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NTSB investigation record

ERA10FA502

Completed

Cessna 172· N84249

Date
September 25, 2010
Location
Chatsworth, GA
Conditions
VMC
Record
Published September 25, 2020

Primary finding

Probable cause

The pilot's inadequate flight planning and in-flight fuel management resulting in a total loss of engine power due to fuel exhaustion. Contributing to the accident was the operator's failure to ensure aircraft records pertaining to engine modifications and fuel burn rates were available to flight crewmembers.

Investigator assessment

Analysis narrative

Prior to departure, the pilot filed an instrument flight rules (IFR) flight plan to his destination airport and calculated a fuel burn rate of 9 gallons of fuel per hour. Approximately 2 hours and 30 minutes after departure, the pilot canceled his IFR flight plan with the air traffic controller without giving a reason and changed his destination airport. One minute later, the pilot declared an emergency with air traffic control, reporting his engine had failed. Witnesses in the vicinity of the crash site observed the airplane flying at tree top level, and reported they could not hear the engine running. The airplane made a steep right turn, struck the top of a tree, and collided with the ground. Examination of the airframe and engine revealed no anomalies. The right main fuel tank was not ruptured and contained 1 quart of fuel. The left main fuel tank was not ruptured and contained 2 1/2 gallons of fuel, 2 of which were considered unusable fuel. Review of the airplane logbooks revealed the engine horsepower had been increased to 160 horsepower, and the airplane's fuel burn rate was increased due to a modification by a Supplemental Type Certificate (STC) 8 years prior to the accident. A copy of the STC was not located in the airplane wreckage. The registered owner reported the pilot had received instruction on the STC; however, no documentation was provided substantiating this instruction. He further stated the STC only increased the fuel burn rate for the first 5 minutes of flight at takeoff power. Review of the engine Operator's Manual revealed the maximum fuel usage at full power, is about 13.6 gallons per hour. At 82 percent power the fuel burn rate is about 11.25 gallons per hour.

Source record

Factual narrative

HISTORY OF FLIGHT On September 24, 2010, at 2249 eastern daylight time, a Cessna 172K, N84249, registered to Flight Training Express (FTE) LLC, operating as a 14 Code of Federal Regulations Part 91 personal flight, collided with a tree and the ground during a forced landing in the vicinity of Chatsworth, Georgia. Visual meteorological conditions (VFR) prevailed. The certificated commercial pilot, located in the right front seat, and the private pilot rated passenger, located in the left front seat, were killed. The rear seat passenger received serious injuries. The airplane sustained substantial damage. The flight originated from Massey Ranch Airpark (X50) New Smyrna Beach, Florida. The pilot obtained an instrument flight rules clearance from Daytona Approach Control at 1908, en-route to Lovell Field Airport (CHA), Chattanooga, Tennessee. According to Chattanooga Approach Control, the pilot canceled the IFR flight plan at 2242:23 and proceeded VFR. The controller acknowledged the cancellation and informed the pilot to maintain his present transponder squawk and to report Chattanooga in sight. At 2244: 23, the pilot informed the controller that he was going to land at Dalton, Georgia, and the controller informed the pilot to report the airfield in sight. At 2245:52, the pilot stated, "and Chattanooga approach mayday, mayday, mayday, we have an engine failure". The controller replied, do you have Dalton in sight? The pilot responded we are at 2,000 feet and have the airfield in sight. The controller asked the pilot at 2246 if he was able to make the airport and he stated, "We are not sure". The pilot asked the controller at 2246:17 if he was familiar with the terrain and the controller replied negative. There was no further communication between the pilot and the controller. At 2248:09, Atlanta Air Route Traffic Control Center contacted Chattanooga approach and stated, "This is north, I don't know if you noticed but southeast of Dalton I saw the seventy seven hundred code squawking". He further stated the airplane was about 3.1 miles southeast of Dalton, Georgia. Emergency 911 operators in vicinity of Chatsworth, Georgia, received calls stating an airplane had crashed and emergency first responders arrived on scene at 2256. The rear seat passenger stated he was asleep for most of the flight. When he woke up the pilot informed him, "I think we need to land". The passenger looked at one of the fuel tank gauges and it was very low. The engine then started running rough. The pilot started switching the fuel tanks and the engine quit. The pilot declared an emergency and made a right turn. The airplane clipped a tree and the passenger later woke up in the hospital. Two witnesses located in the vicinity of the crash site observed the airplane flying towards their home north bound at tree top level. The white landing light was on and a red and green light was also visible. They could not hear the engine running as it went directly over them. The engine was whistling like a fan. The airplane made a steep right turn over the race track located near the house and came directly over their son’s house trailer. The airplane struck the top of a tree and descended nose down over a logging truck and collided with a ditch/culvert. The airplane bounced, went through a barbed wire fence, spun around, and came to rest facing back toward the trailer and was adjacent to the road. PERSONNEL INFORMATION The pilot located in the right front seat, age 24, held a commercial pilot certificate issued on August 24, 2010, with ratings for airplane single-engine land, airplane multi-engine land, and instrument airplane. In addition, the pilot held a CFI certificate with ratings for airplane single-engine land and instrument airplane issued on April 12, 2010. The pilot’s last instrument proficiency check and last flight review was conducted on September 1, 2010. The pilot’s log book was not located and his total time was not determined. The pilot held a Federal Aviation administration (FAA) first class medical certificate, issued on August 14, 2007, with the restriction, “must wear corrective lenses.” The private pilot rated passenger, located in the left front seat, age 21, held a private pilot certificate issued on June 1, 2010, with a rating for airplane single-engine land. No medical certificate was located at the crash site. Review of the FAA data base revealed the passenger held a third class medical dated April 8, 2010 with no restrictions. Review of the pilot’s log book revealed she had logged 54 total flight hours in airplane single-engine land. No flight time had been logged in the Cessna 172K. The pilot had 10.5 total hours as pilot in command. The last flight entry in her log book prior to the accident was May 30, 2010. The last flight review was conducted on June 1, 2010. AIRCRAFT INFORMATION The Cessna 172K was a four-place airplane with a fixed tricycle landing gear, serial number 17258394, manufactured in 1969. A Lycoming, 160-horsepower, horizontally-opposed four-cylinder engine powered the airplane. Review of the airplane logbooks revealed the last annual inspection was conducted on January 3, 2010, at a recorded tachometer time of 3684.6 hours. The last 100-hour inspection was conducted on September 7, 2010, at a recorded tachometer time of 4,183.1 hours. The tachometer meter at the accident site indicated 4,226.3 hours. The airplane flew 43.2 hours since the last 100-hour inspection. The engine was overhauled on May 15, 2002, by Coastal Aviation Services and has 1,695.2 hours since major over haul. The total airframe hours at the time of the accident was 5,708. The HOBBS meter was destroyed. The airplane was last refueled at Massey Ranch Air Park (X50), on September 24, 2010, with 13 gallons of 100 low lead fuel. The aircraft airworthiness certificate and aircraft registration were not located at the crash site. The airplane was modified in accordance with RAM Supplemental Type Certificate (STC) Number SE3692SW, which modified the Lycoming model O-320-E2D engine, serial number L-43485-27A, to increase 5 minute takeoff maximum power rating to 160 horsepower, in accordance with RAM Aircraft Limited Partnership. The Owner’s Manual and the FAA Form 337 including Flight Manual Supplements as required by the STC were not found in the airplane. The registered owner stated the missing items were located in a black vinyl zippered bag issued to the pilot and kept in the airplane during the flight. The black zippered bag was not located at the crash site or in the accident airplane. The registered owner stated the pilot was aware of the increase engine horsepower and fuel burn rate. In addition, he had received instruction on this, however no documentation to support this was received from FTE. An email received from the deceased left front seat passenger's family stated they had received documents from the funeral director with their daughters personal effects. The email stated a blue folder was sent with her belongings containing several documents from FTE containing aircraft information pertinent to N84249. METEOROLOGICAL INFORMATION The 2219 Dalton Municipal Airport (DNN), Dalton, Georgia, surface weather observation was: wind calm, visibility 10 miles, scattered clouds 8,500 feet, temperature 22 degrees Celsius, dew point temperature 17 degrees Celsius, and altimeter 30.10 inches of mercury. WRECKAGE AND IMPACT INFORMATION Examination of the crash site revealed the airplane grazed the top of a 75-foot tall tree in a descending attitude. The airplane collided with a culvert 127 feet down the crash debris field measured with a traffic wheel and global positioning system. The airplane rotated around its horizontal axis and came to rest on a heading of 020 degrees magnetic. The crash debris line extended 189 feet. Examination of the wreckage revealed the upper and lower engine cowling remained attached to the ai

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