ANC03LA069

NTSB accident investigation · Cessna 172 · Seldovia, AK · July 4, 2003

Accident · No injuriesLimited investigationFinal report
Date
July 4, 2003, 10:46 local (18:46 UTC)
Place
Seldovia, AK
Injuries
3 uninjured
Damage
Substantial damage
Phase of flight
Landing
Aircraft
N63541Cessna 172
Weather
Visual (VMC) · Day
Status
Completed · report December 30, 2003
Report
Approved by Office Director
NTSB office
Alaska Regional Office
Parties
Anchorage FSDO
FAA report
20030704037289A
Case key
57413

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

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Probable cause

The failure of company maintenance personnel to properly maintain the airplane's brake system, which resulted in a loss of the right brake during landing roll due to a chafed brake line.

Sequence of events

NTSB’s coding before 2008: each occurrence and phase of flight, and the causes and factors under it. The codes are defined in NTSB’s coding manual.

Airframe/component/system failure/malfunctionLanding - roll
Brakes(normal) - not maintainedCompany maintenance personnelCause
Landing gear,normal brake system - chafedCause
Fluid,hydraulic - loss,total
Landing gear,normal brake system - failureCause
Loss of control - on ground/waterLanding - roll
Directional control - not possiblePilot in command
On ground/water encounter with terrain/waterLanding - roll
Terrain condition - downhill

Analysis

The private pilot was landing a wheel-equipped airplane on a 1,845-foot long by 60-foot wide, gravel-covered runway. During the landing roll, he applied heavy braking to slow the airplane. The pilot said as the airplane tracked down the centerline of the runway for about 900 feet, the right hand brake pedal "just went flat", and the airplane veered to the left, towards an occupied airplane that was stopped on an adjacent taxiway. When the brake pedals were released, the airplane realigned with the runway centerline. As the airplane neared the end of the runway, the pilot applied full left brake in an attempt to stop the airplane before reaching the end of the runway. The airplane veered sharply to the left, continued off the left side of the runway and down an embankment. The airplane's right wing struck the ground and sustained structural damage. A postaccident inspection revealed that a 6-inch section of the aluminum hydraulic brake line tubing, which is covered by the right main landing gear's fiberglass fairing assembly, had chafed through about mid-span between the fuselage and right wheel assembly. Additionally, no hydraulic brake fluid was found in the right hydraulic brake reservoir. Prior to the accident, and in accordance with the manufacturer's recommended inspection intervals, the operator would remove the fiberglass fairing assembly and inspect the aluminum hydraulic brake line tubing every 400 hours, or during the airplane's annual inspection. As a result of the accident, and due to the high hourly utilization of the rental/instruction airplanes in the operator's fleet, the operator now removes the fiberglass fairing assembly to inspect the aluminum hydraulic brake line tubing during each 100-hour inspection.

Factual narrative

On July 4, 2003, about 1046 Alaska daylight time, a wheel-equipped Cessna 172 airplane, N63541, sustained substantial damage when it departed the runway and encountered terrain during landing at the Seldovia Airport, Seldovia, Alaska. The airplane was being operated as a visual flight rules (VFR) cross-country personal flight under Title 14, CFR Part 91, when the accident occurred. The private pilot and two passengers were not injured. The airplane was operated by Take Flight Alaska, Inc., Anchorage, Alaska, and was rented by the pilot. The flight originated about 0915 from the Merrill Field Airport, Anchorage. Visual meteorological conditions prevailed, and a VFR flight plan was filed.

During a telephone conversation with the National Transportation Safety Board investigator-in-charge on July 8, the pilot reported that just after landing on runway 16, he applied heavy braking to slow the airplane before reaching the end of the 1,845-foot long by 60-foot wide, gravel-covered runway. He said that as the airplane tracked down the centerline of the runway for about 900 feet, he noticed that the right hand brake pedal "just went flat." The airplane then veered to the left, towards an occupied Cessna 206 that was stopped on an adjacent taxiway. When the pilot released both brake pedals, the airplane realigned with the runway centerline. As the pilot attempted to stop the airplane, he used a combination of right rudder and the left brake. As the airplane neared the end of the runway, he applied full left brake in an attempt to stop the airplane before reaching the end of the runway. The airplane veered sharply to the left, continued off the left side of the runway and down an embankment. The airplane's right wing struck the ground and sustained structural damage.

The operator reported that during a postaccident inspection of the accident airplane, maintenance crews removed the fiberglass fairing assembly that covers the right main landing gear strut. The inspection revealed that a 6-inch section of the aluminum hydraulic brake line tubing, which is covered by the fiberglass fairing assembly, had chafed through about mid-span between the fuselage and right wheel assembly. Additionally, no hydraulic brake fluid was found in the right hydraulic brake reservoir.

According to the operator, the airplane had accumulated a total time in service of 16,200.2 hours. The airplane was maintained under a Federal Aviation Administration (FAA) approved maintenance inspection program, and the most recent 100-hour inspection was accomplished on June 10, 2003, 56.1 hours before the accident. The last annual inspection was completed on November 18, 2002.

After the accident airplane was ferried to the operator's maintenance facility in Anchorage, an FAA airworthiness inspector, from the Anchorage Flight Standards District Office, inspected the accident airplane, and reviewed the airplane's inspection and maintenance records. The FAA inspector reported that prior to the accident, and in accordance with the manufacturer's recommended inspection intervals, the operator would remove the fiberglass fairing assembly and inspect the aluminum hydraulic brake line tubing every 400 hours, or during the airplane's annual inspection. The FAA inspector added that following the accident, and due to the high hourly utilization of the rental/instruction airplanes in the operator's fleet, the operator now removes the fiberglass fairing assembly to inspect the aluminum hydraulic brake line tubing during each 100-hour inspection.

Aircraft

Registration
N63541
Reported as
Cessna 172
Category
Airplane
Serial number
17275449
Airframe hours
16,200.2
Engine
Lycoming O-320-D2J, 150 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Registered owner
Take Flight Alaska, Inc.
Airworthiness certificate
Standard, Normal
Last inspection
100 hour · June 10, 2003 · 56.1 hours before
Departed
MRI · Anchorage, AK
Destination
SOV · Seldovia, AK
Flight plan
VFR
Airport
SOV · Seldovia, runway 16, 1,845 × 60 ft, gravel

Matched to the registry by N-number and the event date; the registry’s history has gaps, so older matches can be wrong. Compare the reported make and model.

Flight crew

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
36
Injuries
None
Certificate
Private
Airplane ratings
Single-engine land
Medical
Class 3, Valid Medical--no waivers/lim.
Last flight review
May 29, 2003
Seat
Left
Flight hours
145 total · 42 in this make and model · 111 as pilot in command

Weather

Conditions
Visual (VMC) · Day
Visibility
10 statute miles
Temperature
63 °F
Altimeter
29.95 inHg

FAA reports on this event · 1

The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.

Other investigations on N63541 · 2

Matched to the same aircraft by N-number and date.