# NTSB WPR16CA077: Stinson 108 3, N862C, Livermore, CA, February 25, 2016 - Type: NTSB accident investigation - Classification: Accident · No injuries · Data collection · Final report - Date: February 25, 2016, 11:30 local (19:30 UTC) - Place: Livermore, CA - Coordinates: 37.693332, -121.820274 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=37.6933&lon=-121.8203&mi=10 - Phase of flight: [Landing](https://openairdocs.org/ntsb-phases/550) (OpenAirDocs' grouping) - Defining event: [Landing-landing roll: Loss of control on ground](https://openairdocs.org/ntsb-events/230) - Highest injury: No injuries - Injuries: 2 uninjured - Status: Completed, report May 3, 2016 - Report: Approved by Office Director - NTSB office: Western Pacific Region - Parties: FSDO - NTSB case key (mKey): 92795 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=WPR16CA077 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/92795/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=92795 - Page: https://openairdocs.org/ntsb/WPR16CA077 ## Probable cause The pilot's failure to maintain directional control during the landing roll. Contributing to the accident was maintenance personnel's failure to detect the worn tailwheel assembly during the airplane's annual inspection. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Performance/control parameters: directional control](https://openairdocs.org/ntsb-findings/01062020): Aircraft › Aircraft oper/perf/capability · Not attained/maintained (probable cause); cases with it: [Stinson 108-3, 11 cases](https://openairdocs.org/ntsb-findings/01062020/cases.md?model=9230408), [All aircraft, 3,958 cases](https://openairdocs.org/ntsb-findings/01062020/cases.md) - [Use of equip/info: aircraft control](https://openairdocs.org/ntsb-findings/02063040): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Stinson 108-3, 9 cases](https://openairdocs.org/ntsb-findings/02063040/cases.md?model=9230408), [All aircraft, 9,295 cases](https://openairdocs.org/ntsb-findings/02063040/cases.md) - [Landing gear system: nose/tail landing gear](https://openairdocs.org/ntsb-findings/01023220): Aircraft › Aircraft systems · Fatigue/wear/corrosion (probable cause); cases with it: [Stinson 108-3, 1 case](https://openairdocs.org/ntsb-findings/01023220/cases.md?model=9230408), [All aircraft, 185 cases](https://openairdocs.org/ntsb-findings/01023220/cases.md) - [Landing gear system: nose/tail landing gear](https://openairdocs.org/ntsb-findings/01023220): Aircraft › Aircraft systems · Failure (probable cause); cases with it: [Stinson 108-3, 1 case](https://openairdocs.org/ntsb-findings/01023220/cases.md?model=9230408), [All aircraft, 185 cases](https://openairdocs.org/ntsb-findings/01023220/cases.md) - [Landing gear system: nose/tail landing gear](https://openairdocs.org/ntsb-findings/01023220): Aircraft › Aircraft systems · Inadequate inspection (probable cause); cases with it: [Stinson 108-3, 1 case](https://openairdocs.org/ntsb-findings/01023220/cases.md?model=9230408), [All aircraft, 185 cases](https://openairdocs.org/ntsb-findings/01023220/cases.md) - [Inspection: scheduled/routine inspection](https://openairdocs.org/ntsb-findings/02061520): Personnel issues › Task performance · Maintenance personnel (probable cause); cases with it: [Stinson 108-3, 1 case](https://openairdocs.org/ntsb-findings/02061520/cases.md?model=9230408), [All aircraft, 167 cases](https://openairdocs.org/ntsb-findings/02061520/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: Loss of control on ground](https://openairdocs.org/ntsb-events/230) (defining event); cases with it: [Stinson 108-3, 12 cases](https://openairdocs.org/ntsb-events/230/sequence.md?model=9230408), [All aircraft, 4,585 cases](https://openairdocs.org/ntsb-events/230/sequence.md) - [Landing-landing roll: Runway excursion](https://openairdocs.org/ntsb-events/300); cases with it: [Stinson 108-3, 9 cases](https://openairdocs.org/ntsb-events/300/sequence.md?model=9230408), [All aircraft, 3,643 cases](https://openairdocs.org/ntsb-events/300/sequence.md) ## Analysis **This report was modified on February 20, 2020. Please see the public docket for this accident to view the original report.** The pilot reported that during the landing on runway 25L in the tail-wheel equipped airplane, it touched down in a three-point landing attitude on the centerline. Shortly thereafter, it started to veer to the right. The pilot applied full left rudder and brake application; however, the airplane continued to veer off the right edge of the runway into tall grass and ground looped. The airplane sustained substantial damage to the left wing. While taxiing the airplane back to the hangar, the pilot stated that he noticed that the wind was blowing from the northeast and that runway 7L was now in use. He also noticed that the left rudder/brake pedal required more travel distance than the right pedal, with reduced brake effectiveness on the left side. The National Transportation Safety Board's (NTSB) postaccident examination of the brake system found no evidence of preimpact mechanical malfunctions or failures were revealed that would have precluded normal operation. Subsequent to the NTSB's examination, a mechanic examined the tailwheel unit and found that it was loosely mounted and that the steering springs were weak. The mechanic then disassembled the tailwheel unit and found that the mount hole was excessively large and that a dowel and compression spring were worn. The mechanic's findings were consistent with wear over time and not a sudden failure. Thus, the issues with the tailwheel assembly existed before the accident and likely contributed to the uncommanded right turn; however, with appropriate braking, the pilot should have been able to regain directional control and keep the airplane on the runway. The airplane's last annual inspection before the accident occurred on August 20, 2015. The issues with the tailwheel assembly would have developed over a period of time that was much longer than the 6 months between the annual inspection and the accident. Thus, maintenance personnel should have detected the tailwheel assembly issues during the annual inspection. ## Factual narrative The pilot reported that during the landing on runway 25L in the tail-wheel equipped airplane, it touched down in a three-point landing attitude on the centerline. Shortly thereafter, it started to veer to the right. The pilot applied full left rudder and brake application; however, the airplane continued to veer off the right edge of the runway into tall grass and ground looped. The airplane sustained substantial damage to the left wing. While taxiing the airplane back to the hangar, the pilot stated that he noticed that the wind was blowing from the northeast and that runway 7L was now in use. He also noticed that the left rudder/brake pedal required more travel distance than the right pedal, with reduced brake effectiveness on the left side. During a postaccident examination of the brake system, no evidence of preimpact mechanical malfunctions or failures were revealed that would have precluded normal operation. ## Aircraft - Registration: [N862C](https://openairdocs.org/aircraft/N862C), registered now, S/N 1083862, built 1947 (OpenAirDocs) - Reported make and model: STINSON 108 3 (UNDESIGNAT) - Registry model: [Stinson 108-3](https://openairdocs.org/model/stinson-108-3) (registry code 9230408) (OpenAirDocs) - Registry engine: [Franklin 6A4165 series](https://openairdocs.org/engine/franklin-6a4165-series) (registry code 27025, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 1083862 - Year built: 1947 - Airframe hours: 1923 - Engines: FRANKLIN 6A4165 SERIES 165 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Operator: WHALEN FRANK and EPPERSON MARK - Registered owner: WHALEN FRANK and EPPERSON MARK - Airworthiness certificate: Standard, Normal - Last inspection: Annual, August 20, 2015 - Departed: TCY, TRACY, CA - Destination: LVK, Livermore, CA - Airport: LVK, Livermore Muni, runway 25L, 2,699 × 75 ft, asphalt ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 68; injuries: none; flight instructor, airline transport; airplane ratings: multi-engine land; instrument ratings: airplane; medical: class 2, with waivers/limitations; last flight review October 30, 2015; seat: right; flight hours: 17,940 total, 1 in this make and model, 15,090 as pilot in command, 210 in the last 90 days, 67 in the last 30 days, 3 in the last 24 hours - Pilot; age 67; injuries: none; airline transport, flight instructor; airplane ratings: single-engine land, multi-engine land; instrument ratings: airplane; medical: class 3, with waivers/limitations; last flight review September 5, 2015; seat: left; flight hours: 22,300 total, 45 in this make and model, 17,800 as pilot in command, 12 in the last 90 days, 10 in the last 30 days, 1 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: variable at 10 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 64 °F, dew point 39 °F - Altimeter: 30.15 inHg - Observed at: KLVK ## 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 20160225003619A](https://openairdocs.org/incident/20160225003619A), Feb 25, 2016: Stinson 108-3, Livermore, CA, Substantial damage. Aircraft was landing at Livermore, CA. (Lvk) runway 25L, after touch down aircraft veered off runway, ground looped in tall grass between runways with left… ## Docket (9 files) The files NTSB released with the investigation on April 26, 2016, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=92795. 10.8 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 4.1 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40439320&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Master.PDF - Witness Statement (item 2, .PDF, 48 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40439321&FileExtension=.PDF&FileName=Witness%20Statement-Master.PDF - NTSB Brakes Exam (item 3, .PDF, 86 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40439322&FileExtension=.PDF&FileName=NTSB%20Brakes%20Exam-Master.PDF - FAA Assessment of the Damage (item 4, .PDF, 10 photos, 920 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40439323&FileExtension=.PDF&FileName=FAA%20Assessment%20of%20the%20Damage-Master.PDF - Photos (item 5, .PDF, 3 photos, 2.0 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40439324&FileExtension=.PDF&FileName=Photos-Master.PDF - Petition for Reconsideration (item 6, .PDF, 1.1 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40481296&FileExtension=.PDF&FileName=Petition%20for%20Reconsideration-Master.PDF - Response to Petition for Reconsideration (item 7, .PDF, 809 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40481297&FileExtension=.PDF&FileName=Response%20to%20Petition%20for%20Reconsideration-Master.PDF - Changes to Aviation Accident Final Report (item 8, .PDF, 42 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40481298&FileExtension=.PDF&FileName=Changes%20to%20Aviation%20Accident%20Final%20Report-Master.PDF - Changes to Aviation Accident Final Report (item 9, .PDF, 1.7 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40481299&FileExtension=.PDF&FileName=Changes%20to%20Aviation%20Accident%20Final%20Report-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.