# NTSB MIA06LA073: Piper PA-28-180, N2182T, Bunnell, FL, March 29, 2006 - Type: NTSB accident investigation - Classification: Accident · No injuries · Limited investigation · Final report - Date: March 29, 2006, 08:40 local (13:40 UTC) - Place: Bunnell, FL - Coordinates: 29.4672222222222, -81.1969444444445 - Nearby events: https://openairdocs.org/map.md?lat=29.4672&lon=-81.1969&mi=10 - Phase of flight: [Other](https://openairdocs.org/ntsb-phases/800) (OpenAirDocs' grouping) - Highest injury: No injuries - Injuries: 1 uninjured - Status: Completed, report July 25, 2007 - Report: Approved by Office Director - Parties: FAA Flight Standarrds District Office - NTSB case key (mKey): 63436 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=MIA06LA073 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/63436/pdf - Page: https://openairdocs.org/ntsb/MIA06LA073 ## Probable cause The failure of the pilot to perform a preflight inspection of the airplane resulting in departure with an inadequate oil supply, subsequent engine failure due to oil starvation, and damage to the airplane during a forced landing. Contributing to the accident was the improper installation of the engine-driven vacuum pump by a mechanic. ## Sequence of events In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf). - Miscellaneous/other, other - vacuum system - loose - maintenance,installation - improper, other maintenance personnel (cause) - fluid,oil - leak - Loss of engine power(total) - mech failure/malf, climb - to cruise - aircraft preflight - inadequate, pilot in command (cause) - fluid,oil - starvation - engine assembly - seized - Forced landing, emergency descent/landing - On ground/water collision with object, landing - roll - object - tree(s) ## Analysis The pilot stated that earlier that morning he flew to the Flagler County Airport, landed, and secured the engine. He then elected to return to the departure airport. He did not perform a preflight inspection of the airplane, and after starting the engine he taxied to and departed from runway 29. During the initial climb at approximately 1,500 feet he noted smoke coming from the engine compartment and the engine experienced a partial loss of power. He turned to return to the airport and the engine seized. He performed a forced landing on a dirt road and during the landing roll ran off the road and collided with a tree. Post accident examination of the engine by an FAA airworthiness inspector revealed an oil film inside the engine cowling and also on the right side of the fuselage from the engine cowling to midspan of the right wing. Additionally, damage to one of the cylinders was noted. The engine driven vacuum pump was found to have not been installed correctly with incorrect gasket material which was baffle gasket material and that the nuts that hold and seal the vacuum pump on were not torqued to proper specs and/or were missing all together and that there was oil on the rubber gaskets. The owner/pilot admitted to having worked along side with the IA to install the engine driven vacuum pump. The owner/pilot also stated that after they were finished installing the pump, he asked the IA if they had installed it correctly because it was sticking out more then he was used to. The IA reported having supervised the owner/pilot who did the work, then checked what he had done and signed it off. The engine had only 8 hours and was within a month of being overhauled at the time of the accident. ## Factual narrative On March 29, 2006, about 0840 eastern standard time, a Piper PA-28-180, N2182T, registered to a private individual, experienced a loss of engine power shortly after takeoff and collided with a tree during a forced landing near Bunnell, Florida. Visual meteorological conditions prevailed at the time and no flight plan was filed for the 14 CFR Part 91 personal flight from Flagler County Airport, Bunnell, Florida, to Ormond Beach Municipal Airport, Ormond Beach, Florida. The airplane was substantially damaged and the commercial-rated pilot was not injured. The flight originated about 0835, from the Flagler County Airport. The pilot stated that earlier that morning he flew to the Flagler County Airport, landed, and secured the engine. He then elected to return to the departure airport, but did not perform a preflight inspection of the airplane. After starting the engine, he taxied to and departed from runway 29. During the initial climb at approximately 1,500 feet he noted smoke coming from the engine compartment and the engine experienced a partial loss of power. He elected to return to the departure airport and the engine seized. He performed a forced landing on a dirt road and during the landing roll, the airplane traveled off the road and collided with a tree. Post accident examination of the engine by an FAA airworthiness inspector revealed an oil film inside the engine cowling and also on the right side of the fuselage from the engine cowling to midspan of the right wing. The engine experienced oil exhaustion, and the No. 1 cylinder connecting rod was fractured. Examination of the engine-driven vacuum pump (Sigma-Tek P/N 1U478-003) revealed 1 of the 4 nuts was separated, 1 was finger loose, and the remaining 2 were not properly torqued. Additionally, incorrect gasket material (engine baffling gasket material) was used as a gasket instead of the specified gasket. A review of the maintenance records revealed an entry dated February 21, 2006, which indicates that the overhauled engine was installed into the airframe, and a new vacuum pump was also installed at that time. The sign-off was done by a mechanic with inspection authorization (IA). The airplane had accumulated 7.69 hours at the time of the accident since the overhauled engine was installed. The owner/pilot reported installing the engine-driven vacuum pump under direct supervision of the mechanic with inspection authorization (IA). During the installation, he and the mechanic talked at length about the installation of it, and after it was installed, he asked the mechanic if they had installed it correctly because it was sticking out farther than usual. He also asked the mechanic if they could make a metal spacer in lieu of the gasket material. The mechanic replied that as long as it is tight and did not leak, it was fine. ## Aircraft - Registration: [N2182T](https://openairdocs.org/aircraft/N2182T), registered now, S/N 28-7205037 (OpenAirDocs) - Reported make and model: Piper PA-28-180 - Registry model: [Piper PA-28-180](https://openairdocs.org/model/piper-pa-28-180) (registry code 7102808) (OpenAirDocs) - Category: Airplane - Serial number: 28-7205037 - Airframe hours: 5812.16 - Engines: Lycoming O-360-A4A 180 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Registered owner: Donald S. Willis - Airworthiness certificate: Standard, Utility; Standard, Normal - Last inspection: Annual, February 1, 2006, 7.69 hours before - Departed: X47, Bunnell, FL - Destination: KOMN, Ormond Beach, FL - Airport: X47, Flagler County, runway 29, 4,999 × 100 ft, asphalt ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 64; injuries: none; commercial; airplane ratings: single-engine land; instrument ratings: airplane; medical: class 2, with waivers/limitations; last flight review October 1, 2005; seat: left; flight hours: 2,500 total, 2,000 in this make and model, 2,450 as pilot in command, 25 in the last 90 days, 10 in the last 30 days, 3 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: 220° at 4 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 66 °F, dew point 48 °F - Altimeter: 30.28 inHg - Observed at: KDAB, 19 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 (OpenAirDocs). - [Accident 20060329005939A](https://openairdocs.org/incident/20060329005939A), Mar 29, 2006: Piper PA28180, Bunnell, FL, Substantial damage. (-23) Engine began running rough during climb out, pilot turned back to airport. After turn engine quit. Pilot landed on dirt road short of runway. Wind struck… 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.