LAX02FA157

After flying for about an hour, the engine lost power and the airplane collided with obstacles and the ground on a freeway during an attempted forced landing. The recently overhauled engine had just been installed the morning of the accident in the airframe and this was the first flight following this maintenance activity. The mechanic who installed the engine said after he completed the reinstallation he performed a 20-minute ground run of the engine. A fuel leak was noted in a fitting in the line to the carburetor and that was tightened. There were no other discrepancies noted in the engine indications. The pilot arrived at the airport after the mechanic had performed the ground run of the engine. He said the mechanic told him that the airplane was ready for a test flight and that he should take it up for about an hour to break-in the engine, changing the rpm setting every 5 minutes. The pilot said he did a preflight inspection, which included the determination that he had 6 gallons in each of the wing tanks and 6 gallons in the header tank, for a total of about 18 gallons. After the preflight, he started the engine and taxied down to the runway where he did his normal run-up process, which included two separate magneto checks. After takeoff he flew out about 3 miles and orbited while varying the rpm every 5 minutes. During the entire flight from engine start, the power plant performed perfectly with no abnormal engine indications. At the end of 1 hour, he reported to the control tower that he was ready to land and turned inbound toward the runway. On final approach, the engine just quit without any precipitating roughness or engine spool down. He said it was "like someone just turned off the key." He did not have enough altitude to make the runway and the airplane hit a fence and landed inverted on the highway. Post accident examination of the engine and related systems found numerous discrepancies and abnormal conditions related to the engine overhaul and its reinstallation in the airframe. While many of these discrepancies would have eventually induced a catistrophic engine failure, they were not contributory to the loss of engine power. Three specific conditions were likely related to the engine power loss. The engine driven fuel pump's outlet fitting was found loose and was easily moved, and the nuts attaching the fuel pump to the crankcase were found to be only finger tight. The nuts securing the P-leads for both magnetos were loose, with the nuts 2-turns from finger tight. The scuffing on the pistons indicates that the overhaul shop did not pre-oil the pistons, rings, and cylinders when the engine was put back together; this dry condition allowed a large quantity of oil to migrate past the rings, fouling the plugs with carbon deposits. The fuel system in the aircraft consists of a 6-gallon tank in each wing and a 6-gallon header tank, which is mounted in front of the cockpit. Fuel is supplied to the engine's carburetor via gravity fed line only from the header tank. The engine driven fuel pump moves fuel from the wing tanks to the header tank to replenish that supply as the engine uses it. According to the Teledyne Continental operating manual for the "C" series engines, the typical cruise fuel consumption rate of the C75 engine is between 5 and 6 gallons per hour. At the conclusion of the impact sequence, the aircraft came to rest inverted, with all three fuel tanks breched. A fuel spill was noted under the fuel tank locations in both wings, and based on the size of the fuel stain, investigators estimated at least 10 gallons had leaked. The loose fitting on the fuel pump likely allowed it to suck air and resulted in inefficeincey to the extent that the header tank was depleted of fuel, which in turn resulted in a fuel starvation event. The mechanic was going to leave town immediately after completing this job for a planned multi week vacation trip.

1.1 History of flight

On May 11, 2002, at 1242 Pacific daylight time, a Ercoupe (Engineering & Research Corp.) 415C, N2948H, collided with obstacles and the ground on a freeway in El Cajon, California, during an attempted forced landing following a loss of engine power. No automobiles were involved on the ground. The airplane was owned and operated by the pilot under the provisions of 14 CFR Part 91 of the Federal Aviation Regulations. The airplane was destroyed in the collision sequence. The private pilot, the sole occupant, sustained serious injuries. Visual meteorological conditions prevailed at the time and no flight plan had been filed. The local area post maintenance test flight originated at the Gillespie Field airport, El Cajon, at 1140.

According to controllers at the Federal Aviation Administration (FAA) Air Traffic Control Tower at Gillespie Field, when the pilot departed he informed them that he would be breaking in a new engine and would be orbiting northeast of the airport. About 1240, the pilot radioed the local controller and declared an emergency, noting that he had a rough-running engine. At the time he stated his position as 5 miles east of the airport. The local controller cleared the pilot to land on runway 27R. Shortly after that, the pilot stated "mayday mayday." The controller stated that he saw the airplane on final approach and it "nose dived" out of his sight.

The airplane collided with the eastern most fence bordering the freeway right of way, then the ground in the northbound lanes of highway 67 about 1/2 mile from the approach end of runway 27R. The airplane came to rest inverted on the freeway.

A post accident investigation disclosed that the recently overhauled engine had just been installed in the airframe and this was the first flight following this maintenance activity. The mechanic who installed the engine was initially interviewed on site by a responding FAA inspector. During the interview, he provided the airframe and engine maintenance records to investigators. He stated that the Teledyne Continental C-75 engine had been overhauled and he completed the reinstallation that morning. Following installation, he performed a 20-minute ground run of the engine. A fuel leak was noted in a fitting in the line to the carburetor and that was tightened. There were no other discrepancies noted in the engine indications. The pilot then took the airplane for a post maintenance test flight and engine break-in. The mechanic noted that the carburetor was overhauled at the same time as the engine.

1.1 Pilot's Statement

The pilot, who is also the owner of the airplane, was interviewed at his residence following release from the hospital. He said that he did not participate in any of the maintenance activities associated with the removal or installation of the engine. The mechanic who installed the engine is the one who does all of the maintenance on the airplane and has a key to the hangar where the airplane is kept.

He noted that it was in late November 2001 that he first became aware of a low oil pressure and a high oil temperature condition. This first manifested itself during a video taping flight over the southern San Diego area. The readings were of such concern that he diverted the flight to Brown Field and landed. The mechanic was contacted by telephone and he came out to troubleshoot the problem. Over a week-long period the mechanic attempted to resolve the problem without success. Eventually he determined that it was safe to move the airplane back to Gillispie Field. The pilot stated that the mechanic telephoned an engine overhaul shop, Barkhorn Precision Engines, and the resulting recommendation was for an overhaul, which the pilot agreed to. He denied that he instructed the mechanic to do only a "bottom end overhaul."

He could not recall the date of the last fueling on the airplane, however, he acknowledged that it could have been in early December.

While he is unsure of the dates, he believes that the engine was removed in the early December time frame for the overhaul. The overhaul seemed to take a long time and they were anxious to have their airplane back, but he did not pressure the mechanic to get the airplane back quickly. He was advised when the engine was delivered on May 6, and then the mechanic telephoned on May 10 and said the airplane would be ready the next day. The pilot arrived at the airport after the mechanic had performed the ground run of the engine. He was not present during any of the final installation or test run processes.

The mechanic told him that the airplane was ready for a test flight and that he should take it up for about an hour, changing the rpm setting every 5 minutes. The pilot said he did a preflight inspection, which included sump checking the fuel tanks. As for determination of quantity, the fuel gage in the cockpit read 3/4ths and the sight gage on the header tank was showing about 6 gallons. He explained that the one fuel gage combines the readings for both wing tanks. He interpreted the readings to mean that he had 6 gallons in each of the wing tanks and 6 gallons in the header tank, for a total of about 18 gallons. On the subject of the fuel tanks, he said that he was under the impression that the mechanic removed the header tank during the engine removal process.

After the preflight, he started the engine and taxied down to the runway where he did his normal run-up process, which included two separated magneto checks. He was number 5 for takeoff and was on the ground for about 10 minutes until he received his takeoff clearance. After takeoff he flew out about 3 miles and orbited while varying the rpm every 5 minutes. During the entire flight from engine start, the power plant performed perfectly with no abnormal engine indications. At the end of 1 hour, he reported to the Gillispie Field control tower that he was ready to land and turned inbound toward the runway. On final approach, the engine just quit without any precipitating roughness or engine spool down. He said it was "like someone just turned off the key." He did not have enough altitude to make the runway and did not want to take the chance of injuring someone on the ground by landing in a residential area or on the freeway. He selected a Christmas tree farm and set up to land there; however, he was slightly high and decided to "pancake it into the trees." After the airplane hit, it bounced back into the air and hit a fence. He does not remember anything after that.

1.2 Personnel information

Review of the records maintained by the FAA in the airman and medical records section disclosed that the pilot held a private pilot certificate with category ratings for airplanes single engine land and gliders. The most recent third-class medical certificate was issued on November 2, 2001, and contained the limitation that correcting lenses be worn for near vision.

The pilot supplied his most recent personal flight record logbook for review by investigators. The numeral 3 was written on the outside cover. The book encompasses entries from February 1992 to December 2001. (Note that the engine overhaul began in January 2002 and was completed on May 2, and that this was the first flight since December).

The estimated total time is 750 hours, with 70 at night. No determination could be made as to the total time in the airplane; however, all flights listed in this book were in the accident airplane. The pattern of activity averages about 5 hours per month over the course of the logbook entries, with the typical flight lasting around 0.5-hours.

A Biennial Flight Review endorsement was dated August 8, 2000, and was completed in the accident airplane.

1.3 Aircraft information

1.3.1 General Information

Review of FAA Aircraft Registry files disclosed that the airframe, an Ercoupe 415C, serial number 3573, was manufactured i