ERA13LA398

NTSB accident investigation · Cessna 210J · Fort Myers, FL · September 5, 2013

Accident · No injuriesLimited investigationFinal report
Date
September 5, 2013, 11:30 local (15:30 UTC)
Place
Fort Myers, FL
Injuries
1 uninjured
Damage
Substantial damage
Phase of flight
Landing
Aircraft
N210WSCessna 210J
Defining event
Landing-flare/touchdown: Landing gear collapse
Weather
Visual (VMC) · Day
Status
Completed · report August 14, 2014
Report
Approved by Office Director
NTSB office
Eastern Region Aviation
Parties
FAA/FSDO
FAA report
20130905019339A
Case key
87982

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 failure of the landing gear hydraulic power pack system to provide sufficient pressure to lock the main landing gear in the down position. Contributing to the accident was the improper maintenance and inspection of the landing gear system, the pilot’s continued operation of the airplane with a known mechanical problem with the landing gear system, and the pilot’s failure to visually verify that the landing gear were down.

Findings · 6

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.

Landing gear system: main landing gearAircraft › Aircraft systems · Incorrect service/maintenanceCessna 210J: 2 casesAll aircraft: 241 casesProbable cause
Landing gear system: main landing gearAircraft › Aircraft systems · Inadequate inspectionCessna 210J: 2 casesAll aircraft: 241 casesProbable cause
Action: lack of actionPersonnel issues › Action/decision · Maintenance personnelCessna 210J: 1 caseAll aircraft: 792 casesProbable cause
Action: lack of actionPersonnel issues › Action/decision · PilotCessna 210J: 1 caseAll aircraft: 792 casesProbable cause

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 pilot stated that the airplane had been experiencing landing gear problems before the most recent annual inspection in April 2013 but that he thought that the landing gear problems had stopped after that inspection and maintenance. During departure, the landing gear failed to retract, and the amber light indicating that the landing gear fully retracted did not illuminate. After the pilot cycled the landing gear, the landing gear retracted, the amber light illuminated, and he continued the flight. The pilot stated that, as he neared his destination, he placed the landing gear handle in the "down" position and felt the "clunk" associated with the landing gear locking into place. He added that he quickly checked his wing mirror and confirmed that the landing gear were down before landing and that the green landing gear down-and-locked light "appeared" to be illuminated on the landing gear console. (The wing mirror can only show the position of the nose landing gear.) The airplane subsequently landed without the main landing gear down-and-locked, slid down the runway, and departed its left side. The left main landing gear hydraulic down lock was not in the locked position. A witness, who was also a mechanic, stated that, when the airplane arrived at the airport, he saw the main landing gear trailing aft during landing but that the nose landing gear were down-and-locked. He asked the pilot if he had looked out his left window to visually inspect the left main landing gear and verify that it was down. The pilot replied that he did not think of that and that no one had ever showed him that. Examinations determined that the hydraulic power pack that operates the functions of the landing gear was past its useful life and needed to be overhauled. The O-rings within the apparatus were malfunctioning and not providing the pressure needed to lock the main landing gear in the down position. If the pilot had looked out the window to visually verify the position of the main landing gear, he likely would have noticed that it was not in the correct position, and he could have accomplished emergency checklists that might have allowed the main landing gear to lock in the down position.

Factual narrative

On September 5, 2013, about 1130 eastern daylight time, a Cessna 210J, N210WS, owned and operated by a private individual, was substantially damaged during landing at Page Field Airport, (FMY) Fort Myers, Florida. The private pilot was not injured. The personal flight was conducted under the provisions of Title 14 Code of Federal Regulations Part 91. Visual meteorological conditions prevailed and no flight plan was filed for the personal flight that departed Opa-Locka Executive Airport (OPF) Miami, Florida about 1100. The pilot stated that after takeoff from OPF, the landing gear would not lock into place on the first attempt to retract, the amber light did not illuminate on the landing gear console, and that he had to recycle the landing gear handle to get the landing gear to retract and lock. The pilot stated that the remainder of the flight was "uneventful" to FMY. While on final approach for runway 5 at FMY, the pilot configured the airplane for landing with a "notch" of flaps and by placing the landing gear handle in the "DOWN" position. He stated that he felt the associated "clunk" of the landing gear locking into place, set the elevator trim for landing, and adjusted for a right crosswind. For further confirmation, the pilot stated that he looked out the window and at the mirror mounted on the right wing and confirmed that the landing gear were down. The pilot also stated that the green landing gear "LOCKED" light "appeared" to be illuminated. The pilot stated that upon touchdown at FMY, the plane "took flight again." As this transpired, the pilot leveled his attitude and "held steady." The stall warning horn sounded, the tail lowered and the airplane "took flight again." The airplane then settled to the tarmac and exited the left side of the runway. A witness to the accident stated that he observed the airplane during landing, and that the main landing gear was trailing aft upon landing. He added that the nose landing gear was down and locked and that the airplane was "being cushioned by the partially extended main landing gear tires". He watched the airplane slide down the runway until it exited into the dirt. The witness asked the pilot if he looked out his left window to visually inspect the left main landing gear and the pilot stated that no one had ever showed him that. Examination of the airplane by a Federal Aviation Administration (FAA) inspector revealed substantial damage to the right wing, aileron, horizontal stabilizer; and elevator. The left main landing gear hydraulic down lock was not in the locked position. The pilot, age 41, held a private pilot certificate with a rating for single-engine land that was issued on August 31, 2004. According to pilot logbooks, the pilot had accrued 772 total flight hours of which 301 hours were in the same make and model as the accident airplane. FAA records indicate that the pilot's third-class medical was issued on April 3, 2013, with no restrictions. The 1142 recorded weather observationat FMY included wind 120 degrees at 7 knots, visibility 10 statute miles, few clouds at 1,900 feet mean sea level, temperature 28 degrees C, dew point 26 degrees C, and an altimeter setting of 30.08 inches of mercury. The 6 seat, high-wing, retractable gear airplane, serial number 21059135, was manufactured in 1969. According to airplane maintenance records, the most recent annual inspection was completed on April 1, 2013 at a recorded airframe total time of 6066.4 hours. At the time of the accident, the airplane hour meter read 6,081 hours. The airplane was powered by a Continental IO-520-F, 290-hp engine. Engine maintenance records showed that the engine had accrued 3,583 total hours, 1,249 hours since overhaul, and 11 hours since its most recent recorded inspection. The engine was equipped with a McCauley, model number E-01, three-bladed, controllable pitch propeller. Propeller maintenance logs showed that the last annual inspection was completed on April 1, 2013 at that time had 546.7 hours total time in service since new. According to maintenance records, during the airplane's most recent annual inspection, hydraulic fluid was added, a hydraulic filter, and a hydraulic hose fitting was replaced. A landing gear inspection with normal and emergency extension operations was also completed by the maintenance facility, in Orlando, Florida. According to a written statement by the pilot, the airplane was experiencing landing gear problems prior to the most recent annual inspection in April 2013, and perceived that the landing gear problems had ceased after that inspection and maintenance. Further examination of the landing gear system by an FAA inspector at a maintenance facility revealed that the hydraulic level was normal but needed about one pint to completely service the fluid quantity. The down locks and main landing gear linkages were void of any lubrication, would not move freely, and covered with rust. The maintenance facility stated that the landing gear would only fully extend and lock two or three times out of 10 attempts, and the green down and locked light would illuminate with the gear unlocked. The mechanic's list of discrepancies is located in the public docket.

Aircraft

Registration
N210WS
Reported as
Cessna 210J
Category
Airplane
Serial number
21059135
Built
1969
Airframe hours
6,081
Engine
Cont Motor IO 520 SERIES, 290 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Operator
Olin David G
Registered owner
Olin David G
Airworthiness certificate
Standard, Normal
Last inspection
Annual · March 15, 2013
Departed
OPF · Opa Locka, FL
Destination
FMY · Fort Myers, FL
Airport
FMY · Page Field Airport, runway 05, 6,406 × 150 ft, asphalt
Equipment
Stall warning system

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
41
Injuries
None
Certificate
Private
Airplane ratings
Single-engine land
Medical
Class 3, Without waivers/limitations
Last flight review
October 11, 2012
Seat
Left
Restraint
Lap only
Flight hours
772 total · 301 in this make and model · 732 as pilot in command

Weather

Conditions
Visual (VMC) · Day
Wind
120° at 7 knots
Visibility
10 statute miles
Lowest ceiling
None
Temperature
82 °F, dew point 79 °F
Altimeter
30.07 inHg
Observed at
FMY

Docket · 11

The files NTSB released with the investigation on March 14, 2014, on NTSB’s docket system: statements, records, photos and specialists’ reports. 4.4 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.