ERA22LA322

NTSB accident investigation · Vans RV10 · Palatka, FL · July 18, 2022

Accident · Serious injuriesClass 3 · LimitedFinal report
Date
July 18, 2022, 08:04 local (12:04 UTC)
Place
Palatka, FL · 3 NE of airport
Injuries
1 serious
Damage
Substantial damage
Phase of flight
Initial climb
Aircraft
N910BWVans RV10
Defining event
Initial climb: Loss of engine power (total)
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
20220718012539A
Case key
105519

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

Total loss of engine power due to the improper installation of an electronic ignition system connector plug.

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.

Maintenance: installationPersonnel issues › Task performance · Maintenance personnelDarrell Bryan Wade RV-10: 1 caseAll aircraft: 371 casesProbable cause
Ignition system: ignition system wiringAircraft › Aircraft power plant · Incorrect service/maintenanceDarrell Bryan Wade RV-10: 1 caseAll aircraft: 16 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 experimental amateur-built airplane’s engine lost total power and the pilot made an off-airport forced landing, resulting in substantial damage to the fuselage, both wings, and the tail section. Postaccident examination of the engine revealed that a cannon plug-type circular connector that connected the engine’s electronic ignition system’s wire harness to the two electronic control units was not properly connected. The manufacturer of the ignition system stated that disengagement of the connector, which carried all electrical signals required to run the ignition system, “…would result in a single point failure of the entire ignition system.” Maintenance records showed that the ignition system had been installed about 21 months before the accident, with no other work to that system detailed between that time and the accident. Based on this information, it is likely that the connector had not been fully secured when the system was installed, and that over time, the partial connection had loosened, ultimately resulting in the loss of engine power.

Factual narrative

On July 18, 2022, at 0804 eastern daylight time, an experimental amateur-built RV-10 airplane, N910BW, was substantially damaged when it was involved in an accident near Palatka, Florida. The pilot was seriously injured. The airplane was operated as a Title 14 Code of Federal Regulations Part 91 personal flight. The pilot stated that shortly after takeoff, the engine sputtered then lost total power. He was unable to return to the airport and made a forced landing to heavily wooded terrain, resulting in substantial damage to the fuselage, both wings, and the tail section. Postaccident examination of the engine revealed that the cannon plug type circular connector that connected the electronic ignition wiring harness to the firewall was not locked, and the connector was partially engaged. The connector provided the connection between the wiring harness and the two electronic control units located on the cockpit side of the firewall. According to a representative of the manufacturer of the ignition system, if the firewall connector was not secure “…this would result in a single point failure of the entire ignition system.” A review of the airplane’s maintenance records revealed that the electronic ignition system was installed in October 2020. There were no subsequent entries that discussed maintenance of the ignition system since that date.

Aircraft

Registration
N910BW
Reported as
Vans RV10
Category
Airplane, amateur-built
Serial number
40929
Airframe hours
195.6
Engine
Lycoming IO-540-T4B5D, 300 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Airworthiness certificate
Special, Experimental (Special)
Last inspection
Annual · November 30, 2021
Destination
GKT · Gatlinburg, TN
Flight plan
IFR
Airport
28J · Palatka Muni - Lt Kay Larkin Fld
Equipment
Angle of attack indicator, Auto-pilot, ADS-B, Data recorder, Electronic multifunction display, Stall warning system, Electronic primary flight display, Heads up display, Onboard weather, Satellite tracking 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
Pilot
Age
55
Injuries
Serious
Certificate
Private
Airplane ratings
Single-engine land
Instrument ratings
Airplane
Medical
Class 3, With waivers/limitations
Last flight review
May 5, 2021
Seat
Left
Restraint
Lap only
Flight hours
682.6 total · 56.8 in this make and model · 638.5 as pilot in command · 56.8 in the last 90 days · 23.3 in the last 30 days · 0 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
Variable at 3 knots
Visibility
8 statute miles
Temperature
72 °F, dew point 72 °F
Altimeter
30.07 inHg
Observed at
28J, 3 nm away
METAR
SA 18/07/2022 11:35-> METAR K28J 181135Z AUTO VRB03KT 8SM 22/22 A3007

Docket · 5

The files NTSB released with the investigation on November 15, 2023, on NTSB’s docket system: statements, records, photos and specialists’ reports. 57.2 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.