The NTSB has released an Aviation Investigation Report (AIR-22-04) urging Cirrus Aircraft and the Federal Aviation Administration (FAA) to address safety issues identified in investigations involving Cirrus SR22T airplanes in which an excessive fuel condition led to a loss of engine power during the takeoff climb. We investigated six accidents involving Cirrus SR22T airplanes; in five of them, we were able to retrieve fuel flow data from the recoverable data modules (RDM) installed in the accident airplanes. In each case, the fuel flow data indicated an excessively high fuel flow (ranging from 42.2 to 50.1 gallons per hour [gph]) to the engine just before the loss of power.
What You Should Know
Our examination of these investigations suggests a lack of system safety assessments to identify the cause and reduce the potential of the hazard from occurring. We concluded:
the Cirrus SR22T can experience a loss of engine power due to excessive fuel flow and some causes of excessive fuel flow during takeoff and climb may not have been identified and mitigated. We have recommended that Cirrus Aircraft conduct a functional hazard assessment (FHA) to identify the causes, effects, and severity levels for the SR22T excessive fuel flow hazard condition during takeoff and climb phases of flight and, based on the FHA, update the system safety assessment.
until the FAA requires implementation of appropriate mitigating actions to prevent the loss of engine power due to excessive fuel flow in the SR22T, additional accidents may occur due to this hazard. We have recommended the FAA review the functional hazard assessment (FHA) recommended in Safety Recommendation A-22-7 and ensure it meets the objectives of Advisory Circular 23.1309-1 E. Upon approval of the FHA, work with Cirrus to identify necessary mitigating actions and require their implementation through the appropriate means, such as an airworthiness directive.
What You Can Do
We encourage all pilots and operators with Cirrus Aircraft to read this AIR and review the circumstances of the six accidents investigated by the NTSB.
Additional Participating Entities:
Federal Aviation Administration / Flight Standards District Office; Birmingham, Alabama
Cirrus Design Corporation; Duluth, Minnesota
Continental Motors; Mobile, Alabama
Aviation Accident Factual Report - National Transportation Safety Board: https://app.ntsb.gov/pdf
Investigation Docket - National Transportation Safety Board: https://dms.ntsb.gov/pubdms
http://registry.faa.gov/N289CM
Location: Tuskegee, AL
Accident Number: ANC18LA004
Date & Time: 10/15/2017, 1100 CDT
Registration: N289CM
Aircraft: CIRRUS DESIGN CORP SR22T
Aircraft Damage: Substantial
Defining Event: Loss of engine power (partial)
Injuries: 3 None
Flight Conducted Under: Part 91: General Aviation - Personal
On October 15, 2017, about 1100 central daylight time, a Cirrus Design SR22T airplane, N289CM, sustained substantial damage during a forced landing following a partial loss of engine power shortly after takeoff from Moton Field Municipal Airport (06A), Tuskegee, Alabama. The airplane was registered to Skylane Partners, LLC and operated by the pilot as a visual flight rules flight under the provisions of 14 Code of Federal Regulations Part 91 when the accident occurred. The certificated private pilot and three passengers were not injured. Visual meteorological conditions prevailed, and an instrument flight plan had been filed.
The pilot reported that after completion of the preflight inspection and the before takeoff checks, he departed runway 13 from 06A. Shortly after takeoff, during the initial climb, he sensed the airplane slow down and the climb rate diminish. Realizing the airplane had suffered a partial loss of power well below 1,000 feet above ground level (AGL), and unable to return to the airport, he selected a sod field as an off-airport landing site. During the forced landing the airplane's landing gear collapsed and the airplane sustained substantial damage to the fuselage.
In a written statement, a fixed base operator (FBO) Line Service Technician at 06A reported that he observed a cloud of faint white smoke after the accident airplane's engine was started. He wrote that the engine sounded "choppy" throughout the entire takeoff. After liftoff, about midfield, he observed grey smoke being emitted from the airplane's exhaust. About 200 feet AGL, the airplane's speed began to decrease as it entered a gradual left bank and began to lose altitude. Concerned for the occupant's safety, he radioed the pilot and asked, "Is everything OK" and the pilot responded, "We have a field in sight." He continued to observe the airplane as it disappeared behind the trees, followed by the sounds of an airplane impacting the ground. Unable to contact the pilot on the radio, he immediately notified first responders of the accident.
In a separate conversation, the pilot reported that during the advancement of the throttle lever for takeoff, when the manifold pressure reached 36.5 in.Hg, he stopped the movement of the throttle lever, even though it was prior to the full forward limit stop.
The Cirrus SR22T Pilot's Operating Handbook and FAA Approved Flight Manual, the section titled Takeoff Power Check, states in part: "Check full-throttle engine operation early in takeoff run. The engine should run smoothly and turn approximately 2500 RPM. All engine parameters are not in caution or warning ranges. Discontinue takeoff at any sign of rough operation or sluggish acceleration. Make a thorough full-throttle static run-up before attempting another takeoff. Manifold pressure may temporarily increase to 36.0 - 37.0 in.Hg on first flight of the day due to cooler oil temperatures and associated higher oil pressures. This is acceptable under these conditions but normal full throttle manifold pressure should be 36.0 in.Hg. The fuel flow will normally also increase in proportion to the increase in manifold pressure. If manifold pressure exceeds 37.0 in.Hg on takeoff or during full power climbs, reduce power to maintain no more than 37.0 in.Hg."
The Continental Motors, Continental Aircraft Engine Maintenance Manual, Standard Practice For Spark Ignited Engines, Engine Inspection and Service, 6-4.7.4.3 Fuel System Operational Checkout Procedure, states in part:
Manifold Pressure ............................................ Check
RESULT: Manifold pressure should equal the value specified for the engine model in Section 6-4.7.1. If manifold pressure is not within the specified limits, adjust the Wastegate Controller according to instructions in Section 6-4.10.3.
Section 6-4.10.3.3 Sloped Controller Adjustment states in part:
Applicable Engines: TSIO-520-BE; TSIO-550-A, B, C, E, G, K, N TSIOL-550-C
CAUTION: Instructions in this section were verified on TSIO-550-C engine models. For all other engine models, consult the Aircraft Maintenance Manual before proceeding.
The sloped controller limits oil flow through the wastegate, which determines the position of the butterfly valve in the wastegate. Adjustment of the sloped controller may be required after an engine is installed, rebuilt, serviced, or overhauled, or sloped controller replacement. Procedure 1. Orient the aircraft nose into the prevailing wind and run the engine at 1500 to 1800 RPM until the oil temperature is 160 to 180° F (71 to 82°C). 2. Using a handheld digital tachometer set the propeller controls according to the Section 6-4.7.1. 3. With the throttle in the FULL FORWARD position, set the intake manifold pressure according to the value in Section 6-4.7.1 for the engine model by turning the adjusting screw on the bottom of the slope controller (Figure 6-56) using a wide blade common screwdriver. Turning the screw clockwise (CW) increases manifold pressure, counter-clockwise (CCW) decreases manifold pressure. NOTE: 1/8 turn of the adjusting screw=@1.0 inch Hg.
Table 6-4. Fuel System Adjustment Values
On March 29, 2018, an engine examination was performed by Continental Motors, Mobile, Alabama, under the supervision of the NTSB. Due to limited damage, an engine test run was conducted. The engine was fitted with a test club propeller for the TSIO-550 series engine.
The engine experienced a normal start without hesitation or stumbling in observed rpm. The warm-up sequence was completed over a span of about 20 minutes before the engine throttle was advanced to the full open position. As the throttle was advanced it was noted that the fuel flow exceeded the Continental Motors' full throttle highside limit once the manifold pressure surpassed 36 in.Hg. Continued movement of the throttle resulted in a manifold pressure of around 39 in.Hg before the engine began experiencing fuel flows that were too excessive to support combustion.
During the engine test, the magnetos were checked and a drop of 38 rpm was noted for the left magneto and a drop of 56 rpm was noted for the right magneto.
The slope controller was adjusted to reduce manifold pressure to that specified by Cirrus and the engine test run continued with high fuel flows. Following the manifold pressure adjustment, the engine throttle was rapidly advanced multiple times from idle to full throttle without any hesitation, stumbling or interruption in power.
A review of the airplane's maintenance records revealed that the last annual inspection was completed on January 11, 2017, at a total time in service of 725.5 flight hours.
The airplane was equipped with a Cirrus Perspective integrated avionics from Garmin and a Heads Up Technologies recoverable data module (RDM) data recorder. Flight data recorded by the RDM was downloaded by the NTSB's Vehicle Recorder Division in Washington DC. Review of the data revealed that the engine was started about 10:41:20 CDT and run up to 1700 rpm about 90 seconds later. The run up lasted approximately 30 seconds. The aircraft began to taxi at 10:44:55 and turned on to the runway heading and began to accelerate for takeoff at 10:47:20.
At 10:47:45, the aircraft rotated for takeoff at 75 knots. Pitch stabilized at 11 degrees and airspeed reached a peak of 85 knots, although airspeed began to decrease about one knot per second, slowing to 79 knots. The engine was stable during the initial climb at about 2,480 rpm and manifold pressure of 35.2 inHg. Fuel flow was about 41 gph.
At 10:48:07, the climb was interrupted at 250 ft pressure altitude (487 ft GPS altitude). Airspeed began to increase again, at about two knots per second. At 10:48:10 the aircraft began a turn to the left, and engine manifold pressure and fuel flow increased to a peak of 40.3 inHg and 48.1 gph, respectively. Within one second, both engine EGT and TIT began to decrease.
At 10:48:30, engine RPM began to decrease along with manifold pressure and fuel flow. The aircraft was descending at this time. At 10:48:39, the aircraft reached ground level and groundspeed decelerated from 89 knots to 0 at 10:48:48. The engine also stopped turning at that time.
The closest weather reporting facility was Auburn University Regional Airport (AUO), Auburn, Alabama, about 16 miles northeast of the accident site. At 1056, a METAR from AUO was reporting, in part: wind from 180 °at 5 knots; visibility, 10 statute miles; clouds and sky condition, few clouds at 1,100 feet, broken clouds at 5,500 feet; temperature, 77 °F; dew point 70° F; and altimeter, 30.20 inches of mercury.
Pilot Information
Certificate: Private
Age: 49, Male
Airplane Rating(s): Multi-engine Land; Single-engine Land
Seat Occupied: Left
Other Aircraft Rating(s): None
Restraint Used:
Instrument Rating(s): Airplane
Second Pilot Present:
Instructor Rating(s): None
Toxicology Performed: No
Medical Certification: Class 3 With Waivers/Limitations
Last FAA Medical Exam: 11/11/2015
Occupational Pilot: No
Last Flight Review or Equivalent: 08/26/2017
Flight Time: 2128 hours (Total, all aircraft), 732 hours (Total, this make and model), 8 hours (Last 90 days, all aircraft), 8 hours (Last 30 days, all aircraft)
Aircraft and Owner/Operator Information
Aircraft Make: CIRRUS DESIGN CORP
Registration: N289CM
Model/Series: SR22T
Aircraft Category: Airplane
Year of Manufacture: 2010
Amateur Built: No
Airworthiness Certificate: Normal
Serial Number: 0014
Landing Gear Type: Tricycle
Seats:
Date/Type of Last Inspection: 01/11/2017, Annual
Certified Max Gross Wt.:
Time Since Last Inspection:
Engines: 1 Reciprocating
Airframe Total Time: 725.5 Hours as of last inspection
Engine Manufacturer: CONT MOTOR
ELT: Installed
Engine Model/Series: TSIO-550 -K1B
Registered Owner: On file
Rated Power: 0 hp
Operator: On file
Operating Certificate(s) Held: None
Meteorological Information and Flight Plan
Conditions at Accident Site: Visual Conditions
Condition of Light: Day
Observation Facility, Elevation: KAUO
Distance from Accident Site: 16 Nautical Miles
Observation Time: 1556 UTC
Direction from Accident Site: 45°
Lowest Cloud Condition: Few / 1100 ft agl
Visibility: 10 Miles
Lowest Ceiling: Broken / 5500 ft agl
Visibility (RVR):
Wind Speed/Gusts: 5 knots /
Turbulence Type Forecast/Actual:
Wind Direction: 180°
Turbulence Severity Forecast/Actual:
Altimeter Setting: 30.2 inches Hg
Temperature/Dew Point: 25°C / 21°C
Precipitation and Obscuration: No Obscuration; No Precipitation
Departure Point: Tuskegee, AL (06A)
Type of Flight Plan Filed: IFR
Destination: MILLINGTON, TN (NQA)
Type of Clearance: None
Departure Time: 1100 CDT
Type of Airspace: Class G
Airport Information
Airport: Moton Field Municipal Airport (06A)
Runway Surface Type: N/A
Airport Elevation: 264 ft
Runway Surface Condition: Unknown
Runway Used: N/A
IFR Approach: None
Runway Length/Width:
VFR Approach/Landing: Forced Landing
Wreckage and Impact Information
Crew Injuries: 1 None
Aircraft Damage: Substantial
Passenger Injuries: 2 None
Aircraft Fire: None
Ground Injuries:N/A
Aircraft Explosion: None
Total Injuries: 3 None
Latitude, Longitude: 32.460556, -85.680000 (est)
14 CFR Part 91: General Aviation
Accident occurred Sunday, October 15, 2017 in Tuskegee, AL
Aircraft: CIRRUS DESIGN CORP SR22T, registration: N289CM
Injuries: 3 Uninjured.
This is preliminary information, subject to change, and may contain errors. Any errors in this report will be corrected when the final report has been completed. NTSB investigators may not have traveled in support of this investigation and used data provided by various sources to prepare this aircraft accident report.
On October 15, 2017, about 1100 central daylight time, a Cirrus SR22T airplane, N289CM, sustained substantial damage during a forced landing following a partial loss of engine power shortly after takeoff from Moton Field Municipal Airport (06A), Tuskegee, Alabama. The airplane was registered to Skylane Partners, LLC and operated by the pilot as a visual flight rules flight under the provisions of 14 Code of Federal Regulations Part 91 when the accident occurred. The certificated private pilot and two passengers were not injured. Visual meteorological conditions prevailed, and an instrument flight plan had been filed.
The pilot reported that after completing the preflight inspection and the before takeoff checks, he departed runway 13 from 06A. Shortly after takeoff, during the initial climb, he sensed the airplane slow down and the climb rate diminish. Realizing the airplane had suffered a partial loss of power well below 1,000 feet above ground level, and unable to return to the airport, he selected a sod field as an off-airport landing site. During the forced landing the airplane's landing gear collapsed and the airplane sustained substantial damage to the fuselage.
In a written statement, a fixed base operator (FBO) Line Service Technician at 06A reported that he observed a cloud of faint white smoke after the accident airplane's engine was started. He stated that the engine sounded "choppy" throughout the entire takeoff. After liftoff, about midfield, he observed grey smoke being emitted from the airplane's exhaust. About 200 feet above ground level, the airplane's speed began to decrease as it entered a gradual left bank and began to lose altitude. Concerned for the occupant's safety, he radioed the pilot and asked, "Is everything OK" and the pilot responded, "We have a field in sight." He continued to observe the airplane as it disappeared behind the trees followed by the sounds of an airplane impacting the ground. Unable to contact the pilot on the radio, he immediately notified first responders of the accident.
The closest weather reporting facility was Auburn University Regional Airport (AUO), Auburn, Alabama, about 16 miles northeast of the accident site. At 1056, a METAR from AUO was reporting, in part: wind from 180° at 5 knots; visibility, 10 statute miles; clouds and sky condition, few clouds at 1,100 feet, broken clouds at 5,500 feet; temperature, 77° F; dew point 70° F; altimeter, 30.20inches of mercury.
The airplane was equipped with a Continental TSIO-550 series engine; a detailed engine examination is pending.
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