# Incident 20200329006539I: Costruzioni Aeronautiche Tecna P92 EAGLET, Richmond, VA, March 29, 2020 - Type: FAA incident report (Accident/Incident Data System), as reported - Date: March 29, 2020, 21:17 local time - Place: Richmond, VA - Airport: Richmond International Airport - Damage: Substantial damage - Phase of flight: Cruise/Level Flight - Operating rules: General operating rules (Part 91) - Location: 37.5052° N, 77.3197° W: Placed by OpenAirDocs at RICHMOND INTL (RIC), within about a mile (OpenAirDocs) - Nearby events: https://openairdocs.org/map.md?lat=37.5052&lon=-77.3197&mi=10 - Aircraft: N353TA, registered now (https://openairdocs.org/aircraft/N353TA) (OpenAirDocs) - Registry model: Costruzioni Aeronautiche Tecna P92 EAGLET (registry code 0600045, https://openairdocs.org/model/costruzioni-aeronautiche-tecna-p92-eaglet) (OpenAirDocs) - Registry engine: Rotax 912ULS series (registry code 55572, https://openairdocs.org/engine/rotax-912uls-series) (OpenAirDocs) - Reported make and model: COSTRUZIONI AERONAUTICHE TECNA P92 EAGLET - Reported engine: ROTAX 912ULS SERIES - People aboard: 2 - Fatal injuries: 0 - Other injuries: 0 - FAA source: FAA Aviation Safety Information Portal (https://asip.faa.gov/) - Page: https://openairdocs.org/incident/20200329006539I ## Narrative As the FAA filed it, in capitals; the FAA replaces private details with ^PRIVACY DATA OMITTED^. ^PRIVACY DATA OMITTED^ HOLDER OF BOTH AIRFRAME AND POWER PLANT RATINGS (CERT ^PRIVACY DATA OMITTED^) WAS INVOLVED WITH THE REGULATORY DEVIATION. THE SPECIFIC REGULATORY REQUIREMENT THAT WAS NOT MET WAS 14 CFR 43.13 (B). THE DEVIATION OCCURRED ON FEBRUARY 27, 2020 AT THE MAINTENANCE FACILITY OF HEART OF VIRGINIA AVIATION, ^PRIVACY DATA OMITTED^. A LATENT FAILURE OF THE OIL FILTER HOUSING WAS CAUSED BY THE IMPROPER ORIENTATION OF A NEWLY INSTALLED EXHAUST RISER; THUS CHAFFING INTO THE OIL FILTER HOUSING RESULTING IN OIL STARVATION TO THE ENGINE AND SUBSEQUENT COMPLETE FAILURE. THE DEVIATION OCCURRED DUE TO COMPLACENCY. THE RESULTS OF THE ROOT CAUSE ANALYSIS (RCA) REVEALED THAT ^PRIVACY DATA OMITTED^ DID NOT UTILIZE FAA APPROVED DATA WHEN REPLACING A CRACKED EXHAUST RISER ON A ROTAX 912 POWER PLANT; THUS RESORTING TO MEMORY WHILE PERFORMING THE MAINTENANCE TASK. THE IDENTIFIED HAZARDS THAT LED TO THE REGULATORY DEVIATION WERE THE IMPROPER INSTALLATION OF A CRITICAL ENGINE COMPONENT THAT SUBSEQUENTLY CAUSED LATENT FAILURES RESULTING IN A CATASTROPHIC ENGINE FAILURE. THE BEHAVIORS WERE ROOTED IN A PRACTICE OF NOT REFERRING TO THE MANUFACTURES MAINTENANCE MANUAL, RELYING ON MEMORY, AND FAILING TO CROSS CHECK THE WORK TO AFFIRM OTHER COMPONENTS ON THE ENGINE ARE NOT AFFECTED. HUMAN FACTORS WERE DISCUSSED TO UNVEIL POTENTIAL RISK. ^PRIVACY DATA OMITTED^ CONCEDED THAT DESPITE HAVING PERFORMED MAINTENANCE TASK IN THE PAST BY MEMORY WITHOUT INCIDENT, HE NOW REALIZES THE BREVITY OF FOLLOWING PUBLISHED PROCEDURES IN MANUFACTURES MAINTENANCE MANUALS CONSISTENTLY. MERELY RELYING ON MEMORY LED TO IMPROPER MAINTENANCE, CAUSING A LATENT FAILURE THAT COMPROMISED THE INTEGRITY OF THE NATIONAL AIRSPACE SYSTEM. THE MITIGATION/CORRECTIVE ACTIONS TAKEN BY THE AIRMAN INCLUDED ELIMINATING THE COMPLACENT BEHAVIOR OF PERFORMING MAINTENANCE TASK BY MEMORY AND PARTICIPATION IN A COMPANY-WIDE MAINTENANCE SAFETY BRIEFING THAT EMPHASIZED THE IMPORTANCE OF REFERENCING CURRENT MANUFACTURES MAINTENANCE MANUALS AND LOOKING AT THE ?BIG PICTURE? TO MITIGATE ANY MAINTENANCE INDUCED LATENT FAILURES. NO ADDITIONAL TRAINING/REMEDIAL TRAINING IS NEEDED; CA COUNSELING IS SUFFICIENT. ## Other reports on N353TA (2) Matched to the same aircraft by N-number and date. - [Incident 20211227021419I](https://openairdocs.org/incident/20211227021419I), Dec 27, 2021: Costruzioni Aeronautiche Tecna P92 EAGLET (N353TA), Hanover, VA, Minor damage. Student pilot was practicing solo touch and go's. weather was VFR and winds were calm. Student pilot had executed 2 prior touch and go's without incident. On… - [Incident 20190614010759I](https://openairdocs.org/incident/20190614010759I), Jun 14, 2019: Costruzioni Aeronautiche Tecna P92 EAGLET (N353TA), Hanover, VA, Minor damage. Right main landing gear collapsed during landing rollout, student flight instruction. This is a fixed gear aircraft. Jmc From the FAA Accident/Incident Data System. Reports are matched to registry aircraft by N-number and event date, checked against the reported make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model. For accidents, the NTSB's own investigation is the fuller record. --- OpenAirDocs.org is an independent research project of [Contrail Labs](https://contraillabs.com/). It is not affiliated with the FAA or the NTSB. Source documents are U.S. government works in the public domain.