# NTSB LAX06LA230: Cessna 152, N25512, Pacoima, CA, July 14, 2006 - Type: NTSB accident investigation - Classification: Accident · Minor injuries · Limited investigation · Final report - Date: July 14, 2006, 15:00 local (22:00 UTC) - Place: Pacoima, CA - Coordinates: 34.259445, -118.413612 - Nearby events: https://openairdocs.org/map.md?lat=34.2594&lon=-118.4136&mi=10 - Phase of flight: [Initial climb](https://openairdocs.org/ntsb-phases/350) (OpenAirDocs' grouping) - Highest injury: Minor injuries - Injuries: 1 minor, 1 uninjured - Status: Completed, report November 29, 2007 - Report: Approved by Office Director - Parties: Federal Aviation Administration - NTSB case key (mKey): 64119 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=LAX06LA230 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/64119/pdf - Page: https://openairdocs.org/ntsb/LAX06LA230 ## Probable cause a loss of engine power due to the failure of maintenance personnel to tighten the top spark plugs, and install the leads for the ignition harness to the top spark plugs. ## Sequence of events In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf). - Loss of engine power(partial) - mech failure/malf, takeoff - initial climb - ignition system,spark plug - loose (cause) - ignition system,ignition harness - not installed (cause) - maintenance,installation - improper, other maintenance personnel (cause) - Forced landing, emergency landing after takeoff - On ground/water encounter with terrain/water, emergency landing after takeoff - terrain condition - soft - Nose over, emergency landing after takeoff ## Analysis The airplane nosed over during an off airport forced landing following a loss of engine power in the takeoff initial climb. The student and certified flight instructor (CFI) departed on runway 14 for pattern work, and made a full stop landing. They taxied back, and took off again. About 150 feet above ground level (agl), the engine lost a little power. They turned back toward the airport. During the turn the engine lost more power, and the airplane could not maintain altitude. The CFI took control, and elected to land in a dry pond. The airplane touched down good, but the nose wheel dug into the soft dirt, and the airplane nosed over. Examination revealed that none of the ignition leads were connected to the top spark plugs. The number 3 cylinder top plug was missing with oil on the upper cowling above the hole, and the top spark plugs for the remaining cylinders were loose, with most only engaged by one or two threads. Two hours prior to the accident flight, a mechanic performed work, including installation of a new left magneto and new spark plugs. ## Factual narrative On July 14, 2006, about 1500 Pacific daylight time, a Cessna 152, N25512, nosed over during an off airport forced landing near Pacoima, California. The student pilot/owner was operating the airplane under the provisions of 14 CFR Part 91. The certified flight instructor (CFI) sustained minor injuries; the student pilot was not injured. The airplane sustained substantial damage. The local instructional flight departed Whiteman Airport, Los Angeles, about 1459. Visual meteorological conditions prevailed, and no flight plan had been filed. The CFI stated that engine roughness and a loss of power occurred about 100 feet above ground level (agl) while departing runway 12 following a touch-and-go. The CFI notified local air traffic control of his situation, and was cleared to land runway 30. Unable to reach the runway, the CFI elected to land in an area of spreading ponds about 3/4 mile southeast of Whiteman. The student pilot/owner stated that he and the instructor flew the airplane 2 days before the accident. The engine had about 600 hours since new. A mechanic had recently replaced the left magneto, adjusted the valves, and replaced the alternator. The student said that they departed on runway 14, and were past Osborne. They planned to do a touch-and-go, but the touchdown was a little long, so they made it a full stop landing. They taxied back, and took off again. About 150 feet above ground level (agl), the engine lost a little power (about 150 rpm). The airplane would not climb, but it could maintain altitude. They turned back toward the airport. During the turn the engine lost more power, and they could not maintain altitude. The CFI took control, and elected to land in a dry pond. The airplane touched down good, but the nose wheel dug into the soft dirt, and the airplane nosed over. The student thought that the CFI tried to put the flaps down, but doesn't think that they were full down. The engine was still running when they touched down. The fire department turned off the master switch, ignition switch, the fuel selector valve, and ELT. There was no fuel leak; they pinched the fuel outlet. The FAA and Textron Lycoming were parties to the investigation. Investigators examined the wreckage at Aircraft Recovery Service, Littlerock, California, on July 17, 2006, under the supervision of the National Transportation Safety Board investigator-in-charge (IIC). When the recovery agent picked the airplane up, it was inverted. He placed it inverted onto his trailer, and offloaded it at his yard in the same orientation with the damaged cowling still in place. Under the supervision of the IIC, the agent righted the airplane, and removed the cowling. Investigators noted that none of the ignition leads were connected to the top spark plugs. Top plug number 3 was missing, and the cowling was oily in this area. The heli-coil thread insert of this spark plug bore was pulled out slightly near the terminating end of the heli-coil. All of the other top plugs were finger loose with about 1 1/2 threads engaged. The number 3 spark plug was not recovered. All spark plugs were clean with no mechanical deformation. The spark plug electrodes were gray, which corresponded to normal operation according to the Champion Aviation Check-A-Plug AV-27 Chart. A borescope inspection revealed no mechanical deformation on the valves, cylinder walls, or internal cylinder head. Investigators manually rotated the crankshaft with the propeller. The crankshaft rotated freely, and the valves moved approximately the same amount of lift in firing order. The gears in the accessory case turned freely. Investigators obtained thumb compression on all cylinders in firing order. Investigators manually rotated the magnetos, and both magnetos produced spark at all posts. They checked the magneto to engine timing utilizing a timing box (syncrophaser) device. The left magneto was at 20 degrees before top dead center (BTDC) on the number one cylinder, while the right was at 25 degrees BTDC. The engine data plate indicated 20 degrees spark advance. An engine logbook entry dated July 10, 2006, noted that a mechanic adjusted the valve clearance, changed the oil and filter, and installed a new left magneto, new spark plugs, new muffler, new crankcase oil seal, new voltage regulator, and an overhauled alternator. The tachometer time was 616.8. The tachometer read 618.8 at the post accident examination. ## Aircraft - Registration: [N25512](https://openairdocs.org/deregistered/N25512-2007-09-17), registration cancelled 2007-09-17, S/N 15280706, built 1977 (OpenAirDocs) - Reported make and model: Cessna 152 - Registry model: [Cessna 152](https://openairdocs.org/model/cessna-152) (registry code 2071835) (OpenAirDocs) - Registry engine: [Lycoming 0-235 series](https://openairdocs.org/engine/lycoming-0-235-series) (registry code 41505, 4 cycle) (OpenAirDocs) - Category: Airplane - Serial number: 15280706 - Airframe hours: 598 - Engines: Lycoming O-235-L2C 115 horsepower reciprocating - Damage: Substantial damage - Flight: Instructional, Part 91 - Operator: Natividad Flores - Registered owner: Holmes Bo - Airworthiness certificate: Standard, Normal; Standard, Utility - Last inspection: 100 hour, January 1, 2006, 2 hours before - Departed: WHP, Los Angeles, CA - Destination: WHP, Los Angeles, CA - Airport: WHP, Whiteman, runway 12, 4,120 × 75 ft, asphalt ## Flight crew As NTSB recorded them. NTSB leaves out names. - Flight instructor; age 37; injuries: minor; commercial, flight instructor; airplane ratings: multi-engine land, single-engine land; instrument ratings: airplane; medical: class 1; last flight review February 1, 2006; seat: right; flight hours: 1,834 total, 274 in this make and model, 1,739 as pilot in command, 181 in the last 90 days, 48 in the last 30 days, 1 in the last 24 hours - Student pilot; age 50; injuries: none; student; medical: class 3; seat: left; flight hours: 100 total, 65 in this make and model, 67 in the last 90 days, 8 in the last 30 days ## Weather - Conditions: Visual (VMC), Day - Wind: 170° at 8 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 99 °F, dew point 52 °F - Altimeter: 29.86 inHg - Observed at: BUR ## 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 20060714014669A](https://openairdocs.org/incident/20060714014669A), Jul 14, 2006: Cessna 152, Los Angeles, CA, Substantial damage. (-23) During second touch and go, engine lost power, forcing off-field landing. At aircraft recovery site, upper cowling removed revealed #3 cylinder's top… ## Other investigations on N25512 (1) 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. - [NTSB FTW86LA110](https://openairdocs.org/ntsb/FTW86LA110), Jun 15, 1986: Cessna 152 (N25512), Mineola, TX, substantial damage 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.