WPR15LA109

NTSB accident investigation · Bell/Garlick UH 1H · Shelton, WA · February 19, 2015

Accident · No injuriesLimited investigationFinal report
Date
February 19, 2015, 13:00 local (21:00 UTC)
Place
Shelton, WA
Injuries
1 uninjured
Damage
Substantial damage
Phase of flight
Maneuvering
Aircraft
N166DRBell/Garlick UH 1H
Defining event
Maneuvering-hover: Powerplant sys/comp malf/fail
Weather
Visual (VMC) · Day
Status
Completed · report March 5, 2018
Report
Approved by Office Director
NTSB office
Western Pacific Region
Parties
Federal Aviation Administration
FAA report
20150219001229A
Case key
90757

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 fatigue failure of the engine-to-transmission driveshaft adapter attachment bolt due to the application of inadequate torque on the bolt during assembly.

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.

Main rotor drive: engine/transmission couplingAircraft › Aircraft propeller/rotor · Fatigue/wear/corrosionBell UH-1H: 1 caseAll aircraft: 24 casesProbable cause
Main rotor drive: engine/transmission couplingAircraft › Aircraft propeller/rotor · FailureBell UH-1H: 1 caseAll aircraft: 24 casesProbable cause
Manufacture/productionOrganizational issues › Development · ManufacturerBell UH-1H: 1 caseAll aircraft: 17 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

While the helicopter was in a hover and beginning to lift a 3,000-lb agricultural application container, the commercial pilot heard a "loud bang," followed by the low rotor warning horn. Ground crew were below the helicopter, so he pulled away from them, and the helicopter then yawed left. He was able to keep the helicopter level about 5 to 7 ft above ground level, and he then pulled the remaining collective pitch to touch down. The helicopter landed on uneven ground and subsequently rolled over onto its right side. During postaccident wreckage examination, the engine-to-transmission driveshaft adapter, which is the component between the engine output and the driveshaft, was found broken in multiple pieces. Further examination revealed thumbnail-shaped patterns and progressive crack arrest marks, consistent with fatigue, on the fracture surfaces. The bolt that attached the adapter to the mating coupling set had separated. The fracture surfaces on the bolt were generally flat with progressive crack arrest lines consistent with fatigue cracking. Given the sizes of the fatigue cracking areas on the components, it is likely that the attachment bolt separated first. Vibrations in the assembly caused by the separation of the bolt likely resulted in the numerous fatigue cracks in the driveshaft adapter. Thirty-four years before the accident, the manufacturer issued a technical bulletin, which addressed an issue with inadequate torque being applied on the attachment bolt during assembly and stated that excessive wear had been noted on the engine-to-transmission driveshaft adapter plug when engines were returned for overhaul. The bulletin noted that the wear resulted in the mating driveshaft adapter bottoming out on the antirotation tangs of the driveshaft adapter plug and causing a false torque of the bolt and wear and reduction gear damage. The bulletin identified a fix that involved reworking the driveshaft adapter spline and applying 160 to 200 inch-lbs of torque on the bolt. However, no evidence was found indicating that the recommended actions had been accomplished. The wear on the driveshaft adapter and mating washer could have been the result of an undertorqued bolt or been related to vibrations in the assembly, which resulted from the fatigue cracking of the bolt.

Factual narrative

On February 19, 2015, about 1300 Pacific standard time, a Bell/Garlick UH 1H Helicopter, N166DR, made an emergency landing and rolled over following a loss of engine power while in a hover near Shelton, Washington. Northwest Helicopters, Inc., was operating the helicopter under the provisions of 14 Code of Federal Regulations Part 137. The commercial pilot received minor injuries, the helicopter was substantially damaged. Visual meteorological conditions prevailed, and no flight plan had been filed. The pilot reported that while in a hover and beginning to lift a 3,000-pound agricultural application container, he heard a "loud bang" followed by the low rotor warning horn sounding. The pilot pulled away from ground crew as the helicopter yawed to the left. He was able to keep the helicopter level about 5 to 7 ft above the ground when he pulled the remaining collective pitch to touch down. The ground underneath was uneven and the helicopter subsequently rolled over onto its right side. During the postaccident wreckage examination, the engine to transmission driveshaft adapter (Part Number 204-040-812-3), was found broken in multiple pieces. The driveshaft adapter is the component between the engine output and the driveshaft. The failed components were recovered and sent to the National Transportation Safety Board Materials Laboratory Division for further examination. The Materials Engineer reported that thumbnail-shaped patterns and progressive crack arrest marks consistent with fatigue were observed on the fracture surfaces. The bolt that attached the driveshaft adapter to the mating coupling set had separated. The fracture surfaces on the bolt were generally flat, with progressive crack arrest lines consistent with fatigue cracking. Bell Helicopter Alert Service Bulletin No. 204-77-6 dated September 30, 1977, Inspection of Engine Drive Shaft Adapter Bolt, P/N 204-040-813-001 for loss of torque, and Technical Bulletin No. 204-81-18 dated June 10, 1981, Engine Driveshaft Adapter P/N 204-040-812-003 rework, indicated that considerable fretting wear damage had occurred to the engine output adapter plug, P/N 1-030-360-04 when engines were returned for overhaul. Extensive wear will allow the drive shaft adapter, P/N 204-040-812-003, to seat on the anti-rotation tangs of the plug and result in a false torque of bolt, P/N 204-040-813-001. The condition will cause plug wear and reduction gear damage. The fretting wear damage of the plug will be eliminated by maintaining the required torque of 160-200 inch-pounds on bolt, P/N 204-040-813-001. Both bulletins recommend compliance times to minimize fretting wear and damage. (See public docket for more information).

Aircraft

Registration
N166DR
Reported as
Bell/Garlick UH 1H
Category
Helicopter
Serial number
66-16949
Built
1995
Airframe hours
11,620.1
Engine
Lycoming T53-L-13, 1,125 horsepower, turbo shaft
Damage
Substantial damage
Flight
External load · Part 137
Operator
Northwest Helicopters LLC
Registered owner
Northwest Helicopters I Inc
Airworthiness certificate
Special, Restricted (Special)
Last inspection
AAIP · January 16, 2014
Departed
Shelton, WA
Destination
Shelton, WA

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
64
Injuries
None
Certificates
Airline transport, Commercial
Airplane ratings
Multi-engine land, Single-engine land
Instrument ratings
Airplane
Medical
Class 2, With waivers/limitations
Seat
Right
Restraint
Lap only
Flight hours
16,600 total · 700 in this make and model · 15,800 as pilot in command

Weather

Conditions
Visual (VMC) · Day
Wind
230° at 10 knots
Visibility
10 statute miles
Lowest ceiling
8,000 ft overcast
Temperature
54 °F, dew point 48 °F
Altimeter
30.21 inHg
Observed at
KSHN, 7 nm away

Docket · 5

The files NTSB released with the investigation on January 2, 2018, on NTSB’s docket system: statements, records, photos and specialists’ reports. 4.0 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.