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NTSB Report

August 8, 1998 · Piper PA-31-350 · N27196

Alamosa, CO

Overview

Report Status
Final with probable cause
Event Type
Accident
Date
August 8, 1998
Injury Outcomes
No injuries (1 uninjured)
Location
Alamosa, CO
Aircraft
Piper PA-31-350
Tail Number
N27196
Operator
Air Bridge
Injuries
None
Aircraft Damage
Substantial
NTSB Number
FTW98LA350

The airplane was being ferried to its home base after both engines had received major overhauls. As the airplane approached Alamosa, the left engine lost power. Unable to restart the engine, the pilot feathered the propeller. The landing gear would only extend partially. The airplane would not maintain flying speed nor altitude and the pilot elected to make a forced landing in a cow pasture. Examination of the engine disclosed a broken coupling bolt on the right side of the turbocharger, preventing the V-band clamp from completely securing the exhaust pipe to the turbocharger, permitting hot exhaust gases to escape into the engine compartment. The turbocharger transition baffle was found partially melted and the manifold pressure line was burnt through and separated, allowing the mixture to enrich and flood the engine. Textron Lycoming Service Bulletin 240P requires all V-band couplings and gaskets to be replaced when an engine is overhauled. The failed V-band coupling was found to be rusted and discolored, suggesting it had not been replaced. Additionally, the failed manifold pressure line used was made of rubber instead of flex stainless steel line.

NTSB Probable Cause

Improper major overhaul of the engine by the overhaul facility. Factors were failure of the V-band clamp, the melting of the baffle and manifold clamp, and the pilot not being able to extend the landing gear.

Full Narrative

On August 8, 1998, approximately 1150 mountain daylight time, a Piper PA-31-350, N27196, owned by Capitol Express Airlines, Inc., and operated by Air Bridge, Inc., was substantially damaged during a forced landing at Alamosa, Colorado. The airline transport-rated pilot, the sole occupant aboard, was not injured. Visual meteorological conditions prevailed, and a VFR flight plan had been filed for the ferry flight being conducted under Title 14 CFR Part 91. The flight originated at Kansas City, Missouri, at 0733 central daylight time. Both engines had recently been overhauled by T.W. Smith Engine Co., Inc., in Cincinatti, Ohio, and the airplane was being ferried to its home base at North Las Vegas, Nevada. The airplane was then to be placed on the operating certificate of a new carrier, Air Bridge, Inc. According to the pilot's accident report, the left engine lost power as the airplane approached Alamosa. Unable to restart the engine, he feathered the propeller. When he attempted to lower the landing gear, it would only partially extend. He attempted but was unable to lower the landing gear manually. This necessitated a go around. The airplane would not maintain flying speed nor altitude due to the drag from the partially extended landing gear. The pilot decided to make a forced landing in a cow pasture about one mile south of the airport. During the ensuing landing, the airplane sustained substantial damage. On August 20, 1998, the left engine, a Lycoming TIO-540-J2BD (s/n L-4489-61A), was examined and functionally tested at the facilities of Mountain View Aeromotive, Alamosa, Colorado. In attendance were representatives of AIG Aviation and T.W. Smith Engine Co., Inc. The Federal Aviation Administration, Textron Lycoming Engines, and Hartzell Propellers chose not to participate. According to reports submitted by Mr. Ronald L. Ecord of Mountain View Aeromotive and Mr. Myron Carlson of AIG Aviation, a broken coupling bolt was noted on the right side of the turbocharger, preventing the V-band clamp from completely securing the exhaust pipe to the turbocharger. This would allow extremely hot exhaust gases to escape into the engine compartment. The turbocharger transition baffle was found to be partially melted and the manifold pressure line leading to the differential pressure controller was burnt through and was separated. This condition would allow the mixture to enrichen and the engine to flood. Its attachment fitting was also partially melted. Without changing the damaged parts, the engine was placed in a test cell and started. Maximum manifold pressure attained was 29 inches and the engine ran rich at all power settings. To simulate the pilot's action, the mixture was placed in the full rich position and the throttle was closed. The engine quit. The damaged manifold pressure line was replaced with a new one and the engine restarted. Maximum manifold pressure attained was 42 inches. The mixture was placed in the full rich position. When the throttle was closed, the engine did not quit but continued to operate at idle power. According to Textron Lycoming Service Bulletin 240P, dated May 4, 1998, all V-band couplings and gaskets are to be replaced when an engine is overhauled. The failed V-band coupling was found to be rusted and discolored. Its condition suggests it had not been replaced. Additionally, the failed manifold pressure line was made of rubber instead of a flex stainless steel line.

Flight

Event TypeAccident
Event Time11:50 MDT
Nearest Airport0nm
Runway0
Flight Plan FiledNone
Aircraft FireNo
Aircraft ExplosionNo

Aircraft

AircraftPiper PA-31-350
Tail NumberN27196
Aircraft CategoryAir
DamageSubstantial
OperatorAir Bridge
Operating RulePart 91
Engines2
Engine TypeReciprocating
Engine DetailsLycoming · TIO-540-J2BD · Reciprocating · 350
Seats10

People & Injuries

Injury SummaryNo injuries (1 uninjured)
Fatal0
Serious0
Minor0
Uninjured1
Total1
Crew 1Age 52 · Second Class

Conditions

ConditionsVMC
LightDaylight
Wind240° @ 7 kt
Visibility10 sm
CeilingNone
Temperature / Dew Point43 C
Altimeter30.00 inHg
Observation Time17:52
Weather SourceWFAC

Appendix: Source Data