FTW95LA174

NTSB accident investigation · Cessna T210L · Estancia, NM · April 19, 1995

Accident · Minor injuriesLimited investigationFinal report
Date
April 18, 1995, 20:30 local (Apr 19, 1995, 02:30 UTC)
Place
Estancia, NM
Injuries
1 minor
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N1664XCessna T210L
Weather
Visual (VMC) · Night/dark
Status
Completed · report October 19, 1995
Report
Approved by Office Director
FAA report
19950418036299A
Case key
19399

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 loss of engine power due to exhaust valve separation resulting from inadequate maintenance. A factor was the dark night and the lack of suitable terrain for the forced landing.

Sequence of events

NTSB’s coding before 2008: each occurrence and phase of flight, and the causes and factors under it. The codes are defined in NTSB’s coding manual.

Loss of engine power(total) - mech failure/malfCruise - normal
Engine assembly,valve,exhaust - separationCause
Maintenance - inadequateOther maintenance personnelCause
Forced landingEmergency descent/landing
In flight collision with objectEmergency descent/landing
Terrain condition - none suitableFactor
Object - wire,transmission
Object - tree(s)
Object - fence
Light condition - dark nightFactor
In flight collision with terrain/waterDescent - uncontrolled

Analysis

During the forced landing, following a total loss of engine power, in dark night conditions, the airplane struck transmission wires and trees before coming to rest inverted along a fence row. Examination of the engine revealed a hole in the #2 piston. Physical evidence indicated that the exhaust valve migrated out the exhaust. Metal parts, found in the oil sump, were identified as parts of the #2 exhaust valve seat. Engine s/n 217105R was overhauled in March, 1992; however, records did not indicate that the valves had been changed at the overhaul. According to the manufacturer representative, 'guidelines for an engine overhaul require changing the valve.' The engine was subsequently removed and reassembled in August, 1993, and in February, 1994.

Factual narrative

On April 18, 1995, at 2030 mountain daylight time, a Cessna T210L, N1664X, collided with trees, transmission wires, and a fence during a forced landing near Estancia, New Mexico. The commercial pilot received minor injuries and the airplane sustained substantial damage. Visual meteorological conditions prevailed for the Title 14 CFR Part 135 on demand cargo cross country flight and a VFR flight plan was filed. The operator was B & M Enterprises, Inc., dba New Mexico Flying Service of Albuquerque, New Mexico.

During personal interviews, conducted by the Federal Aviation Administration (FAA) inspector, with the pilot, and a review of Albuquerque Air Route Traffic Control Center (ABQ ARTCC) data, the information in this paragraph was revealed. En route from Alamogordo, New Mexico, at 2016, radar contact was established and VFR flight following was received. At 2026, the pilot reported a total loss of engine power and declared an emergency. The controller issued the location and distance to the nearest lighted airport. Radar contact was lost at 2029; however, at 2031 the pilot transmitted that the landing would be in a field. Dark night conditions precluded visual contact with the terrain. On final approach, with the landing light on, a tree and houses were observed. At 50 feet above the ground, the pilot deviated to avoid the houses; however, the airplane descended through power lines and impacted the terrain. The airplane came to rest inverted along a fence row. Structural damage occurred to the left horizontal stabilizer, rudder, fuselage,and wings.

An examination by the FAA inspector and the manufacturer representative revealed a hole in the #2 piston. The #2 cylinder exhaust valve head was separated from the valve stem and the head was not located. Physical evidence indicated that the exhaust valve head migrated out the exhaust. Metal parts, found in the oil sump, were identified as parts of the #2 exhaust valve seat. Damage was noted to the turbine section of the turbocharger.

A review of the maintenance records revealed the following information. Engine S/N 217105R was overhauled in March, 1992; however, records did not show that the valves had been changed at the overhaul. According to the manufacturer representative, "guidelines for an engine overhaul require changing the valves." Records further indicated that the engine was removed in August, 1993, due to a cracked case and subsequently reassembled. Cylinders #4 and #6 were replaced in November, 1993, and a compression check conducted in December, 1993, indicated "68" for cylinder #2. The engine was again removed, disassembled, and reassembled in February, 1994, with the #4 cylinder being replaced, and in September, 1994, the #3 cylinder was replaced. On January 28, 1995, the last recorded maintenance record of an engine compression check indicated below "60" for 4 of the 6 cylinders.

Aircraft

Registration
N1664X
Reported as
Cessna T210L
Category
Airplane
Serial number
21060699
Airframe hours
5,743
Engine
Continental TSIO-520-H, 285 horsepower, reciprocating
Damage
Substantial damage
Flight
Part 135
Operator
B & M Enterprises, Inc., doing business as New Mexico Flying Service
Registered owner
Billy J. Ware
Airworthiness certificate
Standard, Normal
Last inspection
Annual · March 30, 1995 · 35 hours before
Departed
HMN · Alamogordo, NM
Destination
ABQ · Albuquerque, NM
Flight plan
VFR

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
25
Certificate
Commercial
Airplane ratings
Single-engine land, Multi-engine land
Instrument ratings
Airplane
Medical
Class 1, Valid Medical--w/ waivers/lim
Seat
Left
Flight hours
1,746 total · 505 in this make and model · 1,555 as pilot in command · 230 in the last 90 days · 57 in the last 30 days · 2 in the last 24 hours

Weather

Conditions
Visual (VMC) · Night/dark
Wind
180° at 9 knots
Visibility
40 statute miles
Temperature
59 °F, dew point 12 °F
Altimeter
29.00 inHg
Observed at
ABQ, 28 nm away

FAA reports on this event · 1

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