37000 Feet | Browse and search NASA's Aviation Safety Reporting System |
|
Attributes | |
ACN | 688233 |
Time | |
Date | 200602 |
Local Time Of Day | 1201 To 1800 |
Place | |
Locale Reference | airport : zzz.airport |
State Reference | US |
Environment | |
Light | Daylight |
Aircraft 1 | |
Operator | common carrier : charter |
Make Model Name | Learjet 60 |
Operating Under FAR Part | Part 135 |
Flight Phase | cruise : level ground : maintenance |
Person 1 | |
Affiliation | other |
Function | maintenance : inspector |
Qualification | technician : airframe technician : powerplant |
Experience | maintenance technician : 10 |
ASRS Report | 688233 |
Person 2 | |
Affiliation | other |
Function | maintenance : technician |
Qualification | technician : airframe technician : powerplant |
Experience | maintenance technician : 5 |
ASRS Report | 688232 |
Events | |
Anomaly | aircraft equipment problem : critical maintenance problem : improper maintenance maintenance problem : improper documentation non adherence : far non adherence : published procedure |
Independent Detector | aircraft equipment other aircraft equipment : main system - press qty and indications other other : 1 |
Resolutory Action | none taken : detected after the fact |
Consequence | other other |
Factors | |
Maintenance | contributing factor : schedule pressure performance deficiency : inspection performance deficiency : installation performance deficiency : logbook entry performance deficiency : non compliance with legal requirements performance deficiency : scheduled maintenance performance deficiency : testing |
Supplementary | |
Problem Areas | Maintenance Human Performance Chart Or Publication Aircraft |
Primary Problem | Maintenance Human Performance |
Narrative:
Learjet 60 experienced a loss of main hydraulic pressure in-flight. Found pressure hose (main) at right engine pump blown (failed). Learjet field service was contacted and had suggested checking main hydraulic reservoir for head pressure; investigation found no head pressure in reservoir due to bleed air check valve for hydraulic reservoir being installed backwards during maintenance. Installed 2 new engine driven hydraulic pumps; new reservoir check valve; and pressure relief valve; 4 hoses (hydraulic at the pumps) and both pressure and return hydraulic filter. Svced and cycled all hydraulic system with no defects noted. Note; no metal was found in main hydraulic system. How the problem arose: as the inspector; I didn't see the regulator/check valve assembly before it was installed on the aircraft reservoir. I couldn't see the check valve due to accessibility. I should have removed the assembly to check for correct installation.
Original NASA ASRS Text
Title: A LEARJET 60 EXPERIENCED LOSS OF MAIN HYD SYS PRESSURE AND QUANTITY. PRIMARY CAUSE WAS INCORRECT INSTALLATION OF MAIN RESERVOIR BLEED AIR CHK VALVE.
Narrative: LEARJET 60 EXPERIENCED A LOSS OF MAIN HYD PRESSURE INFLT. FOUND PRESSURE HOSE (MAIN) AT R ENG PUMP BLOWN (FAILED). LEARJET FIELD SVC WAS CONTACTED AND HAD SUGGESTED CHKING MAIN HYD RESERVOIR FOR HEAD PRESSURE; INVESTIGATION FOUND NO HEAD PRESSURE IN RESERVOIR DUE TO BLEED AIR CHK VALVE FOR HYD RESERVOIR BEING INSTALLED BACKWARDS DURING MAINT. INSTALLED 2 NEW ENG DRIVEN HYD PUMPS; NEW RESERVOIR CHK VALVE; AND PRESSURE RELIEF VALVE; 4 HOSES (HYD AT THE PUMPS) AND BOTH PRESSURE AND RETURN HYD FILTER. SVCED AND CYCLED ALL HYD SYS WITH NO DEFECTS NOTED. NOTE; NO METAL WAS FOUND IN MAIN HYD SYS. HOW THE PROB AROSE: AS THE INSPECTOR; I DIDN'T SEE THE REGULATOR/CHK VALVE ASSEMBLY BEFORE IT WAS INSTALLED ON THE ACFT RESERVOIR. I COULDN'T SEE THE CHK VALVE DUE TO ACCESSIBILITY. I SHOULD HAVE REMOVED THE ASSEMBLY TO CHK FOR CORRECT INSTALLATION.
Data retrieved from NASA's ASRS site as of January 2009 and automatically converted to unabbreviated mixed upper/lowercase text. This report is for informational purposes with no guarantee of accuracy. See NASA's ASRS site for official report.