ERA19LA245

NTSB accident investigation · Schweizer 269C · Allentown, PA · August 11, 2019

Accident · Serious injuriesClass 3 · LimitedFinal report
Date
August 11, 2019, 14:48 local (18:48 UTC)
Place
Allentown, PA
Injuries
1 serious, 1 minor
Damage
Substantial damage
Phase of flight
Initial climb
Aircraft
N1831ASchweizer 269C
Defining event
Initial climb: Loss of engine power (partial)
Weather
Visual (VMC) · Day
Status
Completed
Report
Approved by Office Director
Investigation class
Class 3
NTSB office
Eastern Region Aviation
Parties
Lycoming, Schweizer RSG LLC., Sikorsky, FAA/FSDO
FAA report
20190811017679A
Case key
100040

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

Inadequate maintenance of the helicopter’s magnetos, which resulted in a partial loss of engine power during the initial climb due to a failure of the left magneto and malfunction of the right magneto.

Findings · 2

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.

Ignition system: magneto/distributorAircraft › Aircraft power plant · MalfunctionSchweizer 269C-1: 2 casesAll aircraft: 101 casesProbable cause
Inspection: scheduled/routine inspectionPersonnel issues › Task performance · Maintenance personnelSchweizer 269C-1: 3 casesAll aircraft: 167 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

Shortly after takeoff, the pilot of the helicopter transmitted a mayday call over the radio. The helicopter subsequently impacted a building, resulting in substantial damage to the airframe, serious injury to the pilot, and minor injury to the passenger. Neither the pilot nor the passenger provided statements regarding the events that transpired during the flight. Postaccident examination of the airframe and engine revealed no evidence of any preimpact mechanical malfunctions either, with the exception of the engine’s magnetos. Examination of the right magneto revealed evidence of corrosion and indications of misfiring in the distributor block assembly; therefore, it is likely that the right magneto was not performing optimally during the flight. Additionally, examination of the left magneto revealed a worn cam gear, and functional testing indicated that the magneto could not produce adequate spark for engine operation at any power setting. A review of the helicopter’s maintenance logbooks revealed that the most recent 100-hour inspection was performed about 3 months and 35 flight hours before the accident. The right magneto was installed about 2 years before the accident as a used-serviceable unit, with no previous history or time in service information. The left magneto was installed as a new unit at the same time as the right magneto. There was no indication that the left magneto had been serviced in accordance with the manufacturer’s 500-hour inspection. Given this information, it is likely that the helicopter’s engine at least partially lost power shortly after takeoff, and that the loss of engine power was most likely the result of the failure of the left magneto and the sub-optimal output of the right magneto. Further, it is likely that a lack of adequate maintenance of both magnetos resulted in their degraded performance during the accident flight.

Factual narrative

On August 11, 2019, at 1448 eastern daylight time, a Schweizer 269C-1, N1831A, was substantially damaged when it was involved in an accident near Allentown, Pennsylvania. The commercial pilot sustained serious injuries and the passenger sustained minor injuries. The helicopter was operated by Ace Pilot Training Inc., as a Title 14 Code of Federal Regulations Part 91 sightseeing flight. According to air traffic control, several minutes after being cleared for takeoff, the pilot transmitted via radio, "mayday, mayday, mayday, three one alpha going down." The helicopter subsequently collided with a building shortly thereafter. The pilot and passenger did not provide any statements regarding the circumstances or events that transpired during the flight. Examination of the helicopter by a Federal Aviation Administration inspector revealed that the helicopter came to rest in a grassy area on the side of the building. The cockpit was impact damaged. All three main rotor blades remained attached to the main rotor hub and were buckled. The tail boom was buckled and impact damaged. The tail rotor blades were buckled and remained attached to the tail rotor gearbox. Engine valve train continuity was established. The accessory section of the engine revealed some impact damage. A review of the maintenance logbooks revealed that the engine was installed from another helicopter that was involved in an accident on May 17, 2017. At that time, the left magneto was newly installed. On July 25, 2018, the right magneto was replaced as a used-serviceable unit with no previous history or time in service information. The right magneto accumulated 195.6 hours on the engine since installation. Following the accident, the right magneto could not be bench tested due to impact damage. The harness cap was removed and exhibited severe corrosion and indications of misfiring on the distributor block and the No. 2 insulator. The coil was in good condition with the exception of the bent tab; both primary windings and secondary windings were within allowable limits. The condenser was undamaged and functioned satisfactorily. Examination of the left magneto revealed minor damage on the housing. The magneto was bench tested and failed all sections of the testing. The magneto produced intermittent and weak sparks at all test settings. The left magneto was opened, and the components were inspected. The coil was in good condition and the primary and secondary windings were both within allowable limits. The condenser was undamaged and functioned satisfactorily. The points were worn but in good condition. An attempt was made to reset the E-gap with the old cam installed, but it was worn and did not allow proper function. The distributor block was serviceable and showed minor wear. A new cam was installed, the E-gap reset, and the magneto was retested, during which it performed nominally. The magneto had accumulated 578.8 hours time in service on this engine. There was no indication orlogbook entry of a 500-hour inspection being completed. There were also no indications that the Slick/Champion Aerospace Service Bulletin SB1-15A, for replacement of the distributor block, had been completed.

Aircraft

Registration
N1831A
Reported as
Schweizer 269C (1)
Category
Helicopter
Serial number
0228
Built
2005
Airframe hours
2,547
Damage
Substantial damage
Fire
On-Ground
Flight
Other work use · Part 91
Airworthiness certificate
Standard, Normal
Last inspection
100 hour · May 28, 2019 · 35 hours before
Departed
ABE · Allentown, PA
Destination
ABE · Allentown, PA
Airport
ABE · Lehigh Valley Intl
Equipment
Video recording device

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
Flight instructor
Age
23
Injuries
Serious
Certificates
Commercial, Flight instructor
Instrument ratings
Helicopter
Medical
Class 1, With waivers/limitations
Last flight review
November 26, 2018
Seat
Left
Restraint
3-point
Flight hours
180 total · 180 in this make and model

Weather

Conditions
Visual (VMC) · Day
Wind
250° at 9 knots
Visibility
10 statute miles
Lowest ceiling
None
Temperature
81 °F, dew point 52 °F
Altimeter
30.03 inHg
Observed at
ABE

Docket · 9

The files NTSB released with the investigation on May 23, 2022, on NTSB’s docket system: statements, records, photos and specialists’ reports. 14.1 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.

Other investigations on N1831A · 1

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