# NTSB ERA21LA006: Piper PA28, N6179U, Fulton, NY, October 4, 2020 - Type: NTSB accident investigation - Classification: Accident · Minor injuries · Class 4 · Limited · Final report - Date: October 4, 2020, 12:30 local (16:30 UTC) - Place: Fulton, NY - Coordinates: 43.350778, -76.388056 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=43.3508&lon=-76.3881&mi=10 - Phase of flight: [Initial climb](https://openairdocs.org/ntsb-phases/350) (OpenAirDocs' grouping) - Defining event: [Initial climb: Powerplant sys/comp malf/fail](https://openairdocs.org/ntsb-events/340) - Highest injury: Minor injuries - Injuries: 1 minor - Status: Completed - Report: Approved by Office Director - Investigation class: Class 4 - Basic report with no Prelim publish - NTSB office: Eastern Region Aviation - Parties: FAA/FSDO - NTSB case key (mKey): 102093 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=ERA21LA006 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/102093/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=102093 - Page: https://openairdocs.org/ntsb/ERA21LA006 ## Probable cause The mechanic’s improper maintenance, which resulted in the crankshaft expansion plug dislodging in flight and a subsequent forced landing. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Maintenance: installation](https://openairdocs.org/ntsb-findings/02062035): Personnel issues › Task performance · Maintenance personnel (probable cause); cases with it: [Piper PA-28-160, 1 case](https://openairdocs.org/ntsb-findings/02062035/cases.md?model=7102806), [All aircraft, 371 cases](https://openairdocs.org/ntsb-findings/02062035/cases.md) - [Power plant](https://openairdocs.org/ntsb-findings/01057100): Aircraft › Aircraft power plant · Incorrect service/maintenance (probable cause); cases with it: [Piper PA-28-160, 1 case](https://openairdocs.org/ntsb-findings/01057100/cases.md?model=7102806), [All aircraft, 198 cases](https://openairdocs.org/ntsb-findings/01057100/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 maintenance event](https://openairdocs.org/ntsb-events/040); cases with it: [Piper PA-28-160, 1 case](https://openairdocs.org/ntsb-events/040/sequence.md?model=7102806), [All aircraft, 484 cases](https://openairdocs.org/ntsb-events/040/sequence.md) - [Initial climb: Powerplant sys/comp malf/fail](https://openairdocs.org/ntsb-events/340) (defining event); cases with it: [Piper PA-28-160, 1 case](https://openairdocs.org/ntsb-events/340/sequence.md?model=7102806), [All aircraft, 820 cases](https://openairdocs.org/ntsb-events/340/sequence.md) - [Landing-flare/touchdown: Abnormal runway contact](https://openairdocs.org/ntsb-events/090); cases with it: [Piper PA-28-160, 2 cases](https://openairdocs.org/ntsb-events/090/sequence.md?model=7102806), [All aircraft, 1,506 cases](https://openairdocs.org/ntsb-events/090/sequence.md) - [Landing-landing roll: Runway excursion](https://openairdocs.org/ntsb-events/300); cases with it: [Piper PA-28-160, 3 cases](https://openairdocs.org/ntsb-events/300/sequence.md?model=7102806), [All aircraft, 3,643 cases](https://openairdocs.org/ntsb-events/300/sequence.md) ## Analysis Shortly after takeoff, the engine crankshaft expansion plug dislodged, and oil started to cover the airplane’s windscreen. The pilot attempted to return to, and land on the departure runway; however, the airplane subsequently touched down more than halfway down the runway. The pilot was unable to stop the airplane and it went off the runway and struck a chain link fence, which resulted in substantial damage to the fuselage, vertical stabilizer, and both wings. The crankshaft expansion plug was installed during maintenance that was performed 3 days prior to the accident. The mechanic who performed the maintenance stated that he installed the crankshaft plug using a ball peen hammer; instead of following the procedures outlined by the engine manufacturer; which called for the use of a special tool to properly deform and seat the plug. The mechanic said that he has used a ball peen hammer in the past to install crankshaft plugs with success; however, in this instance, the plug did not seat properly, dislodged, and allowed oil to exit the end of the crankshaft in flight. ## Aircraft - Registration: [N6179U](https://openairdocs.org/deregistered/N6179U-2023-04-05), registration cancelled 2023-04-05, S/N 28-115, built 1964 (OpenAirDocs) - Reported make and model: PIPER PA28 (160) - Registry model: [Piper PA-28-160](https://openairdocs.org/model/piper-pa-28-160) (registry code 7102806) (OpenAirDocs) - Registry engine: [Lycoming 0-320 series](https://openairdocs.org/engine/lycoming-0-320-series) (registry code 41508, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 28-115 - Year built: 164 - Airframe hours: 2792.7 - Engines: Lycoming O-320-B2B 160 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Airworthiness certificate: Standard, Normal - Last inspection: Annual, October 1, 2020, 1 hours before - Destination: Same as departure - Airport: FZY, Oswego County, runway 24, 3,996 × 100 ft, concrete - Equipment: Unknown ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 68; injuries: minor; private; airplane ratings: single-engine land; medical: basicmed, with waivers/limitations; last flight review May 2, 2019; seat: left; restraint: 3-point; flight hours: 170 total, 13.3 in this make and model ## Weather - Conditions: Visual (VMC), Day - Wind: variable at 3 knots - Visibility: 10 statute miles - Lowest ceiling: 11,000 ft broken - Temperature: 57 °F, dew point 32 °F - Altimeter: 30.19 inHg - Observed at: FZY ## 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 20201004012799A](https://openairdocs.org/incident/20201004012799A), Oct 4, 2020: Piper PA-28-160, Fulton, NY, Substantial damage. On Sunday, October 4, 2020 at approximately 1230 pm EST, the pilot of aircraft N6179U, executed a take-off from runway 15 at the oswego county airport (fzy) in… ## Docket (7 files) The files NTSB released with the investigation on June 17, 2021, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=102093. 15.2 MB in all. - Written statement - pilot (item 1, PDF, 2 pages, 3.5 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=11510632&FileExtension=pdf&FileName=Written%20Statement%20-%20Pilot%20Statement_Redacted-Rel.pdf - FAA inspector statement - airplane examination (item 2, PDF, 1 page, 100 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=12387786&FileExtension=pdf&FileName=FAA%20Inspector%20Statement%20-%20AC%20Exam-Rel.pdf - FAA inspector statement - mechanic interview (item 3, PDF, 1 page, 139 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=11511017&FileExtension=pdf&FileName=FAA%20Inspector%20-%20AP%20Interview-Rel.pdf - Maintenance records (item 4, PDF, 2 pages, 2 photos, 10.0 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=11511501&FileExtension=pdf&FileName=Maintenance%20Records_Redacted-Rel.pdf - Photos (item 5, PDF, 4 pages, 4 photos, 1.1 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=11510700&FileExtension=pdf&FileName=Photo%20Array-Rel.pdf - Lycoming mandatory service bulletin 505B (item 6, PDF, 5 pages, 297 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=11511956&FileExtension=pdf&FileName=SB%20505B_Redacted-Rel.pdf - Excerpt from engine overhaul manual (item 7, PDF, 1 page, 102 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=11511589&FileExtension=pdf&FileName=Excerpt%20from%20Engine%20Overhaul%20Manual-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.