# NTSB NYC04CA002: Lake LA250, N64SF, Laconia, NH, October 6, 2003 - Type: NTSB accident investigation - Classification: Accident · No injuries · Data collection · Final report - Date: October 6, 2003, 11:45 local (15:45 UTC) - Place: Laconia, NH - Coordinates: 43.572498, -71.418891 - Nearby events: https://openairdocs.org/map.md?lat=43.5725&lon=-71.4189&mi=10 - Phase of flight: [Standing](https://openairdocs.org/ntsb-phases/150) (OpenAirDocs' grouping) - Highest injury: No injuries - Injuries: 2 uninjured - Status: Completed, report February 5, 2004 - Report: Approved by Office Director - Parties: FAA - NTSB case key (mKey): 58097 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=NYC04CA002 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/58097/pdf - Page: https://openairdocs.org/ntsb/NYC04CA002 ## Probable cause The pilot's improper starting procedure. A factor in the accident was the pilot's lack of recent experience in make and model airplane. ## Sequence of events In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf). - Loss of control - on ground/water, standing - starting engine(s) - lack of recent experience in type of aircraft, pilot in command (contributing factor) - starting procedure - improper, pilot in command (cause) - On ground/water collision with object, standing - starting engine(s) - object - aircraft parked/standing ## Analysis As the pilot attempted to start the engine, it became flooded. The pilot placed the throttle control lever in the "full forward" position, the propeller control lever to the "full forward" position, and the mixture control lever to the "idle cutoff" position. The engine started on the second attempt, and as the pilot pushed the mixture control lever to the "rich" position, the engine went immediately to full power. The pilot attempted to pull the throttle control lever back; however, he pulled the propeller control lever instead. The airplane began to roll forward, and pilot applied full braking. The pilot was unsuccessful in stopping the airplane, and it struck three parked airplanes before the engine stopped. Examination of the airplane revealed the throttle control lever was in the "full forward" position, the propeller control lever in the "full aft" position, and the mixture control lever in the "idle cutoff" position. No anomalies were noted with the throttle linkage or the braking system. According to the airplane's flight manual, the flooded start procedure included, "Clear by operating starter for 5 seconds with mixture at idle cutoff, throttle open, then use normal starting procedure. The normal starting procedure required that the throttle be "OPEN 1/8 TRAVEL." The pilot reported about 150 hours of experience in make and model airplane, none of which were in the preceding 90 days. ## Factual narrative On October 6, 2003, at 1145 eastern daylight time, a Lake LA250, N64SF, was substantially damaged after colliding with three parked airplanes, while starting the engine at the Laconia Municipal Airport (LCI), Laconia, New Hampshire. The certificated airline transport pilot and passenger were not injured. Visual meteorological conditions prevailed, and an instrument flight rules flight plan was filed for the ferry flight, which was destined for the Norfolk International Airport (ORF), Norfolk, Virginia. The flight was conducted under 14 CFR Part 91. According to the pilot, prior to the flight he conducted a pre-flight inspection on the airplane, and spent about an hour with a mechanic on the airplane's procedures, which included starting the airplane. The airplane was started, ground run for several minutes, and shut down without incident. As the pilot was starting the engine for the flight, it became flooded. The pilot then placed the throttle control lever in the "full forward" position, the propeller control lever to the "full forward" position, and the mixture control lever to the "idle cutoff" position. The engine started on the second attempt, and as the pilot pushed the mixture control lever to the "rich" position, the engine went immediately to full power. The pilot attempted to pull the throttle control lever back; however, he pulled the propeller control lever instead. The airplane began to roll forward, and pilot applied full braking. The pilot was unsuccessful in stopping the airplane, and it struck three parked airplanes before the engine stopped. When the pilot secured the airplane after the accident, he placed the mixture control lever to the "idle cutoff" position. A Federal Aviation Administration (FAA) inspector examined the airplane after the accident. He observed the throttle control lever in the "full forward" position, the propeller control lever in the "full aft" position, and the mixture control lever in the "idle cutoff" position. No anomalies were noted with the throttle linkage or the braking system. According to the airplane's flight manual, the flooded start procedure included, "Clear by operating starter for 5 seconds with mixture at idle cutoff, throttle open, then use normal starting procedure. The normal starting procedure required that the throttle be "OPEN 1/8 TRAVEL." The pilot reported about 150 hours of experience in make and model airplane, none of which were in the preceding 90 days. ## Aircraft - Registration: [N64SF](https://openairdocs.org/deregistered/N64SF-2006-04-28), registration cancelled 2006-04-28, S/N 112, built 1991 (OpenAirDocs) - Reported make and model: Lake LA250 - Registry model: [Aerofab LAKE 250](https://openairdocs.org/model/aerofab-lake-250) (registry code 5110322) (OpenAirDocs) - Registry engine: [Lycoming IO-540 series](https://openairdocs.org/engine/lycoming-io-540-series) (registry code 41530, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 112 - Engines: Lycoming N/A 250 horsepower reciprocating - Damage: Substantial damage - Flight: Ferry, Part 91 - Registered owner: DIAL-A-PLANE Inc. - Airworthiness certificate: Standard, Normal - Departed: LCI, Laconia, NH - Destination: ORF, Norfolk, VA - Flight plan: IFR - Airport: LCI, Laconia Municipal ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 58; injuries: none; airline transport; airplane ratings: single-engine land, single-engine sea, multi-engine land; instrument ratings: airplane; medical: class 2, valid medical--w/ waivers/lim; last flight review August 1, 2003; seat: left; flight hours: 22,700 total, 150 in this make and model, 22,550 as pilot in command, 66 in the last 30 days, 0 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: 250° at 4 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 48 °F, dew point 37 °F - Altimeter: 30.14 inHg - Observed at: LCI ## 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 20031006024359A](https://openairdocs.org/incident/20031006024359A), Oct 6, 2003: Lakeac 250LAKE, Laconia, NH, Substantial damage. (-23) Pilot started engine with throttle full forward and mixture at cutoff position. After engine start pilot advanced mixture and retarded prop lever… 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.