History of Flight
On August 23, 2013, at about 1838 Pacific daylight time, a Piper PA-28-180 airplane, N8223W, was substantially damaged when it impacted trees and terrain shortly after takeoff from runway 20 at Sacramento Executive Airport (SAC), Sacramento, California. The private pilot and certified flight instructor (CFI) received serious injuries. The instructional flight was conducted under Title 14 Code of Federal Regulations Part 91. Visual meteorological conditions prevailed, and no flight plan was filed.
The pilot had recently purchased a membership share in Capitol Flying, Inc., and enlisted the CFI to provide a checkout in the accident airplane. The accident flight was their second flight in the airplane. They planned to conduct airwork, fly to University Airport (EDU) in Davis, California, perform pattern work, then return to SAC. Preflight inspection detected no anomalies, and the airplane had about 36 gallons of fuel on board.
Engine start, taxi, runup, and takeoff roll were normal. Shortly after takeoff, the engine "sputtered" momentarily but restored to full power briefly. Both pilots believed this occurred at about 500-600 feet above ground level. Very shortly thereafter, the engine stopped producing sufficient power for flight and ran roughly. In response to the CFI's instruction, the pilot moved the fuel selector handle to switch tanks. The throttle and mixture were verified full forward, but no improvement was noted, and the airplane descended. Neither pilot could recall whether they attempted to apply carburetor heat. They turned left to attempt a landing on a golf course but struck intervening trees. Golfers extracted both pilots and summoned first aid.
Personnel Information
Pilot Under Instruction: The pilot held a private pilot certificate with airplane single-engine land rating, issued October 2011. His most recent FAA second-class medical was August 2013. He reported about 74 total flight hours, with only 0.5 hour in the accident make/model from a flight a week earlier.
Certified Flight Instructor: The CFI held instructor ratings for airplane single- and multi-engine land and instrument airplane. He estimated 7,000 total flight hours, including 500 hours in the accident make/model. His most recent FAA first-class medical was April 2013.
Aircraft Information
The airplane was manufactured in 1965 (serial 28-2356), a low-wing, fixed gear tricycle configuration with a Lycoming O-360 series engine. It was not equipped with shoulder harnesses. The airplane had flown about 3.5 hours in the week prior. The most recent annual inspection was completed in March 2013, with airframe total time about 5,714 hours and tachometer 4,476 hours. The engine had about 1,430 hours since overhaul. Subsequent maintenance included an oil change on June 15, 2013.
Meteorological Information
The SAC 1853 automated observation reported wind 200° at 7 knots, visibility 10 miles, clear skies, temperature 27°C, dew point 11°C, altimeter 29.74 inHg. Relative humidity was approximately 35 percent. The temperature/dew point intersection plotted in the region of a carburetor ice chart denoted "Serious Icing at Glide Power," near the boundary of "Icing - Glide and Cruise Power."
Wreckage and Impact Information
The wreckage was located on a golf course adjacent to SAC's southern boundary. The fuselage came to rest inverted. Both wings fracture-separated, but the cabin remained intact. The engine remained attached to its mount; no fire occurred, but firefighters sprayed the wreckage due to fuel leakage.
NTSB, FAA, Lycoming, and Piper examined the wreckage in December 2013. Flight control continuity was established. Flaps were up, stabilator trim neutral. The engine primer was in and locked; throttle, mixture, and carburetor heat controls were full forward. Carburetor heat airbox damage indicated heat was OFF at impact. The ignition switch was OFF; key absent. Master and fuel pump switches were OFF; other switches ON. Fuel selector handle was OFF; a first responder reported turning it OFF. No pre-impact mechanical failures were found in the fuel system or engine. The crankshaft rotated freely with proper compression. Magneto sparks were observed. Carburetor was clean; no contaminants. Propeller blade damage was consistent with little or no power at impact.
Additional Information
Carburetor Heat and Emergency Procedures: The airplane's checklists were for a PA-28R-180 (fuel-injected) and lacked carburetor heat procedures. The Piper Owner's Handbook mentioned checking carburetor heat before takeoff to clear ice formed during taxi. No emergency procedures were provided in the OH or AFM. The FAA and Piper stated these documents complied with certification regulations.
Fuel Selector: The cockpit fuel selector had three detents (left, right, OFF) and could be rotated 360°. Piper Service Bulletins SB588, SB590, and SB840 recommended modifications to reduce inadvertent OFF selection. SB840 was designated mandatory for the accident airplane but was never accomplished. An FAA proposed AD based on SB840 was later withdrawn.
Fuel Starvation Tests: The investigation attempted to find data on engine run time after fuel shutoff, but no applicable data for a PA-28 with O-360 engine was available. Tests on a PA-28 with IO-360 engine were deemed inapplicable due to data scatter. No tests were conducted for a partially mis-set fuel selector, which could limit fuel flow and cause power loss after carburetor bowl fuel was depleted.
Communications: The SAC tower controller observed the airplane's turnback and descent and queried the flight about 1 minute 54 seconds after takeoff clearance was issued. No response was recorded; the pilots did not transmit after acknowledging takeoff clearance.