# NTSB WPR12LA384: Cessna 182R, N5458N, St. Johns, AZ, August 31, 2012 - Type: NTSB accident investigation - Classification: Accident · Minor injuries · Limited investigation · Final report - Date: August 31, 2012, 16:10 local (23:10 UTC) - Place: St. Johns, AZ - Coordinates: 34.513053, -109.372497 - Nearby events: https://openairdocs.org/map.md?lat=34.5131&lon=-109.3725&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: Minor injuries - Injuries: 1 minor - Status: Completed, report May 21, 2014 - Report: Approved by Office Director - NTSB office: Western Pacific Region - Parties: FAA FSDO - NTSB case key (mKey): 84882 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=WPR12LA384 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/84882/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=84882 - Page: https://openairdocs.org/ntsb/WPR12LA384 ## Probable cause The pilot’s delay in executing a go-around, which resulted in a runway overrun. Contributing to the accident were the pilot’s failure to establish the proper glidepath and airspeed on final approach and his improper use of flaps during the go-around. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Action: delayed action](https://openairdocs.org/ntsb-findings/02041025): Personnel issues › Action/decision · Pilot (probable cause); cases with it: [Cessna 182R, 2 cases](https://openairdocs.org/ntsb-findings/02041025/cases.md?model=2072731), [All aircraft, 894 cases](https://openairdocs.org/ntsb-findings/02041025/cases.md) - [Use of equip/info: use of policy/procedure](https://openairdocs.org/ntsb-findings/02063032): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Cessna 182R, 1 case](https://openairdocs.org/ntsb-findings/02063032/cases.md?model=2072731), [All aircraft, 191 cases](https://openairdocs.org/ntsb-findings/02063032/cases.md) - [Performance/control parameters: descent/approach/glide path](https://openairdocs.org/ntsb-findings/01062040): Aircraft › Aircraft oper/perf/capability · Not attained/maintained (probable cause); cases with it: [Cessna 182R, 3 cases](https://openairdocs.org/ntsb-findings/01062040/cases.md?model=2072731), [All aircraft, 809 cases](https://openairdocs.org/ntsb-findings/01062040/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 182R, 4 cases](https://openairdocs.org/ntsb-events/300/sequence.md?model=2072731), [All aircraft, 3,643 cases](https://openairdocs.org/ntsb-events/300/sequence.md) ## Analysis The pilot reported that the airplane was high and fast on final approach for landing, so he lowered the flaps to 40 degrees and raised the nose to slow down. The pilot then decided to go around, so he applied full power and raised the flaps to 30 degrees. The airplane began to climb, but then it started descending. The pilot reduced the engine power, landed the airplane, and applied heavy braking. The airplane subsequently overran the end of the runway and went through the perimeter fence. After he exited the airplane, the pilot found the flaps fully retracted. The airplane's Pilot Operating Handbook stated that go-arounds should be performed with the flaps at 20 degrees. Further, the pilot should have performed a go-around when he first noticed that the airplane was too high and fast on the final approach. ## Factual narrative On August 31, 2012, about 1610 mountain standard time, a Cessna 182R, N5458N, sustained substantial damage during a runway overrun while landing at St. Johns, Arizona. The private pilot, the sole occupant, received minor injuries. The pilot/owner was operating the airplane under the provisions of 14 Code of Federal Regulations Part 91. Visual meteorological conditions prevailed for the personal cross-country flight, which had originated from Dalhart, Texas, about 3 hours before the accident. A flight plan had not been filed. The pilot said that he started his traffic pattern higher than recommended due to his high density altitude concerns. He said his final approach was longer than normal and his speed was fast. He put the flaps down full and raised the nose to bleed off more airspeed. A witness on the ground said the airplane passed the midfield intersection and was still quite high off the runway. The witness said the accident pilot appeared to be performing a go-around. But then the airplane descended to the runway and touched down with about 3/4 of its length behind him. The pilot said that he realized that the airplane was high, fast, and long for a normal landing. He decided to go around. He applied full power; he reduced flaps by 10 degrees, and the airplane started to climb. However, the airplane then began to descend; "it was sort of mushing out of the sky." He reduced the engine power, landed, and began heavy braking. A witness on the ground said that he observed black smoke coming from the main landing gear tires after the airplane touched down. The airplane departed the end of the runway and went through the airport's perimeter fence. The airplane came to rest on its nose with the right wing strut bent, and both wings bent and wrinkled. After he exited the airplane, the pilot discovered that the flaps were fully retracted. The airplane's manufacturer published a Pilot's Operating Handbook, which states that after the throttle is moved to full power for a go-around, the wing flaps shall be retracted from 40 to 20 degrees. The pilot stated that he had just purchased this particular airplane 4 days earlier. He said he practiced two full stop landings and takeoffs, but he did not practice any go-arounds. The pilot stated that the accident might have been avoided if he had practiced go-arounds with incremental raising of the flaps, or stopped the approach and exited the traffic pattern when he realized he was too high. ## Aircraft - Registration: [N5458N](https://openairdocs.org/deregistered/N5458N-2012-11-08), registration cancelled 2012-11-08, S/N 18267729, built 1980 (OpenAirDocs) - Reported make and model: CESSNA 182R - Registry model: [Cessna 182R](https://openairdocs.org/model/cessna-182r) (registry code 2072731) (OpenAirDocs) - Registry engine: [Continental I0-470 series](https://openairdocs.org/engine/continental-i0-470-series) (registry code 17027, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 18267729 - Year built: 1980 - Airframe hours: 2359 - Engines: CONT MOTOR IO-470 SERIES 260 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Operator: Bruce D. Lisle - Registered owner: Bruce D. Lisle - Airworthiness certificate: Standard, Normal - Last inspection: Annual, January 18, 2012 - Departed: DHT, Dalhart, TX - Destination: SJN, St. Johns, AZ - Flight plan: Unknown - Airport: SJN, St Johns Industrial Air Park, runway 14, 5,322 × 75 ft, asphalt - Equipment: Stall warning system ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 71; injuries: minor; private; airplane ratings: single-engine land; medical: class 3, with waivers/limitations; seat: left; flight hours: 1,550 total, 750 in this make and model, 11 in the last 90 days, 9 in the last 30 days, 6 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: 220° at 7 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 86 °F, dew point 45 °F - Altimeter: 30.12 inHg - Observed at: SJN ## 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 20120831018979A](https://openairdocs.org/incident/20120831018979A), Aug 31, 2012: Cessna 182R, St Johns, AZ, Destroyed. On 8-31-12 at 1620 hours MST at St Johns Industrial air park (sjn) N5458N, a Cessna CE-182R aircraft, was landing on runway 14. The pilot lost control of the… ## Docket (3 files) The files NTSB released with the investigation on April 28, 2014, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=84882. 1.2 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 629 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40411002&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Master.PDF - Witness, Airport Manager (item 2, .PDF, 378 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40411003&FileExtension=.PDF&FileName=Witness,%20Airport%20Manager-Master.PDF - C-182R Pilot Operating Handbook, Balked Landing (item 3, .PDF, 145 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40411004&FileExtension=.PDF&FileName=C-182R%20Pilot%20Operating%20Handbook,%20Balked%20Landing-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. --- 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.