LAX01FA302

NTSB accident investigation · Piper PA-23-150 · Chico, CA · September 10, 2001

Accident · FatalField investigationFinal report
Date
September 9, 2001, 19:11 local (Sep 10, 2001, 02:11 UTC)
Place
Chico, CA
Injuries
1 fatal
Damage
Destroyed
Phase of flight
Initial climb
Aircraft
N2268PPiper PA-23-150
Weather
Visual (VMC) · Day
Status
Completed · report March 30, 2004
Report
Approved by Office Director
Parties
Textron Lycoming, The New Piper Aircraft, Inc., WP Flight Standards District Office
FAA report
20010909025419A
Case key
53441

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

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Probable cause

The loss of right engine power for undetermined reasons, and the pilot's failure to maintain control of the aircraft due to his improper single engine emergency procedures.

Sequence of events

NTSB’s coding before 2008: each occurrence and phase of flight, and the causes and factors under it. The codes are defined in NTSB’s coding manual.

Loss of engine power(partial) - nonmechanicalTakeoff - initial climb
1 engine
Reason for occurrence undeterminedCause
Loss of control - in flightManeuvering - turn to landing area (emergency)
Emergency procedure - improperPilot in commandCause
Directional control - not maintainedPilot in commandCause
In flight collision with objectManeuvering - turn to landing area (emergency)
Object - tree(s)

Analysis

Witnesses observed the airplane climb a maximum of 200 feet above the runway during its initial climb, and then it descended in a right wing low attitude until impacting the level ground short of the airport's perimeter fence. A fire erupted and consumed the airplane. Before the pilot succumbed to his injuries he reported to the responding medical personnel that "my engine failed and I was trying to turn around." The subsequent airframe examination revealed that the wings were fire damaged in areas corresponding to both the inboard and the outboard fuel tanks, and the fuel selectors were on the main tank positions. The landing gear was extended, and the rudder trim tab was set to a position consistent with a right engine power failure. No evidence of any internal engine mechanical malfunction was observed. The left propeller blades were torsionally twisted and gouged; the right blades sustained only minor damage. The pilot was an airframe and powerplant mechanic, had performed the maintenance on his airplane, and was its only pilot. He last flew the airplane about 3.5 months prior to the accident, and this was the first flight following maintenance. No logbook records were found that identified the maintenance performed. The cause of the right engine's nonmechanical loss of power was not determined. Given the prevailing meteorological conditions and the airplane's weight, performance data indicates that the airplane should have had a positive climb rate upon feathering the right engine's propeller blades and retraction of the landing gear.

Factual narrative

History of flight

On September 9, 2001, at 1911 Pacific daylight time, a Piper PA-23-150, N2268P, experienced a partial loss of engine power during takeoff from the Chico Municipal Airport, Chico, California. The airplane impacted terrain on airport property and collided with a berm. Thereafter, a fire erupted, which destroyed the airplane. The commercial certificated pilot owned and operated the airplane, and he was fatally injured. Visual meteorological conditions prevailed. The flight was performed under the provisions of 14 CFR Part 91. At the time of the accident, the planned local area personal flight was originating, and no flight plan had been filed.

An eyewitness, located on the airport's ramp, reported observing the airplane near the approach end of runway 13L. He saw the airplane accelerate and liftoff at a location about 75 yards south of taxiway E. This location was about 3,000 feet from the beginning of the runway. As the airplane flew past the midfield position it had climbed between 125 and 200 feet above the runway. This was the maximum altitude the witness observed the airplane to obtain during its flight. As it passed the witness, he noted that its engines sounded normal, its wings were not rocking, and it looked okay. The witness turned away from the runway and did not see the airplane for several seconds, but he heard a transmission on the local airplane radio frequency that is broadcast over a loudspeaker. The transmission was a one-syllable word that was either "help" or something similar. There were no other airplanes in the area, and the witness believed the transmission came from the accident airplane. He turned back toward the airplane and heard the "pop" sound of an impact that was immediately followed by smoke and fire.

Two witnesses, who were located in an open field just west of the airport, reported that a "pop pop pop pop" sound was coming from the airplane. The noise sounded like a backfiring rather than an engine sputtering. The engine(s) sounded like a "radial engine that was poorly tuned and misfiring." When the airplane was flying just past the south end of the airport it was a lot lower to the ground than other airplanes these witnesses had seen. About 2 seconds before the crash, the airplane was only about 40 feet above the ground. No smoke was coming from the airplane during flight. The popping sound stopped just before impact. The airplane appeared to be in a 45-degree right wing low bank angle as it descended into the ground. The airplane hit the ground and then rotated clockwise. A fire erupted as soon as the airplane came to a stop.

Another witness, sitting at a location south of the airport, observed the airplane flying in a southerly direction and descending. He heard an engine or engines running, and he did not hear any sputtering sounds. Just before the crash he observed the airplane initiate a right turn, and it crashed during the turn. The airplane was not on fire while it was airborne, but a fire started immediately following the impact.

According to the responding emergency medical personnel, the pilot made a statement regarding the flight. The medical personnel reported that the pilot stated, "my engine failed and I was trying to turn around."

Personnel information

The pilot held a commercial pilot certificate, and he was rated to fly single and multiengine land airplanes. He also held an instrument rating and was certified as an advanced and instrument ground instructor. Additionally he was certificated as an airframe and powerplant mechanic.

A review of the pilot's personal flight record logbook indicated that he had a total of about 1,782 flight hours including over 1,000 hours as pilot-in-command. During the 90 days preceding the accident the pilot had flown at least 130 hours combined flight time as a pilot and copilot.

According to his logbook, the pilot had satisfactorily completed his last biennial flight review on June 30, 2000. However, a flight instructor where he was employed reported that he gave the pilot a biennial flight review on May 4, 2001.

The pilot's wife reported that she believed the pilot had last flown the accident airplane in May 2001. According to the pilot's logbook, he had not flown the airplane between May 23 and the accident date.

The flight times listed above and in the "Flight Time Matrix" box of this report are estimates. The flight times consist of a combination of data complied from the pilot's flight logbook, family and employer information, and data listed on a United States Forest Service form, dated May 14, 2001.

Aircraft information

The accident airplane, serial number 23-878, was manufactured in 1957. The airplane's Piper data plate lists the airplane as being a model "PA-23." In various Federal Aviation Administration (FAA) documents it is subsequently referred to as being a model "PA-23-150."

The airplane had undergone several modifications. In pertinent part, its Lycoming O-320 engines (rated at 150 horsepower each) were equipped with Rajay turbochargers (referred to in associated literature as turbosuperchargers). The airplane's flight manual was supplemented to reflect this modification. Affixed on top of the airplane's serial number identification plate was a metal band indicating that the airplane's model was a "PA 23TS."

According to the pilot's wife, her husband was a professional airplane mechanic and pilot. He performed the maintenance on the airplane, which he had owned for about 2 years.

Based upon a review of incomplete records, on May 30, 2000, the pilot had performed an annual inspection on his airplane. On this date the listed airframe total time was 4,288.2 hours. The time since the engines had received a major overhaul was 1,293.0 hours. Since this date, the airplane had been operated for between 42 and 91 hours.

About 1500 on the accident day, a witness observed the pilot at the Chico Airport. The pilot was standing by his airplane with the right engine cowling removed. The witness reported that he asked the pilot, "Are you working on it today?" The pilot replied he would "see if we can get her to go," at which point the witness departed the area.

Meteorological information

In part, Chico Airport reported its weather conditions at 1910 as follows: Sky condition clear, surface wind from 120 degrees at 7 knots, and visibility 10 miles. The ambient temperature at the airport was 27 degrees Celsius. The calculated density altitude was approximately 1,900 feet.

Airport and ground facilities

Chico Municipal Airport runway 13L is 6,724 feet long. The air traffic control tower was closed at the time of the accident.

The airport's elevation is 238 feet mean sea level. The terrain is nearly level between the runway end and the initial point of ground impact (IPI). Between the IPI and the main wreckage, the terrain slopes upward about a 5-degree angle. All vegetation between the runway end and the IPI was less than 2 feet tall.

Wreckage and impact information

The accident site is located adjacent to the Chico Municipal Airport's southern perimeter fence, at the following approximate global positioning satellite coordinates: 39 degrees 47.055 minutes north latitude by 121 degrees 50.935 minutes west longitude. The initial point of impact was about 1,400 feet south of runway 13L's departure end, and about 150 feet west of the runway's extended centerline. The crash site elevation is about 200 feet mean sea level.

The initial point of impact was noted by the presence of a 17-foot-long shallow ground scar swath that was oriented in a southerly (176 degree, magnetic) direction toward the main wreckage. At the end of the swath, an oval shaped depression in the hard-packed ground was apparent that was about 3 feet wide by 9 feet long and 6 inches deep. Adjacent to the crater, green lens fragments were located which resemb

Aircraft

Registration
N2268P
Reported as
Piper PA-23-150
Category
Airplane
Serial number
23-878
Airframe hours
4,379
Engine
Lycoming O-320, 150 horsepower, reciprocating
Damage
Destroyed
Fire
On-Ground
Flight
Personal · Part 91
Airworthiness certificate
Standard, Normal
Last inspection
Annual · May 30, 2000 · 91 hours before
Departed
CIC · Chico, CA
Destination
CIC · Chico, CA
Airport
CIC · Chico Municipal, runway 13L, 6,724 × 150 ft, asphalt

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
49
Injuries
Fatal
Certificate
Commercial
Airplane ratings
Single-engine land, Multi-engine land
Instrument ratings
Airplane
Medical
Class 2, Valid Medical--w/ waivers/lim
Last flight review
May 4, 2001
Seat
Left
Toxicology
Performed
Flight hours
1,782 total · 1,006 in this make and model · 1,002 as pilot in command · 130 in the last 90 days

Weather

Conditions
Visual (VMC) · Day
Wind
120° at 7 knots
Visibility
10 statute miles
Lowest ceiling
None
Temperature
81 °F, dew point 55 °F
Altimeter
29.77 inHg
Observed at
CIC, 1 nm away

Docket · 29

The files NTSB released with the investigation on January 16, 2004, on NTSB’s docket system: statements, records, photos and specialists’ reports. 10.6 MB in all.

Witness StatementsItem 1 · .PDF · 266 KBMaps or Charts of Accident Area, Wreckage DiagramsItem 2 · .PDF · 133 KBWeather Reports and RecordsItem 3 · .PDF · 57 KBReport from Chico Police DepartmentItem 4 · .PDF · 113 KBReport from Textron LycomingItem 5 · .PDF · 584 KBReport from The New Piper Aircraft CompanyItem 6 · .PDF · 555 KBPrecision Airmotive Corporation ReportItem 7 · .PDF · 217 KBToxicological ReportItem 8 · .PDF · 59 KBStatement of Party Representatives to NTSB InvestigationItem 9 · .PDF · 312 KBRelease of Aircraft Wreckage, NTSB Form 6120.15Item 10 · .PDF · 83 KBExtract from Pilot's Flight LogbookItem 11 · .PDF · 521 KBEmployment Flight Time SummaryItem 12 · .PDF · 97 KBAirplane Logbook Page (Maintenance)Item 13 · .PDF · 82 KBOwner's Handbook Extract - Rate of Climb ChartItem 14 · .PDF · 27 KBPhoto 1. Northward view of departure end of runway 13L showing terrain between runway end and the initial point of impact.Item 15 · .PDF · 372 KBPhoto 2. Initial point of impact (center foreground) and left side of airplane.Item 16 · .PDF · 807 KBPhoto 3. Left side of airplane.Item 17 · .PDF · 420 KBPhoto 4. Left side of photograph shows trailing edge of right wing (upside down).Item 18 · .PDF · 493 KBPhoto 5. Front view of airplane.Item 19 · .PDF · 565 KBPhoto 6. Tail.Item 20 · .PDF · 399 KBPhoto 7. Right engine, upside down.Item 21 · .PDF · 507 KBPhoto 8. Left engine.Item 22 · .PDF · 616 KBPhoto 9. Fire destroyed cabin.Item 23 · .PDF · 632 KBPhoto 10. Fire damaged cockpit instruments.Item 24 · .PDF · 576 KBPhoto 11. Right engine and propeller assembly.Item 25 · .PDF · 403 KBPhoto 12. Right propeller.Item 26 · .PDF · 414 KBPhoto 13. Left engine and propeller assembly.Item 27 · .PDF · 428 KBPhoto 14. Left propeller.Item 28 · .PDF · 430 KBPhoto 15. Close up of one deformed left propeller blade.Item 29 · .PDF · 421 KB

FAA reports on this event · 1

The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.