ERA19LA162

NTSB accident investigation · Piper PA28 · Melbourne, FL · April 29, 2019

Accident · No injuriesClass 3 · LimitedFinal report
Date
April 29, 2019, 13:05 local (17:05 UTC)
Place
Melbourne, FL
Injuries
2 uninjured
Damage
Substantial damage
Phase of flight
Maneuvering
Aircraft
N3031WPiper PA28
Defining event
Maneuvering: Fuel related
Weather
Visual (VMC) · Day
Status
Completed
Report
Approved by Office Director
Investigation class
Class 3
NTSB office
Eastern Region Aviation
Parties
FAA/FSDO
FAA report
20190429003609A
Case key
99351

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

On this page

Probable cause

A partial loss of engine power due to carburetor icing, and the flight instructor’s failure to effectively use carburetor heat while operating at an idle engine power setting in conditions conducive to carburetor icing.

Findings · 3

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.

Temp/humidity/pressure: conducive to carburetor icingEnvironmental issues › Conditions/weather/phenomena · Effect on equipmentPiper PA-28-161: 6 casesAll aircraft: 435 casesProbable cause
Action: lack of actionPersonnel issues › Action/decision · Instructor/check pilotPiper PA-28-161: 8 casesAll aircraft: 792 casesProbable cause

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

The flight instructor and student pilot were practicing a simulated engine failure. After completing the emergency checklist, the student added engine power to recover from the maneuver about 500 ft above the ground, but the engine did not respond. The flight instructor took control of the airplane, verified the fuel selector position, and landed. The atmospheric conditions at the time of the accident were conducive to the development of carburetor icing at glide (idle) power settings, and the instructor reported that he did not apply carburetor heat during the simulated engine-out or attempted recovery. Based on the available information, it is likely that the loss of engine power was the result of the accumulation of carburetor ice during the idle-power descent and that the use of carburetor heat would likely have prevented the loss of engine power.

Factual narrative

On April 29, 2019, about 1305 eastern daylight time, a Piper PA-28-161, N3031W, was substantially damaged when it was involved in an accident near Melbourne, Florida. The student pilot and flight instructor were not injured. The airplane was operated as a Title 14 Code of Federal Regulations Part 91 instructional flight. The flight instructor stated that he and the student pilot departed to a nearby practice area to train emergency procedures. At 2,500 ft, they performed a simulated loss of engine power. The student pilot established best glide speed, identified a landing spot, and completed the checklist. At 500 ft, when the student added power to recover from the maneuver, the engine did not respond. The instructor took control of the airplane and verified the correct fuel selector position. The airplane continued to descend, and he landed on a brush-covered island surrounded by swamp. A Federal Aviation Administration (FAA) inspector traveled to the site and examined the airplane. The right wing was partially separated from the fuselage and there was leading edge damage to the right wing. The inspector noted fuel in both wing tanks. The flight instructor later reported to the FAA that he had overlooked the carburetor heat and did not apply it during the simulated loss of engine power or attempted recovery. Review of the icing probability chart contained within Federal Aviation Administration Special Airworthiness Information Bulletin CE-09-35 revealed that the atmospheric conditions at the time of the accident were "conducive to serious icing at glide [idle] power."

Aircraft

Registration
N3031W
Reported as
Piper PA28 (161)
Category
Airplane
Serial number
28-7916348
Built
1979
Airframe hours
7,933.6
Engine
Lycoming O-320-D3G, 160 horsepower, reciprocating
Damage
Substantial damage
Flight
Instructional · Part 91
Operator
Paris Air Inc
Registered owner
Paris Air Inc
Airworthiness certificate
Special, Experimental (Special); Standard, Normal
Last inspection
100 hour · March 6, 2019
Departed
VRB · Vero Beach, FL
Destination
VRB · Vero Beach, FL
Equipment
Unknown

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 · 2

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
38
Injuries
None
Certificates
Private, Commercial, Flight instructor
Airplane ratings
Single-engine land
Instrument ratings
Airplane
Medical
Class 2, With waivers/limitations
Seat
Right
Flight hours
560 total
Role
Student pilot
Injuries
None
Certificate
Student
Medical
Unknown, Unknown
Seat
Left

Weather

Conditions
Visual (VMC) · Day
Wind
70° at 13 knots
Visibility
10 statute miles
Temperature
82 °F, dew point 66 °F
Altimeter
30.14 inHg
Observed at
VRB, 21 nm away

Docket · 4

The files NTSB released with the investigation on May 18, 2022, on NTSB’s docket system: statements, records, photos and specialists’ reports. 2.1 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.