MIA01LA219

NTSB accident investigation · Piper PA-28-140 · Wilgrove, NC · August 17, 2001

Accident · No injuriesLimited investigationFinal report
Date
August 17, 2001, 13:00 local (17:00 UTC)
Place
Wilgrove, NC
Injuries
1 uninjured
Damage
Substantial damage
Phase of flight
Landing
Aircraft
N1453TPiper PA-28-140
Weather
Visual (VMC) · Day
Status
Completed · report December 4, 2001
Report
Approved by Office Director
Parties
FAA FSDO
FAA report
20010817027029A
Case key
53047

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

The failure of maintenance personal to properly reconnect the throttle-cable-to carburetor attachment, resulting in a throttle cable disconnection while in the landing pattern, and collision with trees. A factor in the accident was the failure of the pilot to obtain maintenance assistance once unfamiliar throttle action was detected.

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.

Airframe/component/system failure/malfunctionLanding - aborted
Maintenance,installation - improperOther maintenance personnelCause
Proper assistance - not obtainedPilot in commandFactor
Throttle/power lever,cable - disconnectedCause
In flight collision with objectGo-around (vfr)
Object - tree(s)

Analysis

According to the pilot, the aircraft underwent an annual inspection on August 2, 2001. One of the tasks performed was the removal and replacement of the oil pump impellers, and the throttle linkage must be disconnected to expedite the job. Nine-tenths of a flight hour and seven takeoffs after returning the aircraft to service, the throttle would not respond to the pilot's input while in the landing pattern. The pilot executed a partial power go-around, and the aircraft crashed into trees at the end of the runway. Wreckage examination revealed the throttle cable disconnected at the carburetor, and no drilled bolt, castellated nut or locking cotter pin that forms the throttle cable-to-carburetor connection was found. The pilot mentioned that since the annual inspection, he detected a slight detent in the throttle motion at about 1,100 rpm engine speed, but failed to mention it to the mechanic. The FAA certified IA who signed off the work stated he was 99.9 per cent certain the attaching hardware was correctly installed.

Factual narrative

On August 17, 2001, about 1300 eastern daylight time, a Piper PA-28-140, N1453T, registered to a private individual, operating as a Title 14 CFR Part 91 personal flight, crashed while performing a go-around at the Wilgrove Airpark, North Carolina. Visual meteorological conditions prevailed and no flight plan was filed. The aircraft received substantial damage, and the private-rated pilot, the sole occupant, was not injured. The flight departed the same airport about 30 minutes before the accident.

According to the pilot, he departed runway 17 directly into the landing pattern for touch-and-go landings. As he approached short final for his first landing, he noticed he could not reduce power, and elected to perform a go-around. The throttle did not respond in the increase power direction as well, and he over flew the runway at 100 to 150 feet agl, 1,900 rpm, and 70 mph until he encountered trees at the departure end. Unable to sustain level flight, he reasoned his best alternative was to perform a full stall landing into the tree canopy.

According to the FAA certified aircraft inspector who conducted an annual inspection on N1453T on August 2, 2001, one of the jobs to be performed was compliance with airworthiness directive No. AD 96-09-10, which requires the engine oil pump impellers to be replaced. The throttle linkage has to be disconnected when the crankcase is separated to perform the task. Although the inspector did not perform the impellers change himself, he inspected the finished job, and signed it off. He stated that he is "99.9 percent sure" that the castellated nut was properly replaced onto the threaded connector that forms the throttle linkage-to- carburetor connection, and that a new, properly sized cotter pin was installed to lock the castellated nut in place.

According to an FAA inspector, the pilot is one-half owner of the aircraft, based at the Wilgrove Airport, just east of Charlotte. Since its purchase, on about July 1, 1999, the pilot has flown the aircraft about 40 hours. After the annual inspection, the pilot noticed that the aileron, elevator, and elevator trim controls moved more freely than he remembered, and attributed it to the mechanic's lubricating the controls during inspection. However, for his own peace of mind, the pilot had an instructor accompany him the next time he flew the aircraft, and the CFI confirmed that the "looser" feel was due to lubrication. The pilot also stated that he felt a slight detent in the throttle motion of travel at about the 1,100 rpm engine speed range, but did not inform the mechanic. The aircraft had operated about 9/10 hour, including seven takeoffs since being returned to service following the annual inspection on August 2, 2001. Post crash examination of the aircraft by the inspector revealed the throttle cable separated from its actuator arm at the carburetor, and the attaching hardware, namely, the drilled bolt, castellated nut and cotter pin, were missing. Efforts to find the attaching hardware at the crash site were futile. The throttle setting appeared to be at about the mid-range position. Actioning the throttle from the cockpit revealed normal control movement right down to the rod end that forms the attach point to the carburetor's actuator arm.

Aircraft

Registration
N1453T
Reported as
Piper PA-28-140
Category
Airplane
Serial number
28-7225521
Airframe hours
5,946
Engine
Lycoming O-320-E3D, 150 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Registered owner
William S. Simpson
Airworthiness certificate
Standard, Normal
Last inspection
Annual · August 2, 2001 · 1 hours before
Departed
8A6 · Wilgrove, NC
Airport
8A6 · Wilgrove Airpark, runway 17, 2,700 × 45 ft, asphalt

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
55
Injuries
None
Certificate
Private
Airplane ratings
Single-engine land
Instrument ratings
Airplane
Medical
Class 3, Valid Medical--w/ waivers/lim
Last flight review
May 14, 2001
Seat
Left
Flight hours
134 total · 62 in this make and model · 22 in the last 90 days · 1 in the last 30 days

Weather

Conditions
Visual (VMC) · Day
Wind
230° at 7 knots
Visibility
9 statute miles
Lowest ceiling
25,000 ft broken
Temperature
90 °F, dew point 72 °F
Altimeter
30.12 inHg
Observed at
CLT, 13 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.

Other investigations on N1453T · 1

Matched to the same aircraft by N-number and date.