Sunday, May 19, 2019

Loss of Engine Power (Partial): Piper PA-22-135 Tri-Pacer, N2591A; accident occurred August 14, 2017 near Panola County Airport (4F2), Texas


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

Additional Participating Entities:

Federal Aviation Administration / Flight Standards District Office; Irving, Texas
Lycoming Engines; Williamsport, Pennsylvania 

Aviation Accident Final Report - National Transportation Safety Board: https://app.ntsb.gov/pdf 


Investigation Docket - National Transportation Safety Board:

https://dms.ntsb.gov/pubdms

Aviation Accident Data Summary - National Transportation Safety Board:  https://app.ntsb.gov/pdf


http://registry.faa.gov/N2591A



Location: Beckville, TX
Accident Number: CEN17LA317
Date & Time: 08/14/2017, 1017 CDT
Registration: N2591A
Aircraft: PIPER PA22
Aircraft Damage: Substantial
Defining Event: Loss of engine power (partial)
Injuries: 1 Minor
Flight Conducted Under: Part 91: General Aviation - Aerial Observation 

Analysis 

The commercial pilot reported that, about 2 hours into the pipeline surveillance flight, the engine began running roughly. He initially established a course to a nearby airport; however, the engine was not producing enough power to maintain altitude. He subsequently executed a forced landing to a pasture, which resulted in substantial damage to the left wing.

A postaccident engine examination revealed that the No. 3 cylinder exhaust valve fractured at the stem seat. Metallurgical examination revealed that the fracture features were consistent with torsional loading at fracture. The stem was tapered adjacent to the fracture, and interconnected voids and surface oxidation were observed at the fracture surface. The presence of voids, tapering of the stem, and oxidation are consistent with high-temperature deformation under stress. Further examination revealed grain structure and subsurface oxidation consistent with exposure to elevated temperatures over an extended period of time, consistent with a stuck valve condition.

Factors leading to stuck exhaust valves include excessive engine temperature, dirty or contaminated engine oil, high lead content fuels, hot engine shut-downs, and poor engine baffling. Running engines past the recommended overhaul interval or at elevated temperatures risks creating an exhaust valve fatigue event. The investigation was unable to determine the exact combination of elements that led to the stuck valve. However, based on the available maintenance records, the most recent engine overhaul was completed in 1968, and it is likely that the extended 49-year interval contributed to the stuck valve. While this exceeded the engine manufacturer's 12-year or 1,500-hour time between overhaul interval, the operator was not required to comply under current regulations due to the type of operation.

Probable Cause and Findings

The National Transportation Safety Board determines the probable cause(s) of this accident to be:
A stuck exhaust valve, which resulted in the failure of the valve and a loss of engine power. Contributing to the valve failure and loss of engine power was the extended time since the last overhaul. 

Findings

Aircraft
Recip eng cyl section - Failure (Cause)
Recip eng cyl section - Fatigue/wear/corrosion (Cause)
Engine (reciprocating) - Not serviced/maintained (Factor)

Factual Information

On August 14, 2017, about 1017 central daylight time, a Piper PA22-135 airplane, N2591A, was substantially damaged during a forced landing following a partial loss of engine power near Beckville, Texas. The pilot sustained minor injuries. The airplane was registered to and operated by private individuals as a Title 14 Code of Federal Regulations Part 91 flight. Day visual meteorological conditions prevailed. The flight was not operated on a flight plan. The pipeline surveillance flight originated from Cypress River Airport (24F), Jefferson, Texas, about 0800. The intended destination was the Gladewater Municipal Airport (07F), Gladewater, Texas.

The pilot reported fueling the airplane at 24F before departing on his planned pipeline surveillance route. About 2 hours into the flight, en route to 07F, the engine began running rough. He initially established a course to Panola County Airport (4F2) about 8 miles away. However, the engine was not producing enough power to maintain altitude. He subsequently executed a forced landing to a pasture, which resulted in substantial damage to the left wing.

A postaccident engine examination revealed that the no. 3 cylinder exhaust valve fractured at the stem seat. The intake valve appeared intact. The cylinder walls exhibited impact and scraping marks consistent with secondary damage from the separated exhaust valve head. The piston had fractured at several locations; the features appeared consistent with overstress fractures. The piston crown exhibited multiple impact marks similar to the cylinder walls.

Metallurgical examination revealed that the fracture surface on the separated valve head was obliterated consistent with secondary mechanical damage after separation from the stem. The mating fracture surface on the stem was relatively undamaged. The fracture features were consistent with torsional loading at fracture. The stem was tapered adjacent to the fracture, and interconnected voids were observed at the fracture surface. Surface oxidation, sub-surface intergranular oxidation and deposits of lead-based compounds were also observed. The presence of the voids, the tapering of the stem, and the oxidation are consistent with high-temperature deformation under stress. Further examination revealed grain structure and sub-surface oxidation consistent with exposure to elevated temperatures over an extended period of time.

The available airplane maintenance records included an entry, dated April 5, 1968, that noted: "major overhaul of engine this date;" the associated tachometer time was 1,153 hours. No subsequent entries regarding an engine overhaul were observed in the records. The most recent annual inspection was completed on April 22, 2017, at 1,770.4 hours tachometer time. The current owner purchased the airplane on April 23, 2017. The most recent engine maintenance consisted of an oil change on August 1, 2017. The tachometer indicated 1,986.5 hours at the accident site.

The engine manufacturer recommended time between overhaul (TBO) was 1,500 hours operating time or 12 calendar years. Federal Aviation Administration regulations do not require Part 91 operators to comply with an engine manufacturer's TBO interval provided the engine meets annual inspection requirements. 

History of Flight

Enroute-cruise
Powerplant sys/comp malf/fail
Loss of engine power (partial) (Defining event)

Emergency descent
Off-field or emergency landing


Pilot Information

Certificate: Commercial
Age: 60, Male
Airplane Rating(s): Single-engine Land
Seat Occupied: Left
Other Aircraft Rating(s): None
Restraint Used: Lap Only
Instrument Rating(s): None
Second Pilot Present: No
Instructor Rating(s): None
Toxicology Performed: No
Medical Certification: Class 2 With Waivers/Limitations
Last FAA Medical Exam: 04/18/2017
Occupational Pilot: Yes
Last Flight Review or Equivalent: 06/26/2016
Flight Time:  5941 hours (Total, all aircraft), 203 hours (Total, this make and model), 240 hours (Last 90 days, all aircraft), 70 hours (Last 30 days, all aircraft), 2 hours (Last 24 hours, all aircraft)



Aircraft and Owner/Operator Information

Aircraft Manufacturer: PIPER
Registration: N2591A
Model/Series: PA22 135
Aircraft Category: Airplane
Year of Manufacture: 1952
Amateur Built: No
Airworthiness Certificate: Normal
Serial Number: 22-876
Landing Gear Type: Tailwheel
Seats: 2
Date/Type of Last Inspection: 04/22/2018, Annual
Certified Max Gross Wt.: 2000 lbs
Time Since Last Inspection: 216 Hours
Engines: 1 Reciprocating
Airframe Total Time: 1986 Hours at time of accident
Engine Manufacturer: LYCOMING
ELT: Installed, not activated
Engine Model/Series: O-290-D2
Registered Owner: Steve Chance
Rated Power: 135 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: GGG, 365 ft msl
Observation Time: 0953 CDT
Distance from Accident Site: 20 Nautical Miles
Direction from Accident Site: 323°
Lowest Cloud Condition: Scattered / 1000 ft agl
Temperature/Dew Point: 27°C / 26°C
Lowest Ceiling: None
Visibility:  8 Miles
Wind Speed/Gusts, Direction: 8 knots, 230°
Visibility (RVR):
Altimeter Setting: 29.91 inches Hg
Visibility (RVV):
Precipitation and Obscuration: No Obscuration; No Precipitation
Departure Point: Jefferson, TX (24F)
Type of Flight Plan Filed: None
Destination: Gladewater, TX (07F)
Type of Clearance: None
Departure Time: 0800 CDT
Type of Airspace: Class G

Wreckage and Impact Information

Crew Injuries: 1 Minor
Aircraft Damage: Substantial
Passenger Injuries: N/A
Aircraft Fire: None
Ground Injuries: N/A
Aircraft Explosion: None
Total Injuries: 1 Minor
Latitude, Longitude:  32.243611, -94.455833 (est)

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