LAX07LA114

NTSB accident investigation · Mooney M20B · St. George, UT · March 18, 2007

Accident · No injuriesLimited investigationFinal report
Date
March 17, 2007, 18:00 local (Mar 18, 2007, 00:00 UTC)
Place
St. George, UT
Injuries
2 uninjured
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N74503Mooney M20B
Weather
Visual (VMC) · Day
Status
Completed · report July 25, 2007
Report
Approved by Office Director
Parties
Federal Aviation Administration
FAA report
20070317003199A
Case key
65452

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

Oil contamination of the right magneto. Factors were the airplane owner's failure to comply with manufacturer's service bulletins and overhaul porcedures.

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) - mech failure/malfCruise
Ignition system,magneto - contamination,other than waterCause
Maintenance,service bulletin/letter - not complied withOwner/pilot mechanicFactor
Maintenance,overhaul - not performedOwner/pilot mechanicFactor
Forced landingEmergency landing
On ground/water encounter with terrain/waterEmergency descent/landing
Terrain condition - rough/uneven

Analysis

Ten minutes after takeoff the airplane's engine started running rough, and the airplane collided with terrain during a forced landing into an open area. The pilot leveled the airplane at 6,500 feet for cruise and the engine started running rough and backfiring. The engine would run sporadically rough then smooth out. The pilot executed emergency procedures, switched fuel tanks, and switched on the boost pump, but there was no change in the engine's rough-running condition. He decided to return to the airport, and configured the airplane for best glide. He setup for a 2-mile final to runway 34. The pilot determined that he was not going to make the runway, and force landed the airplane in a clear area by a river bed. An examination of the engine determined that the right magneto contained engine oil. The seal between the engine accessory drive and the magneto was hard, loose fitting, and covered with engine oil. Examination of the engine maintenance logbook revealed that the engine had been manufactured new on February 8, 1979, and installed on the airplane April 13, 1979. A 9-year gap where no maintenance was recorded on the engine occurred between October 1992 (engine total time of 1302.9 hours) and July 2002 (engine total time of 1322.39 hours). A 100-hour inspection was recorded as being completed on July 2, 2002. The most recent 100-hour inspection was performed on June 22, 2006, at 1,439.1 hours total time. There is no record of an engine or magneto overhaul. Lycoming Service Instruction No. 1009AS states that engines that do not accumulate the hourly period of time between overhauls specified (2,000 hours for the O-360-A1D) are recommended to be overhauled in the twelfth year. Teledyne Continental Ignition systems Service Bulletin, SB643B, for all TCM and Bendix magnetos states that the magnetos must be overhauled or replaced at the expiration of 5 years since the date of original manufacture or last overhaul, or 4 years since the date the magneto was placed in service, which ever occurs first with out regard to accumulated operating hours.

Factual narrative

On March 17, 2007, at 1800 mountain daylight time, a Mooney M20B, N74503, experienced a partial loss of engine power after takeoff and forced landed near St. George Municipal Airport, St. George, Utah. The private pilot operated the airplane under the provisions of 14 CFR Part 91. The pilot and single passenger were not injured, and the airplane sustained substantial damage. Visual meteorological conditions prevailed, and no flight plan had been filed. The flight originated at St. George airport at 1745, and was en route to Blackfoot, Idaho.

The pilot stated to the National Transportation Safety Board investigator that 10 minutes after takeoff he leveled the airplane at 6,500 feet for cruise; the engine started running rough and backfiring. The engine would run sporadically rough then smooth out. The pilot executed emergency procedures, switched fuel tanks, and switched on the boost pump, but there was no change in the engine's rough running condition. He decided to return to St. George airport, and configured the airplane for best glide. He setup for a 2-mile final to runway 34. The pilot determined that he was not going to make the runway, and force landed the airplane in a clear area by a river bed.

The next day a Federal Aviation Administration inspector examined the engine and determined that the right magneto contained engine oil. The seal between the engine accessory drive and the magneto was hard, loose fitting, and covered with engine oil. Examination of the engine maintenance logbook revealed that the engine had been manufactured new on February 8, 1979, and installed on the airplane April 13, 1979. A 9-year gap where no maintenance was recorded on the engine occurred between October 1992 (engine total time of 1302.9 hours) and July 2002 (engine total time of 1322.39 hours). A 100-hour inspection was recorded as being completed on July 2, 2002. The most recent 100-hour inspection was performed on June 22, 2006, at 1,439.1 hours total time. There is no record of an engine or magneto overhaul.

Lycoming Service Instruction No. 1009AS states that engines that do not accumulate the hourly period of time between overhauls specified (2,000 hours for the O-360-A1D) are recommended to be overhauled in the twelfth year.

Teledyne Continental Ignition Systems Service Bulletin, SB643B, for all TCM and Bendix magnetos states that the magnetos must be overhauled or replaced at the expiration of 5 years since the date of original manufacture or last overhaul, or 4 years since the date the magneto was placed in service, which ever occurs first with out regard to accumulated operating hours.

Aircraft

Registration
N74503
Reported as
Mooney M20B
Category
Airplane
Serial number
1814
Airframe hours
3,958.5
Engine
Lycoming O-360-A1D, 180 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Registered owner
Steve Laflin
Airworthiness certificate
Standard, Normal
Last inspection
Annual · June 1, 2006
Departed
KSGU · St. George, UT
Destination
KU02 · Blackfoot, ID
Airport
KSGU · St. George

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
50
Injuries
None
Certificate
Private
Airplane ratings
Single-engine land
Instrument ratings
Airplane
Medical
Class 3
Flight hours
462 total · 325 in this make and model · 419 as pilot in command · 68 in the last 90 days · 42 in the last 30 days · 3 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
260° at 14 knots
Visibility
10 statute miles
Lowest ceiling
None
Temperature
82 °F, dew point 21 °F
Altimeter
29.90 inHg
Observed at
KSGU, 2 nm away

FAA reports on this event · 1

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