# NTSB ERA17LA109: Ercoupe 415, N99716, Dawsonville, GA, February 19, 2017 - Type: NTSB accident investigation - Classification: Accident · Minor injuries · Limited investigation · Final report - Date: February 19, 2017, 12:15 local (17:15 UTC) - Place: Dawsonville, GA - Coordinates: 34.338333, -84.091941 - Nearby events: https://openairdocs.org/map.md?lat=34.3383&lon=-84.0919&mi=10 - Phase of flight: [Landing](https://openairdocs.org/ntsb-phases/550) (OpenAirDocs' grouping) - Defining event: [Landing: Collision during takeoff/land](https://openairdocs.org/ntsb-events/490) - Highest injury: Minor injuries - Injuries: 1 minor - Status: Completed, report July 5, 2018 - Report: Approved by Office Director - NTSB office: Eastern Region Aviation - Parties: FAA/FSDO - NTSB case key (mKey): 94724 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=ERA17LA109 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/94724/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=94724 - Page: https://openairdocs.org/ntsb/ERA17LA109 ## Probable cause A decrease in oil pressure due to the pilot's unintentional overfilling of the engine oil sump, and the pilot's subsequent decision to perform an off-airport precautionary landing, which resulted in impact with a tree. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Engine (reciprocating): recip eng oil sys](https://openairdocs.org/ntsb-findings/01058550): Aircraft › Aircraft power plant · Incorrect service/maintenance (probable cause); cases with it: [Ercoupe 415-C, 1 case](https://openairdocs.org/ntsb-findings/01058550/cases.md?model=0420322), [All aircraft, 130 cases](https://openairdocs.org/ntsb-findings/01058550/cases.md) - [Maintenance: scheduled/routine maintenance](https://openairdocs.org/ntsb-findings/02062010): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Ercoupe 415-C, 1 case](https://openairdocs.org/ntsb-findings/02062010/cases.md?model=0420322), [All aircraft, 320 cases](https://openairdocs.org/ntsb-findings/02062010/cases.md) - [Info processing/decision: decision making/judgment](https://openairdocs.org/ntsb-findings/02041520): Personnel issues › Action/decision · Pilot (probable cause); cases with it: [Ercoupe 415-C, 3 cases](https://openairdocs.org/ntsb-findings/02041520/cases.md?model=0420322), [All aircraft, 3,098 cases](https://openairdocs.org/ntsb-findings/02041520/cases.md) - [Object/animal/substance: tree(s)](https://openairdocs.org/ntsb-findings/03022020): Environmental issues › Physical environment · Contributed to outcome; cases with it: [Ercoupe 415-C, 5 cases](https://openairdocs.org/ntsb-findings/03022020/cases.md?model=0420322), [All aircraft, 933 cases](https://openairdocs.org/ntsb-findings/03022020/cases.md) - [Experience/qualifications: total experience w/ equipment](https://openairdocs.org/ntsb-findings/02031025): Personnel issues › Experience/knowledge · Pilot; cases with it: [Ercoupe 415-C, 1 case](https://openairdocs.org/ntsb-findings/02031025/cases.md?model=0420322), [All aircraft, 269 cases](https://openairdocs.org/ntsb-findings/02031025/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: Aircraft servicing event](https://openairdocs.org/ntsb-events/020); cases with it: [Ercoupe 415-C, 1 case](https://openairdocs.org/ntsb-events/020/sequence.md?model=0420322), [All aircraft, 70 cases](https://openairdocs.org/ntsb-events/020/sequence.md) - [Enroute-cruise: Miscellaneous/other](https://openairdocs.org/ntsb-events/900); cases with it: [Ercoupe 415-C, 2 cases](https://openairdocs.org/ntsb-events/900/sequence.md?model=0420322), [All aircraft, 1,556 cases](https://openairdocs.org/ntsb-events/900/sequence.md) - [Landing: Collision during takeoff/land](https://openairdocs.org/ntsb-events/490) (defining event); cases with it: [Ercoupe 415-C, 6 cases](https://openairdocs.org/ntsb-events/490/sequence.md?model=0420322), [All aircraft, 1,309 cases](https://openairdocs.org/ntsb-events/490/sequence.md) ## Analysis The private pilot recently purchased the airplane and was returning it to his home airport. Before the flight, he added 1/2 quart of oil to the engine, bringing the oil level to between 3 1/2 and 4 quarts. About 30 minutes after departure, the pilot noticed that the oil pressure was dropping. He reduced engine power and turned the airplane toward the closest airport. The oil pressure continued to decrease, even though the engine continued to produce power, and the pilot chose to perform a precautionary landing on a road. Upon touchdown, the airplane skidded across the road until it impacted a tree and came to rest in a ditch. Examination of the engine revealed a hole in the oil sump consistent with impact damage, and oil was noted coming from the crankcase breather tube. In addition, oil was noted on the bottom of the airplane from the nose to the empennage. Even after the oil leaked from the broken oil sump and from the breather tube, the postaccident engine oil level was 3 1/2 quarts. A subsequent engine run demonstrated that the engine would experience a momentary drop in oil pressure indication if the oil sump was overfilled. The engine and the oil pressure gauge otherwise operated normally. Since the pilot lacked operational experience with the airplane, it is likely that he unintentionally overfilled the oil sump, which resulted in an interaction between the oil in the sump and the rotating crankshaft. The interaction likely resulted in air bubbles becoming entrained in the oil and a subsequent oil pressure fluctuation. Additionally, since he checked the oil level following a previous flight, it was likely that the oil had not fully drained back into the sump when the reading was taken. Considering that the oil pressure gauge operated normally after the accident, it is unlikely that the gauge was producing a faulty reading in flight. ## Factual narrative On February 19, 2017, about 1215 eastern standard time, an Ercoupe 415-C, N99716, was substantially damaged during a precautionary landing to a road near Dawsonville, Georgia. The private pilot sustained minor injuries. Visual meteorological conditions prevailed, and a visual flight rules flight plan had been filed for the personal flight that was operated under the provisions of 14 Code of Federal Regulations Part 91. The flight departed from Jackson County Airport (JCA), Jefferson, Georgia, about 1100, with the intended destination of Barwick LaFayette Airport (9A5), LaFayette, Georgia.According to the pilot, he had recently purchased the airplane and was flying it back to his home airport. In the day and a half prior to the accident flight, the pilot cleaned oil from underneath the airplane three separate times. When he examined the engine to determine where the oil was leaking from, he only noted oil coming from the crankcase breather tube. In addition, on the afternoon prior to the accident, he checked the oil level after a morning flight and noted the oil level was down "7 ounces" from 3.5 quarts. Then, prior to the accident flight, he added 1/2 quart of oil to bring the oil level up between 3.5 and 4 quarts. About 30 minutes after he departed, the pilot noticed the oil pressure was dropping. He reduced engine power and turned the airplane toward Lee Gilmer Memorial Airport (GVL), Gainesville, Georgia. He watched the oil pressure continue to decrease and decided to perform a precautionary landing on a road. During the landing, the left main landing gear and nose landing gear contacted a grass area to the left of the road. The airplane skidded across the road until it impacted a tree and came to rest in a ditch. The pilot then egressed from the airplane with minor injuries. During an interview with a Federal Aviation Administration (FAA) inspector, the pilot stated that the oil pressure never went to zero and the engine was not running erratically when he made the decision to reduce engine power and perform a precautionary landing. The only indication of an issue was the loss of oil pressure and that there were no issues with oil temperature. According to FAA records, the airplane was manufactured in 1955 and was powered by a Continental Motors C75 series, 75-horsepower engine. According to airplane maintenance logbooks, an annual inspection was performed on September 4, 2016, at a total time in service of 1,880 hours. In addition, the most recent recorded oil change occurred at that time and the oil screen was cleaned with no metallic debris noted. According to the engine manufacturer, the maximum engine oil sump capacity was 4.5 quarts. In addition, the minimum idling oil pressure was 10 psi and the oil pressure at cruise was between 30 psi and 35 psi. Examination of the airplane by an FAA inspector revealed that both wings sustained substantial damage and fuel was noted leaking from the wings. Examination of the engine revealed a hole inthe oil sump consistent with impact damage, and oil was noted coming from the crankcase breather tube. In addition, oil was noted on the bottom of the airplane from the nose to the empennage. Additional examination of the engine was performed at a salvage facility in Griffin, Georgia, under the supervision of an FAA inspector. The oil level was noted at 3.5 quarts before the engine run. The engine was started with no hesitation and was able to maintain an oil pressure of 45 psi. The engine was operated for about 10 minutes at various power settings. To duplicate the loss of oil pressure, 1 quart of oil was added to the engine, bringing the level up to 4.5 quarts, and it was restarted. The engine operated, the oil pressure was noted as 45 psi, however, after about 5 minutes, the oil pressure began to decrease slowly. The oil pressure settled at 25 psi for a few seconds, then gradually increased back to 45 psi, and remained there until the engine was shutdown. According to an academic paper written by an engineer at Massachusetts Institute of Technology titled "Engine Lubrication Oil Aeration," it stated that "if the oil level is too high there is a possibility of interaction between the sump oil and the rotating crankshaft that can cause air bubbles to become entrained in the oil and increase the aeration level." ## Aircraft - Registration: [N99716](https://openairdocs.org/aircraft/N99716), registered now, S/N 2339, built 1946 (OpenAirDocs) - Reported make and model: ERCOUPE 415 (C) - Registry model: [Ercoupe 415-C](https://openairdocs.org/model/ercoupe-415-c) (registry code 0420322) (OpenAirDocs) - Registry engine: [Continental A&C75 series](https://openairdocs.org/engine/continental-a-c75-series) (registry code 17005, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 2339 - Year built: 1946 - Airframe hours: 1880 - Engines: CONT MOTOR C-75-12 75 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Airworthiness certificate: Standard, Normal - Last inspection: Annual, September 4, 2016, 27 hours before - Departed: JCA, JEFFERSON, GA - Destination: 9A5, LAFAYETTE, GA - Flight plan: VFR - Equipment: Handheld GPS ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 69; injuries: minor; private; airplane ratings: single-engine land; medical: sport pilot, with waivers/limitations; last flight review February 6, 2017; seat: left; restraint: lap only; flight hours: 515 total, 3 in this make and model, 515 as pilot in command, 4 in the last 90 days, 4 in the last 30 days ## Weather - Conditions: Visual (VMC), Day - Wind: 340° at 9 knots - Visibility: 10 statute miles - Lowest ceiling: 3,400 ft broken - Temperature: 63 °F, dew point 48 °F - Altimeter: 30.10 inHg - Observed at: GVL, 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 20170219001429A](https://openairdocs.org/incident/20170219001429A), Feb 19, 2017: Ercoupe 415-C, Dawsonville, GA, Substantial damage. On February 19, 2017, about 1315EASTERN standard time, a 1946 Ercoupe 415-C, N99716, lost oil pressure and landed on the shoulder of a county road in… ## Docket (7 files) The files NTSB released with the investigation on December 21, 2017, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=94724. 16.3 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 2.9 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40459007&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Master.PDF - Pilot Statement (item 2, .PDF, 332 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40459008&FileExtension=.PDF&FileName=Pilot%20Statement-Master.PDF - FAA Inspector Statement (item 3, .PDF, 54 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40459009&FileExtension=.PDF&FileName=FAA%20Inspector%20Statement-Master.PDF - Maintenance Logs (item 4, .PDF, 478 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40459010&FileExtension=.PDF&FileName=Maintenance%20Logs-Master.PDF - Engine Lubrication Oil Aeration - MIT Paper (item 5, .PDF, 8.4 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40459011&FileExtension=.PDF&FileName=Engine%20Lubrication%20Oil%20Aeration%20-%20MIT%20Paper-Master.PDF - Engine Specifications (item 6, .PDF, 268 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40459012&FileExtension=.PDF&FileName=Engine%20Specifications-Master.PDF - Photo Array (Courtesy of FAA) (item 7, .PDF, 3 photos, 3.9 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40459013&FileExtension=.PDF&FileName=Photo%20Array%20(Courtesy%20of%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.