# NTSB ERA14LA159: Cessna 500, N125DS, Zephyrhills, FL, March 16, 2014

- Type: NTSB accident investigation
- Classification: Accident · No injuries · Limited investigation · Final report
- Date: March 16, 2014, 10:37 local (14:37 UTC)
- Place: Zephyrhills, FL
- Coordinates: 28.260896, -82.129493 (estimated)
- Nearby events: https://openairdocs.org/map.md?lat=28.2609&lon=-82.1295&mi=10
- Phase of flight: [Landing](https://openairdocs.org/ntsb-phases/550) (OpenAirDocs' grouping)
- Defining event: [Landing-landing roll: Runway excursion](https://openairdocs.org/ntsb-events/300)
- Highest injury: No injuries
- Injuries: 2 uninjured
- Status: Completed, report November 3, 2014
- Report: Approved by Office Director
- NTSB office: Eastern Region Aviation
- NTSB case key (mKey): 88942
- NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=ERA14LA159
- NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/88942/pdf
- NTSB docket: https://data.ntsb.gov/Docket?ProjectID=88942
- Page: https://openairdocs.org/ntsb/ERA14LA159

## Probable cause

The pilots' inadequate in-flight planning and improper selection of runway 36 for landing, which resulted in a significant quartering tailwind during the landing, exceedance of the airplane's braking capability, and a subsequent runway overrun.

## Findings

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

- [Landing gear system: tire casing](https://openairdocs.org/ntsb-findings/01023244): Aircraft › Aircraft systems · Capability exceeded; cases with it: [Cessna 500, 1 case](https://openairdocs.org/ntsb-findings/01023244/cases.md?model=2076602), [All aircraft, 36 cases](https://openairdocs.org/ntsb-findings/01023244/cases.md)
- [Performance/control parameters: surface speed/braking](https://openairdocs.org/ntsb-findings/01062045): Aircraft › Aircraft oper/perf/capability · Capability exceeded (probable cause); cases with it: [Cessna 500, 1 case](https://openairdocs.org/ntsb-findings/01062045/cases.md?model=2076602), [All aircraft, 238 cases](https://openairdocs.org/ntsb-findings/01062045/cases.md)
- [Info processing/decision: decision making/judgment](https://openairdocs.org/ntsb-findings/02041520): Personnel issues › Action/decision · Flight crew (probable cause); cases with it: [Cessna 500, 2 cases](https://openairdocs.org/ntsb-findings/02041520/cases.md?model=2076602), [All aircraft, 3,098 cases](https://openairdocs.org/ntsb-findings/02041520/cases.md)
- [Wind: tailwind](https://openairdocs.org/ntsb-findings/03034015): Environmental issues › Conditions/weather/phenomena · Effect on operation (probable cause); cases with it: [Cessna 500, 1 case](https://openairdocs.org/ntsb-findings/03034015/cases.md?model=2076602), [All aircraft, 594 cases](https://openairdocs.org/ntsb-findings/03034015/cases.md)

## Sequence of events

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

- [Landing-landing roll: Runway excursion](https://openairdocs.org/ntsb-events/300) (defining event); cases with it: [Cessna 500, 2 cases](https://openairdocs.org/ntsb-events/300/sequence.md?model=2076602), [All aircraft, 3,643 cases](https://openairdocs.org/ntsb-events/300/sequence.md)

## Analysis

The two flight crewmembers reported that, after landing on runway 36, the pilot, who was the pilot flying, applied the brakes normally; however, the airplane did not decelerate as expected. The pilot applied the brakes a second time, and the right main landing gear tire subsequently failed. The airplane departed the end of runway 36 and came to rest in an area of unfinished gravel, which resulted in structural damage to the airframe. Examination of the 4,954-feet-long runway revealed that the airplane touched down about 1,400 feet from the approach end. Skid marks were visible for about 2,982 feet, and the tire failure occurred about 3,153 feet into the landing. Examinations revealed that the right main landing gear tire had a flat spot with a 4-inch diameter hole consistent with a locked brake. The airplane was equipped with an optional antiskid wheel braking system; however, it was disabled in 2004. The pilots reported that they decided to land on runway 36 based on the wind at flight level 180 and that they did not check the surface wind at the airport. The surface wind at the airport at the time of the accident was from 158 degrees at 15 knots gusting to 25 knots. Thus, the airplane landed with a significant quartering tailwind, which resulted in it touching down at a location and speed at which the pilots were unable to stop the airplane on the runway using normal braking.

## Factual narrative

On March 16, 2014, about 1037 eastern daylight time, a Cessna 500, N125DS, was substantially damaged following a runway excursion at Zephyrhills Municipal Airport (ZPH), Zephyrhills, Florida. The airline transport pilot-rated pilot and co-pilot were not injured. The airplane was operated by JJ Aeronautics, Inc. under the provisions of 14 Code of Federal Regulations Part 91 as a personal flight. Day, visual meteorological conditions prevailed for the flight, and an instrument flight rules flight plan was filed. The flight originated at Opa Locka, Florida (OPF), about 0952. The pilots reported the following. The pilot was the flying pilot and the co-pilot was the pilot monitoring. After the landing and touchdown on runway 36, the brakes were applied normally; however, the airplane did not decelerate as expected. The brakes were applied a second time and the right main landing gear tire failed. The airplane departed the end of runway 36 and came to a stop in an area of unfinished gravel. An inspector with the Federal Aviation Administration responded to the accident site and inspected the wreckage. He reported the following. The nose gear was separated from the airplane. The right main gear tire had a flat spot and a four-inch diameter hole in the tread area. The tread was otherwise normal in appearance. There was a creased area in the pressure vessel. The airplane was equipped with an anti-skid braking system; however, it was optional equipment and was disabled in 2004. The airplane was not equipped with a cockpit voice recorder. An examination of the landing runway revealed visible skid marks that began about 1,400 feet from the approach end of runway 36, and continued for about 2,982 feet. Evidence of the tire failure was observed about 3,153 feet into the landing. Runway 36 was 4,954 feet in length. According to airport personnel, the recorded surface wind near the time of the accident was from 158 degrees at 15 knots, with gusts to 23 knots. The pilots reported that they made their landing runway determination for runway 36 based on the wind at flight level 180 and not the actual surface wind at the airport.

## Aircraft

- Registration: [N125DS](https://openairdocs.org/deregistered/N125DS-2018-11-14), registration cancelled 2018-11-14, S/N 500-0258 (OpenAirDocs)
- Reported make and model: CESSNA 500
- Registry model: [Cessna 500](https://openairdocs.org/model/cessna-500) (registry code 2076602) (OpenAirDocs)
- Category: Airplane
- Serial number: 500-0258
- Year built: 1975
- Airframe hours: 8736
- Engines: P&W JT15D-4B 2500 lbs thrust turbo fan; P&W JT15D-4B 2500 lbs thrust turbo fan
- Damage: Substantial damage
- Flight: Personal, Part 91
- Operator: Jj Aeronautics Inc
- Registered owner: Jj Aeronautics Inc
- Airworthiness certificate: Standard, Normal
- Last inspection: Continuous airworthiness, August 13, 2013
- Departed: OPF, Opa Locka, FL
- Destination: ZPH, Zephyrhills, FL
- Flight plan: IFR
- Airport: ZPH, Zephyrhills Muni, runway 36, 4,954 × 100 ft, asphalt
- Equipment: Auto-pilot

## Flight crew

As NTSB recorded them. NTSB leaves out names.

- Pilot; age 40; injuries: none; airline transport; airplane ratings: multi-engine land; instrument ratings: airplane; medical: class 2, without waivers/limitations; last flight review November 22, 2013; seat: left; flight hours: 3,921 total, 530 in this make and model, 2,362 as pilot in command, 257 in the last 90 days, 131 in the last 30 days, 6 in the last 24 hours
- Co-pilot; age 32; injuries: none; airline transport; airplane ratings: multi-engine land; instrument ratings: airplane; medical: class 1, without waivers/limitations; seat: right; flight hours: 5,289 total, 1,380 in this make and model, 3,286 as pilot in command, 120 in the last 90 days, 30 in the last 30 days, 6 in the last 24 hours

## Weather

- Conditions: Visual (VMC), Day
- Wind: 170° at 14 knots, gusting 22
- Visibility: 10 statute miles
- Lowest ceiling: none
- Temperature: 73 °F, dew point 61 °F
- Altimeter: 29.94 inHg
- Observed at: ZPH

## 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 20140316004309A](https://openairdocs.org/incident/20140316004309A), Mar 16, 2014: Cessna 500, Zephyrhills, FL, Substantial damage. On March 16, 2014, a Cessna 500, N125DS, registered to jj aeronautics, inc. landed on runway 36 at Zephyrhills Florida (zph) and ran off the end of the runway.…

## Docket (5 files)

The files NTSB released with the investigation on May 29, 2014, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=88942. 4.4 MB in all.

- Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 529 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40412857&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Redacted.PDF
- FAA Inspector Statements (item 2, .PDF, 299 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40412858&FileExtension=.PDF&FileName=FAA%20Inspector%20Statements-Redacted.PDF
- ZPH Weather Data (item 3, .PDF, 46 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40412859&FileExtension=.PDF&FileName=ZPH%20Weather%20Data-Master.PDF
- Photo 1. Crease in Pressure Vessel (Photo Courtesy of FAA) (item 4, .PDF, 1.5 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40412860&FileExtension=.PDF&FileName=Photo%201.%20Crease%20in%20Pressure%20Vessel%20(Photo%20Courtesy%20of%20FAA)-Master.PDF
- Photo 2. Flat Spot and Hole in Right Main Landing Gear (Photo Courtesy of FAA) (item 5, .PDF, 1.9 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40412861&FileExtension=.PDF&FileName=Photo%202.%20Flat%20Spot%20and%20Hole%20in%20Right%20Main%20Landing%20Gear%20(Photo%20Courtesy%20of%20FAA)-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.

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