Aircraft Accident/Incident Report

Lake Elsinore, California 92531
Saturday, January 30, 1999 15:43 PST

NTSB Narrative Summary Released at Completion of Accident

While the pilot was maneuvering about 550 to 650 feet agl, the engine chip light illuminated followed by a complete loss of engine power. She performed an autorotation to a large, open field, flared high about 100 feet agl, then collided with the ground. The skids were found spread outward with the belly touching the ground. Two of the main rotor blades displayed evidence of coning. Post-accident investigation revealed that all components of the lubrication system were intact and functional. When the turbine was disassembled, bearings 6 through 8 were found destroyed and displayed evidence of heat distress and oil starvation. The number 5 bearing evidenced heat distress. The nos. 1 through 5 bearings and the gearbox were lubricated, but there was no visual evidence of oil present downstream from the number 5 bearing. There was scoring and debris present in the oil pump scavenge chamber. Over a period of about 72 flight hours and 1 1/2 months, there were 10 reported engine chip light activations. After three chip lights were reported, the turbine, gear box, and compressor assembly were replaced. Engine chip lights were reported six more times. The number 5 bearing and snap ring were found spinning; a new number 5 bearing was installed. The day of the accident, the chip light came on during a maintenance ground run, then came on again before the engine quit. According to the Allison Engine Operation and Maintenance Manual, 'a maximum of four occurrences of magnetic chip warning lights encountered within any 50 hours of engine operation requires removal of the engine for shipment to an Allison Authorized Maintenance Center (AMC).'

NTSB Probable Cause Narrative

The pilot's failure to maintain main rotor rpm and her misjudged flare. Also causal was the failure of the company maintenance personnel to follow the procedures/directives in the engine manufacturer's operation and maintenance manual and their improper inspection of the engine. A factor was the oil starvation of the nos. 6, 7, and 8 bearings that resulted in a total loss of engine power.

Event Information

Type of Event Accident
Event Date 1/30/1999
Event Day of the Week Saturday
Time of Event 1543
Event Time Zone Pacific Standard Time
Event City LAKE ELSINORE
Event State CALIFORNIA
Event Country --
Zipcode of the event site 92531
Event Date Year 1999
Event Date Month 1
MidAir Collision Indicator No
On Ground Collision occurred ? No
Event Location Latitude --
Event Location Longitude --
Event Location Airport
Event Location Nearest Airport ID
Indicates whether the acc/inc occurred off or on an airport Off Airport/Airstrip
Distance from airport in statute miles --
Degrees magnetic from airport --
Airport Elevation --
Weather Briefing Completeness Unknown
Investigator's weather source Weather Observation Facility
Time of the weather observation 1655 Pacific Standard Time
Direction of event from weather observation facility (degrees) 355
Weather Observation Facility ID RIV
Elevation of weather observation facility 1538
Distance of event from weather observation facility (units?) 18
Time Zone of the weather observation PST
Lighting Conditions Day
Lowest Ceiling Height 25000
Lowest Non-Ceiling Height 15000
Sky/Lowest/Cloud Conditions Scattered
Sky Condition for Lowest Ceiling Broken
Visibility Runway Visual Range (Feet) 0
Visibility Runway Visual Value (Statute Miles) 0
Visibility (Statute Miles) 60
Air Temperature at event time (in degrees celsius) 18
Dew Point at event time (in degress fahrenheit) -2
Wind Direction (degrees magnetic) 320
Variable Wind Indicator Unknown
Wind Speed (knots) 7
Wind Velocity Indicator Unknown
Wind Gust Indicator Not Gusting
Wind Gust (knots) 0
Altimeter Setting at event time (in. Hg) 30
Density Altitude (feet) --
Intensity of Precipitation Unknown
METAR weather report --
Event Highest Injury Serious
On Ground, Fatal Injuries 0
On Ground, Minor Injuries 0
On Ground, Serious Injuries 0
Injury Total Fatal --
Injury Total Minor --
Injury Total None --
Injury Total Serious 2
Injury Total All 2
Investigating Agency NTSB
NTSB Docket Number (internal use) 620
NTSB Notification Source --
NTSB Notification Date Jan 30 1999 12:00AM
NTSB Notification Time 1605
Fiche Number and/or location -used to find docket information IMAGE
Date of most recent change to record Apr 20 2001 4:06AM
User who most recently changed record dbo
Basic weather conditions Visual Meteorological Cond
FAA District Office --

Aircraft Involved

Aircraft #1

Aircraft Registration Number N992SD
NTSB Number LAX99GA083
Missing Aircraft Indicator N
Federal Aviation Reg. Part Part 91: General Aviation
Type of Flight Plan filed Company VFR
Flight plan Was Activated? --
Damage Destroyed
Aircraft Fire None
Aircraft Explosion None
Aircraft Manufacturer's Full Name McDonnell Douglas
Aircraft Model 369E
Aircraft Series Identifier 369E
Aircraft Serial Number 510E
Certified Max Gross Weight 3000
Aircraft Category Helicopter
Aircraft Registration Class U.S. Registered/U.S. Soil
Aircraft is a homebuilt? No
Flight Crew Seats --
Cabin Crew Seats --
Passenger Seats --
Total number of seats on the aircraft 4
Number of Engines 1
Fixed gear or retractable gear Fixed
Aircraft, Type of Last Inspection 100 Hour
Date of Last Inspection Jan 28 1999 12:00AM
Airframe hours since last inspection 2
Airframe Hours 4093
ELT Installed Yes
ELT Activated Yes
ELT Aided Location of Event Site No
ELT Type --
Aircraft Owner Name RIVERSIDE COUNTY SHERIFF DEPT.
Aircraft Owner Street Address 4850 W STETSON AVE
Aircraft Owner City HEMET
Aircraft Owner State CA
Aircraft Owner Country
Aircraft Owner Zipcode 92545
Operator is an individual? --
Operator Name
Operator Same as Owner? Yes
Operator Is Doing Business As --
Operator Address Same as Owner? Yes
Operator Street Address
Operator City
Operator State
Operator Country
Operator Zip code
Operator Code
Owner has at least one certificate None
Other Operator of large aircraft? No
Certified for Part 133 or 137 Operation Unknown
Operator Certificate Number --
Indicates whether an air carrier operation was scheduled or not --
Indicates Domestic or International Flight --
Operator carrying Pax/Cargo/Mail --
Type of Flying (Per_Bus / Primary) Public Use
Second Pilot on Board No
Departure Point Same as Event No
Departure Airport Code HMT
Departure City HEMET
Departure State CA
Departure Country
Departure Time 1505
Departure Time Zone PST
Destination Same as Local Flt dest & departure same, accident can occur anywhere
Destination Airport Code
Destination City
Destination State
Destination Country
Specific Phase of Flight Maneuvering
Report sent to ICAO? --
Evacuation occurred --
Date of most recent change to record Apr 20 2001 4:06AM
User who most recently changed record dbo
Since inspection or accident --
Event Location Runway Number and Location 0
Runway Length --
Runway Width --
Sight Seeing flight No
Air Medical Flight No
Medical Flight --