ERA18LA253

NTSB accident investigation · Cirrus SR22 · Montauk, NY · September 16, 2018

Accident · Minor injuriesLimited investigationFinal report
Date
September 16, 2018, 16:06 local (20:06 UTC)
Place
Montauk, NY
Injuries
1 minor, 1 uninjured
Damage
Substantial damage
Phase of flight
Takeoff
Aircraft
N161DLCirrus SR22
Defining event
Takeoff: Loss of control on ground
Weather
Visual (VMC) · Day
Status
Completed · report April 13, 2020
Report
Approved by Office Director
NTSB office
Eastern Region Aviation
Parties
FAA/FSDO, Cirrus Aircraft
FAA report
20180916013749A
Case key
98309

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

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Probable cause

The pilot's failure to properly secure his seat before initiating the takeoff, which resulted in the seat sliding back as the airplane accelerated during takeoff, his inability to reach the pedals, and the subsequent loss of directional control and impact with trees and shrubs.

Findings · 4

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.

Fuselage: seat/cargo attach fittingAircraft › Aircraft structures · Incorrect use/operationCirrus Design SR22: 1 caseAll aircraft: 27 casesProbable cause
Performance/control parameters: directional controlAircraft › Aircraft oper/perf/capability · Not attained/maintainedCirrus Design SR22: 35 casesAll aircraft: 3,958 casesProbable cause
Object/animal/substance: tree(s)Environmental issues › Physical environment · Effect on operationCirrus Design SR22: 11 casesAll aircraft: 933 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 private pilot was taking off for a personal, cross-country flight. He reported that, at rotation, the pilot's seat "abruptly slid backwards to the outermost distance from the controls." As a result, the pilot could no longer reach the pedals to maintain directional control, and his aileron input could not counteract the airplane's left-turning tendency. The airplane subsequently departed the left side of the runway, struck trees and shrubs, and then came to rest upright. The wings, fuselage, and empennage sustained substantial damage. According to the pilot, except for the pilot seat, the airplane performed as designed with no other anomalies noted. Examination of the pilot's seat revealed no anomalies with the installation, dimensions, or operation. The seat moved freely fore and aft with no binding or anomalous operation noted. During postaccident functional testing of the seat, when twisting forces to the right were applied to the seat and while being slid forward, the seat position locking pin could be partially engaged, but not all the pins would seat, and the control handle would not go fully down nor could it be forced into position. Straightening or forward movement of the seat resulted in full pin engagement with the control handle in the fully down position. Given this information, it is likely that the pilot applied a twisting force when moving the seat and did not fully engage the seat position locking pins before initiating the takeoff, which resulted in the seat subsequently sliding back as the airplane accelerated during takeoff and the pilot's subsequent loss of directional control.

Factual narrative

On September 16, 2018, at 1606 eastern daylight time, a Cirrus SR22, N161DL, was substantially damaged during collision with trees and terrain during takeoff from Montauk Airport (MTP), Montauk, New York. The pilot was not injured, and a passenger sustained minor injuries. Visual meteorological conditions prevailed, and no flight plan was filed for the personal flight, which was conducted under the provisions of Title 14 Code of Federal Regulations Part 91.The pilot provided a written statement and was interviewed by telephone. He said he completed the preflight inspection, engine run-up, and before-takeoff checks with no anomalies noted, and then positioned the airplane for takeoff from runway 24. The pilot advanced the throttle and tracked the runway centerline during the takeoff roll. At rotation, the pilot's seat "abruptly slid backwards to the outermost distance from the controls." The pilot said that he could no longer reach the pedals to maintain directional control, and that aileron input was inadequate to counteract the airplane's left-turning tendency. The airplane departed the left side of the runway, struck trees and shrubs, and came to rest upright. According to the pilot, except for the pilot seat, the airplane performed as designed with no other anomalies noted. The pilot stated that he had adjusted his seat prior to the flight "as normal" and had never had difficulty with the seat at any time in the past. He added that this was the third Cirrus SR22 that he had owned and had no history of seat issues with either of his previous two airplanes. The pilot held a private pilot certificate with ratings for airplane single engine land and instrument airplane. His most recent Federal Aviation Administration (FAA) third class medical certificate was issued January 4, 2018. He reported 750 total hours of flight experience, all of which was in the accident airplane make and model. According to FAA records, the airplane was manufactured in 2014. Its most recent annual inspection was completed October 15, 2017 at 187.9 total aircraft hours. At 1654, the weather recorded at MTP included clear skies and variable winds at 4 knots. The temperature was 24°C, and the dew point was 19°C. The altimeter setting was 30.21 inches of mercury. Examination of photographs revealed that the wings, fuselage, and empennage all sustained substantial impact damage. An FAA inspector who responded to the site said he could not enter the cockpit, as the door was either locked or impinged by impact damage. Examination of the pilot's seat was performed by a manufacturer's representative under the supervision of an NTSB air safety investigator, and cabin safety specialist. The examination revealed no anomalies with the installation, dimensions, or operation of the pilot's seat. The seat moved freely fore and aft, with no binding or anomalous operation noted. While seated in the pilot's seat, the manufacturer's representative applied fore, aft, and twisting forces tothe seat to "unlock" the seat from a locked position. When "twisted to right while being slid forward" partial seat position locking pin engagement could be induced, but not all pins would seat and the control handle would not be fully down, and neither could it be forced into position. Straightening or forward movement of the seat resulted in full pin engagement with the control handle in the fully-down position. According to the Pilot Operating Handbook and the placard on the center console, "CREW SEATS MUST BE LOCKED IN POSITION AND CONTROL HANDLES FULLY DOWN BEFORE FLIGHT"

Aircraft

Registration
N161DL
Reported as
Cirrus SR22 (Undesignat)
Category
Airplane
Serial number
4128
Built
2014
Airframe hours
248
Engine
Continental IO-550-N, 310 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Airworthiness certificate
Standard, Normal
Last inspection
Annual · October 15, 2017
Departed
MTP · Montauk, NY
Destination
HTO · East Hampton, NY
Airport
MTP · Montauk, runway 24, 3,246 × 75 ft, asphalt

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
65
Injuries
None
Certificate
Private
Airplane ratings
Single-engine land
Instrument ratings
Airplane
Medical
Class 3, With waivers/limitations
Seat
Left
Flight hours
750 total · 750 in this make and model

Weather

Conditions
Visual (VMC) · Day
Visibility
10 statute miles
Lowest ceiling
None
Temperature
75 °F, dew point 66 °F
Altimeter
30.20 inHg
Observed at
KMTP

Docket · 6

The files NTSB released with the investigation on November 29, 2019, on NTSB’s docket system: statements, records, photos and specialists’ reports. 4.6 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.