# NTSB NYC91FA246: Cessna 172P, N65729, West Chicago, IL, September 21, 1991

- Type: NTSB accident investigation
- Classification: Accident · Fatal · Field investigation · Final report
- Date: September 21, 1991, 09:09 local (14:09 UTC)
- Place: West Chicago, IL
- Coordinates: 41.879028, -88.21997 (estimated)
- Nearby events: https://openairdocs.org/map.md?lat=41.8790&lon=-88.2200&mi=10
- Phase of flight: [Initial climb](https://openairdocs.org/ntsb-phases/350) (OpenAirDocs' grouping)
- Highest injury: Fatal
- Injuries: 2 fatal
- Status: Completed, report May 5, 1993
- Report: Approved by Office Director
- Safety recommendations: Yes
- NTSB case key (mKey): 36812
- NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=NYC91FA246
- NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/36812/pdf
- Page: https://openairdocs.org/ntsb/NYC91FA246

## Probable cause

THE PILOT'S IMPROPER IN-FLIGHT DECISION TO RETURN TO THE AIRPORT FOLLOWING A LOSS OF ENGINE POWER AT A LOW ALTITUDE. THE PILOT FAILED TO MAINTAIN AIRSPEED WHICH RESULTED IN AN INADVERTENT STALL AT AN ALTITUDE INSUFFICIENT FOR RECOVERY. FACTORS CONTRIBUTING TO THE ACCIDENT WERE THE LOSS OF ENGINE POWER DUE TO THE FAILURE OF THE CARBURETOR VENTURI, THE OPERATOR'S DISREGARD OF THE PRECISION AIRMOTIVE SERVICE BULLETIN.

## Sequence of events

In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf).

- Loss of engine power(partial) - mech failure/malf, takeoff - initial climb
  - fuel system,carburetor - failure,partial (contributing factor)
  - maintenance,service bulletin/letter - not performed, company/operator management (contributing factor)
- Forced landing, descent - emergency
- Loss of control - in flight, descent - emergency
  - procedures/directives - not followed, pilot in command (cause)
  - lack of total experience, pilot in command (contributing factor)
  - in-flight planning/decision - improper, pilot in command (cause)
  - airspeed - not maintained, pilot in command (cause)
  - stall - inadvertent, pilot in command (cause)
- In flight collision with object, descent - uncontrolled
  - object - utility pole
  - object - vehicle

## Analysis

THE PILOT RENTED N65729 FROM AN FBO FOR A LOCAL FLIGHT.  WITNESSES STATED THAT SHORTLY AFTER TAKEOFF FROM RUNWAY 15, THEY SAW THE AIRPLANE TRAILING 'LIGHT GRAY SMOKE' AND HEARD THE ENGINE LOSE POWER.  THE WITNESSES SAW THE AIRPLANE IN A STEEP LEFT BANK TURN AT AN ALTITUDE OF BETWEEN 300 AND 500 FEET AGL.  THE AIRPLANE THEN DESCENDED IN A NOSE LOW ALTITUDE INTO THE PARKING LOT OF AN INDUSTRIAL PLANT.  POST ACCIDENT EXAMINATION OF THE ENGINE REVEALED THE TWO PIECE CARBURETOR PRIMARY VENTURI HAD SEPARATED FROM ITS NORMAL MOUNTED POSITION AND WAS INGESTED INTO THE NO. 2 CYLINDER. SEVERAL SERVICE BULLETINS HAD BEEN ISSUED BY THE MANUFACTURER ADDRESSING THE INSTALLATION OF A NEW ONE PIECE VENTURI. PRECISION AIRMOTIVE ISSUED SERVICE BULLETIN MSA 2 ON OCT. 15 90. REVIEW OF THE ENGINE LOGBOOK FOR N65729 REVEALED SERVICE BULLETIN MSA 2 HAD NOT BEEN ACCOMPLISHED.

## Aircraft

- Registration: [N65729](https://openairdocs.org/deregistered/N65729-1992-01-15), registration cancelled 1992-01-15, S/N 17275839 (OpenAirDocs)
- Reported make and model: CESSNA 172P
- Registry model: [Cessna 172P](https://openairdocs.org/model/cessna-172p) (registry code 2072436) (OpenAirDocs)
- Category: Airplane
- Serial number: 17275839
- Airframe hours: 3686
- Engines: LYCOMING O-320-D2J 160 horsepower reciprocating
- Damage: Substantial damage
- Flight: Personal, Part 91
- Operator: Dupage Airport Authority, doing business as Planemasters Services, Inc.
- Registered owner: Quenton Goblish
- Airworthiness certificate: Standard, Utility; Standard, Normal
- Last inspection: Annual, July 25, 1991, 94 hours before
- Flight plan: VFR
- Airport: DPA, Dupage County

## Flight crew

As NTSB recorded them. NTSB leaves out names.

- Pilot; age 40; private; airplane ratings: single-engine land; medical: class 3, valid medical--no waivers/lim.; toxicology performed; flight hours: 139 total, 62 in this make and model, 37 as pilot in command, 1 in the last 90 days

## Weather

- Conditions: Visual (VMC), Day
- Wind: 180° at 10 knots
- Visibility: 10 statute miles
- Lowest ceiling: none
- Temperature: 46 °F, dew point 39 °F
- Altimeter: 30.00 inHg

## 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 19910921042059A](https://openairdocs.org/incident/19910921042059A), Sep 21, 1991: Cessna 172P, Chicago/West Ch, IL, Substantial damage, 2 fatal. Engine faltered on climbout. Stalled turning back. Piece carburetor venturi ingested. Service bulletin not complied.

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.

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