Hurricane - Salt Lake City
Flight / Schedule
Hurricane - Salt Lake City
Registration
N413LL
MSN
46-36413
Year of Manufacture
2007
Operator
Keystone AviationDate
October 21, 2018 at 03:00 PM
Type
CRASHFlight Type
Private
Flight Phase
Takeoff (climb)
Crash Site
Airport (less than 10 km from airport)
Crash Location
Hurricane Utah
Region
North America • United States of America
Coordinates
37.1750°, -113.2899°
Crash Cause
Human factor
Narrative Report
On October 21, 2018 at 03:00 PM, Hurricane - Salt Lake City experienced a crash involving Piper PA-46 (Malibu/Meridian/Mirage/Matrix/M-Class), operated by Keystone Aviation, with the event recorded near Hurricane Utah.
The flight was categorized as private and the reported phase was takeoff (climb) at a airport (less than 10 km from airport) crash site.
5 people were known to be on board, 0 fatalities were recorded, 5 survivors were identified or estimated. This corresponds to an estimated fatality rate of 0.0%.
Crew on board: 1, crew fatalities: 0, passengers on board: 4, passenger fatalities: 0, other fatalities: 0.
The listed crash cause is human factor. Shortly after takeoff, the pilot smelled smoke. As he began to turn the airplane back to the airport, the engine lost total power. He conducted a forced landing in a field just short of the airport, during which the airplane struck a metal fence and pipe. All occupants egressed, and the pilot then noticed that a fire had erupted under the airplane's engine cowling. Postaccident examination revealed that the airplane sustained fire damage to the roof and forward end of the baggage compartment along with the engine accessory area between the firewall and aft air baffles. Further examination revealed that one of the engine exhaust crossover pipe assemblies was misaligned at the slip joint. An engine manufacturer service bulletin (SB) called for inspections of the exhaust system slip and flange joints to identify misaligned exhaust components. The last maintenance event occurred about 7 1/2 flight hours before the accident, during which the SB was performed and resulted in the replacement of crossover pipes. The mechanic who had performed the most recent maintenance did not follow the correct procedures for reinstallation of the crossover pipe, and the inspector who reviewed his work did not examine the installation as it progressed but instead inspected the pipes after they were installed and essentially hidden from view by their protective heat shield. As a result of the misaligned engine exhaust crossover pipe, hot exhaust gases escaped into the engine compartment and started a fire, which compromised critical engine fuel and oil lines, and resulted in the loss of engine power.
Aircraft reference details include registration N413LL, MSN 46-36413, year of manufacture 2007.
Geospatial coordinates for this crash are approximately 37.1750°, -113.2899°.
Fatalities
Total
0
Crew
0
Passengers
0
Other
0
Crash Summary
Shortly after takeoff, the pilot smelled smoke. As he began to turn the airplane back to the airport, the engine lost total power. He conducted a forced landing in a field just short of the airport, during which the airplane struck a metal fence and pipe. All occupants egressed, and the pilot then noticed that a fire had erupted under the airplane's engine cowling. Postaccident examination revealed that the airplane sustained fire damage to the roof and forward end of the baggage compartment along with the engine accessory area between the firewall and aft air baffles. Further examination revealed that one of the engine exhaust crossover pipe assemblies was misaligned at the slip joint. An engine manufacturer service bulletin (SB) called for inspections of the exhaust system slip and flange joints to identify misaligned exhaust components. The last maintenance event occurred about 7 1/2 flight hours before the accident, during which the SB was performed and resulted in the replacement of crossover pipes. The mechanic who had performed the most recent maintenance did not follow the correct procedures for reinstallation of the crossover pipe, and the inspector who reviewed his work did not examine the installation as it progressed but instead inspected the pipes after they were installed and essentially hidden from view by their protective heat shield. As a result of the misaligned engine exhaust crossover pipe, hot exhaust gases escaped into the engine compartment and started a fire, which compromised critical engine fuel and oil lines, and resulted in the loss of engine power.
Cause: Human factor
Occupants & Outcome
Crew On Board
1
Passengers On Board
4
Estimated Survivors
5
Fatality Rate
0.0%
Known people on board: 5
Operational Details
Schedule / Flight
Hurricane - Salt Lake City
Operator
Keystone AviationFlight Type
Private
Flight Phase
Takeoff (climb)
Crash Site
Airport (less than 10 km from airport)
Region / Country
North America • United States of America
Aircraft Details
Registration
N413LL
MSN
46-36413
Year of Manufacture
2007
