NYC05FA005

NTSB accident investigation · Piper PA-28-161 · Madison, CT · October 11, 2004

Accident · FatalField investigationFinal report
Date
October 11, 2004, 17:48 local (21:48 UTC)
Place
Madison, CT
Injuries
2 fatal
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N233PAPiper PA-28-161
Weather
Visual (VMC) · Day
Status
Completed · report May 30, 2006
Report
Approved by Office Director
Parties
Textron Lycoming, New Piper, FAA/FSDO
FAA report
20041011026979A
Case key
60306

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

On this page

Probable cause

A loss of engine power due to separation of the propeller due to under-torqued retention bolts.

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
Propeller system/accessories,prop blade retention - undertorquedCause
Propeller system/drive assembly - separation
Forced landingEmergency descent/landing
In flight collision with objectEmergency descent/landing
Object - residence

Analysis

The pilot made a "Mayday" call, and reported that he was at 4,000 feet msl and descending without engine power. An approach controller acknowledged the pilot's distress call, and attempted to direct him to a nearby airport. The pilot subsequently elected to perform a forced landing to a field; however, during the landing the airplane impacted a private residence. A witness, located about 4 miles north of the accident site, saw the accident airplane flying normally, then heard a "bang." He then heard about 5 seconds of intermittent engine noise, followed by white smoke, which began trailing behind the airplane as it flew. The propeller was found about 3.4 miles from where the airplane came to rest. Examination of the airframe revealed no mechanical anomalies, and examination of the engine revealed damage consistent with an engine overspeed. Examination of the propeller, propeller flange, and associated hardware revealed signatures consistent with insufficient propeller retention bolt torque.

Factual narrative

History of flight

On October 11, 2004, about 1748 eastern daylight time, a Piper PA-28-161, N233PA, was substantially damaged when it impacted a private residence in Madison, Connecticut, while attempting to execute a forced landing. The certificated private pilot and passenger were fatally injured. Visual meteorological conditions prevailed for the personal flight that departed Nantucket Memorial Airport (ACK), Nantucket, Massachusetts, destined for Danbury Municipal Airport (DXR), Danbury, Connecticut. No flight plan was filed for the flight, which was conducted under 14 CFR Part 91.

According to air traffic control communication tapes, the pilot made a "Mayday" call on 121.5 megahertz. The pilot then reported he was at 4,000 feet msl, and descending without engine power. Bradley Approach Control acknowledged the pilot's distress call, and instructed him to "squawk 7700." Another pilot transmitted a suggestion to switch fuel tanks, and to turn the electric boost pump on. The accident pilot replied he had switched to the right fuel tank, and that the boost pump was on, but there was oil on the windscreen. The controller then provided radar vectors toward a small airport, approximately 4 nautical miles to the southeast. When the airplane was approximately 2 miles from the airport, and at 1,600 feet msl, the pilot reported seeing a field to his left. The controller asked the pilot if he thought he could make the airport. The pilot paused, and then said he was going for the field, which was also his final recorded transmission.

A witness, located about 4 miles north of the accident site, stated that he saw the accident airplane flying normally, then heard a "bang." He then heard about 5 seconds of intermittent engine noise, followed by white smoke, which began trailing behind the airplane as it flew southwest.

Another witness, who was standing about 30 feet from the accident site, stated that the airplane came through the trees, and impacted her house. The witness added she did not hear the engine running, and that the sound of the airplane in the trees was what initially caught her attention.

The accident occurred during the hours of daylight. The wreckage was located at 41 degrees, 17.080 minutes north latitude, 72 degrees, 35.080 minutes west longitude, and an elevation of approximately 45 feet msl.

Personnel information

The pilot held a private pilot certificate with a rating for airplane single engine land. On his most recent application for a Federal Aviation Administration (FAA) third-class medical certificate, dated July 13, 2003, he reported 20 total hours of flight experience. According to the pilot's logbook, at the time of the accident he had accumulated 96.8 total hours of flight experience, 76.6 hours of which were in the accident airplane make and model.

Aircraft information

According to maintenance records, the engine was overhauled on May 1, 2004, and then reinstalled on June 2, 2004. On August 27, 2004, a 100-hour inspection was completed. On October 5, 2004, the propeller was removed in an effort to troubleshoot a low engine rpm issue, no anomalies were identified with the propeller, and it was reinstalled. Holes were then identified in the mufflers, and the necessary repairs were made. The low rpm issue was resolved, and the airplane was returned to service. At the time of the accident, the airplane accumulated 17.4 hours of operation since being returned to service, 160 hours since the most recent engine overhaul, and 11,756 total hours of operation.

Meteorological information

A weather observation taken about 5 minutes after the accident at the Tweed-New Haven Airport, about 13 miles west of the accident site, recorded the wind as 340 degrees at 12 knots, visibility 10 statute miles, ceiling 4,800 feet broken, temperature 57 degrees Fahrenheit, dew point 39 degrees Fahrenheit, and an altimeter setting of 29.95 inches of mercury.

Wreckage and impact information

The start of the debris path was marked by freshly broken branches near the top of an approximately 70-foot tall tree. The debris path was approximately 130 feet long, orientated on a 240-degree magnetic heading, and terminated at the main wreckage, which was located on the first floor roof of a two-story house. The main wreckage came to rest on a magnetic heading of 270 degrees, and was comprised of all the major airplane components, except for the propeller, which was later located several miles north of the accident site.

Examination of the main wreckage revealed the airplane had partially penetrated the roof and ceiling of the house, and inside the house was a pronounced odor consistent with 100LL aviation fuel. The windscreen and vertical stabilizer were covered with a lubricant, consistent with engine oil. The left wing had separated from the airframe, and the empennage and right wing were attached. Flight control continuity was confirmed from the ailerons, vertical stabilator, and rudder to the floor of the cockpit, but not to the control yokes due to impact damage. Elevator trim was approximately 2 degrees nose down, and the flaps were fully extended.

Examination of the cockpit revealed the shoulder harnesses were connected to the buckle, and the belt straps had been cut. The floor tracks were intact, and both seats were attached. The engine oil pressure gauge indicated zero, the engine oil temperature gauge indicated zero, and the tachometer indicated 375 RPM, and 295.2 hours. The throttle was in the "IDLE" position, the mixture control was in the "RICH" position, and the engine primer plunger was in and locked.

Examination of the fuel system revealed that the left wing tank contained approximately 5 gallons of fuel, and the right tank contained less than 1 gallon. The fuel selector was set to the right tank, and when removed from the airframe, fuel drained from all three fuel lines. The electrical master and boost pump switches were placed in the "ON" position, and the electric fuel pump produced suction. The engine driven fuel pump was removed from the engine accessory section, a force was applied to the pump arm, and the pump produced suction. The fuel lines from both fuel tanks to the carburetor displayed multiple breaks, and continuity could not be confirmed. Continuity of the engine control cables from the cockpit to the carburetor was confirmed. The carburetor fuel screen was absent of debris.

Examination of the ignition system revealed the ignition switch was "OFF," and the key had been removed. Continuity between the ignition switch and the magnetos could not be confirmed because of impact damage. Continuity from the magnetos to all eight sparkplugs could also not be confirmed due to impact damage. The magnetos were removed from the engine accessory section, a rotational force was applied to the input drives, and spark was observed on all the magneto towers.

Examination of the engine oil system revealed approximately 1 quart of oil in the oil reservoir, and no contaminants were identified in the reservoir, oil filter, or oil suction screen. Continuity of the engine oil lines could not be confirmed because of impact damage.

Examination of the engine revealed that the propeller had separated from the propeller flange in-flight, and five of the six propeller bolt shanks remained in the flange. The engine case was compromised at the crankshaft nose seal, and the nose seal was broken. Continuity of the induction and exhaust systems could not be confirmed because of impact damage. All four top sparkplugs were removed, and the electrodes were gray in color. A rotational force was applied to the crankshaft, and the crankshaft, camshaft, and accessory gears all rotated, but compression was not obtained. The engine was then disassembled, and damage consistent with an engine overspeed was identified for all four valve assemblies.

The propeller, along with four propel

Aircraft

Registration
N233PA
Reported as
Piper PA-28-161
Category
Airplane
Serial number
28-7816676
Airframe hours
11,703
Engine
Lycoming O-320, 160 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Operator
Danbury Flight School
Registered owner
Sunshine Equity Trust
Airworthiness certificate
Standard, Normal
Last inspection
100 hour · August 1, 2004 · 50 hours before
Departed
ACK · Nantucket, MA
Destination
DXR · Danbury, CT

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
44
Injuries
Fatal
Certificate
Private
Airplane ratings
Single-engine land
Medical
Class 3, Without waivers/limitations
Last flight review
February 1, 2004
Seat
Left
Toxicology
Performed
Flight hours
96 total · 76 in this make and model

Weather

Conditions
Visual (VMC) · Day
Wind
340° at 12 knots
Visibility
10 statute miles
Lowest ceiling
4,800 ft broken
Temperature
57 °F, dew point 39 °F
Altimeter
29.95 inHg
Observed at
HVN, 13 nm away

Docket · 11

The files NTSB released with the investigation on March 22, 2006, on NTSB’s docket system: statements, records, photos and specialists’ reports. 10.9 MB in all.

FAA reports on this event · 1

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

Other investigations on N233PA · 1

Matched to the same aircraft by N-number and date.