SEA06LA135

NTSB accident investigation · Hughes 369D · Moab, UT · June 30, 2006

Accident · No injuriesLimited investigationFinal report
Date
June 30, 2006, 17:35 local (23:35 UTC)
Place
Moab, UT
Injuries
3 uninjured
Damage
Substantial damage
Phase of flight
Maneuvering
Aircraft
N369PBHughes 369D
Weather
Visual (VMC) · Day
Status
Completed · report February 26, 2007
Report
Approved by Office Director
Parties
Boeing, FAA FSDO
FAA report
20060630013469A
Case key
64055

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 failure of the collective bungee support bracket due to non-compliance with a service information notice, which resulted in the pilot executing a precautionary autorotative landing. A contributing factor was the lack of suitable terrain for the landing.

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/malfunctionManeuvering
Maintenance,service bulletin/letter - not complied withOther maintenance personnelCause
Rotorcraft flight control system,collective trim - failureCause
Precautionary landing - initiatedPilot in command
On ground/water encounter with terrain/waterLanding - flare/touchdown
Terrain condition - rough/unevenFactor
Terrain condition - none suitableFactor
Misc rotorcraft,main rotor/tail boom contact

Analysis

The pilot reported that he was maneuvering the helicopter at an altitude of about 200 feet agl conducting filming operations when he heard a loud bang after which the collective control felt "mushy" and "as if there was no positive control." He initiated a precautionary power on autorotative landing. The helicopter touched down on top of a ridgeline and then slid approximately 50 to 75 feet into a gully area, coming to rest in a 40 to 45 degree nose down attitude. During the landing, the main rotor contacted and severed the tail boom. Examination of the helicopter revealed that the collective bungee support bracket was fractured. A service information notice issued by the helicopter's manufacturer on March 7, 1980, called for a one time inspection of the collective bungee support bracket to ensure that thickness of the machine web surface in the aft lug area of the bracket was 0.065 inch or more. Excerpts from the helicopter's maintenance records provided by the pilot indicated that the service information notice was complied with prior to June 25, 1997. Examination of the fractured bracket revealed that the web thickness varied from 0.036 to 0.052 inch, which was below the minimum thickness requirement. Additionally, a hole that would have been drilled in the bracket during compliance with the service information notice was not present, indicating the procedure was not performed.

Factual narrative

On June 30, 2006, about 1730 mountain daylight time, a Hughes 369D helicopter, N369PB, sustained substantial damage during a precautionary autorotative landing on rough terrain in Castle Valley near Moab, Utah. The commercial pilot and the two crewmembers aboard the helicopter were not injured. The helicopter was registered to Helicopter Aviation Services and Leasing Inc. of Miami, Florida, and operated by Camera Copters Inc. of Miami. Visual meteorological conditions prevailed and a company flight plan was filed for the 14 CFR Part 91 business flight. The purpose of the flight was to film a ground event.

The pilot reported that he was maneuvering the helicopter at an altitude of about 200 feet agl conducting filming operations when he heard a loud bang after which the collective control felt "mushy" and "as if there was no positive control." He initiated a precautionary power on autorotative landing. The helicopter touched down on top of a ridgeline and then slid approximately 50 to 75 feet into a gully area, coming to rest in a 40 to 45 degree nose down attitude. During the landing, the main rotor contacted and severed the tail boom. Examination of the helicopter revealed that the collective bungee support bracket was fractured.

According to a representative of the manufacturer of the helicopter, the collective bungee helps maintain the pilot's selected collective pitch stick position in flight by counteracting forces that are fed back into the collective pitch stick. The collective bungee counteracts these forces so that collective stick loads are relatively constant throughout the full range of collective stick travel. Failure of the collective bungee bracket would not result in loss of use of the collective control. It would result in the pilot experiencing varying degrees of feedback forces to the collective stick depending on collective position.

The helicopter manufacturer's representative provided a copy of Service Information Notice No. DN-54.1 issued on March 7, 1980. The notice called for a one time inspection of the collective bungee support bracket to ensure that thickness of the machine web surface in the aft lug area of the bracket was 0.065 inch or more.

The pilot provided excerpts from the helicopter's maintenance records. According to the pilot, these excerpts detailed major repairs made to the helicopter in Canada. Examination of the excerpts revealed that an entry dated June 25, 1997, stated in part, "COLLECTIVE BUNGEE ASSY P/N 369D27371 INSTALLED (PREV CERT C-FOZW)." Additionally, the entry included "DN 54.1 COLLECTIVE TORQUE TUBE BRACKET" in a list of DNs that "were found to be previously complied with."

The fractured collective bungee support bracket was examined under the supervision of an FAA inspector at the helicopter manufacturer's facility in Mesa, Arizona. The examination revealed the following:

1. The collective bungee support bracket fractured due to fatigue emanating from one of the corners bracketing the recessed area on the machined web. No material anomalies were observed at the fatigue origin.

2. Hardness of the material was measured to be 79 HBS, which coincides with the hardness range typical for the material used to manufacture the part.

3. Service Information Notice DN-54.1 directed that a hole be drilled in the web to perform a measurement of the web thickness. No hole was present at the prescribed location in the bracket, indicating that the procedure was not performed.

4. The machined web, including coating thickness, varied from 0.036 to 0.052 inch thick at the fracture surface, below the minimum thickness requirement of 0.065 inch specified in Service Information Notice DN-54.1.

Aircraft

Registration
N369PB
Reported as
Hughes 369D
Category
Helicopter
Serial number
480305D
Airframe hours
3,595
Engine
Allison 250-C20B, 420 horsepower, turbo shaft
Damage
Substantial damage
Flight
Other work use · Part 91
Operator
Camera Copters, Inc.
Registered owner
Helicopter Aviation Services & Leasing Inc
Airworthiness certificate
Standard, Normal
Last inspection
100 hour · June 1, 2006 · 4 hours before
Departed
CNY · Moab, UT
Flight plan
Company VFR

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
None
Certificates
Flight instructor, Commercial
Airplane ratings
Single-engine sea, Single-engine land, Multi-engine land
Instrument ratings
Helicopter, Airplane
Medical
Class 2, Without waivers/limitations
Last flight review
May 1, 2005
Seat
Left
Flight hours
10,000 total · 6,000 in this make and model · 10,000 as pilot in command · 185 in the last 90 days · 80 in the last 30 days · 8 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day

FAA reports on this event · 1

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