# NTSB CEN15IA200: Air Tractor AT 402A, N623LA, Brickeys, AR, April 4, 2015 - Type: NTSB incident investigation - Classification: Incident · No injuries · Incident investigation · Final report - Date: April 4, 2015, 14:30 local (19:30 UTC) - Place: Brickeys, AR - Coordinates: 34.84111, -90.527221 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=34.8411&lon=-90.5272&mi=10 - Phase of flight: [Maneuvering](https://openairdocs.org/ntsb-phases/450) (OpenAirDocs' grouping) - Defining event: [Maneuvering-low-alt flying: Flight control sys malf/fail](https://openairdocs.org/ntsb-events/333) - Highest injury: No injuries - Injuries: 1 uninjured - Status: Completed, report December 14, 2015 - Report: Approved by Office Director - NTSB office: Central Region - NTSB case key (mKey): 91047 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=CEN15IA200 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/91047/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=91047 - Page: https://openairdocs.org/ntsb/CEN15IA200 ## Probable cause The in-flight separation of the attachment hardware at the elevator control pushrod due to maintenance personnel's improper reinstallation of the attachment hardware. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Flight control system: elevator control system](https://openairdocs.org/ntsb-findings/01022730): Aircraft › Aircraft systems · Incorrect service/maintenance (probable cause); cases with it: [Air Tractor AT-402A, 1 case](https://openairdocs.org/ntsb-findings/01022730/cases.md?model=0390206), [All aircraft, 74 cases](https://openairdocs.org/ntsb-findings/01022730/cases.md) - [Maintenance: installation](https://openairdocs.org/ntsb-findings/02062035): Personnel issues › Task performance · Maintenance personnel (probable cause); cases with it: [Air Tractor AT-402A, 1 case](https://openairdocs.org/ntsb-findings/02062035/cases.md?model=0390206), [All aircraft, 371 cases](https://openairdocs.org/ntsb-findings/02062035/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Maneuvering-low-alt flying: Flight control sys malf/fail](https://openairdocs.org/ntsb-events/333) (defining event); cases with it: [Air Tractor AT-402A, 1 case](https://openairdocs.org/ntsb-events/333/sequence.md?model=0390206), [All aircraft, 410 cases](https://openairdocs.org/ntsb-events/333/sequence.md) - [Maneuvering-low-alt flying: Off-field or emergency landing](https://openairdocs.org/ntsb-events/440); cases with it: [Air Tractor AT-402A, 2 cases](https://openairdocs.org/ntsb-events/440/sequence.md?model=0390206), [All aircraft, 3,365 cases](https://openairdocs.org/ntsb-events/440/sequence.md) - [Maneuvering-low-alt flying: Loss of control in flight](https://openairdocs.org/ntsb-events/240); cases with it: [Air Tractor AT-402A, 2 cases](https://openairdocs.org/ntsb-events/240/sequence.md?model=0390206), [All aircraft, 5,002 cases](https://openairdocs.org/ntsb-events/240/sequence.md) ## Analysis The pilot reported that, during an agricultural application pass, the elevator control felt abnormal. The pilot chose to return to the airport and noted that the elevator control was unresponsive. The pilot attempted to maintain pitch control by using the elevator trim, but turbulence made this difficult. During the off-field landing, the airplane's nose pitched down. The pilot countered with nose-up trim, and the airplane stalled and then impacted the ground, which resulted in minor damage to the propeller. A postincident examination revealed that the attachment hardware, including the bolt and nut, at the elevator pushrod had separated. Maintenance had been performed on the elevator control pushrod about 20 hours before the incident flight, and the bolt and nut would have been removed and reinstalled during this maintenance. It is likely that maintenance personnel did not properly reinstall the attachment hardware after performing the maintenance. ## Factual narrative On April 4, 2015, about 1430 central daylight time, an Air Tractor AT-402A, N623LA, sustained minor damage during a forced landing to a field near Brickeys, Arkansas. The commercial pilot was not injured. The aerial application flight, owned and operated by Taylor Air Service, LLC., was being conducted under the provisions of 14 Code of Federal Regulations Part 137 without a flight plan. Visual meteorological conditions prevailed at the time of the incident. The local flight departed Dawson's Airport (15AR), Brickeys, Arkansas, about 1230. The pilot reported that during an aerial application pass the elevator control felt abnormal. As he completed the pass he pulled up and detected that the elevator was not responding. The pilot elected to return to the airport and the elevator control continued to be unresponsive. The pilot attempted to maintain pitch control through the use of the elevator trim but turbulence and power changes made this difficult. During an off field landing, the airplane nose pitched down. The pilot countered with nose up trim and the airplane stalled. There was minor damage to the propeller during the impact with the ground. A post incident examination established that the attachment hardware, including the bolt and nut, was missing from the forward end of the #2 elevator control pushrod. The bolt was located in the airplane in the lower fuselage; however, the nut was not located. About 20 hours prior to the incident flight, maintenance had been performed on the forward rod end bearing on the #2 pushrod. The bolt and nut would have been removed and reinstalled during this maintenance. It is not known if original hardware was used or if the hardware was replaced during this maintenance. ## Aircraft - Registration: [N623LA](https://openairdocs.org/aircraft/N623LA), registered now, S/N 402A-1127, built 2000 (OpenAirDocs) - Reported make and model: AIR TRACTOR INC AT 402A - Registry model: [Air Tractor AT-402A](https://openairdocs.org/model/air-tractor-at-402a) (registry code 0390206) (OpenAirDocs) - Registry engine: [Pratt & Whitney PT6A series](https://openairdocs.org/engine/pratt-whitney-pt6a-series) (registry code 52034, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 402A-1127 - Year built: 2000 - Airframe hours: 6476.1 - Engines: Pratt & Whitney PT6-11AE 550 horsepower turbo prop - Damage: Minor damage - Flight: Aerial application, Part 137 - Operator: Taylor Air Service LLC - Registered owner: Taylor Air Service LLC - Airworthiness certificate: Special, Restricted (Special) - Last inspection: Annual, February 3, 2015 - Departed: 15AR, Brickeys, AR - Destination: 15AR, Brickeys, AR - Airport: 15AR, Dawson's Airport - Equipment: Stall warning system ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 53; injuries: none; private, airline transport, commercial; airplane ratings: single-engine land, single-engine sea, multi-engine land; instrument ratings: airplane; medical: class 2, with waivers/limitations; last flight review January 8, 2014; seat: single; restraint: 3-point; flight hours: 25,201 total, 22.2 in this make and model, 20,785 as pilot in command, 75 in the last 90 days, 75 in the last 30 days, 0.8 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: 350° at 10 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 59 °F, dew point 32 °F - Altimeter: 30.36 inHg - Observed at: UTA, 13 nm away ## FAA reports on this event (1) The FAA's own accident and incident reports, matched to the aircraft by N-number and date (OpenAirDocs). - [Incident 20150404003849I](https://openairdocs.org/incident/20150404003849I), Apr 4, 2015: Air Tractor Inc AT-402A, Brickeys, AR, Minor damage. On April 4, 2015 at 1430 cd, an Air tractor AT-402A registered to taylor Air service inc. lost elevator control while performing aerial applications. Following… ## Other investigations on N623LA (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 ERA23LA215](https://openairdocs.org/ntsb/ERA23LA215), Apr 24, 2023: Air Tractor AT-402A (N623LA), Good Hope, AL, substantial damage. Probable cause: The pilot’s decision to land on a runway where there was insufficient clearance from obstructions (wheat crop) to operate safely. ## Docket (5 files) The files NTSB released with the investigation on November 12, 2015, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=91047. 1.2 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 979 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40433793&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Master.PDF - Pilot's Statement (item 2, .PDF, 13 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40433794&FileExtension=.PDF&FileName=Pilot%27s%20Statement-Master.PDF - Record of Conversation - Pilot (item 3, .PDF, 53 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40433795&FileExtension=.PDF&FileName=Record%20of%20Conversation%20-%20Pilot-Master.PDF - Record of Conversation - Air Tractor (item 4, .PDF, 53 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40433796&FileExtension=.PDF&FileName=Record%20of%20Conversation%20-%20Air%20Tractor-Master.PDF - Air Tractor 402A Parts Manual Excerpt (item 5, .PDF, 136 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40433797&FileExtension=.PDF&FileName=Air%20Tractor%20402A%20Parts%20Manual%20Excerpt-Master.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. --- 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.