ERA22LA317

NTSB accident investigation · Cessna T210F · Monticello, NY · July 15, 2022

Accident · No injuriesClass 3 · LimitedFinal report
Date
July 15, 2022, 12:45 local (16:45 UTC)
Place
Monticello, NY
Injuries
1 uninjured
Damage
Destroyed
Phase of flight
Enroute
Aircraft
N6195RCessna T210F
Defining event
Enroute-cruise: Loss of engine power (total)
Weather
Visual (VMC) · Day
Status
Completed
Report
Approved by Office Director
Investigation class
Class 3
NTSB office
Eastern Region Aviation
Parties
FAA
FAA report
20220715012279A
Case key
105495

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

Maintenance personnel’s improper torque of the engine through-bolts during maintenance, which resulted in a bearing shift, oil starvation, and a total loss of engine power.

Findings · 2

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.

Engine (reciprocating): recip engine power sectionAircraft › Aircraft power plant · Incorrect service/maintenanceCessna T210F: 1 caseAll aircraft: 233 casesProbable cause
Maintenance: repairPersonnel issues › Task performance · Maintenance personnelCessna T210F: 1 caseAll aircraft: 99 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 was descending toward the destination airport when the engine began losing power and “making noises.” The pilot switched fuel tanks, but the power loss continued. He subsequently began looking for a place to land the airplane. The pilot then heard what sounded like an “explosion” from the engine. The oil service door blew open and began spewing oil and smoke from the service door opening, covering the windscreen. Smoke then began entering the cabin. The pilot landed on a road with the landing gear retracted, and the airplane slid to a stop. The airplane caught on fire, and the pilot egressed before the cockpit was consumed. Postaccident examination of the engine revealed that the Nos. 5 and 6 connecting rods were fractured. The No. 5 connecting rod was missing and the No. 6 connecting rod exhibited thermal discoloration consistent with a loss of lubrication. The crankshaft and camshaft were fractured at the No. 5 cylinder. Review of the engine logbook revealed that about 100 flight hours (5 months) before the accident flight, engine through-bolt nuts were removed and resealed for oil leaks. Given this information, it is likely that maintenance personnel did not properly torque the crankcase through-bolts, which allowed the No. 5 main bearing to shift, resulting in loss of lubrication to that area and subsequent engine failure.

Factual narrative

On July 15, 2022, at 1245 eastern daylight time, a Cessna T210F, N6195R, was destroyed when it was involved in an accident near Monticello, New York. The pilot was not injured. The airplane was operated as a Title 14 Code of Federal Regulations Part 91 personal flight. The pilot stated that he conducted an uneventful flight earlier during the day from Maine to Sussex County Airport (FWN), Sussex, New Jersey, to fly a potential buyer in the airplane, which he was selling. After the short flight, the pilot dropped off the potential buyer at FWN and planned to fly to Sullivan County International Airport (MSV), Monticello, New York, for fuel before returning home to Maine. Upon beginning a descent into MSV, the engine began losing power and “making noises.” The pilot verified the fuel quantity and mixture setting, and estimated that 10 gallons of fuel remained in each tank. He switched fuel tanks, but the power loss continued. He subsequently began looking for a place to land the airplane. The pilot then heard what sounded like an “explosion” from the engine. The oil service door blew open and began spewing oil and smoke from the service door opening, covering the windscreen. Smoke then began entering the cabin. The pilot reported extending the wing flaps and landing gear, but did not have time to verify extension. He identified a field as an emergency landing location. As the airplane approached the field, about 200 ft above the ground, the pilot saw high voltage power lines crossing the field and he repositioned the airplane for a landing on a road. After landing, the airplane caught on fire, and the pilot egressed before the cockpit was consumed. Postaccident examination of the airplane by a Federal Aviation Administration inspector revealed that the landing gear did not extend, and that the engine had a large section of the crankcase missing from the forward left side. The No. 6 connecting rod was laying on top of the engine and the crankshaft and camshaft were fractured. Further examination revealed that the engine was thermally damaged. The spark plug wires were burnt. The oil filter was thermally damaged. When it was cut open, metal shavings were noted in the filter element. The fuel pump was thermally damaged; however, the shear shaft was unremarkable. The oil pump was impact damaged and could not be rotated. The turbocharger was thermally damaged but rotated freely. Both magnetos were thermally damaged and would not produce spark on any leads. The oil pan was melted away and missing. The crankshaft and camshaft were fractured at the No. 5 cylinder. The propeller, oil cooler, front section of the camshaft and crankshaft were fractured off the engine. The spark plugs exhibited normal wear. The cylinder skirts on cylinder Nos. 5 and 6 were damaged by the corresponding connecting rod failures and the cylinders could not be removed. The connecting rod for cylinder No. 5 was missing. The No. 6 connecting rod was thermally damaged and discolored.The fuel flow divider was thermally damaged, and the diaphragm was melted. The propeller was thermally damaged, and one blade tip was melted away. Review of the airplane’s maintenance logbooks revealed that 105 and 106 flight hours before the accident (about 5 months), engine through-bolt nuts were removed and resealed due to oil leaks.

Aircraft

Registration
N6195R
Reported as
Cessna T210F
Category
Airplane
Serial number
T210-0095
Built
1966
Airframe hours
4,730.3
Engine
Continental TSIO-520-C, 285 hp, reciprocating
Damage
Destroyed
Fire
On-Ground
Flight
Personal · Part 91
Operator
Simmons Mark K Trustee
Registered owner
Simmons Mark K Trustee
Airworthiness certificate
Standard, Normal
Last inspection
Annual · February 28, 2022
Departed
FWN · Sussex, NJ
Destination
MSV · Monticello, NY
Equipment
ADS-B

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
66
Injuries
None
Certificate
Airline transport
Airplane ratings
Single-engine land, Multi-engine land
Medical
BasicMed, With waivers/limitations
Last flight review
February 15, 2022
Seat
Left
Restraint
Lap only
Flight hours
15,000 total · 230 in this make and model · 12,000 as pilot in command

Weather

Conditions
Visual (VMC) · Day
Visibility
10 statute miles
Temperature
79 °F, dew point 52 °F
Altimeter
30.20 inHg
Observed at
KMSV, 7 nm away
METAR
KMSV 151656Z AUTO VRB03KT 10SM FEW065 26/11 A3020 RMK AO2 SLP221 T02610106 PNO $

Docket · 6

The files NTSB released with the investigation on January 4, 2024, on NTSB’s docket system: statements, records, photos and specialists’ reports. 23.8 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.

Other investigations on N6195R · 1

Matched to the same aircraft by N-number and date.