ERA09FA343

A loss of engine power due to oil exhaustion from the fracture of the nipple for the engine oil cooler return line. Contributing to the accident was the mechanic's signoff and release of the airplane without performing the required engine run-up following an annual inspection.

On the initial flight following an incomplete annual inspection, the airplane experienced a total loss of engine power and impacted a tree during the resultant forced landing. The airframe and powerplant (A&P) with an inspection authorization (IA) rated mechanic reported that he signed off the logbooks with the expectation that another mechanic would perform an engine run-up prior to flight. Federal Aviation regulations did not allow delegation of authority with regards to the inspection and that the IA must perform the inspection prior to approving the airplane for return to service. The accident pilot arrived to the maintenance facility prior to the A&P mechanic, retrieved the logbooks that were signed off, and departed. Oil was noticed on the taxiway that services the maintenance facility, in the engine run-up area, and leading to the runway. The oil cooler return line attach nipple was fractured and gouges were noted on the surface of the hose end socket caused by an inadvertent contact by a wrench slipping off of a nearby bolt or nut and striking the surface of the hose end socket. Results of toxicology testing were consistent with recent use of marijuana and amphetamine. It could not be determined whether impairment due to such use may have played a role in the accident.

HISTORY OF FLIGHT On June 13, 2009, about 1614 eastern daylight time, a Cessna 177RG, N52670, crashed while making a forced landing in a hotel parking lot in Gilford, New Hampshire. Visual meteorological conditions prevailed, and no flight plan was filed. The flight departed Laconia Municipal Airport (LCI), Laconia, New Hampshire about, 1612 with an intended destination of Portland International Jetport (PWM), Portland, Maine. Two planned intermediate stops at Eastern Slopes Regional Airport (IZG), Fryeburg, Maine, and Wiscasset Airport (IWI), Wiscasset, Maine, were scheduled. The certificated airline transport pilot was fatally injured. The personal flight was conducted under Title 14 Code of Federal Regulations (CFR) Part 91. The fixed base operator lineman, at LCI pulled the airplane out of a hangar at the request of the pilot and witnessed the pilot begin a preflight inspection of the airplane. Approximately 5 minutes later the lineman heard the pilot attempt to start the airplane several times. He also reported that the engine "backfired or popped" twice; however, the engine started and the pilot began his taxi out for takeoff. The lineman returned to his work and did not observe the airplane taxi out to the runway. Numerous eyewitnesses who observed the airplane after takeoff reported that there was "no engine noise." The airplane's left wing and left horizontal stabilizer struck a tree approximately 55 feet tall, and the stabilizer was found in the lower branches of the tree. The airplane was then observed to bank to the right and then roll wings level, just prior to impacting a second tree near ground level. Several witnesses reported seeing "large quantities of fuel" coming out of the wings, and smoke emanating from the engine area. PERSONNEL INFORMATION The pilot, age 50, held an Airline Transport Pilot (ATP) certificate, with a rating for airplane multi-engine land, and a commercial pilot certificate with a rating for airplane single-engine land. His most recent FAA first-class medical certificate was issued on December 5, 2008. At that time, the pilot reported a total flight time of 6,820 hours. AIRCRAFT INFORMATION The airplane was manufactured in 1977 and was equipped with a Lycoming IO-360-A1B6D engine. The most recent annual inspection was accomplished on June 12, 2009, and maintenance records indicated the airplane had 4,637.8 total hours at that time. The engine was factory overhauled by Lycoming and installed in the accident airplane in May, 2002. At the last annual inspection the engine had a total time in service of 237.8 hours since overhaul. At the time of the accident the airplane was on its first flight since the completion of the annual inspection. METEOROLOGICAL INFORMATION The 1615 recorded weather observation at LCI included wind from 310 degrees at 4 knots; visibility 10 miles, a few clouds at 10,000 feet above ground level, temperature 25 degrees C, dew point 9 degrees C; altimeter 29.89 inches of mercury. AIRPORT INFORMATION LCI was located at an elevation of 545 feet mean sea level. The airport was located 3 miles northeast of Laconia, New Hampshire. There was no Air Traffic Control Tower located at the airport. The airport was equipped with a single asphalt runway designated as 8/26 which measured 5,890 feet long and 100 feet wide, and had a lake located 422 feet off the departure end of runway 26. An examination of the airport taxiways revealed that there was an oil trail on the taxiway beginning approximately 600 feet from the engine run-up area, along the taxiway that services the maintenance facility that performed the 100 hour inspection on the airplane. There was a noticeable thin film refraction of oil in the engine run-up area approximately 3 feet by 4 feet, and a trail of oil on the taxiway leading from the engine run-up area and the runway. WRECKAGE AND IMPACT INFORMATION An on scene investigation by the National Transportation Safety Board (NTSB) revealed that the airplane came to rest upright against a tree, adjacent to a hotel parking lot, 5,316 feet from the departure end of runway 26. The distance from the first tree strike to the wreckage was 121 feet and the wreckage path was oriented on a 289 degree heading. The section of the airplane aft of the firewall to the rudder was oriented on a 332 degree heading, and the engine was found rotated approximately 80 degrees to the right of the longitudinal center line of the airplane. The tail cone was bent up just aft of the baggage compartment, and the bottom of the rudder, which remained attached to the vertical stabilizer, came to rest on the hood of a parked car. Both wings exhibited leading edge crushing. The right wing had impact damage similar in diameter to the last tree struck by the airplane., the right wing flap was found fully extended but moved freely on the tracks. The left wing was bent down approx 55 degrees, starting at the inboard end of the aileron. The left wing flap was found in the fully retracted position. Flight control continuity was verified from the cockpit to all flight control surfaces, and to the fracture point on the left horizontal stabilizer. The main landing gear was found in the up and locked position and the nose landing gear was in the down and unlocked position. The forward door post of the right side passenger door was crushed aft. The cockpit throttle, mixture, and propeller controls were found in the full forward position. The flap selector was found with a 10 degree flap setting and the flap indicator indicated 20 degrees of flaps, however the flap drive mechanism was found with an extension of 4 inches which correlated to a flaps-retracted setting. All engine mounts were fracture-separated, and the engine was attached to the firewall by cables and electrical wires. There was no rotational scoring on the propeller blades or the spinner. One propeller blade had impact marks similar to those associated with impacting a tree. The propeller governor remained secure on the mounting pad and showed no evidence of leaking. The governor control arm assembly was impact separated. The governor was removed and the gasket screen was clean. The governor drive coupling was intact and rotated freely by hand and the unit contained a residual amount of oil. The fuel pump was fractured near the mounting flange. The fuel pump drive mechanism, diaphragms, and valves remained intact. The fuel hoses were impact damaged. The injector servo was impact-separated from the intake manifold; the throttle valve was in the full open position. The injector inlet screen and main fuel strainer were free of debris. The oil sump was impact separated; however, there was no evidence of pre-impact oil loss on any of the fracture surfaces. There was no indication of oil streaming from the fracture surface onto the engine cylinders. Oil was noted on the oil cooler, lower right hand cowling, and along the lower right side and belly of the fuselage. The oil cooler return hose was found fractured at the hose end nipple fitting, where the nut attached to the engine oil return boss fitting near the top of the rear accessory case. The oil cooler and return hose were displaced from their normal mounting positions, while the inlet hose to the cooler remained undamaged. The oil return line nipple fitting and accessory case was completely devoid of oil. The associated broken nipple and socket on the return line to the engine was coated in oil. Gouges were observed on the surface of the hose end socket similar to marks made from contact from a wrench or tool. The engine was examined and partially disassembled. Approximately 2 ounces of oil were extracted from the entire engine oil system. The oil filler cap was secure, but the oil quantity indicator rod was devoid of oil. Crankshaft continuity was confirmed visually; and all four engine connecting rod bearings had signatures similar to