Destin-Fort Walton Beach Airport
Aircraft Accident/Incident Report

Destin, Florida 32540
Sunday, March 2, 2003 11:00 CST

NTSB Narrative Summary Released at Completion of Accident

The pilot stated that he performed a normal preflight of the airplane using the airplane's checklist; the only discrepancy he found was related to the cabin entry door seal. He did add 1 quart of oil to the engine. The flight departed from runway 32 and while climbing between 2,500 and 2,800 feet, the cockpit was enveloped suddenly in thick black smoke. Additionally, he observed flames underneath the instrument panel behind the rudder pedals on both sides of the cockpit. He turned off the master switch and initiated a descending left turn with the intention of ditching the airplane. He reduced the mixture control and opened the cabin entry door in anticipation of ditching but he was able to see outside and elected to return to the airport for landing. He momentarily turned on the master switch and lowered the landing gear; he landed on runway 14. After touchdown, the airplane exited the north side of the runway onto grass where he evacuated the airplane by the cabin entry door. A fire department was not located at the airport. A nearby fire department was alerted at 1101:34, arrived at 1107:09, and extinguished the fire. Examination of the airplane by an FAA Airworthiness inspector-in-charge (FAA-IIC) revealed fire consumed the upper and side fuselage skin of the cockpit and cabin area, and damaged the inboard portion of the right wing including consumption of the area of the right fuel tank. The tailpipe assembly (tailpipe) was found separated from the turbocharger exhaust turbine housing (turbocharger); the coupling used to secure the tailpipe to the turbocharger was found resting on the tailpipe but not in the normally installed position. No safety wire was observed in the coupling; the nut was not recovered. There was no mention of damage to either of the flanges of the tailpipe or of the turbocharger. Additionally, examination of other components of the exhaust system by the FAA-IIC revealed evidence of deterioration that should have been detected during the previous inspection 1.8 hours earlier. Burn damage was noted to plastic tubing in the cockpit forward of the rudder pedals; the tubing was associated with the brake system. Examination of the firewall and cockpit by the NTSB revealed no evidence of burn through or compromise of the firewall. Visual examination of the recovered coupling by the NTSB revealed no damage to the threads. The coupling was determined to be manufactured by Aeroquip as part number (55677-340M), which is specified in the Illustrated Parts Catalog. Review of the Aircraft Log revealed an entry dated November 12, 1990, which indicates replacement of the coupling in accordance with Mooney Special Letter 90-6, dated November 1, 1990. Review of the maintenance records revealed the engine was overhauled on February 22, 1996, and installed in the airplane on May 8, 1996; the entry does not indicate whether a new coupling was installed to connect the tailpipe to the turbocharger. An entry dated March 14, 2001, indicates the exhaust stack was repaired; the entry does not specify what exhaust stack was repaired. An entry dated April 25, 2001, indicates the engine was removed from the airplane for repair. The next entry dated April 20, 2001, indicates the engine was repaired and the wastegate, controllers, and turbo were repaired by Main Turbo Systems, Inc. The entry does not specify if a new coupling was installed to connect the tailpipe to the turbocharger. No other entries related to the exhaust system were noted between that entry and the last annual inspection which occurred on February 13, 2003; the inspection was accomplished using the Mooney Service Guide. The airplane had accumulated approximately 1.8 hours since the inspection at the time of the accident. The mechanic who performed the last annual/100-Hour inspection reported to the FAA-IIC that during the inspection, he removed the turbocharger wastegate for cleaning and also removed the tailpipe. He reported reinstalling the tailpipe using the same nut. Review of the Mooney Aircraft Corporation Service and Maintenance Manual pertaining to the 100-Hour or Annual inspection revealed the exhaust system components are inspected for security. When the airplane was certificated, there was no requirement to protect components aft of the firewall from radiant heat.

NTSB Probable Cause Narrative

The inadequate annual/100-hour inspection of the engine by the mechanic for his failure to properly secure the tailpipe assembly to the turbocharger resulting in separation of the tailpipe and subsequent in-flight fire. Contributing factors in the accident were the inadequate design of the plastic brake line in the cockpit adjacent to the firewall by the airplane manufacturer, and the inadequate certification of the airplane by the FAA for failure to take into account radiant heat when designing components aft of the firewall.

Event Information

Type of Event Accident
Event Date 3/2/2003
Event Day of the Week Sunday
Time of Event 1100
Event Time Zone Central Standard Time
Event City Destin
Event State FLORIDA
Event Country --
Zipcode of the event site 32540
Event Date Year 2003
Event Date Month 3
MidAir Collision Indicator No
On Ground Collision occurred ? No
Event Location Latitude 302400N
Event Location Longitude 0862817W
Event Location Airport Destin-Fort Walton Beach
Event Location Nearest Airport ID KDTS
Indicates whether the acc/inc occurred off or on an airport On Airport
Distance from airport in statute miles --
Degrees magnetic from airport --
Airport Elevation 23
Weather Briefing Completeness Unknown
Investigator's weather source Weather Observation Facility
Time of the weather observation 1055 Central Standard Time
Direction of event from weather observation facility (degrees) --
Weather Observation Facility ID KVPS
Elevation of weather observation facility 87
Distance of event from weather observation facility (units?) --
Time Zone of the weather observation CST
Lighting Conditions Day
Lowest Ceiling Height 12000
Lowest Non-Ceiling Height 1600
Sky/Lowest/Cloud Conditions Few
Sky Condition for Lowest Ceiling Broken
Visibility Runway Visual Range (Feet) --
Visibility Runway Visual Value (Statute Miles) --
Visibility (Statute Miles) 7
Air Temperature at event time (in degrees celsius) 19
Dew Point at event time (in degress fahrenheit) 13
Wind Direction (degrees magnetic) 330
Variable Wind Indicator Wind direction could be determined
Wind Speed (knots) 8
Wind Velocity Indicator --
Wind Gust Indicator Not Gusting
Wind Gust (knots) --
Altimeter Setting at event time (in. Hg) 29.95
Density Altitude (feet) --
Intensity of Precipitation --
METAR weather report --
Event Highest Injury Serious
On Ground, Fatal Injuries --
On Ground, Minor Injuries --
On Ground, Serious Injuries --
Injury Total Fatal --
Injury Total Minor --
Injury Total None --
Injury Total Serious 1
Injury Total All 1
Investigating Agency NTSB
NTSB Docket Number (internal use) 15339
NTSB Notification Source FAA Comm. Center
NTSB Notification Date Mar 2 2003 12:00AM
NTSB Notification Time 1741
Fiche Number and/or location -used to find docket information DMS
Date of most recent change to record Apr 28 2004 3:34PM
User who most recently changed record NTSB\MONR
Basic weather conditions Visual Meteorological Cond
FAA District Office Birmingham, Alabama

Aircraft Involved

Aircraft #1

Aircraft Registration Number N101PB
NTSB Number MIA03LA072
Missing Aircraft Indicator --
Federal Aviation Reg. Part Part 91: General Aviation
Type of Flight Plan filed IFR
Flight plan Was Activated? Yes
Damage Substantial
Aircraft Fire Ground and In-flight
Aircraft Explosion None
Aircraft Manufacturer's Full Name Mooney
Aircraft Model M20M
Aircraft Series Identifier --
Aircraft Serial Number 27-0008
Certified Max Gross Weight 3200
Aircraft Category Airplane
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 Retractable
Aircraft, Type of Last Inspection Annual
Date of Last Inspection Feb 13 2003 12:00AM
Airframe hours since last inspection 1.8
Airframe Hours 1441.2
ELT Installed Yes
ELT Activated No
ELT Aided Location of Event Site No
ELT Type --
Aircraft Owner Name Makaira Aircraft Sales, LLC
Aircraft Owner Street Address 711 Mosswood Cove
Aircraft Owner City Collierville
Aircraft Owner State TN
Aircraft Owner Country USA
Aircraft Owner Zipcode 38017
Operator is an individual? No
Operator Name James A. Massey
Operator Same as Owner? No
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? --
Certified for Part 133 or 137 Operation --
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) Personal
Second Pilot on Board No
Departure Point Same as Event Yes
Departure Airport Code KDTS
Departure City Destin
Departure State FL
Departure Country USA
Departure Time 1057
Departure Time Zone CST
Destination Same as Local Flt --
Destination Airport Code KEKY
Destination City Bessemer
Destination State AL
Destination Country USA
Specific Phase of Flight Takeoff - initial climb
Report sent to ICAO? No
Evacuation occurred Yes
Date of most recent change to record Mar 15 2004 9:11AM
User who most recently changed record KENJ
Since inspection or accident Time of Accident
Event Location Runway Number and Location 14
Runway Length 4999
Runway Width 100
Sight Seeing flight No
Air Medical Flight No
Medical Flight --