Saturday, October 20, 2018

Enstrom F-28F Falcon, registered to and operated by Airwest Aviation Academy LLC, N52PD: Incident occurred August 22, 2017 at Glendale Municipal Airport (KGEU), Maricopa County, Arizona

The National Transportation Safety Board did not travel to the scene of this incident.

Additional Participating Entity:

Federal Aviation Administration / Flight Standards District Office; Scottsdale, Arizona

Aviation Incident 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/N52PD

Location: Glendale, AZ
Incident Number: WPR17IA198
Date & Time: 08/22/2017, 0904 MST
Registration: N52PD
Aircraft: ENSTROM F 28F
Aircraft Damage: None
Defining Event: Fire/smoke (non-impact)
Injuries: 2 None
Flight Conducted Under: Part 91: General Aviation - Instructional 

On August 22, 2017, about 0904 mountain standard time, an Enstrom F-28F helicopter, N52PD, experienced smoke coming from the engine cowling area after touchdown at the Glendale Municipal Airport (GEU) Glendale, Arizona. The certified flight instructor and student pilot were not injured, and the helicopter was not damaged. The helicopter was registered to and operated by Airwest Aviation Academy LLC under the provisions of Title 14 Code of Federal Regulations Part 91, as an instructional flight. Visual meteorological conditions prevailed, and no flight plan had been filed. The local flight departed GEU about 0820.

The flight instructor reported that at the time of the incident, the student was practicing hovering autorotations. Several had been accomplished without incident. During the last one, the engine appeared to have stalled, but sounded as if it were running rough when the cockpit filled with smoke. The helicopter was on the ground and the flight instructor secured the cockpit and both he and the student evacuated the helicopter with the engine still running and smoke coming out of the right side air scoop. About five minutes later, the engine stopped running.

Postincident examination of the helicopter revealed that no fire or other related damage was present. Maintenance personnel reported that the source of the smoke appeared to have originated from the failure of an internal oil seal within the turbocharger-compressor that leaked oil into the turbocharger-compressor's exhaust system. No further examination or repair was accomplished and the turbocharger was replaced.

Further examination identified that the V-clamp assembly that was installed on the turbo-compressor exhaust was damaged. The V-clamp assembly was removed and sent to the National Transportation Safety Board Material Laboratory, Washington DC for further examination. The examination of the V-clamp assembly revealed that the strap portion of the assembly contained cracks on three of the four spot welds that emanated from the outer face of the strap. The edge of the strap portion exhibited evidence of bending deformation on both sides of the assembly. In the deformed areas, the distance between the edge of the retainer and the edge of the strap, were smaller when compared to other non-deformed areas. Microscopic examination of the longest crack revealed that a fatigue crack emanated from the outer surface of the strap. The damage to the V-clamp was unrelated to the source of the smoke.

Flight Instructor Information

Certificate: Flight Instructor; Commercial; Private
Age: 43, Male
Airplane Rating(s): None
Seat Occupied: Right
Other Aircraft Rating(s): Helicopter
Restraint Used: 4-point
Instrument Rating(s): Helicopter
Second Pilot Present: Yes
Instructor Rating(s): Helicopter
Toxicology Performed: No
Medical Certification: Class 2 With Waivers/Limitations
Last FAA Medical Exam: 04/03/2017
Occupational Pilot: Yes
Last Flight Review or Equivalent: 12/18/2015
Flight Time:  (Estimated) 1300 hours (Total, all aircraft), 1280 hours (Total, this make and model), 1220 hours (Pilot In Command, all aircraft), 90 hours (Last 90 days, all aircraft) 

Student Pilot Information

Certificate: Private; Student
Age: 40, Male
Airplane Rating(s): Single-engine Land
Seat Occupied: Left
Other Aircraft Rating(s):
Restraint Used: 4-point
Instrument Rating(s): None
Second Pilot Present: Yes
Instructor Rating(s): None
Toxicology Performed: No
Medical Certification: Class 3 Without Waivers/Limitations
Last FAA Medical Exam: 12/13/2016
Occupational Pilot: No
Last Flight Review or Equivalent:
Flight Time:

Aircraft and Owner/Operator Information

Aircraft Make: ENSTROM
Registration: N52PD
Model/Series: F 28F
Aircraft Category: Helicopter
Year of Manufacture: 1996
Amateur Built: No
Airworthiness Certificate: Normal
Serial Number: 807
Landing Gear Type: Skid
Seats: 2
Date/Type of Last Inspection: 07/06/2017, Annual
Certified Max Gross Wt.: 2600 lbs
Time Since Last Inspection:
Engines: 1 Reciprocating
Airframe Total Time: 6264.3 Hours as of last inspection
Engine Manufacturer: Lycoming
ELT: Not installed
Engine Model/Series: HIO-360-F1AD
Registered Owner: AIRWEST AVIATION ACADEMY LLC
Rated Power: 190 hp
Operator: AIRWEST AVIATION ACADEMY LLC
Operating Certificate(s) Held: None 

Meteorological Information and Flight Plan

Conditions at Accident Site: Visual Conditions
Condition of Light: Day
Observation Facility, Elevation: KGEU, 1071 ft msl
Distance from Accident Site: 0 Nautical Miles
Observation Time: 0853 MST
Direction from Accident Site: 90°
Lowest Cloud Condition: Scattered / 15000 ft agl
Visibility:  10 Miles
Lowest Ceiling:
Visibility (RVR):
Wind Speed/Gusts: 4 knots /
Turbulence Type Forecast/Actual: /
Wind Direction: 20°
Turbulence Severity Forecast/Actual: /
Altimeter Setting: 29.98 inches Hg
Temperature/Dew Point: 33°C / 14°C
Precipitation and Obscuration: No Obscuration; No Precipitation
Departure Point: GLENDALE, AZ (GEU)
Type of Flight Plan Filed: None
Destination: GLENDALE, AZ (GEU)
Type of Clearance: VFR
Departure Time: 0820 MST
Type of Airspace: Class D

Airport Information

Airport: Glendale Municipal Airport (GEU)
Runway Surface Type: Unknown
Airport Elevation: 1071 ft
Runway Surface Condition: Unknown
Runway Used: N/A
IFR Approach: None
Runway Length/Width:
VFR Approach/Landing: Precautionary Landing

Wreckage and Impact Information

Crew Injuries: 2 None
Aircraft Damage: None
Passenger Injuries: N/A
Aircraft Fire: None
Ground Injuries: N/A
Aircraft Explosion: None
Total Injuries: 2 None
Latitude, Longitude:  33.526944, -112.295278 (est)

NTSB Identification: WPR17IA198
14 CFR Part 91: General Aviation
Incident occurred Tuesday, August 22, 2017 in Glendale, AZ
Aircraft: ENSTROM F 28F, registration: N52PD
Injuries: 2 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 used data provided by various sources and may not have traveled in support of this investigation to prepare this aircraft incident report.

On August 22, 2017, about 0904 mountain standard time, an Enstrom F-28F helicopter, N52PD, experienced smoke emanating from the engine cowling area while the flight instructor and student pilot were practicing hovering auto-rotations at the Glendale Municipal Airport (GEU) Glendale, Arizona. The helicopter had just touched down and therefore an immediate engine shutdown was accomplished. The flight instructor and student pilot were not injured. The helicopter was not damaged. The helicopter was registered to and operated by Airwest Aviation Academy LLC as a 14 Code of Federal Regulations Part 91 instructional flight. Visual meteorological conditions prevailed, and no flight plan had been filed. The local flight departed GEU about 0750.

The helicopter was recovered to a secure facility for further examination.

Beech A36, registered to and operated by Gulf Central Aviation LLC, N48TZ: Accident occurred August 17, 2017 near Louisiana Regional Airport (KREG), Gonzales, Ascension Parish, Louisiana


The National Transportation Safety Board did not travel to the scene of this accident.

Additional Participating Entities:

Federal Aviation Administration / Flight Standards District Office; Baton Rouge, Louisiana
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/N48TZ



Location: Gonzales, LA
Accident Number: CEN17LA328
Date & Time: 08/17/2017, 0927 CDT
Registration: N48TZ
Aircraft: BEECH A36
Aircraft Damage: Substantial
Defining Event: Loss of engine power (partial)
Injuries: 2 None
Flight Conducted Under: Part 91: General Aviation - Instructional 

On August 17, 2017, about 0927 central daylight time, a Beech A36 airplane, N48TZ, was substantially damaged during a forced landing after departing from the Louisiana Regional Airport (REG), Gonzales, Louisiana. The pilot and flight instructor were not injured. The airplane was registered to and operated by Gulf Central Aviation LLC under the provisions of Title 14 Code of Federal Regulations Part 91 as an instructional flight. Day visual meteorological conditions prevailed for the local flight, which departed without a flight plan about 0926.

According to the pilot, he departed from Runway 17, following a normal engine run up and takeoff roll. After reaching about 150 ft agl, the pilot noticed the airplane was no longer climbing and lowered the airplane's nose. Based on his perceptions of a partial engine power loss, the pilot checked the throttle and mixture lever positions, both of which were full forward. After maneuvering to avoid trees, the pilot initiated a forced landing into a hay field. During the landing roll, the airplane impacted a small ridge and nosed over, which damaged the engine firewall.

Examination at the recovery location revealed the ignition harness connecting the magnetos to each of the top sparkplugs had been disconnected from the sparkplugs. All twelve sparkplugs appeared new, with no combustion deposits noted. Without authorization, a mechanic who normally performed maintenance on the airplane stated he had removed and discarded the spark plugs due to several having a worn-out condition. Not realizing the airplane should not be disturbed during the investigation, the mechanic had also removed the fuel screen.

Examination of the throttle and mixture control cables revealed proper attachment to their respective control arms. Borescope inspection of piston domes, cylinder wall surfaces, and intake and exhaust valves revealed normal wear patterns and combustion signatures, except for the No. 5 cylinder exhaust valve, which had a green crescent-shaped discoloration on the bottom of the valve face.

After the fuel screen was returned by the mechanic, an engine test run was performed. The engine rotated and ran on the first attempt but stopped after several seconds. A fuel leak was observed adjacent to the fuel pump, with a flexible fuel hose leaking at a B-nut. The nut was tightened about ¼ turn, which seated the nut onto the fitting. The engine driven fuel pump and the adjacent oil filter adapter were stained with a blue color.

A second fuel leak was observed at the throttle body/metering unit, with the fuel mixture arm and shaft bent in a manner consistent with impact damage. A second engine test run was conducted, during which power was not increased above 1,100 rpm, due to a damaged propeller. The engine was operated at varying speeds and a magneto check was accomplished, with no anomalies. The throttle was reduced to idle power and the engine ran smoothly.

The oil on the oil rod was very dark in color. A logbook review revealed the engine had accumulated 163.7 hours since the last oil and oil filter change. The manufacturer recommends oil change intervals of 50 hours for an engine equipped with external filters installed. 


Pilot Information

Certificate: Private
Age: 43, Male
Airplane Rating(s): Single-engine Land
Seat Occupied: Left
Other Aircraft Rating(s): None
Restraint Used: 3-point
Instrument Rating(s): None
Second Pilot Present: Yes
Instructor Rating(s): None
Toxicology Performed: No
Medical Certification: Class 3 Without Waivers/Limitations
Last FAA Medical Exam: 08/28/2017
Occupational Pilot: No
Last Flight Review or Equivalent: 09/19/2016
Flight Time:  302 hours (Total, all aircraft), 165 hours (Total, this make and model), 148 hours (Pilot In Command, all aircraft), 18 hours (Last 90 days, all aircraft), 11 hours (Last 30 days, all aircraft), 3 hours (Last 24 hours, all aircraft)

Flight Instructor Information

Certificate: Airline Transport; Flight Instructor
Age: 58, Male
Airplane Rating(s): Multi-engine Land; Single-engine Land
Seat Occupied: Right
Other Aircraft Rating(s): None
Restraint Used: 3-point
Instrument Rating(s): Airplane
Second Pilot Present: Yes
Instructor Rating(s): Airplane Single-engine; Instrument Airplane
Toxicology Performed: No
Medical Certification: Class 2 With Waivers/Limitations
Last FAA Medical Exam: 02/21/2017
Occupational Pilot: Yes
Last Flight Review or Equivalent: 05/12/2017
Flight Time:  (Estimated) 18100 hours (Total, all aircraft), 3000 hours (Total, this make and model), 17200 hours (Pilot In Command, all aircraft), 100 hours (Last 90 days, all aircraft), 25 hours (Last 30 days, all aircraft), 0 hours (Last 24 hours, all aircraft)

Aircraft and Owner/Operator Information

Aircraft Make: BEECH
Registration: N48TZ
Model/Series: A36
Aircraft Category: Airplane
Year of Manufacture: 1980
Amateur Built: No
Airworthiness Certificate: Normal
Serial Number: E-1804
Landing Gear Type: Retractable - Tricycle
Seats: 6
Date/Type of Last Inspection: 08/08/2016, Annual
Certified Max Gross Wt.: 3651 lbs
Time Since Last Inspection: 163 Hours
Engines: 1 Reciprocating
Airframe Total Time: 6184 Hours at time of accident
Engine Manufacturer: Continental
ELT: Installed, not activated
Engine Model/Series: IO-520
Registered Owner: GULF CENTRAL AVIATION LLC
Rated Power: 285 hp
Operator: GULF CENTRAL AVIATION LLC
Operating Certificate(s) Held: None 

Meteorological Information and Flight Plan

Conditions at Accident Site: Visual Conditions
Condition of Light: Day
Observation Facility, Elevation: KREG, 14 ft msl
Distance from Accident Site: 1 Nautical Miles
Observation Time: 0935 CDT
Direction from Accident Site: 17°
Lowest Cloud Condition: Scattered / 300 ft agl
Visibility: 10 Miles
Lowest Ceiling:
Visibility (RVR):
Wind Speed/Gusts: 6 knots /
Turbulence Type Forecast/Actual: None / None
Wind Direction: 230°
Turbulence Severity Forecast/Actual: N/A / N/A
Altimeter Setting: 30.09 inches Hg
Temperature/Dew Point: 30°C / 26°C
Precipitation and Obscuration: No Obscuration; No Precipitation
Departure Point: GONZALES, LA (REG)
Type of Flight Plan Filed: None
Destination: GONZALES, LA (REG)
Type of Clearance: None
Departure Time: 0926 CDT
Type of Airspace: Class G

Airport Information

Airport: LOUISIANA RGNL (REG)
Runway Surface Type: Asphalt
Airport Elevation: 14 ft
Runway Surface Condition: Dry
Runway Used: 17
IFR Approach: None
Runway Length/Width: 5003 ft / 100 ft
VFR Approach/Landing: Forced Landing

Wreckage and Impact Information

Crew Injuries: 2 None
Aircraft Damage: Substantial
Passenger Injuries: N/A
Aircraft Fire: None
Ground Injuries: N/A
Aircraft Explosion: None
Total Injuries: 2 None
Latitude, Longitude: 30.153889, -90.937778 (est)


NTSB Identification: CEN17LA328
14 CFR Part 91: General Aviation
Accident occurred Thursday, August 17, 2017 in Gonzales, LA
Aircraft: BEECH A36, registration: N48TZ
Injuries: 2 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 August 17, 2017, about 0927 central daylight time, a Beech A36 airplane, N48TZ, was substantially damaged during a forced landing after departing from Louisiana Regional Airport (REG), Gonzales, Louisiana. The private pilot and flight instructor were not injured. The airplane was registered to and operated by Gulf Central Aviation LLC under the provisions of 14 Code of Federal Regulations Part 91 as an instructional flight. Day visual meteorological conditions prevailed for the local flight, which departed about 0926. 

According to the pilot, the departure occurred on Runway 17, following a normal engine run up and takeoff roll. After climbing to about 150 ft agl, the pilot noticed the airplane was no longer climbing and lowered the nose. Based on his perceptions of a partial engine power loss, the pilot checked the throttle and mixture lever positions, which were both full forward. After maneuvering to avoid trees, the pilot initiated a forced landing into a hay field. During the landing roll, the airplane impacted a small ridge and nosed over, which damaged the engine firewall.

North American SNJ-4, registered to and operated by the pilot, N243CC: Accident occurred August 12, 2017 at Ashland County Airport (3G4), Ohio


The National Transportation Safety Board did not travel to the scene of this accident.

Additional Participating Entity:

Federal Aviation Administration / Flight Standards District Office; Cleveland; North Olmsted, Ohio

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/N243CC



Location: Ashland, OH
Accident Number: CEN17LA323
Date & Time: 08/12/2017, 1117 EDT
Registration: N243CC
Aircraft: NORTH AMERICAN SNJ-4
Aircraft Damage: Substantial
Defining Event: Abnormal runway contact
Injuries: 1 Serious, 1 Minor
Flight Conducted Under: Part 91: General Aviation - Personal 

On August 12, 2017, at 1117 eastern daylight time, a North American SNJ-4, N243CC, experienced a bounced landing and veered off runway 19 at Ashland County Airport (3G4), Ashland, Ohio. The airplane nosed-over, impacted terrain, and received substantial damage. The private pilot sustained serious injuries, and a passenger sustained minor injuries. The airplane was registered to and operated by the pilot under 14 Code of Federal Regulations Part 91 as a personal flight that was not operating on a flight plan. Visual meteorological conditions prevailed at the time of the accident. The flight originated from Akron Fulton International Airport (AKR), Akron, Ohio, about 1100 and was destined to 3G4.

The pilot stated that during a "wheel landing" on runway 19, the airplane bounced on touch down and during the second bounce veered off the runway into a grass area. The pilot was unable to return airplane to the runway surface because the airplane was "slipping on the grass" while he applied left rudder and left wheel brake. The airplane nosed-over when it came to a stop in the grass area and impacted the ground.

The pilot stated there was structural damage to the airframe, left wing, and empennage. He stated there was no mechanical malfunction/failure with the airplane.

The Airplane Flying Handbook (FAA-H-8083-3B) stated in part:

"Since a bounce occurs when the airplane makes contact with the ground before the proper touchdown attitude is attained, it is almost invariably accompanied by the application of excessive back-elevator pressure. This is usually the result of the pilot realizing too late that the airplane is not in the proper attitude and attempting to establish it just as the second touchdown occurs.

The corrective action for a bounce is the same as for ballooning and similarly depends on its severity. When it is very slight and there is no extreme change in the airplane's pitch attitude, a follow-up landing may be executed by applying sufficient power to cushion the subsequent touchdown and smoothly adjusting the pitch to the proper touchdown attitude."

"…When a bounce is severe, the safest procedure is to execute a go-around immediately. Do not attempt to salvage the landing. Apply full power while simultaneously maintaining directional control and lowering the nose to a safe climb attitude. The go-around procedure should be continued even though the airplane may descend and another bounce may be encountered. It is extremely foolish to attempt a landing from a bad bounce since airspeed diminishes very rapidly in the nose-high attitude, and a stall may occur before a subsequent touchdown could be made." 



Pilot Information

Certificate: Private
Age: 67, Male
Airplane Rating(s): Single-engine Land
Seat Occupied: Front
Other Aircraft Rating(s): None
Restraint Used: 4-point
Instrument Rating(s): Airplane
Second Pilot Present: No
Instructor Rating(s): None
Toxicology Performed: No
Medical Certification: Class 3 With Waivers/Limitations
Last FAA Medical Exam: 08/10/2017
Occupational Pilot: No
Last Flight Review or Equivalent: 04/25/2017
Flight Time:  1565 hours (Total, all aircraft), 71 hours (Total, this make and model), 1463 hours (Pilot In Command, all aircraft), 14 hours (Last 90 days, all aircraft), 6 hours (Last 30 days, all aircraft), 0 hours (Last 24 hours, all aircraft)

Aircraft and Owner/Operator Information

Aircraft Make: NORTH AMERICAN
Registration: N243CC
Model/Series: SNJ-4
Aircraft Category: Airplane
Year of Manufacture: 1943
Amateur Built: No
Airworthiness Certificate: Normal
Serial Number: 88-13243
Landing Gear Type: Retractable - Tailwheel
Seats: 2
Date/Type of Last Inspection: 05/16/2017, Annual
Certified Max Gross Wt.: 5265 lbs
Time Since Last Inspection:
Engines: 1 Reciprocating
Airframe Total Time: 14658.7 Hours as of last inspection
Engine Manufacturer: Pratt & Whitney
ELT: Installed, not activated
Engine Model/Series: R1340 AN-1
Registered Owner: Pilot
Rated Power: 600 hp
Operator: Pilot
Operating Certificate(s) Held: None 

Meteorological Information and Flight Plan

Conditions at Accident Site: Visual Conditions
Condition of Light: Day
Observation Facility, Elevation: MFD, 1297 ft msl
Distance from Accident Site: 13 Nautical Miles
Observation Time: 1207 EDT
Direction from Accident Site: 145°
Lowest Cloud Condition: Scattered / 2400 ft agl
Visibility:  10 Miles
Lowest Ceiling: Broken / 3100 ft agl
Visibility (RVR): 
Wind Speed/Gusts: 6 knots /
Turbulence Type Forecast/Actual: /
Wind Direction: 300°
Turbulence Severity Forecast/Actual: /
Altimeter Setting: 30.01 inches Hg
Temperature/Dew Point: 22°C / 16°C
Precipitation and Obscuration: No Obscuration; No Precipitation
Departure Point: Akron, OH (AKR)
Type of Flight Plan Filed: None
Destination: Ashland, OH (3G4)
Type of Clearance: None
Departure Time: 1100 EDT
Type of Airspace: Class E

Airport Information

Airport: Ashland County Airport (3G4)
Runway Surface Type: Asphalt
Airport Elevation: 1206 ft
Runway Surface Condition: Dry
Runway Used: 19
IFR Approach: None
Runway Length/Width: 3501 ft / 75 ft
VFR Approach/Landing: Full Stop; Traffic Pattern 

Wreckage and Impact Information

Crew Injuries: 1 Serious
Aircraft Damage: Substantial
Passenger Injuries: 1 Minor
Aircraft Fire: None
Ground Injuries: N/A
Aircraft Explosion: None
Total Injuries: 1 Serious, 1 Minor
Latitude, Longitude: 40.900000, 82.260000 (est)





NTSB Identification: CEN17LA323
14 CFR Part 91: General Aviation
Accident occurred Saturday, August 12, 2017 in Ashland, OH
Aircraft: NORTH AMERICAN SNJ-4, registration: N243CC
Injuries: 1 Serious, 1 Minor.

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 August 12, 2017, at 1117 eastern daylight time, a North American SNJ-4, N243CC, experienced a bounced landing and veered off runway 19 at Ashland County Airport (3G4), Ashland, Ohio. The airplane nosed-over, impacted terrain, and received substantial damage. The private pilot sustained serious injuries and a passenger sustained minor injuries. The airplane was registered to and operated by the pilot under 14 Code of Federal Regulations Part 91 as a personal flight that was not operating on a flight plan. Visual meteorological conditions prevailed at the time of the accident. The flight originated from Akron Fulton International Airport (AKR), Akron, Ohio, about 1100 and was destined to 3G4.

Navion Navion G Rangemaster, registered to Kalea Company LLC and operated by SkyWalker Flying, N249KC: Accident occurred August 11, 2017 near Lenawee County Airport (KADG), Adrian, Michigan

The National Transportation Safety Board did not travel to the scene of this accident.

Additional Participating Entities:

Federal Aviation Administration / Flight Standards District Office; Belleville, Michigan
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/N249KC

Location: Adrian, MI
Accident Number: CEN17LA316
Date & Time: 08/11/2017, 1200 EDT
Registration: N249KC
Aircraft: NAVION NAVION G
Aircraft Damage: Substantial
Defining Event: Loss of engine power (partial)
Injuries: 2 Serious
Flight Conducted Under: Part 91: General Aviation - Instructional 

On August 11, 2017, about 1200 eastern daylight time, a Navion G airplane, N249KC, impacted trees after a loss of engine power near Adrian, Michigan. The flight instructor and private pilot were seriously injured and the airplane sustained substantial damage. The airplane was registered to Kalea Co. LLC and operated by Sky Walker Flying under the provisions of Title 14 Code of Federal Regulations Part 91 as an instructional flight. Visual meteorological conditions prevailed at the time of the accident and a flight plan had not been filed. The local flight departed Lenawee County Airport (ADG), Adrian, Michigan, about 1000.

According to the flight instructor, the engine experienced a loss of power about 1,000 ft above ground level (agl) while over a wooded area and she was unable to glide the airplane to a nearby field. She stated to the sheriff's office that after the accident she walked to a nearby road and waited for a car to pass by for help.

The private pilot stated to the sheriff's office that he was flying the airplane and they were returning to the airport after completing training maneuvers. He stated that the engine experienced a partial loss of power about 1,500 ft agl. He added that the engine still had a little power available during the event.

The responding Federal Aviation Administration (FAA) inspector reported that the airplane was found wedged between trees with the empennage separated from the rear fuselage and engine separated from the firewall (figure 1). There was a smell of aviation fuel at the accident site.


Figure 1 – The airplane suspended above the ground and wedged between trees

A postaccident examination of the airplane was conducted by the FAA inspector and a technical representative from Continental Motors. The examination revealed that more than 4 gallons of fuel was drained from left wing tip tank, which remained intact. The right wing tip tank was found breached and had separated from the wing; there was no fuel present in the tank. The fuel gascolator, which is the low point of the center main fuel tanks, did not contain any fuel. There were fuel stain marks underneath the gascolator as it was installed on the airplane. The gascolator was removed for further testing.

An examination of the engine revealed the engine sustained impact damage concentrated mostly to the left rear side and the crankcase remained intact. All six cylinders remained attached to the engine and displayed impact damage signatures with the left side cylinders sustaining more damage than the right. The induction and exhaust systems both displayed impact damage signatures, but there were no signs of exhaust or induction leaks noted. The fuel pump was impact damaged as were several of the fuel line fittings. The throttle and metering assembly remained attached to the engine and displayed impact damage signatures; both the throttle and mixture arms were broken. The fuel manifold valve remained attached to its installation point and displayed impact damage signatures at the rear fitting. All of the fuel nozzles remained installed in their cylinders and there were no signs of fuel leaks near the nozzles. The 2 magnetos were undamaged and produced a spark at each ignition lead when manually rotated. The ignition harness displayed impact damage signatures to several of the left side cylinder ignition leads. All of the spark plugs remained installed in their cylinders and the top left spark plugs displayed impact damage signatures. The three-blade, constant speed propeller remained attached to the crankshaft and one of the blades was impact damaged. There were no pre-impact anomalies with the engine that would have precluded normal operation or production of rated horsepower.

The gascolator top and bottom seals were comprised of rubber gaskets which were meshed to a wire screen by a glass cylinder. As assembled the glass cylinder was tightened between two caps which each contained the rubber gaskets and wire mesh. The gascolator was examined by an FAA inspector who reported that there were fuel stains on the top seal and the drain valve, indicative of a fuel leak at some point during the life of the unit (figure 2).


Figure 2 – Gascolator installed on the airplane 

Sierra Hotel Aero, Inc. (SHA) holds the type certificate for the Navion. In May of 2007, SHA issued Navion Service Bulletin (SB) 106A - Fuel System - Inspection of the fuel system continued safe operation. The purpose of the SB was to require accomplishment of one time inspection of entire fuel system. This included from firewall aft for condition of all fuel lines installed including tip tanks, metal lines, fittings, hoses, vent system, vapor return, boost pump, and fuel strainer. The SB further states, inspect fuel strainer for evidence of fuel staining and leaking. Disassemble strainer and clean fuel screen. Inspect for damage and reassemble. Perform vacuum test of gascolator to include: connect hand operated vacuum pump and apply 24" of vacuum, verify bleed down does not exceed 4" over one minute, replace gaskets, fuel drain and/or gascolator as needed to ensure proper operation.

The gascolator was subjected to postaccident testing as prescribed in the Navion SB No. 106 A. The outlet port was plugged using an appropriate AN plug fitting. The gascolator was filled with clean 100LL fuel. After the fuel was added, a significant amount of foreign debris was observed floating in the gascolator. A 7-inch aluminum line with AN fittings was attached to the inlet port and the other end to the gascolator. This line was previously leak checked with no anomalies found. The inspector applied 24 inches of vacuum pressure using a hand vacuum pump; the gascolator was tested and failed to hold the required 24 inches of vacuum pressure for any amount of time. During the test the gascolator was leaking from the top seal, bottom seal, and the drain valve.

A review of the airplane maintenance logbooks revealed no record of compliance with the Navion SB No. 106 A, and there was no mention of gascolator maintenance from December 2006 to July 2017. 

Flight Instructor Information

Certificate: Flight Instructor; Commercial
Age: 52, Female
Airplane Rating(s): Multi-engine Land; Single-engine Land
Seat Occupied: Right
Other Aircraft Rating(s):
Restraint Used: Lap Only
Instrument Rating(s): Airplane
Second Pilot Present: Yes
Instructor Rating(s): Airplane Single-engine; Instrument Airplane
Toxicology Performed: No
Medical Certification: Class 2 With Waivers/Limitations
Last FAA Medical Exam: 12/01/2016
Occupational Pilot: Yes
Last Flight Review or Equivalent: 06/23/2016
Flight Time:  1700 hours (Total, all aircraft), 32 hours (Total, this make and model), 1500 hours (Pilot In Command, all aircraft), 80 hours (Last 90 days, all aircraft), 30 hours (Last 30 days, all aircraft)

Pilot Information

Certificate: Private
Age: 49, Male
Airplane Rating(s): Single-engine Land
Seat Occupied: Left
Other Aircraft Rating(s): None
Restraint Used: Lap Only
Instrument Rating(s): Airplane
Second Pilot Present: Yes
Instructor Rating(s): None
Toxicology Performed: No
Medical Certification: Class 2 With Waivers/Limitations
Last FAA Medical Exam: 01/23/2017
Occupational Pilot: No
Last Flight Review or Equivalent: 12/13/2015
Flight Time: (Estimated) 

Aircraft and Owner/Operator Information

Aircraft Make: NAVION
Registration: N249KC
Model/Series: NAVION G
Aircraft Category: Airplane
Year of Manufacture: 1964
Amateur Built: No
Airworthiness Certificate: Normal
Serial Number: NAV-4-2499
Landing Gear Type: Retractable - Tricycle
Seats: 4
Date/Type of Last Inspection: 07/05/2017, Annual
Certified Max Gross Wt.: 
Time Since Last Inspection: 5 Hours
Engines: 1 Reciprocating
Airframe Total Time: 2089.06 Hours at time of accident
Engine Manufacturer: Continental Motors
ELT: Installed, not activated
Engine Model/Series: IO-520BA
Registered Owner: KALEA CO LLC
Rated Power: 285 hp
Operator: Skywalker Flight School, LLC.
Operating Certificate(s) Held: None
Operator Does Business As: SkyWalker Flying
Operator Designator Code: 

Meteorological Information and Flight Plan

Conditions at Accident Site: Visual Conditions
Condition of Light: Day
Observation Facility, Elevation: KADG, 796 ft msl
Distance from Accident Site: 2 Nautical Miles
Observation Time: 1153 EDT
Direction from Accident Site: 355°
Lowest Cloud Condition: Clear
Visibility: 10 Miles
Lowest Ceiling: None
Visibility (RVR):
Wind Speed/Gusts: 7 knots /
Turbulence Type Forecast/Actual: /
Wind Direction: 220°
Turbulence Severity Forecast/Actual: /
Altimeter Setting: 29.99 inches Hg
Temperature/Dew Point: 22°C / 18°C
Precipitation and Obscuration: No Obscuration; No Precipitation
Departure Point: ADRIAN, MI (ADG)
Type of Flight Plan Filed: None
Destination: ADRIAN, MI (ADG)
Type of Clearance: None
Departure Time: 1000 EDT
Type of Airspace: Class E

Airport Information

Airport: LENAWEE COUNTY (ADG)
Runway Surface Type: 
Airport Elevation: 798 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: 2 Serious
Aircraft Damage: Substantial
Passenger Injuries: N/A
Aircraft Fire: None
Ground Injuries: N/A
Aircraft Explosion: None
Total Injuries: 2 Serious
Latitude, Longitude: 41.829167, -84.074444 (est)









NTSB Identification: CEN17LA316
14 CFR Part 91: General Aviation
Accident occurred Friday, August 11, 2017 in Adrian, MI
Aircraft: NAVION NAVION G, registration: N249KC
Injuries: 2 Serious.

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 August 11, 2017, about 1000 eastern daylight time, a Navion G airplane, N249KC, impacted trees after a loss of engine power near Adrian, Michigan. The flight instructor and private pilot were seriously injured and the airplane sustained substantial damage. The airplane was registered to Kalea Co. LLC and operated by Sky Walker Flying under the provisions of 14 Code of Federal Regulations Part 91 as an instructional flight. Visual meteorological conditions prevailed at the time of the accident and no flight plan had been filed. The local flight departed Lenawee County Airport (ADG), Adrian, Michigan, at an unknown time. 

The responding Federal Aviation Administration (FAA) inspector reported that the airplane was found wedged between two trees and the engine had separated from the firewall (figure 1). 

According to the flight instructor, the airplane's engine experienced a total loss of power about 1,000 ft above ground level.

The airplane has been retained for further examination.

Lockheed P2V-5F, registered to and operated by Neptune Aviation Services Inc, N410NA: Accident occurred August 05, 2017 near Pocatello Regional Airport (KPIH), Bannock County, Idaho

The National Transportation Safety Board did not travel to the scene of this accident.

Additional Participating Entities:

Federal Aviation Administration / Flight Standards District Office; Helena, Montana
Neptune Aviation; Missoula, Montana
Department of the Interior; Boise, Idaho

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/N410NA

Location: Pocatello, ID
Accident Number: WPR17LA180
Date & Time: 08/05/2017, 2000 MDT
Registration: N410NA
Aircraft: LOCKHEED P2V 5F
Aircraft Damage: Substantial
Defining Event: Flight control sys malf/fail
Injuries: 3 None
Flight Conducted Under: Public Aircraft 

On August 5, 2017, about 2000 mountain daylight time, a Lockheed P2V-5 airplane, N410NA, was substantially damaged shortly after departure from Pocatello Regional Airport (PIH), Pocatello, Idaho. The airline transport pilot, commercial pilot and mechanic were not injured. The airplane was registered to and operated by Neptune Aviation Services, Inc., Missoula, Montana, as a public aircraft under contract with the United States Forest Service. Visual meteorological conditions prevailed, and a flight plan was not filed for the local flight.

According to the pilot-in-command (PIC), the flight departed on its third mission to disperse fire retardant over a nearby wildfire. During the airplane's climb, the flight crew increased the airplane's nose up pitch by a few more degrees and the PIC subsequently responded with increasing nose down pressure. However, the down pressure control input required additional force, so the PIC used trim inputs to reduce the pressure. Moments later he observed an uncommanded aft movement of the control yoke with a simultaneous increase in the airplane's pitch attitude. He instructed the first officer (FO) to retract the flaps while he re-trimmed the elevator, but they were not able to regain pitch control. The FO attempted to adjust his trim wheel and then re-trim the airplane using the emergency varicam, but the airplane continued to maintain a pitch up attitude. He then deployed 5° of flaps at the PIC's instruction, which reduced the elevator backpressure. The PIC subsequently jettisoned the load of fire retardant over vacant farm land and then asked the FO to declare an emergency with the tower controller while the PIC entered a shallow left turn to intercept the downwind leg for Runway 21. As he made his control inputs he determined that the elevator was bound, as he received little response from the elevator control.

As the PIC had previously demonstrated the ability to land without making any adjustments to power or pitch in flight training, he elected to configure the airplane for an approach without trim or elevator control. The flight crew flew a wide traffic pattern and made small adjustments to compensate for altitude. During the final approach leg, the PIC used a combination of wing flaps and engine power for pitch up adjustments, and the crew coordinated application of elevator for trimmed pitch and turns to make their pitch down adjustments. As the airplane reached about 500 feet above ground level, the flight crew deployed the airplane's remaining 5° of flaps to increase the pitch attitude. Both the PIC and FO pulled hard on the yoke while the FO gently retarded the throttles and the PIC trimmed the emergency varicam.

Postaccident examination of the airplane revealed damage to the varicam. As this secondary control surface is directly connected to the elevators and provides a primary structural load path for all elevator loads, the damage was classified as substantial. Further examination of the varicam showed that one of the varicam actuator's outboard drive stop bolts had backed out of the drive coupling, and that the two bolts had not been safety wired. The airplane did not sustain any damage during the airplane's landing.

The PIC further stated that the airplane was re-trimmed in accordance with the airplane checklist by the FO following the previous landing and is visually inspected after each landing by the FO and the airplane's crew chief.

According to Federal Aviation Administration (FAA) records, the airplane was manufactured in 1954, and registered to Neptune Aviation Services on December 16, 2010. The airplane was powered by two outboard Westinghouse J34-WE-36A, axial flow, turbjet, 2,750 shaft horsepower (hp) engines, and two inboard Curtis Wright R-3350-32WA, twin-row, supercharged, air-cooled, 3,250 shaft hp radial engines. The airplane owner reported that its most recent 100-hour airframe and engine inspections were completed on July 10, 2017, at an accumulated flight time of 8,420.2 total flight hours. Its previous annual inspection was completed in October 2016. At the time of the accident the airplane had accrued a total of 8,486.7 total flight hours.

The company's website stated that Neptune Aviation operated a fleet of 16 firefighting airtankers, including 9 BAe 146 airplanes, and 7 Lockheed P2V airplanes. Neptune's firefighting airplanes are serviced in-house by the company's two certified repair stations located in Missoula, Montana and Alamogordo, New Mexico. The company has been operating under exclusive use contracts with the United States Forest Service for about 24 years.

The airplane was equipped with a variable camber (varicam) horizontal stabilizer in place of an elevator trim tab, mounted on the trailing edge of the fixed horizontal stabilizer. The elevators are hinged to the trailing edge of the varicam, and are kept faired with the varicam by the action of the trim tab installed on the left elevator. The purpose of this type of trim is to provide a wider range of trim movement and to permit the use of a narrow chord elevator, which results in lighter control forces and increased stability. The varicam trim is electrically controlled by switches on both the pilot and co-pilot's yokes, and the travel limitation is controlled by limit switches in the tail section.

When an elevator trim adjustment is made in the cockpit, hydraulic pressure from the main hydraulic system flows to the UP or DOWN port of the main system varicam drive motor, which rotates the varicam drive shaft to move the varicam actuators and the secondary control surface's down or up deflection. The varicam actuators are secured to the drive shaft through universal joints located at the outboard ends, comprised of two bolts that are normally threaded and safety wired to the varicam drive coupling, and two bolts with castellated nuts and cotter pins to secure the yoke to the drive stop.

Variable Camber Examination

An examination of the varicam's LH outboard drive stop and yoke displayed only one bolt that had been secured to the varicam drive stop coupling, which is normally secured to the drive stop using two bolts that are threaded into the coupling and safety wired together at their bolt heads. Photographs provided by Neptune Aviation's Director of Maintenance (DOM) showed that the second bolt was resting against the lower varicam skin, and without any safety wire in the bolt head. Further examination of the varicam did not reveal the presence of safety wire throughout the cavity of the secondary control surface.

The DOM reported that an absence of the one of the drive coupling bolts would hinder the torque capabilities of the drive shaft, thereby allowing one side of the varicam to move and the other side to remain stationary or turn incrementally, which would twist and deform part of the varicam. He further added that since the elevator is hinged to the varicam, the twisted varicam can force one of the elevators into an upward deflected position. The DOM stated that the accident airplane's left side part of the varicam was deformed, and that the left elevator was deflected upward.

Neptune Aviation uses task cards that are distributed to each mechanic prior to the corresponding work being performed. The service facility's task summary card, dated July 27, 2016, and given the numerical reference 163379-244, stated: "L/H side varicam. Universal joints for outboard drive shaft are worn on both inboard and outboard side. Also lock assembly universal joints are worn on both sides." In the notes section of the entry, a mechanic recorded "26Jul2016. Removed and Replaced three sets of universal joints on L/H varicam, inboard, and outboard sides I.A.W. NAVAIR 01-75EDA-2-3. No defects noted." The entry was stamped "M77," a designation assigned to one of the mechanics who left the company a few days after he completed this service for unrelated reasons. Task card 10-3, line "j" of the annual inspection requires the installation of the drive shafts, u-joints and drive shaft stop assembly, secured with lockwire. The entry was verified as completed with the notation of the stamp, "M77." A task card with the numerical reference 163379-17 indicated that card 10-3 was completed on July 28, 2016, at the time of the annual inspection.

Interviews

A series of interviews were conducted by the Department of Interior, Federal Aviation Administration, and the NTSB Investigator-in-Charge at Neptune Aviation's Missoula, Montana offices. Representatives of Neptune Aviation from the following positions were interviewed:

- Director of Maintenance

- Director of Operations

- Shop Manager

- Quality Assurance

Service Facility History

The DOM stated that the accident airplane was serviced at their facility in Alamogordo, New Mexico, which had been dormant until 2014 when they reactivated the repair station. Neptune's New Mexico facility employs only one daytime shift of mechanics who work from 0700 to 1730, 4 days per week. The facility does not employ any contractors and crews only work on one aircraft at a time. At the time of the annual inspection that took place in July 2016, Neptune had a total of 12 full time employees at their New Mexico location: one shop manager, a lead mechanic, a quality assurance mechanic, and 6 line mechanics, each of whom held an airframe and powerplant certificate. The facility additionally employed 3 people whose function was parts purchasing.

After the facility re-opened full time in 2014, the DOM, Assistant DOM, and Chief Inspector cross-trained the employees separately in one-week rotations. The employee who was responsible for the safety wire work in July 2016, was hired in October 2015, and his lead had been with the company since September 2014.

Required Inspection Item Procedures

Neptune's Standard Operating Procedure (SOP) guide includes criteria to designate certain task cards as required inspection items (RII). The lead mechanic is responsible for annotating "RII required" on the corresponding task cards at the time the cards are generated and assigned. From this notation, the quality assurance (QA) inspector is required to inspect the mechanic's work. Under Table 8.1 of the company's RII guidance, ATA 27, item no. 10 states: "Varicam System Components – Install/Rig/Adjust (P2V)." In the right hand column of the same table, item no. 1 states to "Check proper installation, required torque values, security, and safety." An "RII required" notation was not placed on sub-task card 163379-244, the procedure that required lockwire to secure the drive stop bolts. Although the varicam qualifies as an RII under the company SOP, the QA's oversight never registered with either the mechanic or lead mechanic.

At the request of the NTSB, FAA and DOI, the company subsequently completed an audit of the aircraft's annual inspection package and discovered a total of seven task cards that did not record a mandatory RII.

Workflow and Workday

Neptune's maintenance staff includes a shop manager who oversees the lead mechanic's activities and the operations of the overall facility. The lead mechanic is responsible for organizational planning, and normally sits at a desk located atop a podium on the shop floor, accessible to any employees who need assistance during their shift. At his side is the QA inspector who is responsible for overseeing the inspections, but reports to the Chief Inspector. The QA's main responsibility is to review any RII that are notated on a task card. To prevent any lapse in work continuity, the company trained other mechanics at its Alamogordo, New Mexico location in the company's RII procedures in the event the QA is ill or unable to complete an inspection. Part of the QA's responsibility is to also inspect areas that have not been designated as RII as part of his follow-up work, but at his own discretion.

During a normal workday, the lead mechanic will generate and assign task and sub-task cards to the line mechanics that cover different areas of the aircraft. For example, task card 163379-17 furnished specific instructions under its "Task Description" to "Comply with Card 10-3 of Annual Inspection per Neptune Aviation Services AIP." Additionally, task card 163379-16 included instructions to comply with card "10-2 of Annual Inspection…" In this case, the mechanic notated that the work had been completed with his stamp designation, "M77". This particular mechanic was further issued a sub-task card, 163379-244, part of task card 163379-16. In this entry, he notated that three sets of universal joints on the inboard and outboard sides of the L/H varicam were removed and replaced in response to the task description of the sub-task card, which stated that the universal joints for the outboard drive shaft were worn. Once the mechanic has completed the work, he gives the task cards to the lead mechanic who then sends the records to the QA inspector. In this case, the inspector stamped sub-task card 163379-244 with his designated stamp, "Q03" to indicate that the task had been processed by inspector. He additionally processed annual inspection card 10-4, which includes tasks to verify installation and safety of the varicam universal joints and mechanical stop assembly. Entry no. 2, part "a" was stamped as approved by the QA inspector for proper installation of the varicam universal joints, which could not be accomplished without safety wiring the drive stop bolts together.

Training

The DOM further reported that training for incoming and current staff mechanics for the P2V airplane consists of a one-time course that includes both hands-on and classroom training. Additionally, they send their mechanics through recurrent training when necessary. Although the company does maintain a two-year recurrent requirement on RII training, it does not currently offer recurrent training on its internal procedures for quality assurance, lead mechanics and line mechanics.

Mechanic, Lead Mechanic, and Quality Assurance Inspector

The mechanic who was responsible for safety wiring the drive coupling bolts departed the company on August 2, 2016, a few days after he serviced the varicam. At the time of the inspection he had already submitted his 2 weeks notice due to family issues.

The Director of Operations reported that the lead mechanic's employment had been terminated for poor attitude and for falsifying completed work, as he had inscribed a mechanic's name on a task card when the mechanic was not present for work. Additionally, the lead mechanic had created a stressful work environment by reviling the mechanics to expedite their work efforts. The shop manager and the lead mechanic's manager reported that the lead mechanic worked well in his position and with others until his second year, 2016, when he attempted to create a barrier between the New Mexico facility and the company's Missoula headquarters. During this time, the shop manager received complaints from several employees that the lead mechanic was not involved in the day-to-day work of the company. Additionally, he preferred to remain at his desk instead of conversing with the line mechanics and performing spot inspections.

According to the QA inspector, he had been with Neptune Aviation as a mechanic since 2010, and had been the primary QA since November 2015. He reported that the lead mechanic was too preoccupied with paperwork and spent most of his time sitting at the podium instead of completing inspections. When asked about the RII inspection process, the QA mechanic stated that although an RII requirement is not documented on the task card paperwork, the paperwork will go to the lead and then the QA will review the paperwork and stamp the work as approved despite the company's requirement for him to verify if the item is an RII. The QA then returns the paperwork to the mechanic who closes the corresponding aircraft section. 

Pilot Information

Certificate: Airline Transport; Flight Instructor; Commercial; Flight Engineer
Age: 62, Male
Airplane Rating(s): Multi-engine Land; Single-engine Land
Seat Occupied: Left
Other Aircraft Rating(s): Glider
Restraint Used: 3-point
Instrument Rating(s): Airplane
Second Pilot Present: Yes
Instructor Rating(s): Glider
Toxicology Performed: No
Medical Certification: Class 2 Without Waivers/Limitations
Last FAA Medical Exam: 12/12/2016
Occupational Pilot: Yes
Last Flight Review or Equivalent:
Flight Time:    (Estimated) 18200 hours (Total, all aircraft), 2900 hours (Total, this make and model), 15000 hours (Pilot In Command, all aircraft), 200 hours (Last 90 days, all aircraft), 75 hours (Last 30 days, all aircraft), 5 hours (Last 24 hours, all aircraft) 

Co-Pilot Information

Certificate: Commercial
Age: 45, Male
Airplane Rating(s): Multi-engine Land; Single-engine Land
Seat Occupied: Right
Other Aircraft Rating(s): None
Restraint Used: 3-point
Instrument Rating(s): Airplane
Second Pilot Present: Yes
Instructor Rating(s): None
Toxicology Performed: No
Medical Certification: Class 2 Without Waivers/Limitations
Last FAA Medical Exam: 12/15/2016
Occupational Pilot: Yes
Last Flight Review or Equivalent: 03/28/2017
Flight Time:   (Estimated) 3000 hours (Total, all aircraft), 240 hours (Total, this make and model), 2600 hours (Pilot In Command, all aircraft), 150 hours (Last 90 days, all aircraft), 85 hours (Last 30 days, all aircraft), 5 hours (Last 24 hours, all aircraft)

Aircraft and Owner/Operator Information

Aircraft Make: LOCKHEED
Registration: N410NA
Model/Series: P2V 5F H
Aircraft Category: Airplane
Year of Manufacture: 1954
Amateur Built: No
Airworthiness Certificate: Restricted
Serial Number: 131482
Landing Gear Type: Retractable - Tricycle
Seats: 3
Date/Type of Last Inspection: 07/10/2017, AAIP
Certified Max Gross Wt.: 80000 lbs
Time Since Last Inspection: 34 Hours
Engines: 4 Reciprocating
Airframe Total Time: 8486.7 Hours at time of accident
Engine Manufacturer: Westinghouse
ELT: C91A installed, not activated
Engine Model/Series: J34-WE-36A
Registered Owner: NEPTUNE AVIATION SERVICES INC
Rated Power: 2750 hp
Operator: NEPTUNE AVIATION SERVICES INC
Operating Certificate(s) Held: Agricultural Aircraft (137)

Meteorological Information and Flight Plan

Conditions at Accident Site: Visual Conditions
Condition of Light: Night
Observation Facility, Elevation: PIH, 4451 ft msl
Distance from Accident Site: 1 Nautical Miles
Observation Time: 1953 MDT
Direction from Accident Site: 
Lowest Cloud Condition:
Visibility: 6 Miles
Lowest Ceiling: Overcast / 4200 ft agl
Visibility (RVR):
Wind Speed/Gusts: 10 knots /
Turbulence Type Forecast/Actual: /
Wind Direction: 200°
Turbulence Severity Forecast/Actual: /
Altimeter Setting: 29.92 inches Hg
Temperature/Dew Point: 26°C / -2°C
Precipitation and Obscuration: Moderate - Smoke
Departure Point: POCATELLO, ID (PIH)
Type of Flight Plan Filed: None
Destination: POCATELLO, ID (PIH)
Type of Clearance: VFR
Departure Time: 2000 MDT
Type of Airspace: Class D

Airport Information

Airport: POCATELLO RGNL (PIH)
Runway Surface Type: Asphalt
Airport Elevation: 4452 ft
Runway Surface Condition: Dry
Runway Used: 21
IFR Approach: None
Runway Length/Width: 9060 ft / 150 ft
VFR Approach/Landing: Traffic Pattern 

Wreckage and Impact Information

Crew Injuries: 3 None
Aircraft Damage: Substantial
Passenger Injuries: N/A
Aircraft Fire: None
Ground Injuries: N/A
Aircraft Explosion: None
Total Injuries: 3 None
Latitude, Longitude:  42.905833, -112.590833

NTSB Identification: WPR17LA180

14 CFR Part 137: Agricultural
Accident occurred Saturday, August 05, 2017 in Pocatello, ID
Aircraft: LOCKHEED P2V 5F, registration: N410NA
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 August 5, 2017, about 2000 mountain daylight time, a Lockheed P2V-5, N410NA, was substantially damaged shortly after a departure from Pocatello Regional Airport (PIH), Pocatello, Idaho. The airline transport pilot, commercial pilot and passenger were not injured. The airplane was registered to and operated by Neptune Aviation Services, Inc. under contract with the United States Forest Service to provide aerial application services. Visual meteorological conditions prevailed and a flight plan was not filed for the local flight, which was conducted under the provisions of 14 Code of Federal Regulations Part 137. 

According to the pilot-in-command (PIC), the flight departed on its third mission to disperse fire retardant over a nearby wildfire. During the airplane's climb, the PIC observed an uncommanded aft movement of the control yoke with a simultaneous increase in the airplane's pitch attitude. He instructed the first officer (FO) to retract the flaps while he re-trimmed the elevator, but they were not able to regain pitch control. The airplane's varicam indicator showed a few degrees of nose down trim and did not change for the remainder of the flight. The FO attempted to adjust his trim wheel and then re-trim the airplane using the emergency varicam, but the airplane continued to maintain a pitch up attitude. He then deployed 5° of flaps at the PIC's instruction, which reduced the elevator backpressure. The PIC subsequently jettisoned the load of fire retardant over vacant farm land and then asked the FO to declare an emergency with the tower controller while the PIC entered a shallow left turn to intercept the downwind leg for Runway 21. As he made his control inputs he determined that the elevator was bound as he received little response from the elevator control. 

The PIC had previously demonstrated approaches to land without making any adjustments to power or pitch, so he configured the airplane for an approach without trim or elevator control. They flew a wide traffic pattern and made small adjustments to compensate for altitude. During the final approach leg, the PIC used a combination of wing flaps and engine power for pitch up adjustments, crew coordinated application of elevator for trimmed pitch, and turns to make their pitch down adjustments. As the airplane reached about 500 feet above ground level, the crew deployed the airplane's remaining 5° of flaps to increase the pitch attitude. Both the PIC and FO pulled hard on the yoke while the FO gently retarded the throttles and the PIC trimmed the emergency varicam. 

Postaccident examination of the airplane revealed damage to the varicam. As this secondary control surface is directly connected to the elevators and provides a primary structural load path for all elevator loads, the damage was classified as substantial. Further examination of the varicam showed that the varicam actuator's outboard locating bolt had backed out of the drive coupling. The bolt head had not been safety wired.