WPR21LA325

NTSB accident investigation · Stout Garry V Europa - Trigear · Hanksville, UT · August 16, 2021

Accident · No injuriesClass 3 · LimitedFinal report
Date
August 16, 2021, 15:15 local (21:15 UTC)
Place
Hanksville, UT · uneven open terrain
Injuries
1 uninjured
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N133ACStout Garry V Europa - Trigear
Defining event
Enroute-climb to cruise: Powerplant sys/comp malf/fail
Weather
Visual (VMC) · Day
Status
Completed
Report
Approved by Office Director
Investigation class
Class 3
NTSB office
Western Pacific Region
Parties
FAA
FAA report
20210816014369A
Case key
103718

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 pilot’s installation of a non-original equipment manufactured radiator cap, which resulted in the loss of coolant and the engine’s exceedance of the maximum admissible cylinder head temperature. Contributing to the accident was the lack of suitable terrain for the forced landing.

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.

Fluids: coolantAircraft › Fluids/misc hardware · Fluid levelStout Garry V EUROPA - TRIGEAR: 1 caseAll aircraft: 4 casesProbable cause
Maintenance: replacementPersonnel issues › Task performance · PilotStout Garry V EUROPA - TRIGEAR: 1 caseAll aircraft: 70 casesProbable cause
Terrain: rough terrainEnvironmental issues › Physical environment · Effect on equipmentStout Garry V EUROPA - TRIGEAR: 1 caseAll aircraft: 442 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

The pilot replaced lost fluid in the airplane engine’s cooling system with water and after a successful ground run, the pilot departed. During a “stair-stepped” climbout, the engine’s cylinder head temperature (CHT) increased into the red arc of the CHT gauge (the maximum admissible cylinder head temperature of 180°C [356°F]). The pilot immediately reduced the throttle setting to ide and elected to conduct a forced landing. The airplane sustained substantial damage to the wings and fuselage after impacting rough terrain during the landing. Postaccident examination of the cooling system revealed that system components were secured and void of all fluid. Testing of the accident radiator cap revealed that it was a non-original equipment manufactured (OEM) part by a third-party vendor and that the pressure relief valve opened and released air pressure about 0.2 bar (3 psi), less than the manufacturer’s recommended coolant system maximum pressure value of 1.2 bar (18 psi). It is likely that the lack of pressure created by the non-OEM radiator cap reduced the coolant boiling point and system pressure. The pressure reduction and lowering of the boiling point would have allowed the coolant to evaporate, leading to a loss of coolant in the system and the engine’s exceedance of the maximum admissible cylinder head temperature of 180°C (356°F).

Factual narrative

On August 16, 2021, about 1515 mountain daylight time, a Europa Trigear, N133AC, was substantially damaged when it was involved in an accident near Hanksville, Utah. The pilot was not injured. The airplane was operated as a Title 14 Code of Federal Regulations Part 91 personal flight. The pilot reported that during the preflight, he noticed that the coolant in the cooling system’s expansion tank was low. He removed the cowling and did not notice any pooling of coolant in the engine compartment, so he replaced the coolant with about 16 ounces of water. He completed the preflight and ground run without further incident and continued with the departure, which he characterized as a “stair-stepped” climb out to assist with the engine cooling on a hot day over rough terrain. After 30 minutes, the pilot reported that the engine’s CHT was pegged in the red arc [maximum admissible head cylinder temperature of 180°C (356?)] and he immediately reduced the throttle setting to idle and elected to conduct a precautionary landing. While the airplane was descending, he cycled the engine off and on to reduce the CHT, but the temperature remained in the red arc. During the landing roll on an unimproved dirt road, the airplane impacted rough terrain. Postaccident examination of the cooling system revealed that the expansion tank, coolant hoses, and water pump were unremarkable, and that the system was void of any coolant. The manufacturer states that the coolant capacity for the engine is about 0.4 US gallons (about 1.5 liters). TEST AND RESEARCH The pilot stated that about 2 weeks before the accident flight, he removed the original radiator (pressure screw) cap and replaced it with a non-original equipment manufactured radiator cap from a third-party vendor. The original cap and the installed cap were both labeled to maintain system pressure up to 1.2 bar (18 psi) and both caps contained an upper pressure seal, lower pressure seal, pressure relief valve, and return(vacuum) valve. A pressure test of the original/replaced cap revealed that the pressure relief valve opened about 0.8 bar (12 psi). The accident radiator cap was also pressure tested and revealed that the valve opened about 0.2 bar (3 psi). According to the manufacturer, the engine boiling point is influenced by the system pressure and that if temperature exceeds the boiling point, the engine can quickly overheat due to loss of coolant. According to the manufacturer, the radiator cap sits on top of the expansion tank and provides a tight seal to maintain pressurization of the cooling system, which increases the system’s boiling point. As the system pressure reaches the cap’s rated pressure, the cap’s pressure relief valve opens, and the pressurized coolant flows into the overflow bottle; this allows for the expansion of the heated coolant. Conversely, as the temperature drops and the coolant contracts, a vacuum is created within the cooling system. The vacuum seal within the cap opens and allows thecoolant to flow from the overflow bottle back into the radiator. Figure 1. Rotax 914 Cooling System Flow Diagram According to Rotax Service Letter SL-914-012R6 Revision 13 May 2022: The use of any third-party replacement kits, modifications and non-genuine ROTAX® components or accessories for ROTAX® engines is NOT approved by ROTAX® and is very strongly discouraged. Use of any improper third-party replacement kits, improper modifications and non-genuine ROTAX® components or accessories may cause engine damage resulting in catastrophic engine failure. As stated in the manufacturer’s maintenance manual, a rise in the cylinder head temperature above normal operations is a clear signal for a failure in the cooling system, to include the pressure relief valve. Figure 2. Cylinder Head Table from Rotax 914 Maintenance Manual 05-50-00 Edition 2, Revision 2

Aircraft

Registration
N133AC
Reported as
Stout Garry V Europa - Trigear
Category
Airplane
Serial number
A060
Built
1999
Airframe hours
1,099
Engine
Rotax 914, 115 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Airworthiness certificate
Special, Experimental (Special)
Departed
U96 · Halls Crossing, UT
Destination
41U · Manti, MT
Flight plan
VFR
Equipment
Stall warning system, Satellite tracking device, Onboard weather, Handheld GPS, Electronic flight bag or handheld device, 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

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
54
Injuries
None
Certificate
Private
Airplane ratings
Single-engine land
Medical
Class 3
Last flight review
July 18, 2020
Seat
Left
Restraint
3-point
Flight hours
410.5 total · 295 in this make and model · 331.1 as pilot in command · 4.3 in the last 90 days · 22.5 in the last 30 days · 2.9 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
Calm
Visibility
10 statute miles
Lowest ceiling
None
Temperature
93 °F, dew point 37 °F
Altimeter
29.98 inHg
Observed at
KHVE, 22 nm away
METAR
METAR KHVE 162115Z AUTO 00000KT 10SM CLR 34/03 A2998 RMK AO2=

Docket · 6

The files NTSB released with the investigation on March 22, 2023, on NTSB’s docket system: statements, records, photos and specialists’ reports. 11.4 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.