# NTSB CEN16LA184: Cessna 150F, N8619G, Ponca City, OK, May 1, 2016 - Type: NTSB accident investigation - Classification: Accident · Serious injuries · Limited investigation · Final report - Date: May 1, 2016, 11:30 local (16:30 UTC) - Place: Ponca City, OK - Coordinates: 36.731945, -97.099723 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=36.7319&lon=-97.0997&mi=10 - Phase of flight: [Landing](https://openairdocs.org/ntsb-phases/550) (OpenAirDocs' grouping) - Defining event: [Landing-flare/touchdown: Part(s) separation from AC](https://openairdocs.org/ntsb-events/338) - Highest injury: Serious injuries - Injuries: 1 serious, 1 uninjured - Status: Completed, report July 20, 2017 - Report: Approved by Office Director - NTSB office: Central Region - Parties: Federal Aviation Administration - NTSB case key (mKey): 93176 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=CEN16LA184 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/93176/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=93176 - Page: https://openairdocs.org/ntsb/CEN16LA184 ## Probable cause Maintenance personnel's improper installation of the elevator bolt, which resulted in a loss of elevator control during landing. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Maintenance: repair](https://openairdocs.org/ntsb-findings/02062015): Personnel issues › Task performance · Maintenance personnel (probable cause); cases with it: [Cessna 150F, 1 case](https://openairdocs.org/ntsb-findings/02062015/cases.md?model=2071814), [All aircraft, 99 cases](https://openairdocs.org/ntsb-findings/02062015/cases.md) - [Inspection: post maintenance inspection](https://openairdocs.org/ntsb-findings/02061515): Personnel issues › Task performance · Maintenance personnel (probable cause); cases with it: [Cessna 150F, 1 case](https://openairdocs.org/ntsb-findings/02061515/cases.md?model=2071814), [All aircraft, 57 cases](https://openairdocs.org/ntsb-findings/02061515/cases.md) - [Flight control system: elevator control system](https://openairdocs.org/ntsb-findings/01022730): Aircraft › Aircraft systems · Incorrect service/maintenance (probable cause); cases with it: [Cessna 150F, 1 case](https://openairdocs.org/ntsb-findings/01022730/cases.md?model=2071814), [All aircraft, 74 cases](https://openairdocs.org/ntsb-findings/01022730/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Prior to flight: Aircraft maintenance event](https://openairdocs.org/ntsb-events/040); cases with it: [Cessna 150F, 2 cases](https://openairdocs.org/ntsb-events/040/sequence.md?model=2071814), [All aircraft, 484 cases](https://openairdocs.org/ntsb-events/040/sequence.md) - [Prior to flight: Aircraft inspection event](https://openairdocs.org/ntsb-events/050); cases with it: [Cessna 150F, 2 cases](https://openairdocs.org/ntsb-events/050/sequence.md?model=2071814), [All aircraft, 229 cases](https://openairdocs.org/ntsb-events/050/sequence.md) - [Landing-flare/touchdown: Part(s) separation from AC](https://openairdocs.org/ntsb-events/338) (defining event); cases with it: [Cessna 150F, 1 case](https://openairdocs.org/ntsb-events/338/sequence.md?model=2071814), [All aircraft, 563 cases](https://openairdocs.org/ntsb-events/338/sequence.md) - [Landing-flare/touchdown: Loss of control in flight](https://openairdocs.org/ntsb-events/240); cases with it: [Cessna 150F, 16 cases](https://openairdocs.org/ntsb-events/240/sequence.md?model=2071814), [All aircraft, 5,002 cases](https://openairdocs.org/ntsb-events/240/sequence.md) - [Landing-flare/touchdown: Attempted remediation/recovery](https://openairdocs.org/ntsb-events/060); cases with it: [Cessna 150F, 6 cases](https://openairdocs.org/ntsb-events/060/sequence.md?model=2071814), [All aircraft, 1,422 cases](https://openairdocs.org/ntsb-events/060/sequence.md) - [Uncontrolled descent: Collision with terr/obj (non-CFIT) ](https://openairdocs.org/ntsb-events/470); cases with it: [Cessna 150F, 39 cases](https://openairdocs.org/ntsb-events/470/sequence.md?model=2071814), [All aircraft, 10,189 cases](https://openairdocs.org/ntsb-events/470/sequence.md) ## Analysis The private pilot stated that, during the landing flare at the conclusion of a local flight, the airplane's nose "shot up drastically." The pilot "gently" pressed forward on the controls to lower the nose, and the airplane pitched down and impacted the runway. Examination of the airplane revealed that a bolt that attached the left elevator to the control system was not installed, and the FAA inspector reported that the bolt was found undamaged inside the elevator tip. According to the pilot, maintenance personnel had recently removed the left elevator, and it is likely that they failed to properly secure the bolt when they reinstalled the elevator. ## Factual narrative On May 1, 2016, about 1130 central daylight time, a Cessna 150F, N8619G, experienced a loss of pitch control during landing flare and impacted runway 35 at Ponca City Regional Airport, Ponca City, Oklahoma. The airplane sustained substantial damage to the firewall. The pilot sustained serious injuries and the passenger was uninjured. The airplane was operated by the pilot under 14 Code of Federal Regulations Part 91 as a personal flight that was not operating on a flight plan. Visual meteorological conditions prevailed at the time of the accident. The local flight originated from PNC about 1045. The pilot stated that he performed a "full" preflight inspection of the airplane prior to departing for a pleasure flight. The flight returned without incident for an approach for landing to the airport. During landing flare on runway 35 and about 1-2 feet above runway, the airplane "shot up drastically". The airplane climbed about 10-20 feet, the pilot "gently" applied forward control pressure on the control yoke, and the airplane "instantly" pitched down and impacted the runway. The pilot stated that as he waited for an ambulance, he saw the left elevator was separated from the horizontal stabilizer. An airplane maintenance record entry dated November 9, 2015, shows that an annual inspection had been performed and that the bearing in the elevator bearing crank assembly was "reset" by an airframe and powerplant mechanic with inspection authorization. The airplane accumulated about 25 hours of flight time after the annual inspection. Post-accident examination of the airplane by a Federal Aviation Administration (FAA) inspector revealed that a bolt that links the left elevator to the control system was missing. The bolt was found inside the left elevator tip. The FAA Inspector reported that there was an improper reinstallation of the elevator, which resulted in it coming loose. ## Aircraft - Registration: [N8619G](https://openairdocs.org/deregistered/N8619G-2018-03-16), registration cancelled 2018-03-16, S/N 15062719, built 1965 (OpenAirDocs) - Reported make and model: CESSNA 150F - Registry model: [Cessna 150F](https://openairdocs.org/model/cessna-150f) (registry code 2071814) (OpenAirDocs) - Registry engine: [Continental 0-200 series](https://openairdocs.org/engine/continental-0-200-series) (registry code 17020, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 15062719 - Year built: 1965 - Airframe hours: 3234.9 - Engines: Continental O-200-A 100 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Operator: Pilot - Registered owner: Harbor Aviation LLC - Airworthiness certificate: Standard, Utility - Last inspection: Annual, November 9, 2015, 25 hours before - Departed: PNC, Ponca City, OK - Destination: PNC, Ponca City, OK - Airport: PNC, Ponca City Regional Airport, runway 35, 7,201 × 150 ft, concrete - Equipment: Stall warning system ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 52; injuries: serious; private; airplane ratings: single-engine land; medical: class 3, with waivers/limitations; seat: left; restraint: lap only; flight hours: 550 total, 540 in this make and model, 30 in the last 90 days ## Weather - Conditions: Visual (VMC), Day - Wind: 300° at 10 knots, gusting 18 - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 55 °F, dew point 41 °F - Altimeter: 30.10 inHg - Observed at: PNC ## 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 20160501008409A](https://openairdocs.org/incident/20160501008409A), May 1, 2016: Cessna 150F, Ponca City, OK, Substantial damage. Pilot and one passenger were in landing flare when approximately one to two feet off the ground the aircraft began a rapid ascent up to 10-15 feet high… ## Docket (3 files) The files NTSB released with the investigation on May 11, 2017, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=93176. 1.5 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 1.1 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40452119&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Master.PDF - Maintenance Log Excerpt (item 2, .PDF, 386 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40452120&FileExtension=.PDF&FileName=Maintenance%20Log%20Excerpt-Master.PDF - Record of Correspondence (item 3, .PDF, 52 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40452121&FileExtension=.PDF&FileName=Record%20of%20Correspondence-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.