# NTSB ATL94FA099: Beech 58, N66Q, Monroe, NC, May 15, 1994 - Type: NTSB accident investigation - Classification: Accident · Serious injuries · Field investigation · Final report - Date: May 15, 1994, 10:20 local (14:20 UTC) - Place: Monroe, NC - Coordinates: 35.070167, -80.519874 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=35.0702&lon=-80.5199&mi=10 - Phase of flight: [Approach](https://openairdocs.org/ntsb-phases/500) (OpenAirDocs' grouping) - Highest injury: Serious injuries - Injuries: 2 serious, 3 minor - Status: Completed, report January 25, 1995 - Report: Approved by Office Director - NTSB case key (mKey): 3293 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=ATL94FA099 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/3293/pdf - Page: https://openairdocs.org/ntsb/ATL94FA099 ## Probable cause THE PILOT'S INADEQUATE PRE-FLIGHT INSPECTION. ## Sequence of events In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf). - Loss of engine power(total) - nonmechanical, approach - vfr pattern - base turn - all engines - aircraft preflight - inadequate, pilot in command (cause) - refueling - not performed, fbo personnel - fluid,fuel - exhaustion (cause) - Forced landing, descent - emergency - In flight collision with object, descent - emergency - object - tree(s) - object - wire,transmission - In flight collision with terrain/water, descent - uncontrolled ## Analysis THE AIRPLANE HAD BEEN USED FOR A CHARTER FLIGHT AND WAS NOT REFUELED UPON RETURN TO ITS BASE. THE ACCIDENT PILOT REQUESTED THAT THE AIRPLANE BE FUELED, WHICH DID NOT OCCUR. WHILE CONDUCTING HIS PRE-FLIGHT INSPECTION, HE WAS DISTRACTED BY OTHER ACTIVITY AROUND THE AIRPLANE. DURING THE RETURN LEG OF THE PERSONAL FLIGHT, WHICH WAS A WEEKEND FISHING TRIP, BOTH ENGINES QUIT. NO EVIDENCE OF FUEL WAS FOUND IN THE AIRPLANE AT THE CRASH SITE. THE FLIGHT'S ENDURANCE WAS CALCULATED TO BE CONSISTENT WITH THE FUEL REMAINING IN THE AIRPLANE FOLLOWING THE PREVIOUS CHARTER FLIGHT. ## Factual narrative HISTORY OF FLIGHT On May 15, 1994, about 1020 eastern daylight time, a Beech 58, N66Q, collided with trees, power lines, and the ground during a forced landing at Monroe, North Carolina. The airplane was operated by Hines Aviation, Inc., under 14 CFR Part 91, and visual flight rules. An instrument flight rules flight plan was filed for the personal flight to Charlotte, North Carolina. There were serious injuries to the airline transport pilot and one passenger, and minor injuries to three passengers. The airplane was substantially damaged. Origination of the flight was Georgetown, South Carolina, about 0930. The pilot reported an engine malfunction to Charlotte Approach Control, and was diverting to the Monroe airport. Two passengers on the airplane reported that the left engine surged, and was shut down by the pilot. Between five and ten minutes later, the right engine began to surge, also. The pilot confirmed the loss of engine power and stated that he feathered the left propeller. The airplane impacted the ground, adjacent to a county road, at a point that corresponded to a modified left base leg for an approach to runway 23, about two miles from the Monroe airport. Records obtained from Carolina Air Charter, Inc., who leases the airplane from the pilot for charter operations, indicated that the airplane was operated on May 12, 1994. Upon its return from that flight, the hour meter indicated 3109.0 hours. The fuel log indicated that 38 gallons of fuel remained on the airplane. The pilot reported that he requested Signature Aviation to add 60 gallons of L fuel to the airplane, 30 gallons in each wing, on May 13, 1994, in preparation for his cross-country flight. He also requested that the airplane be positioned on the line. When he arrived at the airport to prepare for the departure, the airplane was on the line. His statement of the accident indicates that he believed the airplane had been properly fueled per his instructions. His statement indicates that during his pre-flight inspection of the airplane, there were distractions including conversation with fixed base operator personnel, arrival of the passengers, and debris in the left fuel tank fuel sample that resulted from a recent fuel tank replacement. According to the pilot, the mechanic who installed the fuel bladders informed him that the debris was normal, would be trapped in the fuel filter, and would disappear after a couple of fuel loads. Fueling records from Signature Aviation at Charlotte International Airport, where the airplane was based, indicated that the airplane was last fueled with ten gallons of L aviation gasoline on May 12, 1994. PERSONNEL INFORMATION Information regarding the pilot is contained under the section labeled Pilot Information of the NTSB Form 6120.4. AIRCRAFT INFORMATION Information regarding the airplane is contained under the section labeled Aircraft Information of the NTSB Form 6120.4. At the accident site, the airplane's hour meter indicated 3110.6 hours, or 1.6 hours elapsed time, since the last entry recorded on the Aircraft Flight Log, on May 12, 1994. The expected fuel usage of the airplane was calculated based on the power settings that the pilot stated he used for the flights as follows: ROUTE FUEL Charlotte to Georgetown 38 gallons -2 used for taxi/take off -6 unusable fuel -13.2 used 55 minute flight 16.8 gallons remaining Georgetown to Monroe 16.8 gallons -2 used for taxi/take off -11.9 used 50 minute flight 2.9 gallons remaining The airplane records contained a work order that indicated that the left fuel bladders had been replaced on April 29, 1994. METEOROLOGICAL INFORMATION Information regarding the weather conditions is contained in the NTSB Form 6120.4 under Weather Information. WRECKAGE AND IMPACT INFORMATION The first wreckage debris was the right wing tip which was located in a tree about 50 feet above the ground. Beneath it, on the ground, was the right wing section, outboard of the engine. The right wing fuel bladders were breached. There was no odor of fuel around the right wing section and no discolored foliage. At the point of the right wing tip's separation, there was a chordwise compression indentation, with tree bark transfer. A swath through trees, along a magnetic heading of 030 degrees, and broken tree limbs led to the airplane. The airplane was located about 140 feet northeast of the right wing tip and outboard wing section. The airplane had came to rest beside a county road with the tail cone extended into the road. An electrical power line support pole was toppled and the separated left propeller was entangled in electrical wires, laying on the ground. The fuselage exhibited a crush line that extended from the nose aft through the right wing root to the wing trailing edge. The crush line was consistent with a nose down attitude of about 30 degrees and a right wing down attitude of about 20 degrees. The right wing main spar upper bathtub fitting was fractured. The fuselage was buckled longitudinally at the forward door rear doorpost. There was essentially no damage to the horizontal stabilizer and elevator. The ventral fin and vertical stabilizer exhibited sawing type damage. The left wing exhibited an area of damage that was consistent with contact with a wound cable. The area also exhibited blackening consistent with electrical arcing. The damaged area was at the outboard juncture of the left engine nacelle and the wing leading edge. The damage had breached the fuel bladder. Other than the arcing, there was no evidence of fire. An electrical cable segment was wrapped over the left wing and under the rudder. A chordwise compression indentation was located in the left wing leading edge, midway between the engine and the wing tip. The left propeller blades appeared to be in the feathered position and were locked in place. There was continuity of the flight control cables to all flight control surfaces, except the right aileron. The separated ends of the right aileron cable were unraveled and had damage consistent with a tensile overload failure. The flaps were fully extended and the left main landing gear was extended. The nose gear and right main landing gear were separated from the airplane. Both fuel selectors, mounted on the aft side of the wing spar behind the respective engine, were examined. The right one was positioned between off and on. Aft displacement of the right wing would pull the fuel selector cable so as to move the selector toward the cross feed position. The left fuel selector was in the cross feed position. No odor nor discoloration of fuel was associated with the left wing fuel tank breach. MEDICAL AND PATHOLOGICAL INFORMATION The pilot sustained serious injuries. Toxicological information was not available. ADDITIONAL INFORMATION The airplane wreckage, aircraft log, engine logs, and propeller logs were released to Benjamin M. Hines, President of Hines Aviation, Inc. ## Aircraft - Registration: [N66Q](https://openairdocs.org/deregistered/N66Q-2013-11-12), registration cancelled 2013-11-12, S/N TH-786, built 1977 (OpenAirDocs) - Reported make and model: BEECH 58 - Registry model: [Beech 58](https://openairdocs.org/model/beech-58) (registry code 1152740) (OpenAirDocs) - Category: Airplane - Serial number: TH786 - Airframe hours: 3110 - Engines: Continental IO-520-C 285 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Operator: Hines, Benjamin M. - Registered owner: Hines Aviation, Inc - Airworthiness certificate: Standard, Normal - Last inspection: Annual, April 29, 1994, 22 hours before - Departed: GGE, GEORGETOWN, SC - Destination: CLT, CHARLOTTE, NC - Flight plan: IFR - Airport: EQY, Monroe, runway 23, 5,500 × 100 ft, asphalt ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 37; airline transport; airplane ratings: single-engine land, multi-engine land; instrument ratings: airplane; medical: class 1, valid medical--no waivers/lim.; seat: left; flight hours: 13,581 total, 319 in this make and model, 9,581 as pilot in command, 161 in the last 90 days, 22 in the last 30 days, 1 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: 220° at 9 knots - Visibility: 10 statute miles - Lowest ceiling: 9,500 ft broken - Temperature: 72 °F, dew point 66 °F - Altimeter: 30.00 inHg - Observed at: CLT, 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 19940515010879A](https://openairdocs.org/incident/19940515010879A), May 15, 1994: Beech 58, Monroe, NC, Substantial damage. Lost left engine. Shutdown then right lost power. Crashed near county road, no mechanical. Fuel tanks empty. 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.