Aviation Accident Summaries

Aviation Accident Summary MIA95LA127

N. MIAMI BEACH, FL, USA

Aircraft #1

N3482W

PIPER PA-32-260

Analysis

SHORTLY AFTER TAKEOFF THE PILOT OBSERVED THAT THE OIL PRESSURE BEGAN DECREASING. HE TURNED TO RETURN TO THE DEPARTURE AIRPORT BUT THE ENGINE FAILED AND THE AIRPLANE CRASHED INTO A LAKE NEAR THE AIRPORT. THE AIRPLANE WAS RECOVERED AND EXAMINATION OF THE ENGINE REVEALED THAT AN OIL HOSE FROM THE OIL PUMP TO THE OIL COOLER INLET FAILED IN TWO PLACES INSIDE THE PROTECTIVE FIRE SLEEVE. THE FIRE SLEEVE WAS OIL SOAKED AND INTERNALLY FOUND TO CONTAIN METAL PARTICLES. THE FAILED OIL HOSE WAS MANUFACTURED IN THE THIRD QUARTER OF 1987 AND INSTALLED FOLLOWING ENGINE OVERHAUL ON JULY 22, 1987. FURTHER EXAMINATION OF THE ENGINE REVEALED THAT THREE OF THE SIX CYLINDER CONNECTING RODS FAILED DUE TO LACK OF LUBRICATION. THE REMAINING THREE CONNECTING RODS WERE FOUND TO BE HEAT DISTRESSED AND THEIR ASSOCIATED ROD BEARINGS EXTRUDED. REVIEW OF THE ENGINE LOGBOOK REVEALED THAT THE ENGINE HAD BEEN OPERATED FOR ABOUT 53 HOURS SINCE THE LAST INSPECTION IN NOVEMBER 1994.

Factual Information

On May 5, 1995, about 1024 eastern daylight time, a Piper PA-32-260, N3482W, registered to R & D Aero Service, Inc., crashed in a lake shortly after takeoff from the Opa-Locka Airport, Opa-Locka, Florida, while on a 14 CFR Part 91 personal flight. Visual meteorological conditions prevailed at the time and a VFR flight plan was filed for the flight to Nassau, Bahamas. The airplane was substantially damaged and the commercial-rated pilot, the sole occupant, sustained minor injuries. The flight originated about 1020. The pilot stated that when the flight was about 1/2 mile west of the shoreline at 1,300 feet [mean sea level] flying eastbound, he observed that the oil pressure began decreasing. He turned to return and observed that the oil pressure indicating needle was "in the red." Unable to maintain altitude and land at the departure airport, he crashed the airplane into a lake about 4 nautical miles east-northeast from the departure airport. The airplane was recovered from the lake and examination revealed that the right wing separated at the wing root. Additionally, oil stains were noted on the left side of the fuselage aft of the engine assembly and also on the bottom of the fuselage. The engine was removed from the airplane for further examination. Examination of the engine revealed that an oil hose from the engine-driven oil pump to the oil cooler inlet failed in two places inside the fire sleeve. The fire sleeve was found to be oil soaked and contained metal particles. The data tag attached to the failed oil hose indicated that it was manufactured in the third quarter of 1987 and pressure tested in July 1987. Examination of the failed hose revealed that it was hardened. Further examination of the engine revealed that cylinder Nos. 4, 5, and 6 connecting rods failed at the crankshaft end due to lack of lubrication. Cylinder Nos. 1, 2, and 3 connecting rods were still secured to the crankshaft, however, their associated bearings were extruded and the connecting rods were heat distressed. All oil passages in the crankshaft and crankcase halves were found to be free of obstructions. The oil pump gears were found to be intact, however, slight scoring was observed on the inside of the oil pump housing. Metal was observed in the paper element of the spin on oil filter which was properly torqued and metal was also observed in the oil suction screen. Examination of the main bearings of the crankshaft revealed that they were not heat distressed. Review of the engine logbook revealed that the engine was overhauled on July 22, 1987, and installed in the airplane on August 5, 1987. The associated entry in the engine logbook revealed that new customer supplied oil hoses were installed when the engine was installed. The engine was last inspected on November 28, 1994. The mechanic who performed the inspection indicated that he used the scope and detail of items in Appendix D of 14 CFR Part 43 as a reference. The engine had been operated for about 53 hours since the last inspection in November.

Probable Cause and Findings

INADEQUATE ANNUAL INSPECTION BY MAINTENANCE PERSONNEL FOR FAILURE TO IDENTIFY A HARDENED OIL HOSE FROM THE OIL PUMP TO THE OIL COOLER INLET INSIDE A PROTECTIVE FIRE SLEEVE. ADDITIONALLY, UNSUITABLE TERRAIN ENCOUNTERED DURING THE FORCED LANDING CONTRIBUTED TO THE ACCIDENT.

 

Source: NTSB Aviation Accident Database

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