BFO94LA018

NTSB accident investigation · Beech 58 · Stowe, VT · November 26, 1993

Accident · Serious injuriesLimited investigationFinal report
Date
November 26, 1993, 14:30 local (19:30 UTC)
Place
Stowe, VT
Injuries
1 serious, 2 minor
Damage
Destroyed
Phase of flight
Approach
Aircraft
N4VGBeech 58
Weather
Visual (VMC) · Day
Status
Completed · report December 2, 1994
Report
Approved by Office Director
FAA report
19931126044629A
Case key
8872

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 did not follow the emergency procedure after loss of power in the right engine, by failing to feather the right engine and failing to maintain minimum single-engine control speed. A factor related to the accident was: failure of the pilot to adhere to the cautions concerning operation of the engines during descent.

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 powerApproach - vfr pattern - final approach
1 engine
Information - not followedPilot in commandFactor
Loss of control - in flightApproach - vfr pattern - final approach
Emergency procedure - not followedPilot in commandCause
Propeller feathering - not performedPilot in commandCause
Airspeed(vmc) - not maintainedPilot in commandCause
In flight collision with objectDescent - uncontrolled
Object - tree(s)

Analysis

A passenger reported that when the aircraft was about 6 mi from the destination airport at 6000' MSL, the pilot began a descent by reducing the power to idle, placing the propellers to full forward (high RPM), lowering the landing gear, extending the flaps, & slowing to 110 knots. When the airplane went below the intended approach path on short final approach, the pilot applied power, but the right engine did not respond. The pilot stated that the airplane yawed 80 to 90 degrees to the right. He said a stall was eminent, so he reduced the power & rolled the wings level. The plane struck trees & the terrain. An exam did not reveal any pre-existing anomalies. A review of the airplane & engine handbooks cautioned against rapid descents at idle RPM to avoid low cylinder head temperatures. The engine manual noted that long descents at low manifold pressure could cool the engine(s) excessively & result in unsatisfactory acceleration. The pilot did not feather the right engine.

Factual narrative

On November 26, 1993, about 1430 hours eastern standard time, a Beech BE-58 collided with trees following a loss of power on one of the airplane's engines during an approach to Morrisville-Stowe Airport (MVL), Stowe, Vermont. The certificated private pilot and a pilot rated passenger received minor injuries. The remaining passenger received serious injuries. The airplane was destroyed during the impact sequence and as a result of a post-impact fire. The personal flight was being operated by Vader Air, Incorporated of Saratoga, New York. Visual meteorological conditions prevailed and a flight plan was not filed. The flight departed Schenectady, New York about 1330 hours and was arriving at its destination when the accident occurred.

The pilot completed a signed, written statement as a part of the Pilot/Operator Aircraft Accident Report (NTSB Form 6120.1/2). In that statement, the pilot reported that an annual inspection had just been completed on the airplane in Stowe. He wrote "Paul Cutting, Mechanic/Pilot at MVL, just completed annual on N4VG, and proceeded to fly same to Schenectady, N.Y., whereby I, Frank S. Zilka, became the pilot and took control of aircraft to return to MVL." On the return flight to Stowe, the three occupants consisted of the pilot, the pilot rated passenger, and a passenger who occupied a seat behind the front seats. In his written statement, the pilot said that "On base to final, runway #1 [at the Morrisville-Stowe Airport], approach flaps down, gear down, approach speed approximately 110 knots, 1/8 to 1/4 mile out on final, encountered rapid sink rate, attempted to arrest sink rate with power, severe yaw to right, 80-90 degrees, ridge 1/8 of mile on right, full power, landing gear up, attempted to verify engine out and initiated single engine out procedure." The pilot reported that he "...realized imminent stall, reduced power, leveled wings, contacted right wing on trees, rolled inverted, and contacted ground."

The pilot rated passenger provided an oral statement and additionally submitted a written statement to the NTSB investigator. In that statement, he reported that the flight was "normal" until they were in the vicinity of Stowe. He said that they were about 6 miles from the airport at 6,000 feet mean sea level. He said the pilot moved the propeller levers to the full forward position; moved the throttle levers to the "idle" position; lowered the gear; and put the flaps "down." He reported that as "...we dropped below the desired approach glide path, Frank [the pilot] raised the nose and the a/s went below the blue line." (NOTE: The Beechcraft Baron 58 Pilot's Operating Handbook, page 2-4 the blue radial is a marked on the airspeed indicator at 100 knots.) The pilot rated passenger further stated that when the pilot added power, right engine did not accelerate.

A lawyer for the passenger, who was seated in a seat behind the pilot and the pilot rated passenger, submitted a statement prepared for and signed by the passenger. The statement submitted on the behalf of the passenger contained details of the flight. A comparison of his statement with the statements of the pilot and the pilot rated passenger revealed some additional information. The passenger stated that when "...we lost the engine, the right engine on approach, and all the commotion going on up front, that's when I unbelted myself and was trying to get to the front to see what was going on and..." He also stated that when the right engine lost power the pilot rated passenger placed his left hand on the power levers. When asked by the interviewer "And you saw him reach for a control?" The passenger stated "Reach for full power, which was the wrong thing to do actually." The passenger said that the pilot rated passenger "panicked."

None of the three occupants reported any attempt to feather the propeller on the engine which had the loss of power.

Aircraft information:

A review of the airplane's maintenance records conducted by an FAA representative and the Safety Board investigators did not reveal any unresolved discrepancies prior to the flight which ended in the accident.

The airplane's wreckage was examined at the site of the accident by an FAA Safety Inspector and representatives from Beech Aircraft and Continental Motors. Their examination did not reveal any pre-existing anomalies with the airframe.

The engines were shipped to Continental Motors in Mobile, Alabama for further examination.

Tests and research:

Both of the airplane's engines were examined under the supervision of the Safety Board at Continental Motors on May 17, 1994.

A visual examination of the engines revealed several components were damaged during the post-impact fire and could not be subjected to functional tests.

A tear down of both engines was performed. No pre-existing anomalies were found during the tear down. A report of the engine examinations is attached.

Additional information:

The Continental Motor's Aircraft Engine Operator's Manual lists cautions and notes concerning power and propeller settings for descents. In part, the manual states:

"CAUTION...Rapid descents at high RPM and idle manifold pressure setting are to be avoided."

"NOTE...Avoid long descents at low manifold pressure as the engine can cool excessively and may not accelerate satisfactorily when power is reapplied. If power must be reduced for long periods, adjust propeller to minimum governing RPM and set manifold pressure no lower than necessary to obtain desired performance. If the outside air is extremely cold, it may be desirable to add drag to the aircraft in order to maintain engine power without gaining excess airspeed."

According to the Beechcraft Baron 58 Pilot's Operating Handbook (POH), under the "Normal Procedures" section, the procedure for a DESCENT is:

1. Altimeter - SET 2. Cowl Flaps - CLOSED 3. Windshield Defroster - AS REQUIRED 4. Power - AS REQUIRED (avoid prolonged idle settings and low

cylinder head temperatures)

Recommended descent speeds:

Smooth air..................... 175 kts/201 mph Rough air...................... 156 kts/180 mph

In the same POH, under the "Emergency Procedures" section, the procedure for an EMERGENCY DESCENT is:

1. Propellers - 2700 RPM 2. Throttles - CLOSED 3. Airspeed - 152 kts (175 mph) 4. Landing Gear - DOWN 5. Flaps - Approach (15 degrees)

Under the "Limitations" section of the POH, 2700 rpm is listed as the maximum rpm which is obtained through adjusting the propellers levers full forward or low pitch (high rpm).

Under the "Emergency Procedures" section of the POH, the procedure for an ENGINE FAILURE AFTER LIFT OFF AND IN FLIGHT is:

1. Landing Gear and Flaps - UP 2. Throttle (inoperative engine) - CLOSED 3. Propeller (inoperative engine) - FEATHER 4. Power (operative engine) - AS REQUIRED 5. Airspeed - MAINTAIN SPEED AT ENGINE FAILURE (100KTS/115 MPH MAX.) UNTIL OBSTACLES ARE CLEARED

A note in the same section of the POH states, in part: "NOTE The most important aspect of engine failure is the necessity to maintain lateral and directional control."

Aircraft

Registration
N4VG
Reported as
Beech 58
Category
Airplane
Serial number
TH-865
Airframe hours
3,300
Engine
Continental TSIO-520-C, 285 horsepower, reciprocating
Damage
Destroyed
Fire
On-Ground
Flight
Personal · Part 91
Operator
Vader Air, Inc
Registered owner
Vader Air, Inc.
Airworthiness certificate
Standard, Aerobatic; Standard, Normal; Special, Provisional (Special)
Last inspection
Annual · November 15, 1993 · 3 hours before
Departed
SCH · Schenectedy, NY
Destination
MVL

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
32
Certificate
Private
Airplane ratings
Multi-engine land, Single-engine land
Instrument ratings
Airplane
Medical
Class 3, Valid Medical--no waivers/lim.
Seat
Left
Flight hours
1,250 total · 550 in this make and model · 1,250 as pilot in command · 30 in the last 90 days · 10 in the last 30 days · 1 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
20° at 5 knots
Visibility
25 statute miles
Lowest ceiling
20,000 ft broken
Temperature
36 °F, dew point 1 °F
Observed at
MPV, 1 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.