ERA23LA120

NTSB accident investigation · Mooney M20C · Calhoun, GA · January 28, 2023

Accident · Serious injuriesClass 3 · LimitedFinal report
Date
January 28, 2023, 13:10 local (18:10 UTC)
Place
Calhoun, GA · Off End of Runway 17
Injuries
1 serious, 1 minor
Damage
Destroyed
Phase of flight
Initial climb
Aircraft
N5587QMooney M20C
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 Engines, FAA / FSDO
FAA report
20230128013909A
Case key
106649

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 during the initial climb due to an improperly installed spark 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 personnelMooney M20C: 1 caseAll aircraft: 371 casesProbable cause
Ignition system: spark plugs/ignitersAircraft › Aircraft power plant · Incorrect service/maintenanceMooney M20C: 2 casesAll aircraft: 38 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 pilot reported that the right magneto dropped 150 rpm when he and the flight instructor performed the engine runup. They leaned the fuel mixture and ran the engine up to about 1,700 rpm a couple of times until both magnetos dropped 125 rpm during the magneto checks. Once the magneto checks were normal, they initiated the takeoff. The pilot retracted the landing gear and a few moments later, while they were about 70 ft above the runway, there was a popping noise, the engine rpm went to nearly zero, and they began to lose altitude. They lowered the landing gear and touched down near the end of the runway. The airplane skidded off the end of the runway into the grass and slid into an earth embankment. The airplane then became airborne, rotated 90º to the left, and came to rest after a few hundred feet. The flight instructor then advised the pilot of flames near the pilot’s feet and they both exited the airplane. The airplane was destroyed by the postimpact fire. Examination of the engine revealed that the No. 3 bottom spark plug was not in the spark plug hole and was hanging from the ignition cable. The spark plug hole thread insert (Helicoil) was partially pulled from the spark plug hole. Examination of the spark plug revealed the lower three threads of the spark plug displayed absence of rust, but the threads located above them were rusty, and the bottom portion of the Helicoil was still intact. No other anomalies were discovered with the engine that would have precluded normal operation. Review of maintenance records indicated the engine had last been overhauled about 30 years ago, but this most probably did not contribute to the accident. The most recent annual inspection was completed about 2 months before the accident. Review of the logbook entry for the annual inspection indicated that during the annual, the spark plugs had been “removed, cleaned, inspected and installed.” The engine time in service between the last annual inspection and the last recorded entry in the engine logbook, which stated that the No. 2 cylinder spark plug was replaced was 1 hour. The investigation was not able to determine if the No. 3 cylinder spark plug was removed and reinstalled at that time. The accident occurred 14 days later. Therefore, it is likely that the No. 3 bottom spark plug was either not inserted all the way or it wasn’t properly torqued when it was installed during the annual inspection or most recent maintenance work.

Factual narrative

On January 28, 2023, about 1310 eastern standard time, a Mooney M20C, N5587Q, was destroyed when it was involved in an accident in Calhoun, Georgia. The pilot was seriously injured, and the flight instructor-rated passenger received minor injuries. The airplane was operated as a Title 14 Code of Federal Regulations Part 91 personal flight. The flight departed from Tom B David Field Airport (CZL), Calhoun, Georgia for a local flight with the pilot acting as the pilot-in-command. According to the pilot, before takeoff he performed a preflight check and runup; the oil pressure, oil temperature, and suction were normal. When checking the magnetos, the right magneto dropped 150 rpm. They leaned the fuel mixture and ran the engine up to about 1,700 rpm for about 1 minute. They did this a couple of times until both magnetos dropped 125 rpm. They conducted a couple more magneto checks, and each resulted in both magnetos dropping 125 rpm with normal engine operation. After the preflight runup was completed, they proceeded to runway 17. Full throttle was applied, the oil temperature and pressure were in the green, and the engine sounded normal. Just after liftoff, the pilot retracted the landing gear and a few moments later, while they were about 70 ft above the runway, there was a popping noise, the engine lost power, the engine rpm went to nearly zero, and they began to lose altitude. They had not cleared the south end of the runway, so they lowered the landing gear and the pilot pitched down and started descending. The airplane touched down at the very end of the runway and the pilot applied the wheel brakes. There was not enough runway remaining for them to stop, and the airplane skidded off the end of the runway into the grass and slid into an earth embankment. The airplane then went airborne briefly, rotated 90º to the left and then came to rest after a few hundred feet. At this point, the flight instructor unbuckled his lap belt and saw flames near the pilot’s feet. The flight instructor then advised the pilot of the fire, they both egressed, and moved away from the airplane in a westerly direction in case there was an explosion. According to a witness who was moving airplanes in a hangar about 4,000 ft from runway 17, he heard “sputtering” around the time that the airplane passed him, but it did not sound like a complete engine failure. The landing gear was retracted and then extended when the engine roughness and loss of power occurred. He then ran to the end of the row of hangars and observed the airplane hit the displaced threshold. He heard the tires chirp at impact. The airplane then bounced back into the air, touched down again, then skidded through the grass and hit an embankment about 100 ft off the end of the runway. The airplane momentarily became airborne once again, then cartwheeled into the ground and came to rest. Both pilots were out of the airplane when he arrived at the airplane, which was becoming engulfed in flames. Examinationof the displaced threshold revealed the presence of four propeller strike marks, the spacing of which indicated that the propeller was rotating on impact. Examination of the wreckage revealed that the cabin had been destroyed by the fire. Flight control continuity was established from the flight control surfaces to the cabin. The fuel selector valve was in the right-wing fuel tank position, and when an air source was applied to the port on the fuel selector for the right tank, no blockages were discovered. Examination of the 4-cylinder, horizontally opposed, air-cooled, carbureted engine revealed that the No. 3 bottom spark plug was not in the spark plug hole and was hanging from the ignition cable. The No. 3 bottom spark plug hole thread insert (Helicoil) was partially pulled from the spark plug hole, with the lower three threads displaying an absence of rust. The threads above the lower three threads were rusty, and the bottom portion of the Helicoil was still intact. No other anomalies were discovered that would have resulted in a preimpact failure or malfunction that would have precluded normal operation. Review of maintenance records revealed that the most recent engine overhaul was completed on March 9, 1993, about 30 years before the accident. The most recent annual inspection was completed on December 1, 2022. Review of the logbook entry for the annual inspection indicated that the engine had accumulated 838.24 hours of time in service. The entry indicated that during the annual, the spark plugs had been “removed, cleaned, inspected and installed.” As of the last entry in the engine logbook, dated January 14, 2023, the engine had accumulated 839.24 hours since that overhaul. This last entry stated that the No. 2 cylinder spark plug was replaced. The pilot stated this maintenance was a result of the engine running rough during a magneto check. The investigation was not able to determine if the No. 3 spark plug was removed and reinstalled at that time.

Aircraft

Registration
N5587Q
Reported as
Mooney M20C
Category
Airplane
Serial number
2982
Built
1965
Airframe hours
5,175.84
Engine
Lycoming O-360-A1D, 180 horsepower, reciprocating
Damage
Destroyed
Fire
On-Ground
Flight
Personal · Part 91
Airworthiness certificate
Standard, Normal
Last inspection
Annual · December 1, 2022 · 1 hours before
Departed
CZL · Calhoun, GA
Airport
CZL · Tom B David Field Airport, runway 17, 6,034 × 100 ft, asphalt
Equipment
ADS-B, Electronic flight bag or handheld device, Stall warning system

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
50
Injuries
Serious
Certificate
Private
Airplane ratings
Single-engine land
Medical
Class 3, Without waivers/limitations
Last flight review
August 8, 2022
Seat
Left
Restraint
Lap only
Flight hours
145 total · 111 in this make and model · 59 as pilot in command · 1 in the last 90 days
Role
Flight instructor
Age
60
Injuries
Minor
Certificates
Flight instructor, Airline transport
Airplane ratings
Multi-engine land, Single-engine land
Instrument ratings
Airplane
Medical
Class 2, With waivers/limitations
Last flight review
July 21, 2022
Seat
Right
Restraint
Lap only
Flight hours
7,826 total · 48 in this make and model · 7,786 as pilot in command · 198 in the last 90 days · 65 in the last 30 days

Weather

Conditions
Visual (VMC) · Day
Wind
210° at 6 knots
Visibility
10 statute miles
Lowest ceiling
None
Temperature
54 °F, dew point 30 °F
Altimeter
30.39 inHg
Observed at
KCZL
METAR
METAR KCZL 281815Z AUTO 21006KT 10SM CLR 12/M01 A3039 RMK AO2=

Docket · 11

The files NTSB released with the investigation on February 20, 2025, on NTSB’s docket system: statements, records, photos and specialists’ reports. 22.0 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 N5587Q · 2

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