# NTSB CEN14CA106: Cessna P210N, N4817K, Pagosa Springs, CO, January 8, 2014

- Type: NTSB accident investigation
- Classification: Accident · Minor injuries · Data collection · Final report
- Date: January 8, 2014, 14:30 local (21:30 UTC)
- Place: Pagosa Springs, CO
- Coordinates: 37.239479, -107.029067 (estimated)
- Nearby events: https://openairdocs.org/map.md?lat=37.2395&lon=-107.0291&mi=10
- Phase of flight: [Takeoff](https://openairdocs.org/ntsb-phases/300) (OpenAirDocs' grouping)
- Defining event: [Takeoff: Loss of engine power (partial)](https://openairdocs.org/ntsb-events/342)
- Highest injury: Minor injuries
- Injuries: 2 minor, 1 uninjured
- Status: Completed, report April 1, 2014
- Report: Approved by Office Director
- NTSB office: Central Region
- NTSB case key (mKey): 88651
- NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=CEN14CA106
- NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/88651/pdf
- NTSB docket: https://data.ntsb.gov/Docket?ProjectID=88651
- Page: https://openairdocs.org/ntsb/CEN14CA106

## Probable cause

The pilot's inadequate preflight inspection which led to a loss of oil pressure and partial loss of engine power on takeoff. Contributing to the accident was the pilot's failure to check the security of the oil filler cap prior to the flight.

## Findings

NTSB's coded findings; those marked are part of the probable cause.

- [Inspection: preflight inspection](https://openairdocs.org/ntsb-findings/02061510): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Cessna P210N, 4 cases](https://openairdocs.org/ntsb-findings/02061510/cases.md?model=2073454), [All aircraft, 551 cases](https://openairdocs.org/ntsb-findings/02061510/cases.md)
- [Eng oil sys (airframe furnish): oil storage (airframe furnish)](https://openairdocs.org/ntsb-findings/01057910): Aircraft › Aircraft power plant · Inadequate inspection (probable cause); cases with it: [Cessna P210N, 1 case](https://openairdocs.org/ntsb-findings/01057910/cases.md?model=2073454), [All aircraft, 3 cases](https://openairdocs.org/ntsb-findings/01057910/cases.md)

## Sequence of events

The events NTSB coded, in order, by phase of flight. The defining event best describes what happened.

- [Takeoff: Loss of engine power (partial)](https://openairdocs.org/ntsb-events/342) (defining event); cases with it: [Cessna P210N, 11 cases](https://openairdocs.org/ntsb-events/342/sequence.md?model=2073454), [All aircraft, 1,858 cases](https://openairdocs.org/ntsb-events/342/sequence.md)

## Analysis

The private pilot and his two passengers departed on a local pleasure flight. Right after takeoff, engine oil covered the windscreen and the engine began to lose power. According to a video of the accident, the pilot made a tear-drop turn in an attempt to land on the opposite runway. The airplane lost altitude during the turn and the pilot overshot the runway. The pilot said that as he crossed over the runway, he reduced power to idle. As the pilot attempted to turn back toward the runway, he turned off the master switch. The airplane descended quickly and landed adjacent to the runway in packed snow. The airplane landed hard on the main landing gear and with the right wing low before it slid for about 300 feet resulting in substantial damage to the fuselage and right wing. The landing gear, right flap, left wing tip, and all three propeller blades were also damaged. Postaccident examination of the engine revealed the oil filler cap was not secured to the oil filler neck. The pilot said this was the first flight after the oil had been changed by a maintenance facility. He did not check the oil filler cap before the flight because it was not required per the Federal Aviation Administration (FAA) approved preflight inspection checklist.

## Factual narrative

The private pilot and his two passengers departed on a local pleasure flight. Right after takeoff, engine oil covered the windscreen and the engine began to lose power. According to a video of the accident, the pilot made a tear-drop turn in an attempt to land on the opposite runway. The airplane lost altitude during the turn and the pilot overshot the runway. The pilot said that as he crossed over the runway, he reduced power to idle and tuned the master switch off. The airplane descended quickly and landed adjacent to the runway in packed snow. The airplane landed hard on the main landing gear and with the right wing low before it slid for about 300 feet resulting in substantial damage to the fuselage and right wing. The landing gear, right flap, left wing tip, and all three propeller blades were also damaged. Postaccident examination of the engine revealed the oil filler cap was not secured to the oil filler neck. The pilot said this was the first flight after the oil had been changed by a maintenance facility. He did not check the oil filler cap before the flight because it was not required per the Federal Aviation Administration (FAA) approved preflight inspection checklist.

## Aircraft

- Registration: [N4817K](https://openairdocs.org/deregistered/N4817K-2014-05-12), registration cancelled 2014-05-12, S/N P21000333, built 1979 (OpenAirDocs)
- Reported make and model: CESSNA P210N (N)
- Registry model: [Cessna P210N](https://openairdocs.org/model/cessna-p210n) (registry code 2073454) (OpenAirDocs)
- Registry engine: [Continental TSIO-520 series](https://openairdocs.org/engine/continental-tsio-520-series) (registry code 17040, reciprocating) (OpenAirDocs)
- Category: Airplane
- Serial number: P21000333
- Year built: 1979
- Airframe hours: 5898
- Engines: CONT MOTOR TSIO-520 SER reciprocating
- Damage: Substantial damage
- Flight: Personal, Part 91
- Operator: Performance Associates Inc
- Registered owner: Performance Associates Inc
- Airworthiness certificate: Standard, Normal
- Last inspection: Annual, June 15, 2013
- Departed: PSO, Pagosa Springs, CO
- Destination: PSO, Pagosa Springs, CO
- Airport: PSO, Pagosa Springs, runway 19, 8,100 × 100 ft, asphalt

## Flight crew

As NTSB recorded them. NTSB leaves out names.

- Pilot; age 64; injuries: minor; private; airplane ratings: multi-engine land, single-engine land; instrument ratings: airplane; medical: class 3, with waivers/limitations; seat: left; restraint: 3-point; flight hours: 3,365 total, 2,595 in this make and model

## Weather

- Conditions: Visual (VMC), Day
- Wind: 200° at 5 knots
- Visibility: 10 statute miles
- Lowest ceiling: none
- Temperature: 3,006 °F
- Observed at: PSO

## FAA reports on this event (1)

The FAA's own accident and incident reports, matched to the aircraft by N-number and date (OpenAirDocs).

- [Accident 20140108000029A](https://openairdocs.org/incident/20140108000029A), Jan 8, 2014: Cessna P210N, Pagosa Springs, CO, Substantial damage. On 01/08/2014 at approximately 15:35 MDT, N4817K, a Cessna 210N aircraft sustained substantial damage at Pagosa Springs, CO., airport (kpso). Weather at the…

## Other investigations on N4817K (1)

From the NTSB's public API. Aircraft are matched to registry aircraft by N-number and event date, checked against the reported serial number, make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model.

- [NTSB DEN01LA042](https://openairdocs.org/ntsb/DEN01LA042), Jan 18, 2001: Cessna P210N (N4817K), Pagosa Springs, CO, substantial damage. Probable cause: failure to maintain directional control of the aircraft after an encounter with adverse weather during landing roll. A factor was ground fog.

## Docket (6 files)

The files NTSB released with the investigation on March 19, 2014, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=88651. 7.8 MB in all.

- Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 2.9 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40410658&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Redacted.PDF
- Witness Statements (item 2, .PDF, 835 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40410659&FileExtension=.PDF&FileName=Witness%20Statements-Redacted.PDF
- Copy of FAA approved preflight checklist (item 3, .PDF, 3.8 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40410660&FileExtension=.PDF&FileName=Copy%20of%20FAA%20approved%20preflight%20checklist-Master.PDF
- Email regarding recent oil change (item 4, .PDF, 78 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40410661&FileExtension=.PDF&FileName=Email%20regarding%20recent%20oil%20change-Redacted.PDF
- Video of Accident Flight (item 5, .PDF, 98 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40410663&FileExtension=.PDF&FileName=Video%20of%20Accident%20Flight-Master.PDF
- Email exchange between NTSB and Pilot in Command (item 6, .PDF, 99 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40410662&FileExtension=.PDF&FileName=Email%20exchange%20between%20NTSB%20and%20Pilot%20in%20Command-Redacted.PDF

From the NTSB's public API. Aircraft are matched to registry aircraft by N-number and event date, checked against the reported serial number, make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model.

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