LAX08LA269

NTSB accident investigation · Cessna TU206F · Glendale, AZ · August 19, 2008

Accident · No injuriesLimited investigationFinal report
Date
August 19, 2008, 10:20 local (17:20 UTC)
Place
Glendale, AZ
Injuries
3 uninjured
Damage
Substantial damage
Phase of flight
Initial climb
Aircraft
N62DBCessna TU206F
Defining event
Initial climb: Loss of engine power (partial)
Weather
Visual (VMC) · Day
Status
Completed · report May 12, 2009
Report
Approved by Office Director
Parties
Federal Aviation Administration
FAA report
20080819843879A
Case key
68742

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

A loose fuel line fitting that resulted in a partial loss of engine power during the initial takeoff climb. Contributing to the accident was inadequate maintenance installation of the fitting.

Findings · 5

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.

Runway/land/takeoff/taxi surfaceEnvironmental issues › Physical environment · Contributed to outcomeCessna TU206F: 1 caseAll aircraft: 253 cases
Object/animal/substance: fence/fence postEnvironmental issues › Physical environment · Contributed to outcomeCessna TU206F: 1 caseAll aircraft: 313 cases
Engine fuel and control: fuel distributionAircraft › Aircraft power plant · Incorrect service/maintenanceCessna TU206F: 1 caseAll aircraft: 55 casesProbable cause
Misc hardware: fastenersAircraft › Fluids/misc hardware · Incorrect service/maintenanceCessna TU206F: 1 caseAll aircraft: 58 casesProbable cause
Maintenance: installationPersonnel issues › Task performance · Maintenance personnelCessna TU206F: 1 caseAll aircraft: 371 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 engine began to run rough shortly after takeoff. Unable to return to the airport, he initiated a forced landing in a short field. The airplane collided with a fence during the landing roll. During a post crash examination, a loose fuel line fitting was discovered that was connected to the fuel flow transducer inlet. It was also noted that there were blue stains on the crankcase immediately below the fitting. After tightening the fitting, the engine started and ran smoothly at 1,800 revolutions per minute (rpm) with a smooth rpm drop for each magneto. The fitting was then manually loosened again with the engine running at 1,800 rpm, the fuel pressure fell below the bottom of the green arc, and the engine began to run rough. The fitting was again tightened, and smooth engine operation resumed. The last maintenance recorded that would have involved removal of this fitting was during an engine replacement on July 7, 2007, which was 127 hours prior to the accident.

Factual narrative

On August 19, 2008, about 1020 mountain standard time, a Cessna TU206F, N62DB, collided with a fence during a forced landing near Glendale, Arizona. Airwest Helicopters LLC was operating the airplane under the provisions of 14 Code of Federal Regulations (CFR) Part 135. The certificated airline transport pilot and two passengers were not injured. The airplane sustained substantial damage to the fuselage. The cross-country business flight departed Glendale about 1012, with a planned destination of Grand Canyon Valle Airport, Williams, Arizona. Visual meteorological conditions prevailed, and no flight plan had been filed. The pilot reported that the departure was uneventful until he leveled the airplane at 3,000 feet mean sea level (msl). He noticed that all of the exhaust gas temperature readings were much higher than normal. He adjusted the manifold pressure to 27 inches of mercury, and reduced the revolutions per minute (rpm) to 2,500. The engine began to run rough, so the pilot turned back toward the airport. He tried to get the engine to run more smoothly, but was unsuccessful. The airplane could not maintain altitude, and could not make it back to the airport. He elected to land in a short, open field. After colliding with the fence and coming to a stop, the pilot evacuated his passengers and himself without injuries. Investigators examined the engine. They removed the top spark plugs. All spark plugs were clean with no mechanical deformation. The spark plug electrodes were circular and gray, which corresponded to normal operation according to the Champion Aviation Check-A-Plug AV-27 Chart. A borescope inspection of the cylinders revealed no mechanical deformation on the valves, cylinder walls, or internal cylinder head. Recovery personnel strapped the airframe to supports and the floor. They plumbed a fuel can into the left wing fuel supply. When they opened the fuel valve allowing gravity flow, fuel leaked from the fuel line fitting that was connected to the fuel flow transducer inlet. There were blue stains on the crankcase immediately below the fitting. The fitting took about 180 degrees of turn to close finger tight, and stop the leak. Investigators tightened the fitting. Investigators started the engine with no difficulties encountered. Investigators left the engine at a low rpm setting until the engine oil temperature was indicating within the green operating arc. They advanced the throttle, and increased the rpm to 1,800, and the engine ran smoothly. The fuel flow was about 14 gallons per hour (gph). A magneto check revealed a smooth rpm drop on each magneto. An investigator manually loosened the fitting with the engine running at 1,800 rpm. The fuel pressure decreased to 6 gpm, which was below the bottom of the green operating arc; the engine began to run rough. The investigator tightened the fitting, and smooth engine operation resumed. The last maintenance recorded that would have involved removal of this fitting was during anengine replacement on July 7, 2007, which was 127 hours prior to the accident. Maintenance personnel completed an annual inspection on May 21, 2008.

Aircraft

Registration
N62DB
Reported as
Cessna TU206F
Category
Airplane
Serial number
U206 03278
Airframe hours
6,301
Engine
Teledyne Continental Motors TSIO-520-C, 285 horsepower, reciprocating
Damage
Substantial damage
Flight
Part 135
Operator
Airwest Helicopters LLC
Registered owner
5688c LLC
Airworthiness certificate
Standard, Normal
Last inspection
Annual · May 21, 2008
Departed
GEU · Glendale, AZ
Destination
40G · Valle, AZ
Flight plan
Company VFR

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
48
Injuries
None
Certificates
Flight instructor, Airline transport, Commercial
Airplane ratings
Multi-engine land, Single-engine sea
Instrument ratings
Airplane, Helicopter
Medical
Class 2, Without waivers/limitations
Last flight review
December 18, 2007
Seat
Left
Flight hours
13,000 total · 425 in this make and model · 12,800 as pilot in command · 166 in the last 90 days · 50 in the last 30 days · 3 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
Calm
Visibility
20 statute miles
Lowest ceiling
None
Temperature
97 °F
Altimeter
29.85 inHg
Observed at
GEU, 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.