# NTSB MIA03LA139: Samual G. DaSilva Velocity, N51576, Sebastian, FL, July 1, 2003 - Type: NTSB accident investigation - Classification: Accident · Serious injuries · Limited investigation · Final report - Date: July 1, 2003, 12:40 local (16:40 UTC) - Place: Sebastian, FL - Coordinates: 27.816667, -80.683334 - Nearby events: https://openairdocs.org/map.md?lat=27.8167&lon=-80.6833&mi=10 - Phase of flight: [Enroute](https://openairdocs.org/ntsb-phases/400) (OpenAirDocs' grouping) - Highest injury: Serious injuries - Injuries: 1 serious, 1 minor - Status: Completed, report October 28, 2004 - Report: Approved by Office Director - Parties: FAA Flight Standards District Office - NTSB case key (mKey): 57503 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=MIA03LA139 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/57503/pdf - Page: https://openairdocs.org/ntsb/MIA03LA139 ## Probable cause The improper repair of the crankshaft by a FAA Certified Repair Station resulting in fatigue failure and subsequent total loss of engine power. A factor in the accident was the rough/uneven terrain encountered by the pilot during the landing roll in a field. ## 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, cruise - normal - engine assembly,crankshaft - fatigue (cause) - maintenance,major repair - improper, other maintenance personnel (cause) - Forced landing, descent - emergency - On ground/water encounter with terrain/water, emergency landing - terrain condition - rough/uneven (contributing factor) ## Analysis The pilot stated that about 10 minutes after takeoff during cruise flight at 1,500 feet with the passenger flying the airplane, the engine briefly "shuddered", and the rpm dropped to 2,000, then to zero. He took the controls and attempted to restore engine power but was unsuccessful. He maneuvered the airplane for a forced landing in a field, and when the flight was approximately 20 feet above ground level he recognized there were drainage ditches in the field. The airplane was landed in the field, and during the landing roll the nose landing gear collapsed after traveling into a ditch. The airplane then slid into a second ditch, and came to rest approximately 158 feet from the first ditch impact location. Examination of the engine revealed the crankshaft was fractured at the No. 3 cylinder connecting rod journal; there was no evidence of lack of lubrication or fretting on the faying surfaces of the crankcase halves. Metallurgical examination of the crankshaft revealed the fracture surface was located in the aft radius of the No. 3 connecting rod journal; fatigue progression was noted to initiate from the intersection of the radius and the journal. The fracture propagated in a plane perpendicular to the journal surface from a single origin. The fatigue initiation site did not contain scoring marks or scratches. All connecting rod journals measured 2.114 inches. The No. 3 connecting rod journal superficial macro hardness was slightly below the minimum specified limit, while the core hardness was within limits. The overall aft radius was determined to be 0.152 inch, while a localized transition radius of .015 inch at the fatigue origin location was noted. The crankshaft had been to two FAA certified repair stations (FAA CRS), the first time on December 14, 1991, and the second time on August 2, 2001. Both repair stations rejected the crankshaft due to a crack in the No. 1 main bearing area. The records from the facility that inspected the crankshaft in 2001 indicate the No. 3 connecting rod journal measured 2.1193 inches at the time it was rejected; no work was performed to it. The owner reported that following the rejection in 2001, he took the crankshaft to another FAA CRS who reportedly ground two connecting rod journals and polished the crankshaft. The owner did not have a receipt or yellow tag for the work performed to the crankshaft. The engine was assembled, and had been operated 87.8 hours since being reassembled at the time of the crankshaft failure. The president of the FAA CRS that the owner of the airplane reported last worked on the crankshaft reported he did not have any records pertaining to the accident crankshaft. He also reported that he voluntarily closed his business in August 2002, to retire. ## Factual narrative On July 1, 2003, about 1240 eastern daylight time, a homebuilt Velocity, N51576, registered to a private individual, experienced a total loss of engine power during cruise flight near Sebastian, Florida. Visual meteorological conditions prevailed at the time and no flight plan was filed for the 14 CFR Part 91 personal flight. The airplane was substantially damaged and the commercial-rated pilot sustained minor injuries while a passenger sustained serious injuries. The flight originated about 10 minutes earlier from the Sebastian Municipal Airport, Sebastian, Florida. The pilot stated that about 10 minutes after takeoff during cruise flight at 1,500 feet with the passenger flying the airplane, the engine briefly "shuddered", and the rpm dropped to 2,000, then to zero. He took the controls and attempted to restore engine power but was unsuccessful. He maneuvered the airplane for a forced landing in a field, and when the flight was approximately 20 feet above ground level he recognized there were drainage ditches in the field. The airplane was landed in the field, and during the landing roll the nose landing gear collapsed after traveling into a ditch. The airplane then slid into a second ditch, and came to rest approximately 158 feet from the first ditch impact location. Examination of the engine revealed the crankshaft was fractured at the No. 3 cylinder connecting rod journal; there was no evidence of lack of lubrication, or fretting on the faying surfaces of the crankcase halves. The crankshaft was removed and sent to the NTSB Metallurgy Laboratory located in Washington, D.C., for further examination. NTSB metallurgical examination of the crankshaft revealed the fracture surface was located in the aft radius of the No. 3 connecting rod journal; fatigue progression was noted to initiate from the intersection of the radius and the journal. The fracture propagated in a plane perpendicular to the journal surface from a single origin. The fatigue initiation site did not contain scoring marks or scratches. All connecting rod journals measured 2.114 inches. The No. 3 connecting rod journal superficial macro hardness was slightly below the minimum specified limit, while the core hardness was within limits. The overall aft radius was determined to be 0.152 inch, while a localized transition radius of .015 inch at the fatigue origin location was noted. The crankshaft had been to two FAA certified repair stations (FAA CRS), the first time on December 14, 1991, and the second time on August 2, 2001. Both repair stations rejected the crankshaft due to a crack in the No. 1 main bearing area. The records from the facility that inspected the crankshaft in 2001 indicate the No. 3 connecting rod journal measured 2.1193 inches at the time it was rejected; no work was performed to it. The owner reported that following the rejection in 2001, he took the crankshaft to another FAA CRS who reportedly ground two connecting rod journals and polished the crankshaft. The owner did not have a receipt or yellow tag for the work performed to the crankshaft. The engine was assembled, and had been operated 87.8 hours since being reassembled at the time of the crankshaft failure. The president of the FAA CRS that the owner of the airplane reported last worked on the crankshaft reported he did not have any records pertaining to the accident crankshaft. He also reported that he voluntarily closed his business in August 2002, to retire. The airplane minus the retained crankshaft was released to the airplane owner on October 29, 2003. The retained crankshaft was also released to the airplane owner on August 20, 2004. ## Aircraft - Registration: [N51576](https://openairdocs.org/aircraft/N51576), registered now, S/N DM0112, built 1993 (OpenAirDocs) - Reported make and model: Samual G. DaSilva Velocity - Registry model: [Dasilva Samuel G VELOCITY](https://openairdocs.org/model/dasilva-samuel-g-velocity) (registry code 05620HE) (OpenAirDocs) - Registry engine: [Lycoming I0360 SER A&C](https://openairdocs.org/engine/lycoming-i0360-ser-a-c) (registry code 41511, reciprocating) (OpenAirDocs) - Category: Airplane, amateur-built - Serial number: DMO-0112 - Airframe hours: 760 - Engines: Lycoming O-360-A1A 180 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Registered owner: Samuel G. DaSilva - Airworthiness certificate: Special, Experimental (Special) - Last inspection: Condition, March 11, 2003, 24.1 hours before - Departed: X26, Sebastion, FL - Destination: KPIE, St. Petersburg, FL ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 67; injuries: minor; commercial, flight instructor; airplane ratings: single-engine land; instrument ratings: airplane; medical: class 2, valid medical--w/ waivers/lim; last flight review August 10, 2002; seat: left; flight hours: 4,200 total, 1,247 in this make and model, 4,200 as pilot in command, 4 in the last 90 days, 3 in the last 30 days, 1 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: 130° at 15 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 88 °F, dew point 75 °F - Altimeter: 30.11 inHg - Observed at: KVRB ## 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 20030701037639A](https://openairdocs.org/incident/20030701037639A), Jul 1, 2003: Amtr VELOCITY, Sebastian, FL, Substantial damage. (-23) The aircraft engine lost power about 10 minutes after departing Sebastian, FL (X26), and a forced landing was made in a field where the airplane impacted… 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.