ERA17LA024

NTSB accident investigation · Cessna 172 · Cedar Key, FL · October 19, 2016

Accident · Minor injuriesLimited investigationFinal report
Date
October 19, 2016, 07:25 local (11:25 UTC)
Place
Cedar Key, FL
Injuries
2 minor, 1 uninjured
Damage
Substantial damage
Phase of flight
Maneuvering
Aircraft
N1827YCessna 172
Defining event
Maneuvering-low-alt flying: Loss of control in flight
Weather
Visual (VMC) · Day
Status
Completed · report December 14, 2017
Report
Approved by Office Director
NTSB office
Eastern Region Aviation
Parties
FAA/FSDO
FAA report
20161019016879A
Case key
94243

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

A partial loss of engine power due to a stuck exhaust valve and the noncertificated pilot's inadequate preflight planning, which resulted in the airplane being overloaded, both of which led to the airplane's inability to attain a positive climb rate. Contributing to the accident was the pilot's improper decision to attempt to return to the airport at low altitude and his subsequent failure to maintain adequate airspeed and his exceedance of the airplane's critical angle of attack, which led to an aerodynamic stall.

Findings · 10

NTSB’s coded findings. Those marked are part of the probable cause; the rest are factors or other findings. Under each, the cases with the same finding.

Engine (reciprocating): recip eng cyl sectionAircraft › Aircraft power plant · MalfunctionCessna 172C: 1 caseAll aircraft: 373 casesProbable cause
Performance/control parameters: climb rateAircraft › Aircraft oper/perf/capability · Not attained/maintainedCessna 172C: 1 caseAll aircraft: 265 casesProbable cause
Aircraft capability: maximum weightAircraft › Aircraft oper/perf/capability · Capability exceededCessna 172C: 1 caseAll aircraft: 152 casesProbable cause
Performance/control parameters: airspeedAircraft › Aircraft oper/perf/capability · Not attained/maintainedCessna 172C: 4 casesAll aircraft: 1,681 casesProbable cause
Performance/control parameters: angle of attackAircraft › Aircraft oper/perf/capability · Capability exceededCessna 172C: 4 casesAll aircraft: 990 casesProbable cause
Use of equip/info: aircraft controlPersonnel issues › Task performance · PilotCessna 172C: 7 casesAll aircraft: 9,295 casesProbable cause
Terrain: waterEnvironmental issues › Physical environment · Contributed to outcomeCessna 172C: 1 caseAll aircraft: 97 cases

Sequence of events

The events NTSB coded, in order, by phase of flight. The defining event is the one that best describes the accident. Under each, the cases with the same event anywhere in their sequence.

Analysis

Two witnesses reported that, during the first takeoff attempt, the accident airplane's engine was "sputtering," and the pilot aborted the takeoff about halfway down the 2,355-ft-long runway. The noncertificated pilot reported that, during the accident takeoff, the airplane would not climb out of ground effect. (The witnesses stated that the engine sounded normal.) When the airplane reached about 100 ft above ground level, the pilot attempted to return to the airport; however, the airplane descended and impacted shallow water about 600 ft short of the runway. Postaccident examination of the airplane revealed damage consistent with a Review of weight and balance data and loading information revealed that the airplane's gross weight at the time of the accident was about 50 lbs over its maximum allowable gross weight and that the center of gravity was at or beyond the forward limit. The pilot's loading of the airplane placed it outside of its operating envelope, which likely significantly degraded its performance. Postaccident examination of the engine found one exhaust valve stuck in the "open" position. If the valve had been stuck during all or a portion of either takeoff, the airplane's acceleration and climb performance would have been significantly degraded. It is likely that the airplane was unable to attain a positive climb rate due to a combination of the stuck exhaust valve and the pilot's operation of the airplane over its weight limit. It is also likely that, while attempting to return to the airport instead of landing straight ahead, the pilot failed to maintain adequate airspeed and exceeded the airplane's critical angle of attack, which led to an aerodynamic stall.

Factual narrative

On October 19, 2016, about 0725 eastern daylight time, a Cessna 172C, N1827Y, was substantially damaged when it impacted terrain during an attempt to return to the airport immediately after takeoff from George T. Lewis Airport (CDK), Cedar Key, Florida. The pilot was not injured and the two passengers received minor injuries. Visual meteorological conditions prevailed, and no flight plan was filed for the personal flight. The airplane was privately owned, and was operated under the provisions of 14 Code of Federal Regulations Part 91.According to the pilot, during takeoff from runway 05, the airplane "wasn't climbing" as he attempted to climb "out of ground effect." At an altitude about 100 feet above ground level, the pilot attempted to return to the airport and land on runway 23. The airplane then descended and impacted a swamp about 600 feet short of the runway. The pilot indicated that the engine sounded normal, and there were no issues with the airplane other than the climb performance. Two witnesses reported that the pilot had aborted a previous takeoff immediately prior to the accident takeoff. They reported that the airplane's engine was "sputtering" as it accelerated. When it was approximately halfway down the runway, the pilot aborted the takeoff, then turned around and performed the accident takeoff. They indicated that the accident takeoff roll was unremarkable. According to Federal Aviation Administration (FAA) records, the pilot's certificate status was "revoked", effective July 2005. He had held a commercial pilot certificate with ratings for airplane single and multiengine land, and instrument airplane. He also held private pilot certificate with privileges for airplane single engine sea. His most recent FAA third-class medical certificate was issued in January 2009, at which time he reported a total of 1,800 flight hours of flight experience. The four-seat, single-engine, high-wing airplane was manufactured in 1962, and was equipped with a Continental O-300D, 145-horsepower reciprocating engine. According to the pilot, its most recent annual inspection was completed on October 3, 2015, at 5,013 total aircraft hours, and 1,031 hours since engine overhaul. The airplane's maintenance logbooks were not recovered. CDK was located at an elevation of 11 feet mean sea level, and was surrounded by water. The airport was equipped with one asphalt runway, oriented 05/23, which measured 2,355 feet long by 100 feet wide. Examination of the airplane by an FAA inspector revealed that it came to rest upright and partially submerged in shallow water. The outboard 3 feet of both wingtips were crushed aft and bent upwards. Both ailerons were damaged. The fuselage was buckled on the right side in the area of the cabin door, and the firewall was damaged. The airplane was further damaged during the recovery operation due to being submerged in water. The engine's crankshaft was rotated by hand via the propeller, and compression was confirmed on allcylinders with the exception of the No. 4 cylinder. Valve action was observed on all rocker arms; however, the exhaust valve on the No. 4 cylinder was found stuck in the open position. The top spark plugs were removed. Their electrodes were intact, and slightly corroded with surface rust consistent with water immersion. The pilot reported that the fuel tanks were nearly full, as the airplane had flown one flight leg (about 20 minutes long) since the last full fueling. The airplane was equipped with an 18-gallon auxiliary fuel tank that was installed in the baggage compartment, which was also full. According to first responders, there was an estimated 25 pounds of baggage found in the unoccupied rear seat. According to the owner's manual, the maximum allowable gross weight for the airplane was 2,250 pounds. The airplane's weight at the time of the accident was estimated to be 2,307 pounds based on the available weight and balance data for the airplane, fuel records, and self-reported occupant weights. The center of gravity was estimated to be 90.6 pound-inches, which was slightly forward of the maximum gross weight forward limit of 91. Takeoff performance data found in the airplane owner's manual indicated that a maximum gross weight takeoff at sea level and 59 degrees F would require a ground roll of 825 feet, with a distance of 1430 feet require to clear an obstacle 50 feet tall. Crystal River Airport, Crystal River Florida, was located about 30 nautical miles southeast of the accident site, at an elevation of 9 feet. At 0715 the reported weather included wind calm, temperature 17 degrees C (62 F), dew point 17 degrees C (62 F), and an altimeter setting of 30.06 inches of mercury.

Aircraft

Registration
N1827Y
Reported as
Cessna 172 (C)
Category
Airplane
Serial number
17249427
Built
1962
Airframe hours
5,013
Engine
Cont Motor O-300D, 145 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Airworthiness certificate
Standard, Utility; Standard, Normal
Last inspection
Annual · October 3, 2015 · 87 hours before
Departed
CDK · Cedar Key, FL
Airport
CDK · George T Lewis, runway 05, 2,355 × 100 ft, asphalt
Equipment
Stall warning system

Matched to the registry by N-number and the event date; the registry’s history has gaps, so older matches can be wrong. Compare the reported make and model.

Flight crew

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
75
Injuries
None
Seat
Left
Flight hours
1,800 total · 600 in this make and model · 3 in the last 90 days · 1 in the last 30 days

Weather

Conditions
Visual (VMC) · Day
Wind
Calm
Visibility
10 statute miles
Lowest ceiling
None
Temperature
63 °F, dew point 63 °F
Altimeter
30.05 inHg
Observed at
KCGC, 30 nm away

Docket · 7

The files NTSB released with the investigation on October 2, 2017, on NTSB’s docket system: statements, records, photos and specialists’ reports. 2.2 MB in all.

FAA reports on this event · 1

The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.

Other investigations on N1827Y · 2

Matched to the same aircraft by N-number and date.