# NTSB WPR10LA002: Cessna 421B, N31KT, San Simeon, CA, October 3, 2009 - Type: NTSB accident investigation - Classification: Accident · No injuries · Limited investigation · Final report - Date: October 2, 2009, 17:16 local (Oct 3, 2009, 00:16 UTC) - Place: San Simeon, CA - Location: 35.6182° N, 121.1374° W: Placed by OpenAirDocs: center of San Simeon, CA, within about 6 miles (OpenAirDocs) - NTSB coordinates: 33.663612, -121.198608, outside the stated state - Nearby events: https://openairdocs.org/map.md?lat=35.6182&lon=-121.1374&mi=10 - Phase of flight: [Standing](https://openairdocs.org/ntsb-phases/150) (OpenAirDocs' grouping) - Defining event: [Standing-engine(s) shutdown: Ground collision](https://openairdocs.org/ntsb-events/200) - Highest injury: No injuries - Injuries: 6 uninjured - Status: Completed, report March 3, 2010 - Report: Approved by Office Director - NTSB office: Western Pacific Region - Parties: Federal Aviation Administration - NTSB case key (mKey): 74841 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=WPR10LA002 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/74841/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=74841 - Page: https://openairdocs.org/ntsb/WPR10LA002 ## Probable cause The pilot's failure to follow the manufacturer’s checklist and set the parking brake. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Parking/securing: parking/storage](https://openairdocs.org/ntsb-findings/01011010): Aircraft › Aircraft handling/service · Not specified (probable cause); cases with it: [Cessna 421B, 1 case](https://openairdocs.org/ntsb-findings/01011010/cases.md?model=2076014), [All aircraft, 5 cases](https://openairdocs.org/ntsb-findings/01011010/cases.md) - [Use of equip/info: use of checklist](https://openairdocs.org/ntsb-findings/02063030): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Cessna 421B, 1 case](https://openairdocs.org/ntsb-findings/02063030/cases.md?model=2076014), [All aircraft, 336 cases](https://openairdocs.org/ntsb-findings/02063030/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Standing-engine(s) shutdown: Ground collision](https://openairdocs.org/ntsb-events/200) (defining event); cases with it: [Cessna 421B, 2 cases](https://openairdocs.org/ntsb-events/200/sequence.md?model=2076014), [All aircraft, 618 cases](https://openairdocs.org/ntsb-events/200/sequence.md) ## Analysis The pilot taxied into the parking area, which appeared to be level from his perspective in the cockpit. Although the checklist called for setting the parking brake, the pilot elected to not use it since there were several chocks available on the ramp and no movement of the airplane was observed. He walked back to open the passenger door when the airplane began rolling backwards and impacted the windshield of a parked car. Although the parking area appeared level, the pilot indicated that later analysis showed there was a gradual slope. ## Factual narrative On October 2, 2009, at 1716 Pacific daylight time, N31KT, a Cessna 421B, rolled backwards into a parked car at the Hearst Castle Airstrip, San Simeon, California. The empennage sustained substantial damage. Western Air Charter was operating the airplane under the provisions of 14 Code of Federal Regulations Part 135. The airline transport pilot and five passengers were not injured. Visual meteorological conditions prevailed and the pilot had requested and received flight following. The pilot departed from Santa Monica Municipal Airport, Santa Monica, California, at 1600 and was at his destination when the accident occurred. The pilot reported that he had shutdown the engines and secured the airplane. The pilot indicated that although the checklist called for setting the parking brake, he elected to not use it since there were several chocks available on the ramp and no movement of the airplane was observed. He walked back to open the passenger door when the airplane began rolling backwards and impacted the windshield of a parked car. Although the parking area appeared level, the pilot indicated that later analysis showed there was a gradual slope. ## Aircraft - Registration: [N31KT](https://openairdocs.org/aircraft/N31KT), registered now, S/N 421B0011, built 1970 (OpenAirDocs) - Reported make and model: CESSNA 421B - Registry model: [Cessna 421B](https://openairdocs.org/model/cessna-421b) (registry code 2076014) (OpenAirDocs) - Registry engine: [Continental GTSIO-520-C](https://openairdocs.org/engine/continental-gtsio-520-c) (registry code 17035, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 421B0011 - Airframe hours: 4850 - Engines: Teledyne Continental Motors GTSIO-520-H 375 horsepower reciprocating - Damage: Substantial damage - Flight: Part 135 - Operator: Western Air Charter - Registered owner: Kenneth Smith - Airworthiness certificate: Standard, Normal - Last inspection: 100 hour, December 24, 2008, 73 hours before - Departed: SMO, Santa Monica, CA - Destination: PVT, San Simeon, CA - Airport: PVT, Hearst Castle Airstrip ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 56; injuries: none; flight instructor, airline transport; airplane ratings: single-engine land, multi-engine land; instrument ratings: airplane; medical: class 2, with waivers/limitations; last flight review March 31, 2009; seat: left; flight hours: 5,612 total, 1,700 in this make and model, 5,518 as pilot in command, 59 in the last 90 days, 28 in the last 30 days ## Weather - Conditions: Visual (VMC), Day - Wind: 200° at 12 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 84 °F, dew point 34 °F - Altimeter: 29.80 inHg - Observed at: PRB, 30 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 (OpenAirDocs). - [Accident 20091003019429A](https://openairdocs.org/incident/20091003019429A), Oct 3, 2009: Cessna 421B, San Simeon, CA, Substantial damage. The pilot (kenneth smith) left the flight compartment ot open the passenger door. By the pilot's own admission to san luis obispo county sheriff department the… ## Docket (1 files) The files NTSB released with the investigation on November 23, 2009, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=74841. 698 KB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 698 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40320793&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Redacted.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. --- OpenAirDocs.org is an independent research project of [Contrail Labs](https://contraillabs.com/). It is not affiliated with the FAA or the NTSB. Source documents are U.S. government works in the public domain.