Wednesday, December 18, 2019

Loss of Control on Ground: Piper PA-20, N7409K; accident occurred July 12, 2019 at Ravalli County Airport (6S5), Hamilton, Montana

View of right wing lift strut damage.
Federal Aviation Administration



Additional Participating Entity:
Federal Aviation Administration / Flight Standards District Office; Helena, Montana

Aviation Accident Final Report - National Transportation Safety Board: https://app.ntsb.gov/pdf

Investigation Docket - National Transportation Safety Board: https://dms.ntsb.gov/pubdms

https://registry.faa.gov/N7409K

Location: Hamilton, MT
Accident Number: GAA19CA408
Date & Time: 07/12/2019, 1230 MDT
Registration: N7409K
Aircraft: Piper PA 20
Aircraft Damage: Substantial
Defining Event: Loss of control on ground
Injuries: 1 Minor
Flight Conducted Under: Part 91: General Aviation - Personal 

Analysis 

The pilot of the tailwheel-equipped airplane reported that, upon landing and approaching the taxiway he intended to exit, he lifted his feet from the "rudderbars" to engage the brakes. The airplane abruptly entered a left turn, and he thought he used the right rudder, but he mistakenly used brake pedal. Immediately thereafter, the airplane nosed over.

The airplane sustained substantial damage to the right wing lift strut and rudder.

The pilot reported that there were no preaccident mechanical failures or malfunctions with the airplane that would have precluded normal operation.

The pilot reported that he believes the accident could have been avoided "if [he] had kept [his] feet on the rudderbars until [the airplane] had exited the runway." 

Probable Cause and Findings

The National Transportation Safety Board determines the probable cause(s) of this accident to be:
The pilot's loss of directional control due to his unintentional use of brakes instead of the rudder during the landing roll, which resulted in a nose-over.

Findings

Aircraft
Brake - Unintentional use/operation (Cause)
Directional control - Not attained/maintained (Cause)

Personnel issues
Use of equip/system - Pilot (Cause)

Factual Information

History of Flight

Landing
Loss of control on ground (Defining event)
Attempted remediation/recovery
Nose over/nose down

Pilot Information

Certificate: Private
Age: 74, Male
Airplane Rating(s): Single-engine Land
Seat Occupied: Left
Other Aircraft Rating(s): None
Restraint Used: 3-point
Instrument Rating(s): None
Second Pilot Present: No
Instructor Rating(s): None
Toxicology Performed: No
Medical Certification: Class 3 With Waivers/Limitations
Last FAA Medical Exam: 02/15/2018
Occupational Pilot: No
Last Flight Review or Equivalent: 05/05/2019
Flight Time:  (Estimated) 726 hours (Total, all aircraft), 460 hours (Total, this make and model), 595 hours (Pilot In Command, all aircraft), 4 hours (Last 90 days, all aircraft), 4 hours (Last 30 days, all aircraft), 1 hours (Last 24 hours, all aircraft) 

Aircraft and Owner/Operator Information

Aircraft Make: Piper
Registration: N7409K
Model/Series: PA 20 Undesignated
Aircraft Category: Airplane
Year of Manufacture:
Amateur Built: No
Airworthiness Certificate: Normal
Serial Number: 20-318
Landing Gear Type: Tailwheel
Seats: 4
Date/Type of Last Inspection: 06/13/2019, Annual
Certified Max Gross Wt.: 1950 lbs
Time Since Last Inspection:
Engines: 1 Reciprocating
Airframe Total Time: 3433.89 Hours at time of accident
Engine Manufacturer: Lycoming
ELT: C91 installed, activated, did not aid in locating accident
Engine Model/Series: O-320-A2A
Registered Owner: On file
Rated Power: 150 hp
Operator: On file
Operating Certificate(s) Held:None 

Meteorological Information and Flight Plan

Conditions at Accident Site: Visual Conditions
Condition of Light: Day
Observation Facility, Elevation: K6S5, 3189 ft msl
Distance from Accident Site: 40 Nautical Miles
Observation Time: 1835 UTC
Direction from Accident Site: 2°
Lowest Cloud Condition: Clear
Visibility:  10 Miles
Lowest Ceiling: None
Visibility (RVR):
Wind Speed/Gusts: 6 knots /
Turbulence Type Forecast/Actual: None / None
Wind Direction: 10°
Turbulence Severity Forecast/Actual: N/A / N/A
Altimeter Setting: 30.06 inches Hg
Temperature/Dew Point: 25°C / 13°C
Precipitation and Obscuration: No Obscuration; No Precipitation
Departure Point: Hamilton, MT (6S5)
Type of Flight Plan Filed: None
Destination: Hamilton, MT (6S5)
Type of Clearance: None
Departure Time: 1120 MDT
Type of Airspace: Class G

Airport Information

Airport: Ravalli County (6S5)
Runway Surface Type: Asphalt
Airport Elevation: 3644 ft
Runway Surface Condition: Dry
Runway Used: 34
IFR Approach: None
Runway Length/Width: 4200 ft / 75 ft
VFR Approach/Landing: Full Stop; Traffic Pattern

Wreckage and Impact Information

Crew Injuries: 1 Minor
Aircraft Damage: Substantial
Passenger Injuries: N/A
Aircraft Fire: None
Ground Injuries: N/A
Aircraft Explosion: None
Total Injuries: 1 Minor
Latitude, Longitude: 46.251389, -114.125556 (est)

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