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NTSB Report
September 17, 1989 · Mooney M20E · N9462V
Brenham, TX
Overview
Report Status
Probable Cause
Event Type
Accident
Date
September 17, 1989
Injury Outcomes
2 injuries (2 minor injuries)
Location
Brenham, TX
Aircraft
Mooney M20E
Tail Number
N9462V
Operator
Hall David W
Injuries
Minor
Aircraft Damage
Substantial
NTSB Number
FTW89LA167
DURING CRUISE AT 6500 FT, OIL APPEARED ON THE WINDSCREEN. FORWARD VISIBILITY WAS SOON RESTRICTED & SEVERE VIBRATIONS PROMPTED THE PLT TO SECURE THE ENG. SUBSEQUENTLY, THE ACFT WAS DMGD WHEN IT HIT A SMALL TREE & ENCTRD UNEVEN TERRAIN DRG A FORCED LNDG. INV REVEALED A 90 DEG ALUMINUM FITTING ON THE PROP GOVERNOR OIL LINE HAD FAILED WHERE IT ENTERED THE ENG CASE. THE OIL LINE WAS STAINLESS STEEL & ITS MOVEMENT WAS DESIGNED TO BE RESTRAINED BY CLAMPS, WHICH WERE NOT IN PLACE. A SVC INSTRN, ISSUED IN 1986, RCMNDD THAT ALUMINUM FITTINGS BE UPGRADED TO STAINLESS STEEL. A SVC BULLETIN DATED 9/8/89 RELATED TO NUMEROUS 'ENGINE FAILURES DUE TO OIL STARVATION RESULTING FROM BROKEN GOVERNOR LINES.' ACCORDING TO THAT BULLETIN, FAILURE TO RE-INSTALL THE GOVERNOR LINE CLAMPS AFTER MAINT HAD BEEN THE CAUSE OF NUMEROUS ENG FAILURES. MAINT PERSONNEL ACCOMPLISHED BOTH A TOP OVERHAUL & AN ANNUAL INSPN, 50 & 12 HRS, RESPECTIVELY, BFR THE ACDNT.
NTSB Probable Cause
IMPROPER MAINTENANCE, IMPROPERLY SECURED OIL LINE TO THE PROPELLER GOVERNOR, FAILURE OF THE PROPELLER GOVERNOR OIL LINE, AND SUBSEQUENT LOSS OF OIL, WHICH RESULTED IN OIL EXHAUSTION. FACTORS RELATED TO THE ACCIDENT WERE: FAILURE OF MAINTENANCE PERSONNEL TO FOLLOW THE SERVICE BULLETIN/INSTRUCTION, AND THE TREE AND ROUGH TERRAIN IN THE EMERGENCY LANDING AREA.
Full Narrative
DURING CRUISE AT 6500 FT, OIL APPEARED ON THE WINDSCREEN. FORWARD VISIBILITY WAS SOON RESTRICTED & SEVERE VIBRATIONS PROMPTED THE PLT TO SECURE THE ENG. SUBSEQUENTLY, THE ACFT WAS DMGD WHEN IT HIT A SMALL TREE & ENCTRD UNEVEN TERRAIN DRG A FORCED LNDG. INV REVEALED A 90 DEG ALUMINUM FITTING ON THE PROP GOVERNOR OIL LINE HAD FAILED WHERE IT ENTERED THE ENG CASE. THE OIL LINE WAS STAINLESS STEEL & ITS MOVEMENT WAS DESIGNED TO BE RESTRAINED BY CLAMPS, WHICH WERE NOT IN PLACE. A SVC INSTRN, ISSUED IN 1986, RCMNDD THAT ALUMINUM FITTINGS BE UPGRADED TO STAINLESS STEEL. A SVC BULLETIN DATED 9/8/89 RELATED TO NUMEROUS 'ENGINE FAILURES DUE TO OIL STARVATION RESULTING FROM BROKEN GOVERNOR LINES.' ACCORDING TO THAT BULLETIN, FAILURE TO RE-INSTALL THE GOVERNOR LINE CLAMPS AFTER MAINT HAD BEEN THE CAUSE OF NUMEROUS ENG FAILURES. MAINT PERSONNEL ACCOMPLISHED BOTH A TOP OVERHAUL & AN ANNUAL INSPN, 50 & 12 HRS, RESPECTIVELY, BFR THE ACDNT.
Flight
Event TypeAccident
Event Time11:54 CDT
Nearest Airport0nm N
Runway0
Flight Plan FiledVFR
Aircraft FireNo
Aircraft ExplosionNo
Aircraft
AircraftMooney M20E
Tail NumberN9462V
Aircraft CategoryAir
DamageSubstantial
OperatorHall David W
Operating RulePart 91
Engines1
Engine TypeReciprocating
Engine DetailsLycoming · IO-360-A1A · Reciprocating · 200
Seats4
People & Injuries
Injury Summary2 injuries (2 minor injuries)
Fatal0
Serious0
Minor2
Uninjured0
Total2
Crew 1Age 63 · Third Class
Conditions
ConditionsVMC
LightDaylight
WindCalm
Visibility9 sm
CeilingNone
Temperature / Dew Point0 C
Altimeter0
Weather SourcePILO