# NTSB ERA19LA245: Schweizer 269C, N1831A, Allentown, PA, August 11, 2019 - Type: NTSB accident investigation - Classification: Accident · Serious injuries · Class 3 · Limited · Final report - Date: August 11, 2019, 14:48 local (18:48 UTC) - Place: Allentown, PA - Coordinates: 40.652221, -75.440551 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=40.6522&lon=-75.4406&mi=10 - Phase of flight: [Initial climb](https://openairdocs.org/ntsb-phases/350) (OpenAirDocs' grouping) - Defining event: [Initial climb: Loss of engine power (partial)](https://openairdocs.org/ntsb-events/342) - Highest injury: Serious injuries - Injuries: 1 serious, 1 minor - Status: Completed - Report: Approved by Office Director - Investigation class: Class 3 - NTSB office: Eastern Region Aviation - Parties: Lycoming, Schweizer RSG LLC., Sikorsky, FAA/FSDO - NTSB case key (mKey): 100040 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=ERA19LA245 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/100040/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=100040 - Page: https://openairdocs.org/ntsb/ERA19LA245 ## 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 NTSB's coded findings; those marked are part of the probable cause. - [Ignition system: magneto/distributor](https://openairdocs.org/ntsb-findings/01057414): Aircraft › Aircraft power plant · Malfunction (probable cause); cases with it: [Schweizer 269C-1, 2 cases](https://openairdocs.org/ntsb-findings/01057414/cases.md?model=8059504), [All aircraft, 101 cases](https://openairdocs.org/ntsb-findings/01057414/cases.md) - [Inspection: scheduled/routine inspection](https://openairdocs.org/ntsb-findings/02061520): Personnel issues › Task performance · Maintenance personnel (probable cause); cases with it: [Schweizer 269C-1, 3 cases](https://openairdocs.org/ntsb-findings/02061520/cases.md?model=8059504), [All aircraft, 167 cases](https://openairdocs.org/ntsb-findings/02061520/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Initial climb: Loss of engine power (partial)](https://openairdocs.org/ntsb-events/342) (defining event); cases with it: [Schweizer 269C-1, 4 cases](https://openairdocs.org/ntsb-events/342/sequence.md?model=8059504), [All aircraft, 1,858 cases](https://openairdocs.org/ntsb-events/342/sequence.md) - [Emergency descent: Collision with terr/obj (non-CFIT) ](https://openairdocs.org/ntsb-events/470); cases with it: [Schweizer 269C-1, 13 cases](https://openairdocs.org/ntsb-events/470/sequence.md?model=8059504), [All aircraft, 10,189 cases](https://openairdocs.org/ntsb-events/470/sequence.md) ## 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](https://openairdocs.org/deregistered/N1831A-2021-01-30), registration cancelled 2021-01-30, S/N 0228, built 2005 (OpenAirDocs) - Reported make and model: Schweizer 269C (1) - Registry model: [Schweizer 269C-1](https://openairdocs.org/model/schweizer-269c-1) (registry code 8059504) (OpenAirDocs) - Registry engine: [Lycoming HIO-360-G1A](https://openairdocs.org/engine/lycoming-hio-360-g1a) (registry code 41898, reciprocating) (OpenAirDocs) - Category: Helicopter - Serial number: 0228 - Year built: 2005 - Airframe hours: 2547 - 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 ## Flight crew As NTSB recorded them. NTSB leaves out names. - Flight instructor; age 23; injuries: serious; 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 ## 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 20190811017679A](https://openairdocs.org/incident/20190811017679A), Aug 11, 2019: Schweizer 269C-1, Allentown, PA, Substantial damage. Helicopter departed abe hangar 7 helo pad for airwork. Aircraft crashed shortly after takeoff during climb out. Helicopter experienced engine roughness and low… ## Other investigations on N1831A (1) 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. - [NTSB ANC06CA090](https://openairdocs.org/ntsb/ANC06CA090), Jul 12, 2006: Schweizer 300C (N1831A), Titusville, FL, substantial damage. Probable cause: The failure of the certificated flight instructor (CFI) to maintain control of the helicopter, which resulted in an in-flight collision with terrain. A factor associated with the accident was the… ## Docket (9 files) The files NTSB released with the investigation on May 23, 2022, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=100040. 14.1 MB in all. - Pilot/operator aircraft accident report, NTSB form 6120.1 - not submitted (item 1, PDF, 1 page, 9 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=9662202&FileExtension=pdf&FileName=No%206120%20Form-Rel.pdf - Transcript of radio communications (item 2, PDF, 2 pages, 552 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=9646580&FileExtension=pdf&FileName=Signed%20Partial%20Transcripts%20LC_Redacted-Rel.pdf - Memorandum of record FAA correspondence (item 3, PDF, 1 page, 106 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=9656740&FileExtension=pdf&FileName=Memorandum%20Of%20Record%20FAA%20telephone%20correspondence%20JB%20LA245-Rel.pdf - Magneto examination findings (item 4, PDF, 2 pages, 117 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=9654930&FileExtension=pdf&FileName=NTSB%20findings%20of%20mags%20removed%20from%20N1831A%20Oct%2008,%202019_Redacted-Rel.pdf - Airframe examination summary (item 5, PDF, 2 pages, 49 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=9656291&FileExtension=pdf&FileName=Schweizer%20%20N1831A%20Notes_Redacted-Rel.pdf - Maintenance records (item 6, PDF, 7 pages, 7.2 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=9662587&FileExtension=pdf&FileName=MX%20record%20excerpts_Redacted-Rel.pdf - Slick/champion aerospace service bulletin SB1-15A excerpts (item 7, PDF, 2 pages, 142 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=9662680&FileExtension=pdf&FileName=Memorandum%20Of%20Record%20SB1-15A%20excerpts%20LA245-Rel.pdf - Statement of party representatives to NTSB investigation (item 8, PDF, 17 pages, 5.2 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=9655231&FileExtension=pdf&FileName=Casanova%20Sikorsky%20Certification-of-Party-Representation-Form%20LA245_Redacted-Rel.pdf - Photo array (item 9, PDF, 4 pages, 717 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=9654793&FileExtension=pdf&FileName=Photo%20Array%20LA245-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.