Pilot Debrief

PIPER PA46 - 350P near Spokane, WA — 2015-02-22

Final reportWPR15LA111
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Date
2015-02-22
Location
Spokane, WA, USA
Airport
SFF
Aircraft
PIPER PA46 - 350P
Registration
CGVZW
Category
Airplane
Highest injury
Fatal
Fatalities
1
Phase of flight
Takeoff roll

Probable cause

A total loss of engine power due to the refueler’s incorrect refueling of the airplane. Contributing to the accident was the fixed-base operator’s improper fueling nozzle, which facilitated the use of an incorrect fuel, and the pilot’s inadequate preflight inspection.

Contributing factors

Contributing to the accident was the fixed-base operator's improper fueling nozzle, which facilitated the use of an incorrect fuel, and the pilot's inadequate preflight inspection.

NTSB narrative

The pilot was conducting a cross-country flight from Canada to California and had landed to clear customs into the United States and to refuel his airplane. The pilot then departed to continue the flight. During the initial climb after takeoff, the engine experienced a total loss of power, and the pilot attempted to make an off-airport forced landing. The right wing struck railroad tracks at the top of a hill, and the airplane continued down an embankment, where it came to rest adjacent to the bottom of a railroad bridge. Postaccident interviews revealed that, when requesting fuel from the fixed-base operator (FBO), the pilot did not specify a grade of fuel to be used to service the airplane. The refueler mistakenly identified the airplane as requiring Jet A fuel, even though the fuel filler ports were placarded "AVGAS (aviation gasoline) ONLY." The fueler subsequently fueled the airplane with Jet A instead of aviation gasoline. Additionally, the fueling nozzle installed on the fuel truck at the time of the refueling was not the proper type of nozzle. Jet A and AvGas fueling nozzles are different designs in order to prevent fueling an airplane with the wrong type of fuel. Following the fueling, the pilot returned to the FBO and signed a receipt, which indicated that the airplane had been serviced with Jet A. There were no witnesses to the pilot's preflight activities, and it is unknown if the pilot visually inspected or obtained a fuel sample before takeoff; however, had the pilot done this, it would have been apparent that the airplane had been improperly fueled.

Analysis

Primary failure mode
Fuel management
First missed decision gate
Pilot did not verify fuel type before departure, leading to engine failure.

NTSB coding

Evidence available

  • Photos
  • 10 docket documents
View NTSB final reportView NTSB docket

Docket documents10

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