WPR19LA136

NTSB accident investigation · Piper PA28R · Winter Haven, FL · May 4, 2019

Accident · No injuriesClass 3 · LimitedFinal report
Date
May 4, 2019, 11:00 local (15:00 UTC)
Place
Winter Haven, FL
Injuries
2 uninjured
Damage
Substantial damage
Phase of flight
Approach
Aircraft
N2134TPiper PA28R
Defining event
Approach-IFR initial approach: Loss of engine power (partial)
Weather
Visual (VMC) · Day
Status
Completed
Report
Approved by Office Director
Investigation class
Class 3
NTSB office
Western Pacific Region
Parties
Piper Aircraft, Federal Aviation Administration
FAA report
20190504003919A
Case key
99397

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 NTSB’s determination of the probable cause, and any contributing factors.

A partial loss of engine power due to worn fuel valve O-rings, which allowed air into the fuel system and resulted in a forced landing to unsuitable terrain.

Findings · 2

NTSB’s coded findings. Those marked are part of the probable cause; the rest are factors or other findings.

Analysis

The instructional flight was in-bound to the initial approach fix to practice a simulated instrument approach when the engine began to fluctuate and sputter. The flight instructor switched fuel tanks and turned on the fuel pump to no avail. The airplane was unable to reach a nearby airport, so the flight instructor accomplished a forced landing in an open field. During the forced landing, the airplane’s left wing sustained substantial damage when the landing gear struck a rut in the field. Postaccident examination of the airplane revealed no pre-impact anomalies. During the first of several engine runs, the engine started uneventfully but subsequently surged and stopped. Pressure was applied to the fuel system and fuel was observed leaking out of the top two vent holes of the fuel selector. The fuel selector was subsequently bypassed, and the engine started and ran with no additional anomalies noted. The fuel selector was removed and examined. During a pressure test, when the fuel valve was positioned to the left or right tank position, a fuel leak occurred again from the vent holes. Subsequently, the fuel valve was disassembled to examine the housing, shaft, and four O-rings. No anomalies were observed to the housing or shaft. Microscopic examination revealed that two O-rings appeared to have frictional interactions with the inner surface of the housing bore, and the other two O-rings exhibited wear on the surfaces in contact with the inner surface of the housing bore. No additional anomalies were noted. The circumstances of the accident are consistent with air entering the fuel system where the fuel leaks occurred in the fuel selector valve. Air in the fuel lines would have interrupted the flow of fuel to the engine, resulting in a loss of engine power.

Factual narrative

The factual narrative564 words

On May 4, 2019, about 1100 Eastern daylight time, a Piper PA-28R-200 airplane, N2134T, was substantially damaged when it was involved in an accident near Bartow, Florida. The flight instructor and the pilot receiving instruction were not injured. The airplane was operated as a Title 14 Code of Federal Regulations Part 91 instructional flight. The flight proceeded south to their normal practice area. Steep turns, slow flight and stalls were performed. Subsequently, they proceeded north to intercept the initial approach fix. According to the flight instructor, as they flew toward the initial approach fix for a simulated instrument approach at BOW, the engine experienced a power fluctuation. The flight instructor switched tanks and turned on the fuel pump but shortly thereafter, the engine began to “sputter.” He therefore decided to land at Winter Haven Regional Airport (GIF) Winter Haven, Florida, but was unable to make it to the runway. A forced landing was accomplished to an open field, about 2 miles northeast from GIF. During the landing sequence, the airplane’s left wing sustained substantial damage when the landing gear struck a rut in the field. Examination of the engine revealed no anomalies that would have prevented the normal production of power. The airplane was secured for an engine run. The airplane’s battery was charged, and a fuel source was secured to the right tank fuel line leading into the fuel selector. The engine started uneventfully but subsequently surged and stopped. An external fuel tank was then secured inside the cockpit to manually pump the primer ball and allow pressure in the system. The ball was pumped four times and fuel was observed leaking out of the top two vents (weep holes) in the fuel selector. There were no fuel stains or evidence of a fuel leak observed on the fuel selector valve before the engine run. The fuel selector was removed, and the external fuel source was connected directly to the fuel line past where the fuel selector would be situated. The engine was started and run at various low to medium power settings, with no anomalies noted. The fuel selector was removed for pressure tests and examination. The pressure bench checks of the fuel selector valve were accomplished in accordance with Piper Service Letter No. 1273, dated March 29, 2021, which provided instructions for a recurring bench check of the valve. The airplane’s fuel valve was pressurized to the appropriate psi and checked for evidence of leaks. The valve passed the test, and no leaks were observed. The second pressure test was accomplished with valve’s left and right outlet ports capped. A relatively small amount of fuel leaked around the shaft when it was positioned to the off position. However, when positioned to the left or right positions, a substantial fuel leak occurred. Another exemplar fuel valve was tested in a similar manner and no leaks were observed. The fuel valve was disassembled to examine the housing, shaft, and O-rings,for any potential damage or wear. No corrosion or damage was observed to the housing or shaft. The microscopic examination of the four O-rings revealed that the No. 3 and No. 4 O-rings appeared to have frictional interactions with the inner surface of the housing bore. Additionally, the No. 1 and No. 2 O-rings exhibited wear on the surfaces in contact with the inner surface of the housing bore. No additional anomalies were noted.

Sequence of events

The events NTSB coded, in order, by phase of flight. The defining event is the one that best describes the accident.

Aircraft

Registration
N2134T
Reported as
Piper PA28R (200)
Category
Airplane
Serial number
28R7135142
Built
1971
Airframe hours
5,635
Engine
Lycoming IO-320-C1C, 200 horsepower, reciprocating
Damage
Substantial damage
Flight
Instructional · Part 91
Airworthiness certificate
Standard, Normal
Last inspection
100 hour · April 24, 2019
Departed
BOW · Bartow, FL
Destination
BOW · Bartow, FL
Airport
GIF · Winter Haven Rgnl, runway 23, 5,006 × 100 ft, asphalt
Equipment
Stall warning system, Auto-pilot, ADS-B

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 · 2

As NTSB recorded them. NTSB leaves out names.

Role
Flight instructor
Age
46
Injuries
None
Certificates
Flight instructor, Commercial
Airplane ratings
Multi-engine land, Single-engine land
Instrument ratings
Airplane
Medical
Class 2, With waivers/limitations
Last flight review
January 20, 2018
Seat
Right
Flight hours
5,500 total · 200 in this make and model · 4,300 as pilot in command · 200 in the last 90 days · 90 in the last 30 days
Role
Pilot
Age
49
Injuries
None
Certificate
Commercial
Airplane ratings
Single-engine land
Instrument ratings
Airplane
Medical
Class 3, With waivers/limitations
Last flight review
February 16, 2019
Seat
Left

Weather

Conditions
Visual (VMC) · Day
Wind
200° at 4 knots
Visibility
10 statute miles
Lowest ceiling
None
Temperature
73 °F, dew point 70 °F
Altimeter
29.97 inHg
Observed at
KGIF, 2 nm away

Docket · 11

The files NTSB released with the investigation on April 25, 2022, on NTSB’s docket system: statements, records, photos and specialists’ reports. 14.6 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.