indication. As the engine's power output continued to gradually decrease, the pilot decided to perform a precautionary landing to a farm field. Approaching the field, the pilot felt that the airplane was too high and too fast for landing, so he performed a go-around in order to approach the field from the opposite direction. During the second landing attempt, the airplane touched down "hard," collapsing the nose landing gear and resulting in substantial damage to the firewall. A Federal Aviation Administration inspector examined the airframe and engine following the accident. During the examination, the inspector noted that the compression of the engine's No. 1 cylinder was intermittently lower than expected. Disassembly and examination of the cylinder revealed that the intake valve was not seating properly and that the hydraulic lifter spring was rubbing against the inside of the spring containment barrel. Removal of the intake valve revealed that the head of the valve was deformed and the stem was elongated by 0.1 inches when compared to another similar valve. The No. 1 cylinder assembly was forwarded to the NTSB materials laboratory for detailed examination. The examination confirmed that the deformed intake valve displayed the correct part number, that the material was of the proper hardness and alloy. The examination further confirmed the head of the valve displayed "cupping" or "tuliping" deformation. Review of maintenance logs for the airframe and engine revealed that the airplane's most recent annual inspection was completed on July 21, 2014, about 19 flight hours before the accident. An overhaul of the airplane's engine was most recently completed in May 2012, about 121 flight hours before the accident. The maintenance log entry documenting the engineoverhaul contained a parts list that noted the installation of, "New Lycoming nitrided cylinder assy's…" The logs did not note any maintenance to the No. 1 cylinder or its internal components between the time of the engine overhaul and the accident. ## Aircraft - Registration: [N57SH](https://openairdocs.org/deregistered/N57SH-2016-01-27), registration cancelled 2016-01-27, S/N 28-7415336, built 1974 (OpenAirDocs) - Reported make and model: PIPER PA-28-151 - Registry model: [Piper PA-28-151](https://openairdocs.org/model/piper-pa-28-151) (registry code 7102805) (OpenAirDocs) - Registry engine: [Lycoming 0-320 series](https://openairdocs.org/engine/lycoming-0-320-series) (registry code 41508, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 28-7415336 - Year built: 1974 - Airframe hours: 2818 - Engines: LYCOMING O-320-E3D 150 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Airworthiness certificate: Standard, Normal - Last inspection: Annual, July 21, 2014, 19 hours before - Departed: GFL, GLENS FALLS, NY - Destination: OWD, NORWOOD, MA - Equipment: Electronic flight bag or handheld device ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 59; injuries: none; private; airplane ratings: single-engine land; instrument ratings: airplane; medical: class 3, without waivers/limitations; seat: left; restraint: 3-point; flight hours: 805 total, 813 in this make and model, 813 as pilot in command, 19 in the last 90 days, 11 in the last 30 days, 1 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 61 °F, dew point 39 °F - Altimeter: 30.23 inHg - Observed at: BAF, 10 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 20141012020579A](https://openairdocs.org/incident/20141012020579A), Oct 12, 2014: Piper PA-28-151, Granville, MA, Substantial damage. Pilot departed great barrington airport, MA (kgbr) destined for norwood airport, MA (kowd). During enroute to destination pilot declared mayday emergency due… ## Docket (6 files) The files NTSB released with the investigation on October 9, 2020, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=90253. 2.2 MB in all. - Pilot/operator aircraft accident report, NTSB form 6120.1 (item 1, PDF, 8 pages, 522 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=4160273&FileExtension=pdf&FileName=6120_Redacted-Rel.pdf - Record of correspondence - engine examination, FAA (item 2, PDF, 1 page, 86 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=4159908&FileExtension=pdf&FileName=Record%20of%20Correspondence%20-%20FAA%20Engine%20Examination-Rel.pdf - Investigation photographs (item 3, PDF, 2 pages, 2 photos, 461 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=4159899&FileExtension=pdf&FileName=Docket%20Photos-Rel.pdf - Maintenance records (excerpts) (item 4, PDF, 8 pages, 541 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=4159637&FileExtension=pdf&FileName=Maintenance%20Records%20Excerpts_Redacted-Rel.pdf - Materials laboratory factual report (item 5, PDF, 4 pages, 2 photos, 176 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=4160203&FileExtension=pdf&FileName=Materials%20Laboratory%20Factual%20Report-Rel.pdf - Release of aircraft wreckage, NTSB form 6120.15 (item 6, PDF, 4 pages, 376 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=4159917&FileExtension=pdf&FileName=Wreckage%20Release%20-%20Final_Redacted-Rel.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.