MIA04LA050

NTSB accident investigation · Mooney M20K · Immokalee, FL · February 3, 2004

Accident · Minor injuriesLimited investigationFinal report
Date
February 3, 2004, 10:15 local (15:15 UTC)
Place
Immokalee, FL
Injuries
2 minor
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N252WFMooney M20K
Weather
Visual (VMC) · Day
Status
Completed · report September 13, 2005
Report
Approved by Office Director
Parties
FAA FSDO
FAA report
20040203001509A
Case key
58705

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 loss of engine power due to the airplane mechanic's improper maintenance/installation and failure to ensure that the B-nut on the inlet side of the fuel manifold was properly tightened, which resulted in a fuel leak, and fuel starvation.

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(total) - mech failure/malfCruise - normal
Maintenance,installation - improperOther maintenance personnelCause
Fuel system,line fitting - loose part/bolt/nut/clamp/etc
Fluid,fuel - leak
Fluid,fuel - starvation
Forced landingEmergency descent/landing
On ground/water encounter with terrain/waterEmergency landing
Terrain condition - plowed/furrowed

Analysis

The pilot stated that the airplane was in cruise flight, at an altitude of 4,500 feet, when he detected a slight engine vibration. He noted that the fuel consumption had increased from the usual 12.5 gals/hr to 15.7 gals/hr, at 2,300 rpm and a manifold pressure of 30.00. Shortly thereafter he said the engine ceased operating. and he made a forced landing to the field. During the landing rollout the airplane incurred damage. An FAA airframe and powerplant mechanic with an inspection authorization rating, who responded to the scene of the accident stated that he found the B-nut on the inlet side of the fuel flow divider loose, about one full turn. In addition he said he saw signatures consistent with a leak which originated at the B-nut and ran down the right front of the engine case. Follow-on examination of the accident airplane revealed that at the connection of the B-nut on the fuel inlet line to the manifold, there was torque putty on the threaded connection on the manifold side, and no putty was observed on the B-nut. In addition, when conditions were recreated and the engine given a test run, when the electric fuel boost pump turned on, fuel leaked from around the B-nut. According to the airplane's engine log book, the engine had been rebuilt by Teledyne Continental Motors, and shipped to Mod Works Inc., Punta Gorda, Florida, who installed it in the accident airplane on March 03, 2003. At the time of the accident the engine had accumulated a total time of 80 hours since installation, and had received two previous oil changes, all of which had been performed by Mod Works Inc.

Factual narrative

History of flight

On February 3, 2004, about 1015, eastern standard time, a Mooney M-20K, N252WF, registered to and operated by a private individual as a Title 14 CFR Part 91 personal flight, made a forced landing in a potato field, about 7 miles east of Immokalee Airport, Immokalee, Florida. Visual meteorological conditions prevailed, and no flight plan was filed. The private-rated pilot and one passenger received minor injuries, and the airplane incurred substantial damage. The flight originated at Kendall-Tamiami Airport, Miami, Florida, the same day, about 0945.

The pilot stated that he was en route to Punta Gorda, Florida, to the Mooney maintenance facility where he has his airplane serviced, to have a 25-hr oil change performed. He further stated that the airplane was in cruise flight, at an altitude of 4,500 feet, when he detected a slight engine vibration. He noted that the fuel consumption had increased from the usual 12.5 gals/hr to 15.7 gals/hr, at 2,300 rpm and a manifold pressure of 30.00. He said that the characteristics he noted at that time were similar to those of a partially plugged fuel injector he had encountered in the past, and since he was half the distance to Punta Gorda, he elected to continue. Shortly thereafter he said the engine ceased operating. He said there were no sputtering or other noises, the engine just abruptly ceased operating, while the propeller continued to windmill. He said he established the proper glide attitude, while looking for a place to land. He said he switched fuel tanks, turned on the boost pump, and attempted to restart the engine, but it did not restart. At an altitude of about 3,000 feet, he said he noticed a field with long furrows, and after declaring an emergency and performing prelanding tasks, made a forced landing to the field. During the landing rollout the airplane incurred damage.

An FAA airframe and powerplant mechanic with an inspection authorization rating, who responded to the scene of the accident stated that he found the B-nut on the inlet side of the fuel flow divider loose, about one full turn. In addition he said he saw signatures consistent with a leak which originated at the B-nut and ran down the right front of the engine case.

On February 10, 2004, the NTSB conducted a follow-on examination of the accident airplane. Assisting the NTSB was a representative from Teledyne Continental Motors, as well as the airplane mechanic who had responded to the scene of the accident, and had witnessed the loose B-nut on the inlet side of the fuel flow divider. The examination revealed that the fuel manifold was properly positioned, and there were no anomalies noted with the unit. In addition, when the fuel manifold was opened, the screen was found to be clean and fuel was present. At the connection of the B-nut on the fuel inlet line to the manifold, torque putty was noted on the threaded connection on the manifold side, and no putty was observed on the B-nut. In addition, the engine was given an initial test run and no anomalies were noted. The B-nut was then placed in the position it was found at the accident scene, and the engine tested a second time, and during the test run, when the electric fuel boost pump turned on, fuel poured from around the B-nut.

Tests and research

The accident airplane was equipped with a Teledyne Continental Motors TSIO-360-MB2B, 210 horsepower engine, serial number 279325-R. According to the airplane's engine log book, the engine had been rebuilt by Teledyne Continental Motors, and shipped to Mod Works Inc., Punta Gorda, Florida, who installed it in the accident airplane on March 03, 2003. According to the engine logbook, at the time of the accident the engine had accumulated a total time of 80 hours since installation, and had received two previous oil changes, all of which had been performed by Mod Works Inc.

Aircraft

Registration
N252WF
Reported as
Mooney M20K
Category
Airplane
Serial number
25-1189
Airframe hours
1,680
Engine
Teledyne Continental TSIO-360-MB2B, 210 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Registered owner
George M. Darnell
Airworthiness certificate
Standard, Normal
Last inspection
Annual · March 3, 2003 · 80 hours before
Departed
TMB · Miami, FL
Destination
PGD · Punta Gorda, FL

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
68
Injuries
Minor
Certificate
Private
Airplane ratings
Single-engine land
Instrument ratings
Airplane
Medical
Class 3, Valid Medical--w/ waivers/lim
Last flight review
April 22, 2002
Seat
Left
Flight hours
1,800 total · 1,560 in this make and model · 1,800 as pilot in command

Weather

Conditions
Visual (VMC) · Day
Wind
0° at 0 knots
Visibility
10 statute miles
Lowest ceiling
None
Temperature
70 °F, dew point 59 °F
Altimeter
30.14 inHg
Observed at
APF, 28 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.