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NTSB Identification: ERA12LA246
14 CFR Part 91: General Aviation
Accident occurred Friday, March 23, 2012 in Beaver Falls, PA
Probable Cause Approval Date: 05/23/2013
Aircraft: DIAMOND AIRCRAFT IND INC DA 20-C1, registration: N166SE
Injuries: 1 Serious,1 Minor.
NTSB investigators may not have traveled in support of this investigation and used data provided by various sources to prepare this aircraft accident report.
According to the flight instructor, while on final approach, he perceived that the airplane was low on the desired glidepath. He said that he issued corrective instructions to the student twice before taking the flight controls. The instructor moved the throttle forward to increase power, and the engine stopped producing power. He selected a forced landing site, issued a Mayday call to the tower, and attempted an engine restart. However, he had to conduct a power-off landing on a roadway. Before ground contact, the airplane struck wires, and, during the accident sequence, the nose gear and tail section of the airplane separated.
During the examination of the wreckage, the engine was started, and it ran continuously on the airframe using the airplane's own fuel system. However, when the power was reduced to idle, the engine did not respond as expected to subsequent throttle and mixture inputs. After the initial run, the operator's director of maintenance was asked to produce the tools and documents used to calibrate the fuel system at installation. He produced instructions and gauges that resembled those used at the manufacturer’s factory, but no calibration stickers were displayed on the gauges. The gauges were installed, and, during a subsequent engine run, both the metered and unmetered fuel pressure readings were below factory specifications.
The fuel system was removed and flow tested at the engine manufacturer's facility. The fuel pump and fuel control assembly were intact, and bench testing demonstrated their ability to function, but both were found with several parameters outside of their respective calibrated specifications. The fuel manifold and nozzles were also tested and found to exhibit a normal flow vs. pressure indication on the test bench. The fuel pump was found adjusted "down" and flowed less than the required fuel flow specifications. The throttle body and mixture control unit were found adjusted to a position that allowed more than the required fuel flow at three specific settings. The combination of both the fuel pump and throttle body mixture control adjustments resulted in an idle fuel flow rate 2.5 times the maximum required. When the throttle was advanced quickly to full throttle, the fuel flow rate was 40 percent of the required rate. This significant transition in fuel flow rates likely resulted in a momentary "cavitation" of the fuel pump, which allowed air to enter the system and resulted in a total loss of engine power.
The National Transportation Safety Board determines the probable cause(s) of this accident to be:
The operator’s maintenance personnel’s improper adjustment of the engine's fuel system, which resulted in a total loss of engine power.
HISTORY OF FLIGHT
On March 23, 2012, about 1220 eastern daylight time, a Diamond DA20-C1, N166SE, was substantially damaged during a forced landing following a total loss of engine power while on final approach to land at Beaver County Airport (BVI), Beaver Falls, Pennsylvania. The certificated flight instructor sustained minor injuries, and the student pilot was seriously injured. Visual meteorological conditions prevailed, and no flight plan was filed for the instructional flight operated by Aviation Certification and Education Solutions (ACES), Inc., and conducted under the provisions of Title 14 Code of Federal Regulations Part 91.
In a telephone interview, the flight instructor stated that the purpose of the flight was for his student to conduct a navigation exercise. The instructor followed the student as she conducted her preflight, and the instructor noted that there was approximately 13 gallons of fuel in the 26-gallon tank.
After completing the approximate 45-minute round-trip flight, that included a landing and takeoff at an intermediate stop, the airplane entered a left downwind for landing on Runway 10 at BVI. While on final approach, the instructor perceived that the airplane was low on the desired glidepath based on the Precision Approach Path Indicator (PAPI) lights. He said that he issued corrective instructions to the student twice before taking the flight controls.
The instructor increased the throttle, and the engine stopped producing power. He selected a forced landing site, issued a Mayday call to the tower, attempted an engine restart, but completed a power-off landing to a roadway. Prior to ground contact, the airplane struck wires, and during the accident sequence the nose gear and tail section of the airplane separated.
PERSONNEL INFORMATION
The instructor held a commercial pilot certificate with ratings for airplane single-engine land, multiengine land, and instrument airplane. He also held a flight instructor certificate with ratings for airplane single-engine, multiengine, and instrument airplane. His most recent Federal Aviation Administration (FAA) third-class medical certificate was issued May 10, 2007. The instructor reported 593 total hours of flight experience, 206 hours of which were in the accident airplane make and model.
The student pilot was issued a third class medical certificate on August 22, 2011. She reported 30 total hours of flight experience, all of which were in the accident airplane make and model.
AIRPLANE INFORMATION
According to FAA records, the airplane was manufactured in 2004, and issued a standard airworthiness certificate on June 16, 2004. The most recent annual inspection was completed December 6, 2011, at 1756.8 total aircraft hours. At the time of the accident, the airplane had accrued 1,825.7 total aircraft hours.
Examination of maintenance records revealed that the engine was removed for overhaul on October 4, 2011, and reinstalled December 6, 2011, at the time of the annual inspection. At the time of the engine installation, calibration of the fuel system was required and performed by the operator's Director of Maintenance (DOM).
METEOROLOGICAL INFORMATION
At 1147, the weather reported at BVI included clear skies and wind from 110 degrees at 3 knots. The temperature was 23 degrees C, and the dewpoint was 8 degrees C.
ADDITIONAL INFORMATION
On March 28, 2012, an engine examination and test run were conducted under the supervision of FAA aviation safety inspectors. The engine was started and ran continuously on the airframe using the airplane's own fuel system. However, when the power was reduced to idle, the engine did not respond as expected to subsequent throttle and mixture inputs.
After the initial run, the operator's DOM was asked to produce the tools and documents used to calibrate the fuel system at installation. He produced factory instructions and gauges that resembled those used at the Diamond Aircraft factory, but no calibration stickers were displayed on the gauges.
The gauges were installed, and during a subsequent engine run, both the metered and un-metered fuel pressure readings were below factory specifications.
The fuel system was removed, and flow-tested at the engine manufacturer's facility in Mobile, Alabama, under the supervision of an NTSB investigator. According to the examination report:
"The fuel pump and fuel control assembly were intact and demonstrated the ability to function, but both were found with several parameters outside of each of their respective calibrated specifications. The fuel manifold and nozzles exhibited a normal flow vs. pressure indication on the test bench."
The fuel pump was found adjusted "down" and flowed less than the required fuel flow specifications. The throttle body and mixture control unit were found adjusted to a position that allowed more than the required fuel flow at three specific settings.
The combination of both the fuel pump adjustments and throttle body mixture control adjustments resulted in an idle fuel flow rate 2.5 times the maximum required. When the throttle was advanced quickly to full throttle, the fuel flow rate was 40 percent of the required rate.
FAA IDENTIFICATION
Regis#: 166SE Make/Model: DA20 Description: DIAMOND DA 20-C1
Date: 03/23/2012 Time: 1625
Event Type: Accident Highest Injury: None Mid Air: N Missing: N
Damage: Substantial
LOCATION
City: BEAVER State: PA Country: US
DESCRIPTION
AIRCRAFT CRASHED OFF THE END OF THE APPROACH END OF THE RUNWAY, BEAVER
VALLEY, PA
INJURY DATA Total Fatal: 0
# Crew: 2 Fat: 0 Ser: 0 Min: 0 Unk:
# Pass: 0 Fat: 0 Ser: 0 Min: 0 Unk:
# Grnd: Fat: 0 Ser: 0 Min: 0 Unk:
OTHER DATA
Activity: Training Phase: Unknown Operation: OTHER
FAA FSDO: ALLEGHENY CO., PA (EA03) Entry date: 03/26/2012
Video: Uploaded on June 8, 2011
07Jun2011 @ approx. 1800 hrs EDT in Diamond DA20-C1 (N166SE) from KBVI.
An airplane with two passengers went down around 12:30 p.m. Friday in a yard in Chippewa Township on McClain Road. The pilot was out and walking about, but both he and his passenger, a woman, were taken to Heritage Valley Beaver hospital for examination.
Crash site photo gallery
CHIPPEWA TWP. -- A two-person training plane attempting an emergency landing crashed at 11:45 a.m. Friday on McClain Road in Chippewa Township, a half-mile from Blackhawk High School.
Chippewa police said pilot Dan Soloski was able to climb from the plane, but his passenger, Shakura Rowe, 19, complained of back pain and was helped from the aircraft by emergency responders. Both were taken to Heritage Valley Beaver hospital for evaluation and treatment.
Rowe, from Edwardsburg, Mich., is an air traffic control student at the Community College of Beaver County, according to a CCBC release. Soloski is an instructor for Aces Aviation, a Beaver County Airport-based business contracted by the college.
The plane, a Diamond C1-Eclipse, came to rest in a nose-down position, partially on McClain Road and partially on the lawn of Ray Blazak, 199 McClain. It stopped six feet from a tree, six feet from a parked car, and in a hollow 200 yards from the end of a runway at Beaver County Airport. The runway sits on a bluff above McClain.
The tail section of the plane was fractured, and the pilot-side landing gear was detached.
Blazak, a former small-plane pilot, was installing a fence around his garden and witnessed the incident. He said the plane was having problems with its engine.
"He had no engine," Blazak said. "It made a distinctly different sound. You could hear the wind rushing through the landing gear, and that's not a sound you can hear when the engine's running."
Blazak said the plane was approaching the runway from the west and began losing altitude. The pilot banked, approached McClain from the north, and was centered over the road as he descended.
"He was in control and gliding," Blazak said. "I would call it a controlled crash landing."
The attempted landing was interrupted when some part of the plane, possibly the tail section, got hooked on a power line.
"It just slammed him down," Blazak said.
Alan Kincade, who lives at 197 McClain, was cleaning an oil lamp on his porch when the plane crashed 150 feet from him.
"It shook the whole house," Kincade said. "I looked down and couldn't believe there was an airplane on the road."
The force of the landing brought down a utility wire leading to Kincade's home.
Federal Aviation Administration officials conducted an on-site investigation, but will not determine a cause for the crash.
National Transportation Safety Board investigators, after examining the engine and instruments, will determine a cause. NTSB officials were not on site as of Friday afternoon.
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FAA spokeswoman Arlene Salac said the single-engine, two-seat Diamond DA20 was attempting to land Friday just after noon at Beaver County Airport when it struck a power line and ended up on McClain Road, not far from Blackhawk High School.
The pilot declared a mayday just before the crash, said Federal Aviation Administration spokesman Jim Peters.
The tail was nearly snapped off and the plane pitched forward with its propeller on the ground.
Ray Blazak said he was working in his garden when the plane nearly hit him before crashing.
“It slammed right into the ground, nose first. By time I got there, the pilot was opening the canopy and I helped him out,” Blazak said. “The girl, his student, was screaming and crying. She was in severe back pain she said, but we got her to move her arms and legs.”
Salac said both people in the plane were taken to a nearby hospital to be checked out; the injuries were not serious.
The aircraft is registered to Curtis Cousins of Shelton, Wash., Peters said. He did not identify the pilot or the passenger.
Officials are still investigating the cause of the crash.
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