# NTSB LAX89FA140: Piper PA-60-601P, Newport Beach, CA, March 31, 1989

- Type: NTSB accident investigation
- Classification: Accident · Fatal · Field investigation · Final report
- Date: March 31, 1989, 08:35 local (16:35 UTC)
- Place: Newport Beach, CA
- Coordinates: 33.619991, -117.870826 (estimated)
- Nearby events: https://openairdocs.org/map.md?lat=33.6200&lon=-117.8708&mi=10
- Phase of flight: [Takeoff](https://openairdocs.org/ntsb-phases/300) (OpenAirDocs' grouping)
- Highest injury: Fatal
- Injuries: 5 fatal
- Status: Completed, report May 15, 1992
- Report: Approved by Office Director
- NTSB case key (mKey): 26220
- NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=LAX89FA140
- NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/26220/pdf
- Page: https://openairdocs.org/ntsb/LAX89FA140

## Probable cause

FAILURE OF THE PILOT TO ATTAIN ADEQUATE AIRSPEED BEFORE MANEUVERING (TURNING) BACK TOWARD THE AIRPORT, WHICH RESULTED IN A LOSS OF AIRCRAFT CONTROL.  A FACTOR RELATED TO THE ACCIDENT WAS:  IMPROPER MAINTENANCE/INSTALLATION OF A FUEL INJECTOR REFERENCE AIR LINE, WHICH ALLOWED CONTAMINATION OF THE INJECTORS AND LOSS OF POWER IN THE RIGHT ENGINE.

## Sequence of events

In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf).

- Loss of engine power(total) - mech failure/malf, takeoff
  - 1 engine
  - induction air control/system - improper (contributing factor)
  - maintenance,installation - improper, other maintenance personnel (contributing factor)
  - fuel system,injector - contamination (contributing factor)
- Loss of control - in flight, maneuvering
  - precautionary landing - initiated, pilot in command
  - maneuver - initiated, pilot in command
  - airspeed - inadequate, pilot in command (cause)
  - aircraft control - not maintained, pilot in command (cause)
  - overconfidence in personal ability, pilot in command (contributing factor)
  - self-induced pressure, pilot in command (contributing factor)
- In flight collision with terrain/water, descent - uncontrolled

## Analysis

SVRL MECHANIC WITNESSES AT THE ARPT SAID THE RGT ENG BACKFIRED & TRAILED BLACK SMOKE DURING THE TAKEOFF GROUND ROLL. RPRTDLY, THE TAKEOFF ROLL WAS ABOUT 80% LONGER THAN NORMAL.  WITNESSES SAID THE ACFT STAGGERED OFF THE GROUND, WAS SLOW & NEVER GOT ABOVE 100 FEET AGL.  THE PLT RPRTD TO THE TOWER THAT THE FLT HAD TO COME BACK TO THE RWY.  SHORTLY THEREAFTER, WITNESSES SAW THE ACFT ENTER A STEEP LEFT TURN, APPARENTLY STALL, THEN CRASH INTO SOME TENNIS COURTS.  AN INVESTIGATION REVEALED EVIDENCE THAT THE RGT ENG HAD LOST POWER.  A MODIFICATION KIT FOR THE FUEL INJECTOR REFERENCE AIR LINES WAS INCORRECTLY INSTALLED & ALLOWED AN UNFILTERED AIR SOURCE.  SPECTRAL ANALYSIS OF RESIDUE (FROM THE RGT ENG TURBO CHARGER COMPRESSOR) REVEALED THAT IT HAD THE SAME COMPOSITION AS THE ALTERNATE AIR DOOR SEAL.  TRACES OF THE MATERIAL WERE FOUND IN THE FUEL INJECTOR REFERENCE AIR LINE.

## Aircraft

- Registration: CGWPS (not matched to a registry record)
- Reported make and model: PIPER PA-60-601P
- Category: Airplane
- Serial number: 61P-0522-219
- Airframe hours: 1908
- Engines: LYCOMING IO-540-S1A5 290 horsepower reciprocating
- Damage: Destroyed
- Fire: On-Ground
- Flight: Personal, Part 91
- Operator: Anthony Deis
- Registered owner: Richardsons Jewellery Ltd.
- Airworthiness certificate: Standard, Normal
- Last inspection: Unknown, July 18, 1988, 204 hours before
- Departed: SNA
- Destination: PIH, POCATELLO, ID
- Flight plan: IFR
- Airport: SNA, John Wayne, runway 19R, 5,700 × 150 ft, asphalt

## Flight crew

As NTSB recorded them. NTSB leaves out names.

- Pilot; age 35; private, foreign; airplane ratings: multi-engine land, single-engine land; instrument ratings: airplane; medical: class 3, valid medical--no waivers/lim.; seat: left; toxicology performed; flight hours: 1,490 total, 243 in this make and model, 1,440 as pilot in command, 75 in the last 90 days, 24 in the last 30 days

## Weather

- Conditions: Visual (VMC), Day
- Wind: calm
- Visibility: 4 statute miles
- Lowest ceiling: none
- Temperature: 70 °F, dew point 55 °F
- Altimeter: 30.00 inHg
- Observed at: SNA, 2 nm away

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.