NTSB Incident Report on the Mankovich Sonerai at Jeffersonville, IN (CHI96FA322)

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NTSB Identification: CHI96FA322.
The docket is stored in the (offline) NTSBImaging System.

Accident occurred AUG-30-96 at JEFFERSONVILLE, IN
Aircraft: Mankovich SONERAI, registration: N7037J
Injuries: 1 Fatal.

The pilot’s airplane was #2 in a 4-airplane ferry formation of Formula V Class racingairplanes. The #3 pilot said that the #2 pilot’s flying was erratic during the flight.”He had a hard time staying in position. He would fly ahead, then drop back.”The witness said when they were within a mile of the landing airport, [the pilot]”pulled straight up, pulled left to the east at full power, then went into a slightdescent.” The witness said that he flew up along side of the pilot’s airplane to tryand get his attention. “I couldn’t get his eye. He would not even look at me. Ichased him about 5 miles before I lost sight of him. The last time I saw him, he was below500 feet.” Examination of the wreckage revealed that the adhesive resin which boundthe rubber stripping forming the firewall lower seal was missing. The airplane had beeninvolved in 2 earlier landing accidents, and had been repaired/inspected bypilots/mechanics of the racing association. The pilot/mechanic performed the annualinspection on 5/1/96. Two days before the accident flight the pilot said that heexperienced smoke in the cockpit. He also said that the temperature was “185degrees” and that he was very hot. The results of FAA toxicology specimens from thepilot revealed a carboxyhemoglobin saturation of 41.000 percent in the blood; loss ofconsciousness is attained at approximately 30.000 percent.

Probable Cause
inadequate maintenance and inspection of the airplane by the pilot/owner and otherairframe and powerplant mechanics, which failed to assure adequate sealing of the enginefirewall, and led to the pilot’s incapacitation due to carbon monoxide.

HISTORY OF FLIGHT

On August 30, 1996, at 1230 eastern daylight time (edt), a Mankovich Revenge, N7037J,operated by an airline transport pilot, was destroyed when during descent for landing, theairplane departed controlled flight. The airplane subsequently impacted in a corn field 4miles northeast of Jeffersonville, Indiana. Visual meteorological conditions prevailed atthe time of the accident. The business flight was part of a ferry formation to an airshowperformance with three other Formula V class airplanes being conducted under 14 CFR Part91. No flight plan was on file. The pilot sustained fatal injuries. The flight originatedat Seymour, Indiana, at 1210 edt.

According to officials in the Formula V Air Racing Association, two days of practiceand race familiarization flights for new Formula V air racing pilots were held at FreemanMunicipal Airport, Seymour, Indiana, beginning on August 28, 1996. At the practicesessions, the pilot, a new Formula V air racing pilot, was to demonstrate competency inthe maneuvers required by the Formula V Air Racing Association to compete in air races.

According to one witness who spoke to the pilot several times on August 28, 1996, thepilot said that he experienced smoke in the cockpit and had to cut short a qualifyingflight where he was required to demonstrate 180-degree rolls to inverted flight, both tothe left and right. He did not accomplish the maneuvers.

The pilot told the witness that there was a small hole in the firewall and with thehelp of some of the other air race pilots, he changed a hose. He also told the witnessthat the temperature in the cockpit was 185 degrees and that he was very hot.

The witness spoke to the pilot again on August 29, 1996. The pilot told the witnessthat during one of his practice flights, he ran out of fuel and had to perform adead-stick landing on another runway. The pilot accomplished the landing without incident.The pilot again mentioned that the cockpit was extremely hot and that he was veryuncomfortable.

A witness, who was the lead airplane in the formation flight said that prior to theflight, the four pilots held a pilot briefing and went over emergency procedures. They hadplanned the route of flight to follow Interstate 65 south to Clark County MunicipalAirport, Jeffersonville, Indiana at 2,000 above ground level. “Our route was going totake us over Scottsburg airport, so if anyone had a problem, they could land there. It washalf-way down.” The witness said that they all refueled at Freeman Municipal Airport,Seymour, Indiana, prior to the flight and had plenty of fuel to make the flight. “Wetook off in a wide echelon. I gave [the pilot] big hand signals from the cockpit; wewanted to be spread out. We climbed out at 120 miles per hour, turned [south], andfollowed the interstate down.” The witness said that the pilot’s flying was erratic.”He [the pilot] passed me up, then fell back. When we got to Scottsburg, everythinglooked okay. I looked back, everyone was there. As we got to Clark County, I didn’t seehim. I didn’t see [the pilot] pull up and away. I didn’t even find out about the accidentuntil I was on the ground.”

A witness who flew in the formation flight as the number three airplane said that thepilot’s flying along the route was erratic. He said that, “he had a hard time stayingin position. He would fly ahead, then drop back.” The witness said, “We were onemile north of the field, heading southbound, when [the pilot] pulled straight up, pulledleft to the east at full power, then went into a slight descent.” The witness saidthat he flew up along side of the pilot’s airplane to try and get his attention. “Icouldn’t get his eye. He would not even look at me. I chased him about 5 miles before Ilost sight of him. The last time I saw him, he was below 500 feet.”

Another witness who flew in the formation flight as the number four airplane said thatbefore they took off, the pilot expressed concern to the witness about his fuel. Thewitness said that he checked the pilot’s airplane. “It [the fuel level] was halfwaybelow the top where it should be, about 8 to 9 gallons.” The witness said that they”took off around noon and headed south east until we intercepted theinterstate.” The witness said that during the first couple of minutes of the flight,the pilot made some altitude deviations. At the halfway point on the route, the witnesssaid that he saw the pilot pull ahead, then return to the formation. The witness said thathe only saw the pilot do this the one time. “As we got close to Clark County airport,we began to drift the formation further left toward the airport. As we were just gettingto the airport, I saw a Sabreliner cross in front of us. He was a long way off and headingdown in a big hurry. I knew he wasn’t going to be a conflict. Just as I saw the Sabrelinerahead, [the pilot] pitched up sharply, about 30 degrees, and began a slow left turnfollowed by a gentle descent. He continued the descent until I lost sight of him. We wentinto the airport and landed. Five minutes after we landed, we found out that something hadgone wrong.”

PERSONNEL INFORMATION

The pilot held certificates as an airline transport pilot, a certified flightinstructor in single and multi-engine instrument airplanes, and an airframe and powerplantmechanic. The pilot also held a Statement of Aerobatic Competency card and a certificateauthorizing aerial pesticide application.

According to the pilot’s logbook, the pilot had 8,831.6 total flying hours; 8,290.7hours in single engine land airplanes; and 7,826.9 hours as a flight instructor.

The pilot’s business partner said that when she spoke to the pilot the day prior to theaccident, the pilot said that he had to bring his logbook up to date so that he could meetshow requirements. This required putting flight time in his logbook.

According to the pilot’s logbook and two witnesses, one who was the pilot’s businesspartner, the pilot had logged approximately 4.0 total hours in the Revenge airplane.

The Formula V Air Racing Association had a Letter of Formula V Air Race PilotCompetency, dated August 29, 1996, on file for the pilot.

AIRCRAFT INFORMATION

The airplane was a homebuilt kit constructed by Stanley J. Mankovich, Jr. The airplanewas issued a special airworthiness certificate, experimental, amateur-built airplane, onMarch 16, 1989. According to the aircraft logbook, the airplane made its first flight onApril 2, 1989.

According to the builder, the airplane was built and used predominantly for air racingin the Formula V air racing category. The builder flew the airplane in air racecompetitions between 1989 and 1993. In 1993, the builder decided to discontinue air racingand put the airplane up for sale. During 1994, the airplane continued to be flown inFormula V class air races, by other air racing pilots.

According to a witness who was responsible for transporting the airplane to airshowsduring the 1994 Formula V air racing season, the airplane was involved in two incidentswhere the airplane sustained substantial damage and required major repair. Neitheraccident was reported to the National Transportation Safety Board. The first accidentoccurred on September 9, 1994, at Virginia Beach, Virginia, when during landing followinga qualifying air race, the airplane was ground looped. The witness said that the tailwheel was broken, the left wing tip was bent up and the main landing gear spar box wasbent. The witness stated that members of the Formula V Air Racing Association groupedtogether to repair the airplane. The second accident occurred on October 9, 1996, atMyrtle Beach, South Carolina, when on landing from a race, the airplane was ground loopedagain. The witness stated that the pilot “stepped on the brakes and one grabbedsooner than the other. The airplane spun around and stood on its nose damaging the spinnerand breaking off one of the propeller blades.” The left wing was bent. “A coupleof the ribs in the wing tip were bent. The left main landing gear was bent underneath theairplane.” The airplane sat in the witness’ garage for several months before anairframe and power plant mechanic, who was also a Formula V racing pilot, came to retrievethe airplane and fix it.

Another witness, a Formula V air racing pilot, who observed the incident at MyrtleBeach, South Carolina, said that the left wing outer skin panel, ribs and spar were bentback. The witness stated that the airplane did not participate in the 1995 Formula V airracing season.

A third witness, an airframe and powerplant mechanic and Formula V air racing pilot,who observed the incident at Myrtle Beach, South Carolina, confirmed that the airplane hadbeen ground looped and confirmed the damage to the airplane’s wing and landing gear. Thewitness said that after the incident, he installed another landing gear on the airplane.

According to his wife, the airplane was purchased by the pilot-owner on April 25, 1996.The airplane was first flown by the pilot-owner on May 1, 1996. The airplane’s lastrecorded annual inspection was performed on May 1, 1996, by the pilot- owner, who was alsoan airframe and powerplant mechanic. Previous to that inspection, the last annualinspection was performed on August 8, 1995. No record of major repairs during 1994 or 1995was found in the aircraft logbook. The aircraft logbook indicated that as of July 10,1996, the airplane had logged 89.6 hours.

WRECKAGE AND IMPACT INFORMATION

The NTSB on site investigation began on September 30, 1996 at 0800 edt.

The accident site was located on the edge of a cornfield 25 feet west of Bud PratherRoad, a winding, predominately north-south running paved road. The cornfield was slightlyrolling in feature. At the time of the accident the corn stalks were approximately 4 feetin height. Examination of the accident site revealed one single ground scar in the centerof a 30 foot diameter flattened area. The scar was approximately three feet in length andwas oriented east to west. The scar was approximately 5 inches wide at the center, and 4inches in depth.

The area was significantly eroded since the accident. A 4 foot high north-south runningbob-wire fence lined the east side of the accident site. At the time of the accident, thefence was damaged when the right wing of the airplane struck it. Small pieces of fuselagefabric and fiberglass from the cowling was still evident at the site.

The wreckage had been moved into a warehouse at M & K Aviation in Jeffersonville,Indiana. The main wreckage included the fuselage aft of the firewall, both wings and theempennage.

The engine cowling, fiberglass fuselage forward of the cockpit, and the canopy werebroken into several large pieces. The plexiglass which made up the bubble-windscreen wasbroken out. Several pieces of the plexiglass were missing.

The forward landing gear legs, main wheels and gear mounting box were intact and hadseparated from the fuselage metal frame tubing. The mounting box was bent to the leftapproximately 25 degrees.

The metal frame tubing which made up the cockpit area of the fuselage was bent to theleft approximately 10 degrees. The floor of the fuselage was broken out. The fabric whichmade up the skin around the cockpit area was torn and twisted. The instrument panel wascracked and bent aft and down. The engine instruments were destroyed. The fuel tank wasstill strapped to the frame forward of the instrument panel. The bottom of the fuel tankwas torn open and separated. Fuel stains and a faint smell of fuel were noticed in thefabric along side and beneath the fuel tank. The fuselage aft of the cockpit was bent tothe left approximately 30 degrees. There was some minor skin wrinkling just behind thecockpit area.

The underside of the fuselage, just aft of the cockpit was crushed upward approximately3 inches. The remaining fuselage aft to the empennage was intact. The horizontalstabilizer, vertical stabilizer, elevator and rudder were undamaged. The fuselage skin,1/2-inch forward of the rudder hinge line had a 1 and 1/4 inch puncture where the upperelevator pulley had punched through. A part of the pulley was observed in the skinpuncture. Flight control continuity to the elevator and rudder were confirmed. The tailwheel of the airplane was bent upward.

The left wing was still attached to the fuselage at the forward spar box and the aftattach pin. The forward third of the left wing tip was broken off. The left wing wascrushed aft from the leading edge to the main wing spar, and crushed up approximately 30degrees from underneath along the lateral span of the wing. The upper wing surface wasopened up longitudinally along the center rivet line, 14 inches aft from the leading edge.The upper wing skin showed a 30 degree longitudinal buckling from the wing root outboardand aft to the aileron hinge line. The inboard 6 inches of the left wing leading edge wasbent laterally inward approximately 60 degrees. The underside of the wing surface wasbuckled upward and aft. The left aileron was positioned 80 degrees up from the neutralposition. The aileron was bent upward approximately 30 degrees at mid-span and was buckledjust outboard of the wing root. The left counterweight was bent inboard. Flight controlcontinuity to the left aileron was confirmed.

The right wing was still attached to the fuselage at the forward spar box and the aftattach pin. The upper wing surface was bent upward and slightly aft, and was wrinkledalong the entire span. The upper skin was separated from the main wing spar along a 9 inchsection beginning at the wing root and running outboard along the rivet line. The inboard7 inches of the left wing leading edge was bent laterally inward approximately 55 degrees.The right wing tip was cracked longitudinally along the outboard edge. The tip waspartially separated from the wing skin along a 12 inch rivet seam beginning at the leadingedge of the wing and moving aft. The right aileron trailing edge was in the neutralposition. The aileron was bent slightly upward approximately 3 inches outboard of the wingroot. Flight control continuity to the right aileron was confirmed.

The engine, propeller and firewall had separated from the forward fuselage just forwardof the instrument panel. The engine was examined and showed no anomalies. The engine wasturned and exhibited rotation and proper valve action. One blade of the wooden propellerwas predominately intact and still attached to the hub. The blade was cracked slightlyaft, 7 inched out from the hub. The other blade had broken off at the hub and was split inhalf. The blade tip was missing. The metal spinner was bent aft and outward. The spinnerexhibited conformity with the propeller hub. Impressions from the propeller mounting boltsand safety wires were observed in the metal. There were no rotation signatures on thepropeller blades or the spinner. Three of the four engine mounts were broken. The firewallremained attached to the mounting frame. Heat discoloration was observed on the lowerfirewall metal, engine-side, near the exhaust manifold. The insulation around the lowerfirewall at the firewall lower seal was charred and melted. The adhesive resin which boundtogether two pieces of rubber stripping forming the firewall lower seal between the engineand the cockpit was missing. The outboard rubber strip was stiff and showed signs ofcharring. The inboard strip was clean of resin and showed some minor charring. Thefiberglass inside the underside fuselage panel containing the exhaust port showed charringand delamination.

MEDICAL AND PATHOLOGICAL INFORMATION

An autopsy of the pilot was performed on August 30, 1996, by the Clark County, Indiana,Medical Examiner, in Jeffersonville, Indiana.

The results of Federal Aviation Administration (FAA) toxicology specimens from thepilot revealed a carboxyhemoglobin saturation of 41.000 percent in the blood. The Managerof the FAA Toxicology and Accident Research Laboratory, Oklahoma City, Oklahoma statedthat loss of consciousness is attained at a carboxyhemoglobin saturation of approximately30.000 percent.

TESTS AND RESEARCH

The Formula V Air Racing Association publishes several documents which providestandardization for technical inspections of the airplanes, and competency of the airracing pilots.

In the Formula V Procedural and Safety Rules Guide, it states that “a competingaircraft must possess a valid certificate of airworthiness or equivalent of the country oforigin and must pass the technical inspection.”

The Formula V Guide for New Race Pilots states that the technical inspection will beperformed “before flying. The inspection will be performed by the Formula V TechnicalInspection staff.” The pilot will “be required to uncowl [the] engine.”And, “a new competitor’s aircraft will receive a more careful scrutiny than otheraircraft which have raced regularly.”

The Formula V Aircraft Technical Inspections Guide states, “Materials andworkmanship (going into the airplane) must conform to aircraft standards or equivalent.The Technical Committee is empowered to refuse permission to fly, attempt to pass flighttest, or to qualify an aircraft, which in their opinion, is not up to reasonably safestandards in either materials, workmanship, detail design, or condition. This applies tonew, modified, repaired, or damaged aircraft.”

A witness said that when technical inspections are performed may vary. “Sometimesthey are done every race. They are done whenever there is a protest.” The witnesssaid that one person in the Formula V Air Race Association does all the technicalinspections. The witness also said that the race pilot does not receive any documentationthat an airplane meets Formula V technical specifications.

According to the Formula V Air Racing Association Procedural and Safety Rules Guide,for a pilot to be eligible to compete in Formula V air racing, he/she must meet a list ofspecified qualifications. The qualifications include possessing a current private pilot’slicense, a current medical certificate, a pilot logbook with current biennial endorsementand a letter of Formula V air racing competency. The pilot must have a minimum of 200hours pilot-in-command time in a fixed-wing airplane, a minimum of 10 hours in thespecific Formula V airplane to be raced or 25 hours in any Formula V, Formula One or SportBiplane race type, a minimum of 5 take-offs and landings in any Formula V race plane typeduring the previous 90 days, and a minimum of 1 hour in the specific Formula V airplane tobe raced during the previous 30 days or a minimum of 10 hours in any aircraft type duringthe previous 30 days. The pilot must also demonstrate in his/her airplane before a FormulaV Safety Officer, an abort from a simulated racing start, a take off at full throttlewithout veering more than 10 feet to either side of a straight line, three 180-degreeturns at race speed without appreciable loss of altitude, a slow roll in each directionwithout loss of altitude exceeding 50 feet or stalling, and execute a half roll (to theinverted position) then reverse roll in each direction without exceeding 50 feet orstalling. Lastly, the pilot must demonstrate flight around the race course including aracing takeoff, 10 laps of the race course at racing speed, passing another airplane,being passed by another airplane, a race finish and landing.

A witness stated that a simulated dead-stick landing was also required of theparticipants, and that new Formula V air racing pilots were considered on probation fortheir first couple of air racing competitions.

ADDITIONAL DATA/INFORMATION

A party to the investigation was the Federal Aviation Administration Flight StandardsDistrict Office, Indianapolis, Indiana.

All wreckage was released and returned to a representative designated by the pilot’sfamily.

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