CEN18LA211

NTSB accident investigation · Thrush S2R-H80 · Parkin, AR · May 31, 2018

Accident · No injuriesLimited investigationFinal report
Date
May 31, 2018, 11:15 local (16:15 UTC)
Place
Parkin, AR
Injuries
1 uninjured
Damage
Substantial damage
Phase of flight
Takeoff
Aircraft
N6215PThrush S2R-H80
Defining event
Takeoff: Loss of control on ground
Weather
Visual (VMC) · Day
Status
Completed · report April 30, 2019
Report
Approved by Office Director
NTSB office
Central Region
Parties
FAA -LIT FSDO
FAA report
20180531006459A
Case key
97402

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

On this page

Probable cause

The improper operation of the rudder pedal adjustment mechanism for an undetermined period of time, which led to the failure of the rudder pedal adjustment track, the detachment of the rudder pedal, and the pilot’s subsequent inability to maintain directional control.

Findings · 3

NTSB’s coded findings. Those marked are part of the probable cause; the rest are factors or other findings. Under each, the cases with the same finding.

Flight control system: rudder control systemAircraft › Aircraft systems · FailureAll aircraft: 93 casesProbable cause
Flight control system: rudder control systemAircraft › Aircraft systems · Incorrect use/operationAll aircraft: 93 casesProbable cause
Terrain: sloped/uneven terrainEnvironmental issues › Physical environment · Contributed to outcomeAll aircraft: 270 cases

Sequence of events

The events NTSB coded, in order, by phase of flight. The defining event is the one that best describes the accident. Under each, the cases with the same event anywhere in their sequence.

Analysis

The commercial pilot reported that, during the takeoff roll for the agricultural application flight, the right rudder pedal went full forward against the material hopper and that he subsequently could not maintain directional control of the airplane. The airplane subsequently exited the left side of the runway and struck a ditch. Examination of the airplane revealed that the right rudder pedal had become detached from the rudder pedal adjustment mechanism due to wear on the adjustment track. The Before Starting Engine checklist included a step to adjust and lock the rudder pedals before starting the engine; however, the condition of the rudder system indicated that the airplane had been operated with the rudder pedal forward of the final detent position and against the safety stop rather than in a locked detent position for an undetermined amount of time. The improper adjustment and locking of the rudder pedal adjustment mechanism over time likely led to the excessive wear on the rudder pedal adjustment track, the detachment of the rudder pedal, and the pilot’s subsequent inability to maintain directional control. After the accident, the airplane manufacturer released a service letter detailing the proper use, rigging, and maintenance of the rudder system, including the rudder pedal adjustment mechanism.

Factual narrative

On May 31, 2018, about 1115 central daylight time, a Thrush Aircraft S2R-H80, N6215P, received substantial damage during a runway excursion during takeoff on runway 18 from a private airstrip near Parkin, Arkansas. The pilot was not injured. The aircraft was registered to Mid Continent Aircraft Corp and operated by Air Aids, Inc., under the provisions of Title 14 Code of Federal Regulations Part 137 as an aerial application flight. Visual meteorological conditions prevailed for the flight, which was operated without a flight plan. The local flight was originating at the time of the accident. The pilot reported that during the takeoff roll the right rudder pedal went all the way forward. Since the airplane was equipped with toe-brakes, once the pedal was all the way forward against the material hopper, he had no way to maintain directional control of the airplane. The pilot attempted to stop the airplane using reverse pitch on the propeller, but the airplane went off the east side of the runway and struck a ditch. Examination of the airplane after the accident revealed that the rudder pedal adjustment mechanism consisted of a track that allowed the rudder pedal shaft to move fore and aft, with a detent pin that engaged holes in the track. The track was equipped with a safety stop bolt to prevent the rudder pedal shaft from travelling too far forward and exiting the end of the track. The track assembly for both the left and right rudder pedal showed wear on the track and the stop bolt installed forward of the most forward detent position. The right adjustment track had a semi-circular section worn completely through that matched the shape of the rudder shaft. This was consistent with the rudder shaft being stopped by the stop bolt rather than being locked in the forward detent position. Determination of how long the rudder system had been used in this manner could not be determined. The "Before Starting Engines" checklist current at the time of the accident contained the instruction "Rudder Pedals – ADJUST and LOCK". Review of the airplane maintenance records showed that the airplane had accumulated 991 hours time in service as of its most recent annual inspection dated December 29, 2017. The airplane manufacturer released a Service Letter, SL-AG-126, on June 11, 2018, entitled "Rudder Pedal Mechanism Inspection", detailing proper use, rigging, and maintenance of the rudder system, including the rudder pedal adjustment mechanism.

Aircraft

Registration
N6215P
Reported as
Thrush S2R-H80 (NO SERIES)
Category
Airplane
Serial number
H80-180DC
Built
2016
Airframe hours
991
Engine
GE Aviation Czech H80-100, 800 horsepower, turbo prop
Damage
Substantial damage
Flight
Aerial application · Part 137
Operator
Air Aids Inc
Registered owner
Mid Continent Aircraft Corp
Airworthiness certificate
Special, Restricted (Special)
Last inspection
100 hour · December 29, 2017
Departed
PVT · Parkin, MO
Destination
PVT · Parkin, MO
Airport
PVT · Private, runway 180, 2,500 × 75 ft, grass/turf
Equipment
Unknown

Flight crew

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
31
Injuries
None
Certificate
Commercial
Airplane ratings
Single-engine land, Multi-engine land
Instrument ratings
Airplane
Medical
Class 1, Without waivers/limitations
Seat
Single
Restraint
4-point
Flight hours
2,900 total · 1,600 in this make and model

Weather

Conditions
Visual (VMC) · Day
Wind
190° at 16 knots, gusting 25
Visibility
10 statute miles
Lowest ceiling
None
Temperature
91 °F, dew point 70 °F
Altimeter
29.81 inHg
Observed at
AWM, 20 nm away

Docket · 5

The files NTSB released with the investigation on November 8, 2018, on NTSB’s docket system: statements, records, photos and specialists’ reports. 2.1 MB in all.

FAA reports on this event · 1

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