The pilot was going to perform a local flight for the first time after an overhauled engine was installed on the Piper PA-28-201T.
During engine ground operations, no leaks were noted, and the engine operated normally.
After takeoff, he flew around the traffic pattern at the airport in Versailles, Missouri, and accomplished a touch-and-go landing. During the climbout, at 400′ to 500′ above ground level, the engine lost total power. The pilot conducted a forced landing to a field.
During the landing roll, the left wing hit a metal fence post, which resulted in substantial damage to the airplane.
A post-accident examination revealed that the inlet tee fitting on the throttle body/fuel metering unit was missing a cap fitting, which was subsequently found between the Nos. 3 and 5 cylinders.
After the cap fitting was reinstalled, the engine was restarted and ran normally.
The mechanic who installed the overhauled engine stated that the cap fitting was in its proper place during the installation of the engine and that he had not disturbed the cap fitting during the maintenance that was performed before the maintenance check flight.
The repair station’s quality control manager reported that an inspector checked all of the engine fittings to verify that they were secure. During the engine test run, the tee fitting was not disturbed because it was not used to attach the gauge for the fuel system checks, and the engine met all performance objectives of the test run.
The engine experienced a total loss of power due to fuel starvation when the cap fitting came off the inlet tee fitting on the throttle body/fuel metering unit. However, the available evidence was not sufficient to determine how the cap fitting became loose and displaced from its installed location.
Probable cause: The total loss of engine power due to fuel starvation when the cap fitting came off the inlet tee fitting on the throttle body/fuel metering unit.
NTSB Identification: CEN18LA065
This December 2017 accident report is provided by the National Transportation Safety Board. Published as an educational tool, it is intended to help pilots learn from the misfortunes of others.
Absolutely, this crap about passing the buck has gone far enough !!! Someone needs to be held accountable for all this bad wrenching and not facing up to the person responsible. What if someone had gotten serious hurt or worse, then what, some more buck passing? they call themselves professionals (mechanics) if you ask me, nothing but ripoff shoddy type of work, I would be damn pissed if I had just paid for an engine o/haul & ended crashing my airplane for the lack of a,” alleged mechanic” tightened B nut !!! I would definitely hire an attorney !!
It’s unfortunate that the mechanic, or the pilot, didn’t ‘put a wrench’ on every fastener on the engine, and check the torque on critical bolt/nuts.!
An engine is the most unreliable after any work is done on it, and a new or overhauled engine is more so., for about the first 50 hours. Then there is the next 1,800 hours [ or more ], of useful life.
With all the connections to be made installing an engine, which includes the fuel lines, why not check all the other parts ?
It has always bothered me that there is no way to safety wire a B-nut…maybe a tabbed washer could be devised, like on the carb screws.?
“B” nuts can be safety wired due to a small hole on the side of the B nut. At least most can, and you can always use one that has a safety hole in it,
The problem is that many owners think they are licensed A&P . Most should just keep their hands off, besides being illegal it’s just plain stupid.
I looked over the collection that I have assembled for my current project and I did not find any of them that had a hole through which they could be safety wired. They were sourced through the usual outlets, Wicks and Aircraft Spruce and they were for -4 and -6 tubing. Maybe some out there do have that feature but it does not appear that the current stock available to GA does not. It would certainly be a nice feature but lacking that I would make an application of Torque Seal after it is tightened to indicate that it has been tightened to specification (not just assembled to finger tight) and also to indicate if it has moved since then.
I have about 8 AN hose/ tubing fittings on my old Cessna’s fuel system, and none have any means for safety wire. Torque seal works, but some of the fittings are under the floor and are not readily visible.
Using locktite blue thread lock is possible, but I don’t know if it’s legal on certified aircraft.?
A new engine install would REQUIRE all fittings be tested. The guy should sue the mechanics.
Great idea! Get lawyers involved, that will fix everything! Especially the lawyers bank accounts…