MIA06LA002

NTSB accident investigation · Piper PA-46-350P · Destin, FL · October 3, 2005

Accident · No injuriesLimited investigationFinal report
Date
October 3, 2005, 12:05 local (17:05 UTC)
Place
Destin, FL
Injuries
2 uninjured
Damage
Substantial damage
Phase of flight
Landing
Aircraft
N9199PPiper PA-46-350P
Weather
Visual (VMC) · Day
Status
Completed · report September 27, 2007
Report
Approved by Office Director
Parties
FAA FSDO
FAA report
20051003022929A
Case key
62632

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 inadequate design of the engine mount which led to cracking of the mount resulting in a loss of directional control and collapse of the nose landing gear. A contributing factor was the failure of maintenance personnel to comply with a service bulletin to inspect the engine mount for cracks.

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 - roll
Maintenance,service bulletin/letter - not complied withOther maintenance personnelFactor
Acft/equip,inadequate designManufacturerCause
Engine assembly,mount - cracked
Landing gear,nose gear attach point - separation
Loss of control - on ground/waterLanding - roll
Directional control - not possiblePilot in command
Nose gear collapsedLanding - roll

Analysis

The pilot reported that the landing seemed normal for a few seconds, and then the airplane started to swerve to the right. He tried to compensate with the application of hard left brake and full left aileron, but the airplane continued swerving to the right and departed the runway. The nose gear collapsed, and the airplane then slid approximately 300 feet on the main landing gear and the underside of the cowling before coming to a stop. Examination of the airplane revealed that the engine mount was fractured at the right nose gear actuator attach foot. Rust was visible on the fracture surface, indicating the crack was pre-existing. The crack was in the area that was the subject of a Piper Service Bulletin. The Service Bulletin required operators to inspect the engine mounts for cracks after every 100 hours of flight time, until the engine mount was replaced with a newer model which incorporated one-piece feet at the nose gear actuator attach points. The engine mount installed in the airplane was the original Piper design configuration (two-piece welded foot design). Review of the airplane's maintenance records indicated that the Service Bulletin had not been complied with at the most recent annual inspection conducted 89.1 flight hours prior to the accident.

Factual narrative

On October 3, 2005, about 1205 central daylight time, a Piper PA-46-350P, N9199P, registered to Lookout Leasing Co. and operated by an individual as a Title 14 CFR Part 91 personal flight, veered off the runway during the landing roll at the Destin-Fort Walton Beach Airport, Destin, Florida. The private pilot and the passenger reported no injuries, and the airplane incurred substantial damage. Visual meteorological conditions prevailed at the time and location of the accident, and an instrument flight rules (IFR) flight plan was filed. The flight originated from the Lovell Field Airport, Chattanooga, Tennessee, about 1015.

The pilot reported that the flight from Chattanooga to Destin was uneventful, and about 5 miles out from the airport, he canceled the IFR flight plan. He obtained weather information from the airport's automated surface observation system and elected to land on runway 14. The landing seemed normal for a few seconds, and then the airplane started to swerve to the right. The pilot further stated that the airplane pulled harder to the right as it slowed down, and that he tried to compensate with the application of hard left brake and full left aileron, but the airplane continued swerving to the right and departed the runway. The nose gear collapsed before the airplane came to a stop.

A witness stated that he watched the airplane during the last portion of its approach and that it appeared to be a normal landing. After touchdown, the airplane began to drift to the right and only traveled a short distance, before the nose wheel struck the grass. The nose wheel immediately collapsed, and the propeller blades struck the ground and stopped. The aircraft then slid approximately 300 feet on the main landing gear and the underside of the cowling before coming to a stop.

Examination of the airplane revealed that the firewall was wrinkled. Additionally, the mechanic who performed the examination noted that the engine mount was fractured at the right nose gear actuator attach foot. The mechanic reported that rust was visible on the fracture surface, indicating the crack was pre-existing.

Piper Service Bulletin (SB) 1103, Engine Mount Inspection, was issued on April 22, 2002. The SB was updated on January 27, 2003 (1103A) and again on November 25, 2003 (1103B). The SB contained the following information. Purpose: It has been determined that cracks may develop on the engine mount in the area of the nose gear actuator feet. This condition typically occurs when the nose landing gear is subjected to excessive loads, possibly through hard landings, rough field operations, excessive speed turns and/or improper towing of the aircraft. PART I of this SB requires a repetitive inspection of the engine mount. PART II of this SB requires replacement of the engine mount. Compliance Time: PART I Inspection to coincide with the next regularly scheduled maintenance event, and each 100 hours time in service or annual inspection, whichever occurs first, thereafter or until PART II of this SB is accomplished. PART II Replacement if cracks are found during the inspection in PART I, replace cracked engine mount. Note: Compliance with PART II of this SB will relieve the repetitive inspection requirements of PART I of this SB. PART II: Insure the new engine mount (P/N 89137-041) has the one piece feet. The old engine mount has a two piece welded foot. This welded area is where the cracks in the engine mounts have been found.

Review of the airplane's maintenance records revealed that during an annual inspection in January 2002, the engine mount was "found cracked at the lower actuator attachment point" and replaced with an overhauled engine mount. The overhauled engine mount had been repaired to the original Piper design configuration (two piece welded foot design) by a certified repair station. The most recent annual inspection was performed on January 14, 2005. As of that date, the airframe had accumulated 3,009.6 hours. The logbook entry for this annual inspection did not indicate compliance with SB 1103B Part I. Review of the checklist used by the facility that performed the annual inspection revealed that it was the 100-hour periodic inspection checklist from the Piper PA-46-310P/350P Maintenance Manual. Under the Engine Group section of the checklist, item 43, "Inspect engine mounts for cracks, corrosion, and loose mounting bolts," was initialed as complete. Under the General section of the checklist, item 2, "All Airworthiness Directives, Service Bulletins, Letters and Instructions complied with," was initialed as complete; however, the portion of this item reading, "Service Bulletins, Letters and Instructions complied with," was crossed out. At the time of the accident, the airplane had accumulated 89.1 hours since the annual inspection.

Aircraft

Registration
N9199P
Reported as
Piper PA-46-350P
Category
Airplane
Serial number
4622107
Airframe hours
3,099.1
Engine
Lycoming TIO-540-AE2A, 350 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Airworthiness certificate
Standard, Normal
Last inspection
Annual · January 1, 2005 · 89.1 hours before
Departed
KCHA · Chattanooga, TN
Destination
KDTS · Destin, FL
Flight plan
IFR
Airport
KDTS · Destin-Fort Walton Beach, runway 14, 4,999 × 100 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
68
Injuries
None
Certificate
Private
Airplane ratings
Single-engine land, Multi-engine land
Instrument ratings
Airplane
Medical
Class 2, With waivers/limitations
Last flight review
October 1, 2004
Seat
Left
Flight hours
4,035 total · 1,536 in this make and model · 4,107 as pilot in command · 29 in the last 90 days · 8 in the last 30 days

Weather

Conditions
Visual (VMC) · Day
Wind
80° at 11 knots
Visibility
10 statute miles
Lowest ceiling
None
Temperature
84 °F, dew point 70 °F
Altimeter
30.09 inHg
Observed at
DTS

FAA reports on this event · 1

The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.