WPR14LA049

NTSB accident investigation · Firefly Balloons Firefly 10 · Temecula, CA · November 9, 2013

Accident · Serious injuriesLimited investigationFinal report
Date
November 9, 2013, 08:00 local (16:00 UTC)
Place
Temecula, CA
Injuries
5 serious, 5 uninjured
Damage
No damage
Phase of flight
Other
Aircraft
N1623LFirefly Balloons Firefly 10
Defining event
Other: Fire/smoke (non-impact)
Weather
Visual (VMC) · Day
Status
Completed · report January 18, 2017
Report
Approved by Office Director
NTSB office
Western Pacific Region
Parties
RAL FSDO
Case key
88423

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

The pilot's failure to follow the Landing checklist and his inadvertent contact with the blast valve after landing, which released propane that was then ignited by an undetermined source.

Findings · 3

NTSB’s coded findings. Those marked are part of the probable cause; the rest are factors or other findings. Under each, the cases with the same finding.

AircraftAircraft › Aircraft systems · Incorrect use/operationFirefly Balloons FIREFLY 10: 1 caseAll aircraft: 63 casesProbable cause

Sequence of events

The events NTSB coded, in order, by phase of flight. The defining event is the one that best describes the accident. Under each, the cases with the same event anywhere in their sequence.

Analysis

After a 1-hour local sightseeing flight, the commercial pilot landed the balloon, disembarked some passengers, and kept a few passengers on board as he moved the balloon to a trailer. The pilot reported that, after setting the balloon down on the trailer, he extinguished the burner's pilot light and then took the burner down from the flight position to put it in the storage bag attached to the side of the basket. While putting the burner in the bag, he bumped the blast valve, and the burner then released propane, which ignited and resulted in a fire; the ignition source was not determined. The pilot and four passenger sustained serious injuries. The Landing checklist in the Balloon Flight Manual stated, in part, that pilots should ensure that all of the valves were firmly closed before touchdown and should bleed all of the fuel lines after landing. However, a postaccident interview with the pilot revealed the he did not shut off the appropriate valves or bleed the system of gas after he extinguished the pilot light. Therefore, it is likely that the pilot's failure to follow the Landing checklist allowed the burner to release propane when he inadvertently bumped the blast valve after landing.

Factual narrative

On November 9, 2013, about 0800 Pacific standard time, a Firefly Balloons, Inc., Firefly 10, N1623L, experienced a fire after landing near Temecula, California. D&D Hot Air Ballooning was operating the balloon under the provisions of 14 Code of Federal Regulations (CFR) Part 91. The airline transport pilot (commercial lighter-than-air balloon pilot) and four passengers sustained serious injuries; five passengers were not injured. The balloon was not damaged during the accident sequence. The local sight-seeing flight departed Temecula about 0700. Visual meteorological conditions prevailed, and no flight plan had been filed. A passenger reported that the balloon had landed after a 1-hour flight, and some passengers disembarked. The remaining passengers stayed on board as the operator moved the balloon toward the retrieval trailer, and sat it on the trailer. The pilot shut off one of the two burners. A passenger reported smelling propane throughout the flight, and the smell was especially strong during retrieval immediately prior to a flash and a fireball erupting. The pilot provided a written statement. He stated that he shut off the pilot light of the burner, and took the burner down from the flight position to put it in the storage bag attached to the side of the basket. While putting the burner in the bag, he bumped the blast valve, and propane came out of the burner. The propane ignited, but he did not know what the ignition source was. Burner Exams A Federal Aviation Administration (FAA) inspector and the National Transportation Safety Board investigator-in-charge supervised examination of the two burners, and a detailed report is part of the public docket for this accident. Serial Number 836 A visual examination determined that the hoses were about 9 years old. The main burner hose had minor cracks, but was not leaking. The pilot valve hose had minor cracks, but was not leaking. Utilizing a soapy spray solution, it was determined that Fire 2 hose had a minor leak at the fitting, but it was not considered dangerous. There was some black residue, which propane leaves when leaking. Serial Number 856 The main burner hose fitting was loose and leaking slightly. The pilot valve hose was in good condition with no leaks. The Fire 2 hose was in good condition with no leaks. Both burners were individually hooked up to a test unit. The hoses displayed no anomalies. A functional test of each burner was completed with no anomalies noted, and shut down was unremarkable. Flight Manual Excerpts Section 3.6 Landing Just prior to touchdown 1. Make sure that the Trigger Valve (and/or fire 2 valve if in use) is firmly closed 2. Close the pilot light safety shutoff Action 2 is a precaution against possibility that pilot lights or accidental burning might damage the envelope or ignite anything at the landing site. Note that 2 commits the pilot to the landing and must be delayed until possibility of a missed approach has passed. After landing, bleed all fuellines. 1. Make sure that all valves are firmly closed. 2. Check for safety before bleeding fuel lines. If necessary, postpone 3 until at a safe location. 3. Open the Trigger Valve and Pilot Light Safety Shutoff Do not leave the pilot light system pressurized for long periods of time, i.e. do not leave the system with the Pilot Light Valve open, and the Pilot Light Safety Shutoff closed for extended periods. 3.7 Pack up and Storage 3.7.2 Fuel System After assuring that no fuel is trapped in any line, close the trigger valve. Leave the Pilot Light Safety Valve in the open position. Before transport: 1. Dismount the burner from the burner supports 2 Adjust fuel losses so that they do not contact tanks, vibrate against damaging objects, or protrude enough to be hit and damaged in travel. Chord or leather lacing may be used to secure hoses. The FAA inspector interviewed the pilot, and noted that the pilot did not follow the instructions in the FM. The pilot did not shut off the appropriate valves or bleed the system of gas after the pilot light was extinguished.

Aircraft

Registration
N1623L
Reported as
Firefly Balloons Firefly 10
Category
Balloon
Serial number
F10-2007
Built
2007
Damage
No damage
Fire
On-Ground
Flight
Other work use · Part 91
Airworthiness certificate
Standard, Balloon
Departed
Temecula, CA
Destination
Temecula, CA

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
70
Injuries
Serious
Certificates
Flight engineer, Commercial, Flight instructor, Airline transport
Airplane ratings
Multi-engine land, Single-engine land
Instrument ratings
Helicopter, Airplane
Seat
None
Restraint
None
Flight hours
11,000 total · 1,500 in this make and model

Weather

Conditions
Visual (VMC) · Day
Wind
Calm
Visibility
10 statute miles
Lowest ceiling
None
Temperature
52 °F, dew point 30 °F
Altimeter
30.06 inHg
Observed at
KRIV, 24 nm away

Docket · 8

The files NTSB released with the investigation on November 1, 2016, on NTSB’s docket system: statements, records, photos and specialists’ reports. 2.5 MB in all.