ATL97FA030

NTSB accident investigation · Beech A36 · Pensacola, FL · December 28, 1996

Accident · FatalField investigationFinal report
Date
December 28, 1996, 11:05 local (17:05 UTC)
Place
Pensacola, FL
Injuries
2 fatal, 2 serious
Damage
Substantial damage
Phase of flight
Approach
Aircraft
N23652Beech A36
Weather
Instrument (IMC) · Day
Status
Completed · report March 31, 1998
Report
Approved by Office Director
FAA report
19961228040699A
Case key
3772

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

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Probable cause

The pilot's mismanagement of the fuel supply that resulted in fuel starvation and the subsequent loss of engine power. A factor was low ceilings.

Sequence of events

NTSB’s coding before 2008: each occurrence and phase of flight, and the causes and factors under it. The codes are defined in NTSB’s coding manual.

Loss of engine power(total) - nonmechanicalApproach
Fluid,fuel - starvationCause
Fuel management - inadequatePilot in commandCause
Fuel tank selector position - improperPilot in commandCause
Forced landingEmergency descent/landing
In flight collision with objectEmergency descent/landing
Weather condition - low ceilingFactor
Object - tree(s)

Analysis

The flight had arrived at the destination airport, and the pilot had completed an instrument approach, but low clouds prevented him from landing. He requested a second instrument approach. While on a five mile final, the pilot experienced a loss of engine power. Efforts to restart the engine failed. The airplane collided with trees five miles short of the airport. Examination of the airframe failed to disclose a mechanical problem or a system malfunction. During the examination of the wing assembly, there was no fuel recovered from the left fuel tank. The right wing displayed evidence of hydraulic fluid action in the vicinity of the fuel tank installation; the left fuel bladder was not damaged. The engine operated through all power ranges during the functional test. The aircraft fuel selector was in the left tank position.

Factual narrative

History of flight

On December 28, 1996, at 1105 central standard time, a Beech A-36, N23652, collided with trees five miles north of the Pensacola Regional Airport in Pensacola, Florida, while attempting an emergency landing. The personal flight operated under the provisions of Title 14 CFR Part 91 with an instrument approach clearance. Instrument weather conditions prevailed at the time of the accident. The airplane was substantially damaged. The pilot and one passenger were fatally injured, and two passengers were seriously injured. The flight's departure location was from Tampa's Peter O'Knight Airport at an undetermined time.

On December 28, 1996, at 0708:26, a man who identified himself as the pilot of N23652, telephoned St. Petersburg Automated Flight Service Station (AFSS) and requested an instrument flight briefing weather for a flight from The Peter O'Knight Airport in St. Petersburg, Florida, to Pensacola, Florida. The pilot was given the standard briefing that included existing and forecast weather conditions for the intended route of flight. At the completion of the weather briefing, the pilot filed an instrument flight plan. The pilot reported on the flight plan an enroute flight time of two hours and thirty minutes, and a total fuel endurance of four hours and thirty minutes. There was no further communication between the pilot and the St. Petersburg AFSS. A review of communication information between the pilot and other air traffic control facilities appeared to have been routine for a flight operating under visual weather conditions.

According to the passenger, seated in the right front seat of the airplane, she observed the events leading up to the accident. She stated that the flight departed Tampa, Florida, at approximately 1030 eastern standard time. Because the pilot experienced some difficulty with the aircraft communication radios, he used a hand-held portable transceiver; the aircraft radio receiver operated normally. After takeoff, the passenger recalled that the pilot followed the coast line to maintain visual contact while cruising at 8000 feet.. Approximately 45 minutes into the flight, over Crystal River Powerplant, the pilot switched the fuel selector from the left fuel tank to the right fuel tank.

At 1007, the pilot established initial radio contact with Tyndall AFB Approach Control, and requested routine visual flight following to Pensacola. At 1017, Tyndall Approach Control handed the flight off to Eglin AFB Approach. At 1031, Pensacola Approach reported that, the flight was a visual handoff from Eglin AFB Approach, and the pilot had requested an approach into Pensacola, but the pilot was informed of the instrument weather conditions that had prevented other flights from landing. The pilot stated that he would hold south of the airport until approach and landing weather minimums existed. After several minutes of visual holding, Pensacola Approach Control reported that the Runway Visual Range (RVR) for runway 17 had improved to 2,800 feet. The pilot was issued an instrument approach clearance for runway 17 and was also given radar vectors for a final approach. After missing the first approach, the pilot requested a second approach.

At 1104:37, while on a five mile final of the second ILS runway 17 approach, the pilot reported an engine problem and subsequently, that the engine had quit. The pilot requested radar vectors for the final approach to runway 17. The passenger stated that the pilot switched the fuel selector from the right fuel tank to the left fuel tank and attempted to restart the engine. After several attempts, the engine started and ran for about one minute and quit again. At the same time the passenger noticed that both fuel gauges were showing 3/4 tank of fuel. The passenger also stated that, the pilot said, he had flown in the Pensacola area, and was familiar with the terrain. The pilot abandoned efforts to restart the engine and continued an emergency descent for a forced landing. During the final phase of the emergency descent, the passenger felt a jolt and heard a ripping sound on the right side of the airplane. The passenger blacked out, and regained conscience after the airplane had collided trees and the ground. The passenger recalled the strong smell of fuel around her at the accident site. The airplane collided with trees north of the airport in a swampy area.

Personnel information

The pilot held an airline transport pilot certificate with a single engine, multiengine, and airplane instrument rating. His certificate was issued March 26, 1993. His last medical certificate, a first class, was dated February 1, 1996. There were no limitations or waivers on his medical certificate. Additional personnel information is contained in this report on page 3 under "First Pilot Information." The review of the limited pilot information failed to reveal the pilot's total flight experience in the Beech A36.

Aircraft information

The airplane log indicated the annual inspection was completed on November 20, 1996. There were no discrepancies noted in the airplane's log book. Additional information about the airplane is contained on page 2 under "Aircraft Information." According to an official from Tampa Flying Service, they operated N23652 under a lease agreement from a military officer.

Meteorlogical information

The weather at the time of the accident was instrument meteorological conditions. The pilot attempted an instrument approach with the weather just above the required approach minimums. Additional information about the weather is contained on pages 3 and 4 under "Weather Information." The pilot had received a weather briefing and was aware of the marginal weather conditions at the destination airport (see attached preflight weather briefing included in the transcription of communication). According to the approach controllers at Pensacola, low clouds had prevented any flights from landing at Pensacola throughout the previous night and early morning.

Wreckage and impact information

Examination of the accident site disclosed that aircraft wreckage debris was scattered over an area 100 feet long and 40 feet wide. The wreckage debris was orientated on a 195 degree magnetic heading. Examination of the accident site also disclosed that airframe debris from the right horizontal stabilizer was approximately 75 feet north of the main wreckage. Several freshly broken trees were also located in the vicinity of the right stabilizer. Additional wreckage debris was located 35 feet north of the inverted main wreckage.

Examination of the airframe and subsystems failed to disclose a mechanical malfunction or system failure. Additional examinations of the airframe and fuel system revealed that the left fuel tank was not damaged during the crash sequence; no fuel was recovered from the left fuel tank. The left fuel cell was removed from the wing assembly and functionally checked for leaks and breaches in the rubber material; none were found. Examination of the right wing structure disclosed that the skin material in the immediate vicinity of the fuel bladder had been displaced or ballooned outward from the structural supports. The permanent deformation to the right wing skin material was typical of hydraulic action on trapped fluids. The right wing assembly sustained impact damage along the leading edge in the vicinity of the wing root and approximately 30 inches inboard from the wing tip. There was no fuel recovered from the right wing tank. Reportedly heavy rains had fallen before and after the accident, and there were no obvious signs of fuel spillage in the vicinity of the accident site.

An examination of the engine, under the supervision of the National Transportation Safety Board was completed by the manufacturer, Teledyne Continental Motors. During the functional examination, the engine started and maintained operating RPM; the e

Aircraft

Registration
N23652
Reported as
Beech A36
Category
Airplane
Serial number
E-1295
Airframe hours
1,728
Engine
Continental IO-550-B-6, 300 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Operator
Rodney Bailey
Registered owner
Hurd Aero
Airworthiness certificate
Standard, Utility
Last inspection
100 hour · November 20, 1996 · 28 hours before
Departed
TPF · Tampa, FL
Destination
PNS
Flight plan
IFR
Airport
PNS · Pensacola International, runway 17, 7,002 × 150 ft, asphalt

Matched to the registry by N-number and the event date; the registry’s history has gaps, so older matches can be wrong. Compare the reported make and model.

Flight crew

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
40
Certificates
Airline transport, Commercial
Airplane ratings
Single-engine land, Multi-engine land, Single-engine sea
Instrument ratings
Airplane
Medical
Class 1, Valid Medical--no waivers/lim.
Seat
Left
Flight hours
4,000 total · 3,500 as pilot in command

Weather

Conditions
Instrument (IMC) · Day
Wind
120° at 7 knots
Visibility
0.25 statute miles
Temperature
68 °F, dew point 68 °F
Altimeter
30.00 inHg
Observed at
PNS, 5 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.